HomeMy WebLinkAboutBCOI-23-1745 2025 The Commonwealth of Massachusetts
Town of �� YA
ifYARMOUTH 3i .3c1‘!e-f-,-,4-4,.
New and Renewal Certification of Inspection
`'�"._`O?P�R�TEv�;�`.
In accordance with the Massachusetts State Building Code, Section 110.7
Identify Name of Establishment Certificate No.
Issued to Business Name: Sacred Heart Chapel BCOI-23-1745
Trade Name: Sacred Heart Chapel
Identify property address including street number, name, city or town, and county Certificate Expiration
Located at 32 SUMMER ST
YARMOUTH PORT, MA 02675 May 1, 2025
Floor Occupancy_ Use Group Other
Use Group Classification(s) 01st Floor 185 A-3 Lecture halls,dance halls,
churches and places of religious
Allowable Occupant Load worship, recreational centers,
_ terminals,etc.
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 line safety features. This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space as directed
by the undersigned. Failure to post or tampering with the contents of the certificate is strictly prohibited.
Name of Municipal Chief Name of Municipal Building Mark teof Inspection
rylls nspecon
-1 a3 ALI
Commissioner
Signature of Municipal Fire Signature of Municipal Building - Date of Issuance
Chief Commissioner 7 /Z 7/ Z y
of . �y TOWN OF YARMOUTH
• \� ' BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
May 01, 2024 PAYABLE UPON RECEIPT
(X) Fee Required $50.00
( ) 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 Street and Number: z a &Ave.rryl,, )/' rn Si. o ax PI ck \Ok vZ fit C
Name of Premises: '0,Cit`tla, -)-)'col,,"- Tel: 7 0 it '2 7G 6 ir i is
Purpose for which permit is used: 2.J& 3 o 1�t, 1Qa dvbit. 4y)L1.,
License(s) or Permit(s)required for the premises by other governmental agencies: RECEIVED
License or Permit Agency MAY 13 2024
BUILDING DEPARTMENT
By: -
Certificate to be issued to S}: t04,r y xq/Vi tn, an 1.I13 Tel: 5O 7 7 S O Cr-1 8
Address: al 3 al c s s S- J yG n n+s- M0% Gz 2-i.0 i
Owner of Record of Building 5 4- Pt-040 A a(AM,40% 12a 15y1, RA in an Q g iW c..13404e Paol av-(n
Address A 3 ODDS% St J1 y O,tnlft t MC1/4 ts Z lflo
Present Holder of Certificate ' eorst„,,
kua,vn. Pu•m ca.,
sAfif 64.00 --
ignature of person to hom
Title
Certificate is issued or his agent J2 14
D 1
Email Address: 121.0,94..SstAy ® Srr X1l3Ay tS . oci--u
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# 3CQI - a3-1#45
05/01/2024-05/01/2025
(N.
NOTICE NOTICE
TO TO
I! 9 ' EMPLOYEES
1111
EMPLOYEES a
a, . Sys
TheCommonwealtho assac usetts
DEPARTMENT OF INDUSTRIAL ACCIDENTS
LAFAYETTE CITY CENTER, 2 AVENUE DE LAFAYETTE, BOSTON, MA 02111
(617) 727-4900 — www.mass.gov/dia
As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice
that I (we) have provided for payment to our injured employees under the above-mentioned chapter by
insuring with:
Massachusetts Catholic Self Insurance Group, Inc.
NAME OF INSURANCE COMPANY
66 Brooks Drive, Braintree, MA 02184
ADDRESS OF INSURANCE COMPANY
3000001012024 03/31/2024 - 03/31/2025
'OLICY NUMBER EFFECTIVE DATES
A.I.M. Mutual Insurance Companies 54 Third Avenue, P.O. Box 4070 Burlington, MA 01830 800-876-2765
TAME OF INSURANCE AGENT ADDRESS PHONE #
?MPLOYER ADDRESS
;MPLOYER'S WORKERS' COMPENSATION OFFICER (IF ANY) DATE
MEDICAL TREATMENT
The above named insurer is required in cases of personal injuries arising out of and in the course of
employment to furnish adequate and reasonable hospital and medical services in accordance with the
provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the
injured employee. The employee may select his or her own physician. The reasonable cost of the ser-
vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and
reasonably connected to the work related injury. In cases requiring hospital attention, employees are
hereby notified that the insurer has arranged for such attention at the
Cse,pQ Cd
Hrt Qi ?oil< Stfee+ arrol►s I MA
NAME OF HOSPITAL ADDRESS
TO BE POSTED BY EMPLOYER