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Home My WebLink AboutBCOI-23-1705 2025 The Commonwealth of Massachusetts Town of og Y9 =-- ti IF 'uiYARMOUTH ��, . t °' New and Renewal Certification of Inspection °R P°R .... 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 Trade Name: St. David's Episcopal-Nursery/Preschool BCOI 23-1705 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 205 OLD MAIN ST SOUTH YARMOUTH, MA 02664 June 18, 2025 Use Group Classification(s) Floor Occupancy_ Use Group Other 01st Floor 27 1-4 Adult and/or child day care facilities 15 Children infants/toddlers 12 Allowable Occupant Load Children(2.9-5 years) 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 Commissioner Mark ryl ate of Inspection Y//` C(3/ia 04L7 / Signature of Municipal Fire Signature of Municipal Building Chief Commissioner Date of Issuance 40 1'• .Y9R off; TOWN OF YARMOUTH -y) BUILDING DEPARTMENT rs�," T" 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 locatedlo at the following address: Street and Number: a1 S O 1 I' aiAL vl a-' 'V • o-&'q Name of Premises: �u�S /� Sci(00Z Tel: 668— —LeO-a D— Purpose for which permit is used: C .. ,'`A-r;)CI -License(s) or Permit(s) required for the premises by other governmental agencies: IV _ License or Permit Agency ' '�cj MAY 13 2024 BUILDING DEPARTMENT By: Certificate to be issued to C ci-- r S ,��a `'el: "'� 1 '� �-� Address: Q05- D\ IN s ,s.` GWwtUJP M LA- DZ10 b Owner of Record of Building EO,St, C,R4.LAAeL_ Address 5Q,Nf1L Present Holder of Certificate Salim, V ��4(ZaiS•C Signature of person to whom Title Certificate is issued or his agent 1011.10, 1 \ Date Email Address: __�\ CSL(1_ Sod r d p-�'= Instructions: Make check payable to: Town of Yarmouth 1 146 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 # (�f—r� 3/7Q3'— 06/18/2024-06/18/2025 ACC RE) 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 (NC, No, Ext): (800) 293-3525 (NC,No):(800) 557-1395 Bennington, VT 05201 E-MAIL ADDRESS: PRODUCER CUSTOMER ID#: INSURER(S) AFFORDING COVERAGE NAIC # 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. INS ADDCSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENENXIBILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL PREMISES(Ea occurrence) $ . CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'ik'OLICY L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ PRO-CT LOC u IUMUStLjABILITY 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 AND EMPLOYERS' LIABILITY Y/N Y X WC7625900009023110 9/30/2023 9/30/2024 TORY LIMITS ER CUTIUrvRIETOR/PARTNER/EXEE E.L. EACH ACCIDENT $ 1,000,000 f1FFI( FP/IMAFMARFP FX('I I InFrl7 (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 South Yarmouth, MA 02664-4529 ACCORDANCE WITH THE POLICY PROVISIONS. ,` , �,�