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HomeMy WebLinkAboutBLDCI-17-005603-04 The Commonwealth of Massachusetts wA City\Town of YARMOUTH a 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:YARMOUTH NEW CHURCH PRESERVATION FOUNDATION BLDCI-17-005603-04 Trade Name:YARMOUTH NEW CHURCH Identify property address including street number,name, city or town and county Certificate Expiration Located at 05/08/2023 266 ROUTE 6A YARMOUTH PORT, MA 02675 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01 st Floor 175 A-3 Amusement/Church/Gym/Library/Museum Chairs only-175 persons Tables/Chairs-96 Allowable persons Occupant Load 02nd Floor 133 A-3 Amusement/Church/Gym/Library/Museum 133 persons 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 / ^��•yt Building Commissioner Inspection (� sCoC Signature of Municipal ` C 7) Date of Signature of Municipal ���f Z Z Building Commissioner Issuance ee:$100.00 BLD Certoflnspection.rpt ° YAR TOWN OF YARMOUTH " r 3) BUILDING DEPARTMENT NATTACM .�� �' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. :1260 m' RECEIVED APPLICATION FOR CERTIFICATE OF INSPECTIONy0-_ April 1, 2022 PAYABLE UPON RECEIPT az. �2,-7 (X) ecikquitect 14 NT ( ) ----- In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: RJ(4_,—/g_ 64 Name of Premises: Ya( Tel: Lj- , -3 C 2-1 0 Purpose for which permit is used: A 'S G CO t-ii r►i u r,1-• ] et(`'/-; �J�`��.�S rn License(s) or Permit(s)required for the premises by other govemenrtal agencies: License or Permit [[ Agency CertificateA be is ued to ( Tel: Sb8—34 Z-%764-6 Address: VC. 6x 2.3 Owner of Record of Buildir�g ; . Address sclrr)r,- Present Holder of Certificate Barn.e._ f1 ire Signatu of person to who tle Certificate is issued or his agent y j/$ 2-0 2.V IIate ! '36 4. Email Address: tJI pl A 4 d;/. Corn (./ elftE4- 1006" 44,01er_, 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# .34_,L)Cf-1 5-0 L 05/08/2022-05/08/2023 a 4 • • q P +Yc2 f 4st yam_ r:x Y Eii a s:] ! 2f�.;� �3t2,A ir_ .3r .. _ a i t1 J > } + �{, 'y . { .. 7 tR`.'S` .'2}s't2S,Sw}r}at4#.::41.'-� V.11 • • • • • • • • • • t '. • • J _ t. f t • g MMl DATE IDDNYYY) ALOR� CERTIFICATE OF LIABILITY INSURANCE 0E(MMI022 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 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 01173-001 CONTACT Elise Piano Roger Keith&Sons Insurance Agency Inc PHONE FAx (A/C.No.Est): FAx 1575 Main Street EM IILESS: dtaortarelliie rogerkeith.cca Brockton. MA 02301 INSURERISI AFFORDING COVERAGE NAIC I INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: YARMOUTH NEW CHURCH PRESERVATION FOUNDATION INC INSURER C: 266 MAIN ST RT 6A INSURER D: YARMOUTH, MA 02675 — INSURER E: 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 SHOVIM MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE INDSR WVDD POLICY NUMBER POL Y LETS - - -- K GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERALUABILffY DAMAGE TO RENTED $ - - PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED DIP(Any one person) $ PERSONAL d ADV INJURY $ GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 'POLICY ECT LOC AUTOMOBILE LU181UTY COMBINED SINGLE OMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED I I SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS I NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) I I $ UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE AGGREGATE g DED RETENTION$ IMENOEppSIABLY X Tvole ggU MtS Y/ pT $ E A AOFFICEWMEMBEREXCLUDED?ECUTIVE N NIA VWC-100-6023781-2022A 4/1/2022 411/2023 E.L.EACH ACCIDENT S 100,000.00 (Mu datory in NH) EL DISEASE-EA EMPLOYEE $ 100,000.00 e e5CRIPTION�OF OPERATIONS belowEL DISEASE-POLICY LIMIT $ 500,000.00 DES DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space is required) PROOF OF COVERAGE Worker's Compensation Coverage Applies to Massachusetts Employees Only CERTIFICATE HOLDER CANCELLATION YARMOUTH NEW CHURCH PRESERVATION FOUNDATION INC 266 MAIN ST - RT 6A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Yarmouth,MA 02675 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and iogo are registered marks of ACORD r