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Home My WebLink AboutBCOI-23-1707 2025 The Commonwealth of Massachusetts ems' Town of r;o -.Y , ILIV o�\ YARMOUTH ;0E _ �Adl .0 -', H! ,'4,0,,,, RATEo,," . New and Renewal Certification of Inspection In accordance with the Massachusetts State Building Code, Section 110.7 Identify Name of Establishment Certificate No. Issued to Business Name: St. David's Episcopal Church BCOI-23-1707 Trade Name: St. David's Episcopal Church-Parish Hall Identify property address including street number, name, city or town, and county Certificate Expiration Located at 205 OLD MAIN ST June 18, 2025 SOUTH YARMOUTH, MA 02664 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 79 A-3 Lecture halls,dance halls, 49 Person Room 1-10 churches and places of religious Students Room 2-20 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 I Date of Inspection � l i-lid� ( Commissioner / T Signature of Municipal Fire Signature of Municipal Building / Chief Commissioner Date of Issuance 67Z-/ Z i 0-f'Y9R TOWN OF YARMOUTH BUILDING DEPARTMENT cs3 ...,..,.j 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 $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: �� ,n / Street and Number: �0 5 06. v , �' /i 74 62 10-4 Name of Premises: (Pr-1 11 j-4 L L Tel: obi - SC) Purpose for which permit is used: C' kAA . LLA-€ — /01.. ' License(s)or Permit(s)required for the premises by other governmental agenciiP EIVED License or Permit Agency R C VIe.eC-�i \ 'U 1 01.( [ Yi 3 2824 BUILDING DEPARTMENT (( By:_-__-,_. • Certificate to be issued to 4. T XXAJ a �S C -39 L'—`/l 3" Address: aoc D\d ch -E-. S . gaol.OA-L. WA- dZ!Q{o / Owner of Record of Building . AA 5 - C uk,re�. Address saw__ Present Holder of Certificate SCE Fj-k'se AvuivitYL\ (.+ aotivu ec_4' ad-444-1A4 Signature of person to whom Title Certificate is issued or his agent )I ( Date Email Address: �-�- S1 jeatAA -s 6Y/1 C c&s V ) ‘ s . Rs? (-- 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 SSUE YOUR CERTIFICATE OF INSPECTION. akificate of Inspection# /CCU/-73-/70-7 06/18/2024-06/18/2025 ACC)14101� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE July 28,2023 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 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 NAME: Ruth Bland The Church Insurance Agency Corp PHONE FAX 210 South St,Suite 2 (A/C,No,Ext):(800)293-3525 (Nc,No):(800)557-1395 Bennington,VT 05201 E-MAIL ADDRESS: PRODUCER CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC C INSURED INSURER A: Liberty Insurance Corp Diocese Of Massachusetts INSURER B: INSURER C: 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. aV� ADDLSUBR POLICY EFF POLICY EXP nR_ TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENENAIBILITY EACH OCCURRENCEDAMAGE TO $ COMMERCIAL GENERAL PREMISES Eaoccu ence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENII AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO-CT LOC $ U IUMuUILEIABILITY .COMBINED SINGLE LIMIT (Ea accident) _ANY AUTO BODILY INJURY(Per person) $ _ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE __HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- A ANDN D EMPLOYERS'LIABILITY Y/N Y X WC7625900009023110 9/30/2023 9/30/2024 TORY LIMITS ER g CUTIVEETOR/PARTNER/EXE E.L.EACH ACCIDENT $1,000,000 (1FFI(`FGR,spMRFIi FYr:I I Ir1FM (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION St Davids Episcopal Church SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 205 Old Main St THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN So ith Yarmouth,MA 02664-4529 ACCORDANCE WITH THE POLICY PROVISIONS. -;(2yy { .‘ y� ,, - _eziz