The URL can be used to link to this page

Home My WebLink AboutCertificate of Inspection The Commonwealth of Massachusetts City\Town of YARMOUTH New and Renewal Certificate of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name:WEST YARMOUTH CONGREGATIONAL CHURCH BLDCI-16-006479-03 Trade Name:WEST YARMOUTH CONGREGATIONAL CHURCH NMI Identify property address including street number,name,city or town and county Certificate Expiration Located at 383 ROUTE 28 05/01/2020 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 210 A-3 Amusement/Church/Gym/Library/Museum 210 PERSONS Allowable Other 40 A-3 Amusement/Church/Gym/Library/Museum BALCONY Occupant Load This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal rk Grylls Date of Building Commissioner Instion 7-6-717 Signature of Municipal Signature of Municipal °ate of Building Commissioner ,, Issuance '9 '17 Fee:$50.00 I BLD_Certofl nspection.rpt .. •X9Ro TOWN OF YARMOUTH BUILDING DEPARTMENT N MATTA M CSE �, ••,•�' d 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION April 1, 2019 PAYABLE UPON RECEIPT (X) Fee Required 50.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 383 l2Bt I c Name of Premises: WEST YA0,0tictriit GG,/606. TTo4,,tL el: , o(- 771 -Dig ( Purpose for which permit is used: L'G ff5Yf License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to III Coy o4-,TiowAC olita� Tel: 5-Pf-77.s -off( 4c Address: •3 63 knock*. 23� Owner of Record of Building Address Present Holder of Certificate CG/ Si ature o person to whom Title Certificate is issued or his agent 7,;//JQ J / / Date Email Address: 6414/1-91/hef co/nc4fti1 Instructions: Make check payable to: Town of Yarmouth 1146 Route 28, South Yarmouth,MA 02664 Return this application to: Building Inspector's Office Please note: Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten(10) days of any change in the above information. PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection#aDeZ- fe.-006Y79-0 3 5/1/2019-5/1/2020 A d CERTIFICATE OF LIABILITY INSURANCE 07/14/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATIONIS WANED, subject to the terms and conditions of the policy,certain policies may require an endorserns t.A statement on this certificate doss not confer rights to the certificate holder in Neu of such endorsarenifs). PRODUCER CONTACT NAME FITTS INSURANCE AGENCY INC 0808802E PHONE (866)467-8730 FAX No): (888)443-6112 (NC,No,E 2 WILLOW STREET SUITE 102 EMAIL ADDRESS: SOUTHBOROUGH MA 01745 INSURERS) COVERAGE MCI INSURER A: Twin City Fee Insurance Company 29459 INSURED INSURER B: WEST YARMOUTH CONGREGATIONAL CHURCH IasuRER C_ 383 ROUTE 28 WEST YARMOUTH MA 02673-4721 III D ICE: INSURER F: COVERAGES CERTIFICATE RUNNIER: REVISION RUBBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTVdTHSTANDING ANY REQUIRB.IENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND COND(11ONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. ImR TYPE OF INSURANCE IDOL SUER PWJR.:Y E� POLICY ELP LINTS POLICY taw a�DOM YYI 1MrM00fr YYYI. LTR DER .WVD COMMERCIAL GENCRAL UABLITY EACH OCCURRENCE DAMAGE TO RENTED CUUNISMADE) IOCCU R ME D EXP(Any one person) PERSONAL&ADV INJURY GEIL AGGREGATE LINT APPLES PER GENERAL AGGREGATE POLICY I I E'Ra 1 1 LOC PRODUCTS-COMP/OP/UX; .ECT OTHER -COMBINED SINGLE tWITT AUTOIIO IE LIABILITY (Ea accident] ANY AUTO BODILY INJURY(Per person) — ALL OWNED SCHEDULED BODILY SWRY(Pr ao idert) AUTOS AUTOS —HIVED — NONONNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) OCCUMBRELLA R IAB_ � EACH OCCURRENCE EXCESS UAB CIAO AGGREGATE MADE DEDI RETENTION$ WORKERS CO 'EI SMION PER X OM- AND EBILOYERS'LIABILITY STATUTE Eat ANY WWI EL EACH ACCIDENT $1,000,000 A r wA 08 WEC NN5968 10/012 —�018 10/01/2019 EL OYES $1,000,000 OFFICERNAMWER EXCLUDED? Mandatory in NH) I- EL DISEASE-POLICY LOST $1,000.000 I yes,describe%dr DESCRIPTION OF OPERATIONS below DESCRIPTION OFOPERA11ON SILOCAflONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be smelled if more space Is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION West Yarmouth Congregational Church SHOULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED 383 ROUTE 28 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED WEST YARMOUTH MA 026734721 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE d e c Ca 0 1988 2016 ACORD CORPORATION.All rights reserved. ACORD 215(2016/03) The ACORD name and logo are registered marks of ACORD