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HomeMy WebLinkAboutBCOI-24-64 2025 The Commonwealth of Massachusetts 1 V Town of zog..Yo YARMOUTH •.3 � % � .0 : - y; • New and Renewal Certification of inspection I t �'""OR�TEo�".� In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: West Yarmouth Congregational Church BCOI-24-64 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 WEST YARMOUTH, MA 02673 January 20, 2025 - Floor Occupancy_ Use Group Other 01 st Floor 210 A-3 Lecture halls,dance halls, 210 Persons churches and places of religious Use Group Classification(s) worship,recreational centers, terminals,etc. Allowable Occupant Load Other 40 A-3 Lecture halls,dance halls, Balcony churches and places of religious 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 p Commissioner Mark G S D to of Inspection �'{ 1 D ,),q Signature of Municipal Fire Signature of Municipal Building to of Issuance (iD, Chief Commissioner _ 7 Oy s,,: :Y:.:4 TOWN OF YARMOUTH � � , ; w Ifri BUILDING DEPARTMENT 'aten`MATT'ACst,_ 9 1 146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 ' u! APPLICATION FOR CERTIFICATE OF INSPECTION April 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 and Number: 63 71'? /1 ?Z Name of Premises: 4Gd *� (ll Q r�.y1 6 0 C`(j,,, (%'c,' 4re : (a -775 d O 9/ C� q V Purpose for which permit is used: nurd, License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED License or Permit Agen y ' "" . MAY 13 2024 UI ENT By Certificate to be issued to \ (.'( Tel: d'4, -. 76 -S2i d Address: 02, , A4. a! G. .t ge'i 112A ,13 Owner of Record of Building Address a&O X'4z 07S. 7 &)- Y_ Present Holder of Certificate 66q t,,.1( elai r_� 94 vN 045 ail";" Si ature ofperson o whom Title ertificate is issued or his agent _c/a -2 it - Date l� Email Address: UQ/i a h J . (OY� 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# on7i-d}-14 05/01/2024-05/01/2025 CERTIFICATE OF LIABILITY INSURANCE I1.0 05/04/2024 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 SUBROGATIONIS 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 CONTAC-"NAME: FITTS INSURANCE AGENCY INC PHONE (508)620-6200 FAX 08088026 (A/C,No,=xt): (A/C,No): 2 WILLOW STREET SUITE 102 E-MAIL ADDRESS: SOUTHBOROUGH MA 01745 INSURER(S)AFFORDING COVERAGE NAIC# 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 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD IMM/DD/YYYYI (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY Ti PRO- LOC PRODUCTS-COMP/OP AGG L_ PRO- JECT OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) ANY AUTO BODILY INJURY(Per person) —ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE Q MADE DED RETENTION WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY Y/N E.L.EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNER/EXECUTIVE N/A 08 WEC NN5968 10/01/2023 10/01/2024 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 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 (_ - '449"AI) (i�L ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD