Loading...
HomeMy WebLinkAboutBCOI-24-64 2026 The Commonwealth of Massachusetts ... A Town of ,/°� Y..,-T o„ YARMOUTH o i may; C.,RPORAtEO.,,,,- 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: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 January 20, 2026 WEST YARMOUTH, MA 02673 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 Building Mark G ate of Inspection (� I s fs Name of Municipal Chief Commissioner ! Signature of Municipal Fire Signature of Municipal Building),/, ..64,,, Date of Issuance /�j'/zJ�Chief Commissioner t TOWN OF YARMOUTH (f-ryif,- --, � E C--�I.Vt; ® lIffice of the Building Commissioner � 5 ,4 ' -' „t ,,,4 MAY 2 3 20211 6 Route 28, South Yarmouth, MA 02664 `� TA M y; 8 398-2231 ext. 1260 Fax 508-398-0836 _ MATEHEESE t� ,.c�R �.�9' BUILDING— DEPARTMENT —MENT poRATE APPLICATION FOR CERTIFICATE OF INSPECTION April 07, 2025 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: `3?3 f4e 024 G).ja rev')o c.-A Name of Premises: 4/I, 06 ni. ( /Au rC Li Tel: (5JJ ' 7 7 5 Ogf? Purpose for which permit is used: U License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to GJ (o r yr. C' c4 Tel: 50y-- 7?,5-- i Y Address: cy E 3 'u G J 8, kt j . �/Q"ye?es,a Z-Z, )44 CJ�G 7,� Owner of Record of Building (� c cJ Address cs'a_ Pre t Holder of rtificate (�y rr r /�/ ' N QiOri 6c a r-0 vhth Si re of person to whom Title Ce ificate is issued or his agent f//01 v- _ Date Email Address: (3p,�( `f I"v),"tLI C6 it 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#BCOI-24-64 05/01/2025-05/01/2026 CERTIFICATE OF LIABILITY INSURANCE 04/27/2025 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 CONTACT NAME: FITTS INSURANCE AGENCY INC PHONE (508)620-6200 FAX (508)481-0227 08088026 30 TURNPIKE ROAD SUITE 3 (A/C,No, (A/C,No): EMAIL ADDDRDR ESS: SOUTHBOROUGH MA 01772 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 WEST YARMOUTH MA 02673-4721 INSURER D: 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 SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDD/YYYYI (MM/DD/Y YYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) PERSONAL&ADV INJURY GENT AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE POLICY PRO- LOC PRODUCTS-COMP/OP AGG JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY(Per person) —ALL OWNED SCHEDULED _AUTOS AUTOS BODILY INJURY(Per accident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS AUTOS (Per accident) _ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS- AGGREGATE MADE DED RETENTION$ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY YIN El_EACH ACCIDENT $1,000,000 A PROPRIETOR/PARTNER/EXECUTIVE [ N/A 08 WEC NN5968 10/01/2024 10/01/2025 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 DESCRIP71ONOFOPERA7IONS/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( ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD