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HomeMy WebLinkAboutBCOI-23-1817 2026 The Commonwealth of Massachusetts Town of o,,.Y44• � IfYARMOUTH IA-� °,::"..ft,i 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: Roman Catholic Bishop of Fall River-St. Pius C Church BCOI 23-1817 Trade Name: St. Pius X Parish Life Center Identify property address including street number, name, city or town, and county Certificate Expiration Located at 0 STATION AVE SOUTH YARMOUTH, MA 02664 January 17, 2026 Floor Occupancy Use Group Other Use Group Classification(s) 01 st Floor 716 A-3 Lecture halls,dance halls, 716-Concentrated churches and places of religious 334-un-Concentrated worship,recreational centers, RM-18 Con-137/Uncon-63 Allowable Occupant Load terminals,etc. RM-120 Con-53/Uncon-25 RM-121 Con-29/Uncon-53 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. al Chief Name of Municipal Building Name of Municipal Commissioner Mark Gry of Inspection '~ Signature of Municipal Fire Signature of Municipal Building _ Chief Commissioner ate of Issuance ?/JS/Z1— } 1* 1A_ TOWN OF YARMOUTH r �} Ei , Office of the Building Commissioner ' -'''''',.' -'A 1146 Route 28, South Yarmouth, MA 02664 � --= fr,i 508-398-2231 ext. 1260 Fax 508-398-0836 ►{AttACUErt5E- /�c°RPORATE0\k.' APPLICATION FOR CERTIFICATE OF INSPECTION December 02, 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: Street and Number: Z 5 &A 4 e 0. cl�1 Sb v -I 4 ya/ ryl o t-A N 4 o - ‘ (, 4 f7a vi-s /_ Name of Premises: 5 t• 1 ,`vs rC,s;>1) I L •re l eh 1-e.- Tel: 5 C7 se) -S 9 - Z2)-1 S NY, Purpose for which permit is used: d k v r e i, Q c.}'i V► 'bi c s License(s) or Permit(s) required for the premises by other governmental agencies: License or Permit Agency 4V7 Certificate to be issued to s 4-. ?,v s X k V f c (-) Tel: 5 0 e- 3 c1 tb - L 2. Address: �` U�b a S �) So J Xl, G' rh a 0 r 4 144 d t (x(� Owner of Record of Building i u 5 Address 2.5 0 p/ 4 0 ) r► .; +I> p/m o t h , 114 0't 4 G Y Present Holder of Certificate OrQ,',;..s X Cdi ( / ,4-(/ /' Signatu of person to whom Title Certificate is issued or his agent ` 7pLe Date Email Address: 6, i-P i v, C Y'J c *c e u i/% c eLs i-• e% e . \I- DEC 2 3 Mit \4°'1 .______- D\vG DEPARTMENT 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# 01/17/2025-01/17/2026 /QC-/ / --OR 3--1 k/7 -r A C/ ©!S®� DATE(MM/DD/YYYY) CP CERTIFICATE OF LIABILITY INSURANCE 03/21/2024 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 have ADDITIONAL INSURED provisions or 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: PHONE FAX (A/C,No,Ext): (A/C,No): Massachusetts Catholic Self Insurance GroupE-MAIL ADDRESS: Certificates©Ratiorisk.com @ 66 Brooks Drive INSURER(S)AFFORDING COVERAGE NAIC# Braintree MA 02184 INSURERA: Massachusetts Catholic Self Insurance Group INSURED INSURER B Diocese of Fall River INSURER C: St. Pius X Church INSURER D: 5 Barbara Street INSURER E: _ South Yarmouth MA 02664 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. VSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE _TR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION Certificate of Approval 03/31/24 03/31/25 X PER OTH- AND EMPLOYERS'LIABILITY Y/N Commonwealth of STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? N/A Massachusetts (Mandatory in NH) 3000001012024 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 )ESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Workers Compensation Insurance for The Diocese of Fall River and St. Pius X School for Town of Yarmouth Building Department. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1146 Rout 28 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE Amanda Taillon ©1988-2015 ACORD CORPORATION. All rights reserved. kCORD 25(2016/03) The ACORD name and logo are registered marks of ACORD