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HomeMy WebLinkAboutBCOI-23-1741- 1 x C O L U p . N w O ,— N a) -O Z C. N 0 CO k a o r; W o cn m M tA o o O o m a U CO I o _0 h N U U a l/�, cv N m N O v ` U 0 c� 0 0 ,., , a) L V U 0 U a as V) c) C O N v) -C O C C U O C vi O vi O i C 0 a) co a) _ 0 CT12 O o O y U O U w O C-) .0 C v) O U O U) {S (6 co , O O Cr C 'C C C C) C .y) C V • V UQ O 5 . a co a co N C N U) C L 3 m co c a) m IS m p i+ 0 0 o N J) V) V) O a \\� O iE `-w C) C v) y co C C co C 3 E U LON ''C Q � d Z Z = o ' �0 C C) CY)_ E O 4 ca '..F. = ZT�tn fl CU) 0CZ 47 a) 0 (On O 0 c � O z *- 0 co n d U3 ° a n CCZ c O) C) 11 � 0 G1 O L L Y y H L o) " cv1 ' .... Z c ai 0 ulw c a w U a) C)) oz mC C cz I fD E Cty v Q y n O c m (.) C 0 m a CD a) O w s 3 a � 2 � o0 a) a �, Lo cn cn Z a) is C) _a i a E C E E c E-o Q O z0 cZU U 0 _C C) > N ti -0v a .U Q) CO CC) 0 O _' i N a) _n c..) -0 C U) LL E U1 C) III O Cco O v; ucn _c — O v) R E co O J n p J i al y CO CZ A.. a a) t+ V cu, a) d .:. c_CC v y — U Q 3 y Q U O m v U 0 0 0. C) as 0, 3 O O v E 6. �y ! L N22 * .4001 cB U) Q H e o c a N E g c assimos c Z in U TOWN OF YARMOUTH .4.1 BUILDING DEPARTMENT 1146 Route 28,South Yarmouth, MA 02664 508-398-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION July 1,2023 PAYABLE UPON RECEIPT (X) Fee Required$100.00 ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,1 hereby apply for a Certificate of Inspection for the below-named remises located at the following address: Street and Number: (I/CI Pr/ tirt(tii nriP fo Name of Premises: i\f eti7. s.-,„ go_ S ek L.Foaccams itt License(s)or Permit(s)required or the prem's s by other governmental agencies: Purpose for which permit is used: 6 License or Permit Agency CI NR/1 1/0 I nit-Cr. $1/4. Certificate to be issued t • .5??6- Address: 9q ' Artitt 101/51-- OX 76- Owner of Recordo9fauild'nJ t Address Present Holder Holder of Certificate ("\ p \A/ tei/LAAyvi miles?Signature of of person to whom Title Certificate is issued or his agent Date Email Address: 6/94i k-kebig ti rainaprae-fr r r PCW-) 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 YOU k Freticeieu tstycrioN, Certificate of Inspection# _I. V CEIV 08/10/2023-08/10/2024 cui_23 .74, ' [AUG 01 2023 J AU BUILDING DEPARTMENT B DING DEPARTMENT By. COR `A�, ® CERTIFICATE OF L� DATE(MM/DD/YYYY) ..-- IABiLITY INSURANCE � 3/16/2023 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 RogersGray,A Baldwin Risk Partner NAME: 410 Universi Ave PHONE tY MM.No.E,t):800-553-1801 FAX No):877-816-2156 Westwood MA 02090 E-MAIL ADDRESS: mail©rogersgray.Com INSURER(S)AFFORDING COVERAGE NAIC# License#:PC-514062 INSURER A:Selective Insurance Co of Sout 19259 INSURED KINGWAY-02 Kings Way Trust INSURER e:Greenwich Insurance Company 22322 CIO Barkan Management INSURER C: Manufacturers Alliance insuran 36897 64 Kings Circuit INSURER D:Travelers Casualty&Surety Co 31194 Yarmouth Port MA 02675 INSURER E: INSURER F: 1 COVERAGES CERTIFICATE NUMBER:1672857016 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 SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY S 2574336 2/18/2023 2/18/2024 EACH OCCURRENCE CLAIMS-MADE X OCCUR DAMAGE TO RENTED $1,000,000 PREMISES(Ea occurrence) $300,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: EBL Aggregate $ A AUTOMOBILE LIABILITY TBD 2/18/2023 2/18/2024 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) - BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ X HIRED X NON-OWNED PROPERTY DAMAGE - AUTOS ONLY AUTOS ONLY (Per accident) $ $ B X UMBRELLA uA6 X OCCUR PPP7464849 2/18/2023 2/18/2024 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ C WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY 202301-10-06-89-9Y 2/18/2023 2/18/2024 X I STATPERUTE I I ER OTH- ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBEREXCLUDED? N/A E.L.EACHACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Directors&Officers 106878276 2/18/2023 2/18/2024 Per Occurrence Limit 1,000,000 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Blanket Building:$7,493,480;Blanket Business Personal Property:$96,000;Blanket Business Income:$100,000 $25,000 All Peril Deductible Except Wind/Hail which is a 1%per Building Deductible Directors&Officers:$1,000,000 per Claim/$1,000,000 Aggregate $5,000 Retention;$1,000,000 Seperate Defense Limit Outside Limit of Liability Crime:$1,000,000 Employee Theft/$10,000 deductible;$100,000 Theft of Money and Securities/$2,500 deductible CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Insurance Purposes AU D REPRESENTATIVE ,,/ ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD qv* V * /6illY-A4 A\ TOWN OF YARMOUTH BUILDING DEPARTMENT -ic.\ 41 It I 146 Route 28,South Yarmouth,MA 02664 %-*:t•l..,-..?,3,-- ,,... '-*C0---" 508-398-2231 ext. 1260 July l,2023 Kings Way Meeting House 68 Kings Circuit Yarmouth Port,MA 02675 Re: Inspection Date—08/10/2023—08/10/2024 Fee$100.00 Pursuant to the provisions of the Massachusetts State Building Code 780 CMR,Section 110.7 and Table 110,you are required to apply for a Certificate of Inspection for the building located at 68 Kings Circuit,Yarmouth Port,MA 02675 D/B/A Kings Way Meeting House. Please complete the enclosed application and return it with the appropriate fee payment to the Town of Yarmouth Building Department, I 146 Route 28,South Yarmouth,MA 02664. Checks should be made payable to the Town of Yarmouth. IMPORTANT:One(1)re-inspection to confirm the abatement of any violations listed during the initial inspection will be included in the initial fee if the abatement is completed during the time period(typically 10 days)listed on the Inspection Report. Additional re-inspections will cost$80 each,which is payable in advance of the re-inspections. Unless otherwise requested, inspections will be performed unannounced. Typically the following elements/systems are inspected:fire protection equipment, means of egress, including emergency lights, exit signs, egress doors&hardware, clear path of travel, adequate lighting and occupancy total. Also, the building shall he maintained and adequate housekeeping provided to insure public softly. Rooms such as basements and attics are included. Violation details will be provided in the form of a Violation Notice and may delay the issuance of your certificate and/or license,if applicable. Note:After receiving your application a minimum of 3 weeks'notice is required for an inspection. Finally,applications and fees must be received within ten(10)days of receipt of this letter. Failure to comply may jeopardize your license where applicable,and/or the occupancy of the building per 780 CMR section 110.7 periodic inspections. ery truly y r , ,,.. VOUCHER APPROVAL I . Mark A. \toucher iltV 4 : mount:_Lill (2C) Building Commissioner Authorized ht..- Date: — Property: %C,g, Go: 0 Description: