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HomeMy WebLinkAboutCertificate of Inspection 1 The Commonwealth of Massachusetts \;IC6' a City\Town of q()\ YARMOUTH �. l'� • r_ 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: St. Pius Tenth School BLDCI-17-002385-03 Trade Name: St. Pius Tenth School-classrooms Identify property address including street number,name,city or town and county Certificate Expiration Located at 321 WOOD RD 07/01/2020 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) E E 01 st Floor 542 E Educational School to 12th Grade/Child Care(More than 5) Pre-Kindergarten-46 Kindergarten-46 1st Grade-45 Allowable 2nd Grade-44 Occupant Load 3rd Grade-40 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 Mark G Date of Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Building Commissioner (//`411060 Issuance � 9 •�rc' 7 Fee:$0.00 BLD_Certofl nspection.rpt • The Commonwealth of Massachusetts City\Town of `4',Tal;i!_ 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: St. Pius Tenth School BLDCI-17-002395-03 Trade Name: St. Pius Tenth School-2nd floor classrooms Identify property address including street number,name,city or town and county Certificate Expiration Located at 321 WOOD RD 07/01/2020 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) E E 02nd Floor 220 E Educational School to 12th Grade/Child Care(More than 5) 4th Grade-44 5th Grade-44 Allowable 6th Grade-44 7th Grade-44 Occupant Load 8th Grade-44 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 Mark Gryl Date of �`: — _— Building Commissioner spection K' '4, Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance • Fee:$0.00 BLD_Certofl nspection.rpt The Commonwealth of Massachusettsilk re- Lr City\Town of UR.UR'. YARMOUTH �l•x-� 4 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: St. Pius Tenth School BLDCI-17-002397-03 Trade Name: St. Pius Tenth School-Assembly Identify property address including street number,name,city or town and county Certificate Expiration Located at 321 WOOD RD 07/01/2020 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01 st Floor 703 A-3 Amusement/Church/Gym/Library/Museum Cafeteria-130 Chapel-27 Administration-16 Allowable Gym-530 Occupant Load 02nd Floor 166 A-3 Amusement/Church/Gym/Library/Museum Library-80 Art/Music-44 Multi Purpose Rm-42 Resource Rm-15 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 / Mark Gryll Date of Building Commissioner Inspection 5-37-747 Signature of Municipal Signature of Municipal Date of Building Commissioner Q Issuance 4.1y n Fee:$0.00 BLD_Certofl nspection.rpt .YqR TOWN OF YARMOUTH o ''' -y BUILDING DEPARTMENT ��»«•,.oF'�a 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION June 11, 2019 PAYABLE UPON RECEIPT (X) Fee Required 0.00 ( ) 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: �` 1 W C OCI R Dcc,U Name of Premises: 51-' Pus Y . SC koo r Tel: 8 O. 3,3 b I Purpose for which permit is used: rvC k f a J Solt o 'R E C i V E D License(s) or Permit(s)required for the premises by other governmental agencie : JUL 15 2019 License or Permit e DING(DEPARTMENT Co vrt Inoue V teAgtAkerS OtTiS -- l 61,0-) cr{ StCertificate t I e issued to ►'t U-S 1C . S CLk 0 D I Tel: q' 3q ' 6/( o� Address: ,l► a ZaMbliA . /cI A ;dui ,I,: 1 . w Owner of Rec d of Building i M f IMiThi �= i irg1 /('&v..+ Address( WOO(1 Yrl pei-( Present Holder of Certificate , it , . nali G dV I Parr( —Signs re of person to whom Title Certificate is issued or his age ' 1c9d) Q✓U Date r Email Address: C(,vl SP X n d O' ' Ur r 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# -? • / -UO 4 f 2 7/1/2019-7/1/2020 /7-AIPZ377-0 3 /7-4e02,95 0.3nc/r=cZ F. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/08/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACTNAME: Massachusetts Catholic Self Insurance Group PHONE(A/C.No.Ext): 617-746-5742 FAX No): 617-779-4572 66 Brooks Drive AAD RESS: losscontrol@masscatholic.org INSURER(S)AFFORDING COVERAGE NAIC# Braintree MA 02184 ,INSURER A: Massachusetts Catholic Self Insurance Group INSURED INSURER B: Diocese of Fall River,MA INSURER C: Office of The Chancery INSURER D: 450 Highland Avenue/POB 2577 INSURER E: Fall River MA 02722 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,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 CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(My one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PET LOC PRODUCTS-COMP/OP AGG $ $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED (Per accident) $ AUTOS ONLY AUTOS ONLY $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ �/ WORKERS COMPENSATION X PERTUTE ERH AND EMPLOYERS'LIABILITY Y I N Certificate of Approval 03/31/2019 03/31/2020 E.L.EACH ACCIDENT $ 1,000,000 A ANYPROPRIETOR/PARTNER/EXECUTIVE NIA Commonwealth of OFFICER/MEMBER EXCLUDED?(Mandatory in NH) Massachusetts E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If es,describe under 3000001012019 E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Re:St.Pius X School 321 Wood Rd So.Yarmouth,MA 02664 Evidence of Workers Compensation CERTIFICATE HOLDER CANCELLATION Town of Yarmouth, MA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE I 14;°ItkV444/0•40 ° ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 7. ' --- BUILDING TOWN OF YA R M O U T H ELECTRICAL GAS ' C • 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 PLUMBING Telephone(508)398-2231,Ext.I261—Fax(508) 398-0836 SIGNS UILDING DEPARTMENT 5/ /1/4°. -003) Inspection and License Report Date Address 3/ &kkx'/ 11OQ 0/ Business Name Cont Phone During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed: Ca Emergency egress signage Location ❑Emergeng egress lightmg Location ❑Maintenance of exits Location 0 LiGuards/handrails Location Zatiiitg I 6)(7( ❑Signs Location ❑Parking Location r ❑ Other Location merhada Combustion Air Location ❑Storage in Boiler Room Location ❑Vents Location • d Automatic door closures on boiler mom doors Location ❑Clothes dryer vents Location • 0i5er Location The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be responsible for proper maintenance. order to abate the above violation(s)you must: o Make corrections immediately and contact this office for a follow-up inspection. • o Make corrections prior to opening and contact this office for a follow-up inspection. o.Make corrections prior to your next nnual inspection. o Make corrections within days a cottact this ffice for a follow-up inspection. Local O�r Received By " 22 Title • Revised 2/8/13