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HomeMy WebLinkAboutBLDCI-22-007497 The Commons e . ith of Massa chusetts F . r, C ty\Town of Y. R;VIOUTH '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 BLDCI-22-007497 Business Name:West Yarmouth Congregational Church Trade Name:West Yarmouth Congregational Church Identify property address including street number, name,city or town and county Certificate Expiration Located at 383 ROUTE 28 5/1/2023 WEST YARMOUTH, MA 02673 I Other Use Group Floor Occupancy Use Group Classifications(s) Basement/Lower 30 A-3 Amusement/Church/Gym/Library/Museum 30 Person A-3 - r- Allowable 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 Mark Grylls Date of �J�� Building Commissioner Inspection / Signature of Municipal Date of ,/ Signature of Municipal Issuance //� Z J Building Commissioner / ee: $100.00 BLD Certoflnspection.rpt �°a ' TOWN OF YARMOUTH .. tOa it.r.r-:„.1, � �(,a BUILDING DEPARTMENT } ",\MAT A KC S['f�1 ,�.;tm :,~ 1146 Route 28, South Yarmouth, MA 02664 508-398-2 . . , P APPLICATION FOR CERTIFICATE OF INSPECTION jUN 2 7_�022 April 1, 2022 PAYABLE UPON RECEIPT BuisDIN� °c�q TMEN (X) Fee Require. !111 T ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 03 "Wfe &X I./Q f r- Name of Premises: (+). V r),,,,. �1,- f ) ,- Tel: V�� 7 75- 0 kg Purpose for whichpermit is used: , I Cc .o 8' - 7 Z U `ga 1(J cTa�-) m AU re 11 License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency (Jvne1 Certificate to be issued to .�. Q „ ,n ` T(, el: act '77 -0�7/ Address: (1$cI l c- a g L rn - ` _O sj .\ ►- , Q r .- J Owner of Record of Buildin (.1 Gv. ya.r'ry Cav��j CAv rc. Address 0 3-3 Kfc bz.4l W_ V h I+n,M v Present Holder of Certificate (id,/ (c' • 140. 44- O Signature of person to whom Title Certificate is issued or his agent (o •/ 4 - aa- Date Email Address: �'may, @0ay,�), 1-. ea ►,,-) 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 APPLLCA_Ti_ON-OR WE CANNOT ISSUE YOUR CERTIFICATE OFTNSPECTION. - Certificate of Inspection# 6LL I—01,?—. 007c'q7 05/01/2022-05/01/2023 • )UJ.) • ACaRt44 DATE(MreloorrnlY) �.� CERTIFICATE OF LIABILITY INSURANCE 06/18/2022 CERTIFICATETHIS 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 POUCIES 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 SUBROGAT1ONIS 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 CONTACT NAME: FITTS INSURANCE AGENCY INC PHONE (508)620-6200 FAX 08088026 (AIC,No,Eat): (A/C,No): 2 WILLOW STREET SUITE 102 EMAIL ADDRESS: SOUTHBOROUGH MA 01745 INSURERS)AFFORDING COVERAGE NAICE INSURER A: Twin City Fire Insurance Company 29459 INSURED INSURER B: WEST YARMOUTH CONGREGATIONAL CHURCH INSURER C: 383 ROUTE 28 INSURER D: WEST YARMOUTH MA 02673-4721 INSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO EEN CY CERTIFY THAT THE POLICIES OF INSURANCE USTED BELOW HAVE ANYREQUIREMENT,TERM OR CONDITION OF BANY CONTRACT A OR FORNSURED NAMED ABOVE OTHER DOCUMENT WITH RESPECT TOLIWHICH ERIOD ND CATED.NO 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF prSURANCE INSR W VD (MM)OD/YYYYI (MMIDD/Y YYYI LTR EACH OCCURRENCE COMMERCIALGENERAL LIABILITYDAMAGE TO RENTED CLAIMS-MADE (OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GENERAL AGGREGATE GENL AGGREGATE LIArfT APPLIES PER: 1POLICY[]P (—DLO PRODUCTS-COMP/OP AGG — I IIJECT I I • OTHER: _ COMBINED SINGLE LIMIT AUTOMOBILE LIABIIJTY (Fa arr,lent BODILY INJURY(Per person) ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS ERTY DAMAGE —HIRED NON-OWNED PROP PROP ck TY AUTOS AUTOS (Per aent) ' EACH OCCURRENCE UMBRELLA!JAB OCCUR EXCESS UAB — CLAIMS- AGGREGATE MADE DEDI I RETENTION$ —WORKERS COMPENSATION X IPER STATUTE I 10T ANY EMPLOYERS'LIABILITY ER EACH ACCIDENT $1,090,000 ANY YM A PROPRIETOR/PARTNER/EXECUTIVE I N/A 08 WEC NN5968 10/01/2021 10/01/2022 - EL DISEASE-EAEMPLDYEE $1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DluaSE-pOUCV LIMIT $1,000,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below — DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Those usual to the Insured's Operations. CERTIFICATE HOLDER CANCELLATION For Informational Purposes SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 383 ROUTE 28 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED WEST YARMOUTH MA 02673-4721 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD