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Home My WebLink AboutBOI-23-1746 2025 The Commonwealth of Massachusetts Town of °� YAK jg) YARMOUTH .o - H! k''yC�APp RATE�,,,siJ 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: First Congregational church of Yarmouth BCOI-23-1746 Trade Name: First Congregational church of Yarmouth Identify property address including street number, name, city or town, and county Certificate Expiration Located at 329 ROUTE 6A September 1, 2025 YARMOUTH PORT, MA 02675 Floor Occupancy_ Use Group Other Use Group Classification(s) 01st Floor 344 A-3 Lecture halls,dance halls, 342 Persons in pews churches and places of religious 2 Persons wheel chair spaces 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 Building Name of Municipal Chief Ma Date of Inspection Li i i J//ic Lt Commissioner OP Signature of Municipal Fire Signature of Municipal Building AV' Chief Date of Issuance /z� Chief Commissioner ait... r r� --..--,- Ali-I 'Y TOWN OF YARMOUTH Office of the Building Commissioner tilLiA 1146 Route 28, South Yarmouth, MA 02664 N "` 41,1 508-398-2231 ext. 1260 Fax 508-398-0836 NnrucNRese A c°RPORATEO fib',! APPLICATION FOR CERTIFICATE OF INSPECTION August 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: 32 1 Kctin S+, ` otpri Oatik Port- MAr Name of Premises: 'First G�a� Tel: `J�&' (2 Z- (o 9 7 C�urck_n ar o Purpose for which permit is used: License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency RECFIVF Certificate to be issued to C( LA)--cG� y�-yt,IotA'�L� Tel: 5— 362.- 6b '7 Address: ei �Q(n 541 (ev�Mo�'tk POrf- MA- OZee^7S i , AUG 0 7 2024 Owner of Record of Building i t� Address • [yUIIDING DEPARTMENT Present Holder of Certificate ____________ AAMr AI S410. .. re of per n to w m Title Certificate is issued or his agent g"- 4- 2-0 2. ( Date Email Address: &d 1'W 1 a .c1 arnl o a • Q . ll r-----__ ___________� 0 AUG 4 2024 Instructions: Make check payable to: Town of Yarmouth h-G (5 T 73 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# O)3_I?iii ( 1 09/01/2024-09/01/2025 Church Mutual Insurance Company,S.I. NCCI CARRIER CODE NO. 16853 WC 00 00 01A 3 WORKERS COMPENSATION AND EMPLOYj'RS LIABILITY INSURANCE POLICY INFORMATION PAGE 1.The Insured: FIRST CONGREGATIONAL CHURCH policy No. 0187606 07 673564 OF YARMOUTH Renewal of: 0187606 07-473117 Individual Partnership Mailing address:329 ROUTE 6A X Corporation or YARMOUTH PORT, MA 02675-1817 Federal Employers I.D.# See Schedule Inter/Intrastate Risk I.D.# Other I.D.# Other workplaces not shown above:See Schedule Contact Phone Number 2.The policy period is from 12/2 3/2023 12:01 a.m.to 12/2 3/2024 12:01 a.m.standard time at the Insured's mailing address. 3.A.Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B.Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A.The limits of our liability under Part Two are:Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C.Other States Insurance:Part Three of the policy applies to the states,if any,listed here: All states except states designated in Item 3.A. of the Information Page and ND, OH, WA, WY. D. This policy includes these endorsements and schedules: See Schedule 4.The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Code Total Estimated $100 of Estimated Classification No. Annual Remuneration Remuneration Annual Premium See Item 4. Extension WC 00 00 O1A Total Estimated Annual Premium$ 1,841 Expense Constant$ 338 Taxes and Surcharges$ 7 8 Minimum Premium$ 284 (MA) 9101 Deposit Premium $ 1,919 See Item 4. Extension WC 00 00 O1A for the Taxes and Surcharges for: MA Premium Adjustment Period:Annual Countersigned by: Servicing Office: Church Mutual Insurance Company, S.I. Date: 11/07/2023 , Producer: LAURA J. ROGGERO Church Mutual Copyright 1987 National Council on Compensation Insurance. Original INSURANCE' WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NO. 0187606 0 7-6 7 3 5 6 4 EXTENSION OF INFORMATION PAGE 1 ITEM 4.CONTINUED PAGE NO. Estimated Total Rates Per Estimated Annual Premiums $100 of CODE Annual Remun- CLASSIFICATION OF OPERATIONS NO. Remuneration Subject to All Other eration Modification MA-20 LOC. 1 SIC: 8661 NAICS : 813110 329 ROUTE 6A YARMOUTH PORT, (Barnstable) MA 02675-1817 001-001 FIRST CONGREGATIONAL CHURCH OF YARMOUTH FEIN: 04-6110040 From 12/23/2023 To 12/23/2024 RELIGIOUS ORGANIZATION: 8868 187, 634 0 . 60 1, 126 PROFESSIONAL EMPLOYEES & CLERICAL RELIGIOUS ORGANIZATION: ALL OTHER 9101 18, 842 3 . 01 567 EMPLOYEES Deviation 9037 0 . 887 -191 Employer' s Liability (in 000 ' s) 9807 0 . 010 15 Limit: 500/500/500 TOTAL UNMODIFIED PREMIUM 1, 517 TOTAL MODIFIED PREMIUM 1, 517 Merit Rating 9885 0 . 950 -76 STANDARD PREMIUM 1, 441 All Risk Adjustment Program 0277 1 . 000 0 Expense Constant 0900 338 Terrorism 9740 0 . 0300 62 DIA Assessment 0 . 0482000 0935 78 . 00 TOTAL ESTIMATED PREMIUM 1, 841 TOTAL ASSESSMENTS 78 . 00 U4C 00 00 01A ChurchMutual INSURANCE WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY POLICY NO. 0187606 0 7-6 7 3 5 6 4 EXTENSION OF INFORMATION PAGE ITEM 4.CONTINUED PAGE NO. 2 Rates Per Estimated Annual Premiums Estimated Total $100 of CODE Annual Remun- Subject to CLASSIFICATION OF OPERATIONS NO. Remuneration eration Modification All Other MA-20 LOC. 1 SIC : 8661 NAICS : 813110 329 ROUTE 6A YARMOUTH PORT, (Barnstable) MA 02675-1817 TOTAL MA ESTIMATED PREMIUM 1, 841 TOTAL MA ASSESSMENTS 78 . 00 Church WC 00 00 01A Mutual INSURANCE