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HomeMy WebLinkAboutBLDCI-17-000198-06 he Commonwealth of Massachusetts } ....., City\Town of mm = YARMOUTH �3Z . � �. !S�_ i � 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: SOUTH YARMOUTH METHODIST CHURCH BLDCI-17-000198-06 Trade Name: SOUTH YARMOUTH METHODIST CHURCH PARISH HALL Identify property address including street number, name, city or town and county Certificate Expiration Located at 318&324 OLD MAIN ST 07/28/2023 SOUTH YARMOUTH, MA 02664 Use Group Floor Occupancy Use Group Other Classifications(s) A-3 01st Floor 96 A-3 Amusement/Church/Gym/Library/Museum 96 PERSONS-TABLES &CHAIRS 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 g,,,,_ Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Building Commissioner Issuance /0 j/L Fee: $100.00 .BLDCertoflnspection.rpt •° R TOWN OF YARMOUTH ,r cec. a;;� -it' ! •1'C BUILDING DEPARTMENT t.�'4 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 t- t APPLICATION FOR CERTIFICATE OF INSPECTION June 1, 2022 PAYABLE UPON RECEIPT (X) Fee Required $100.00 ( ) 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:) 2 t Old ,(//it/it ci-. ,sue (/Q r n-s o ✓ill o 6 6 / Name of Premises ',/arfrriuvfh 141lcd 41 /4,010 /' tIr i� Co g "3 SI f ,6p 2-- Purpose for which permit is used:tile 1,-5b 1 p ley✓/Ce s ►e_ I i f i o✓S rill to fi„ll S ED License(s) or Permit(s) required for the premises by other g6vernm tal agencies: IV License or Permit Agency i s JUN 10 2022 1 BULKitlittelfeNT By Certificate to be issued to S.. �/ an,lc I it /�vd is f L!/t , 'e&T el: co f'- -3 yr' - •y yr 'i--`" Address: J,V,, G /4/ Al QIAs'. Sa. !l/rrlyti fh Owner of Record of Building--ii--1/5 he - .SG , ir 02c✓lh tin, fc A Al/fc fh.i/s f l'A..,-�_ Address IA D/l /i4 fi . jr, . i/‘rhte(f-/ A4,4- 6 X4.4 / Present Hold of Certificate , e,-- -,9,e.,-4. .Attfar:-.2.—_ iS' nature of person to whom Title Certificate is issued or his agent ‘,(/� . Date Email Address: ,51 t,'vvl C. S L c'r e �a r y' c 1 rill et.,/ C & '1" 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# 6 L1.2-/ /7--(.)9D(9t- gt,..0b 07/28/2022-07/28/2023 - air• •••••• • • A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/07/2022 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 CONTACT Emily Montgomery NAME: Dowling&O'Neil Insurance Agency PHONNo,Ext): (800)640-1620 ac,No): 973 lyannough Road ADDRIesS: emontgomery@doins.com INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURER A: Crum&Forster Specialty Insurance Co. 44520 INSURED INSURER B: Safety Indemnity Insurance Company 33618 Seaside Alarms,Inc. INSURER C: Hartford Fire Insurance Company 19682 1265 Route 28 INSURER D: INSURER E: South Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2222501858 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A GL0087043 02/25/2022 02/25/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2'000'000 POLICY X MT LOC 2,000,000 JEC PRODUCTS-COMP/OPAGG $ PROFESSIONALLIAB. $ 1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED sue/u SCHEDULED 6222107 02/25/2022 02/25/2023 BODILY INJURY(Per accident) $ AUTOS ONLY HIRED Ni/ NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 _ _ A X EXCESS LIAB CLAIMS-MADE SE0117502 02/25/2022 02/25/2023 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EOTH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBEREXCLUDED? N N/A 08WECAE7ZU7 02/25/2022 02/25/2023 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements.Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended thecoverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN South Yarmouth United Methodist Church ACCORDANCE WITH THE POLICY PROVISIONS. 324 Old Main Street AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 .10"s I I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD