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HomeMy WebLinkAboutBCOI-23-1743 2026 The Commonwealth of Massachusetts Town of ;;z0 rit.417 oeYARMOUTH 'o � y• •� H�ORPORATEO�,/� 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. Pius X Church Trade Name: St. Pius X Parish Hall BCOI 23 1743 Identify property address including street number, name, city or town, and county Certificate Expiration Located at 0 STATION AVE SOUTH YARMOUTH, MA 02664 September 1, 2026 Floor Occupancy_ Use Group Other 01 st Floor 300 A-4 Low density recreation and Bingo Hall Use Group Classification(s) similar uses 01st Floor 110 A-3 Lecture halls,dance halls, 9-Classroom Allowable Occupant Load churches and places of religious TOTAL PERSOND-110 worship,recreational centers, terminals,etc. • rills 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 C' Name of Municipal Chief Mark Grylls7 Date of Inspection 3 I ]DS Commissioner j^ Signature of Municipal Fire Signature of Municipal Building / Chief Commissioner Date of Issuance 2 f LT h: - '- r (4.-- -ir:k------'' , TOWN OF YARMOUTH p _- 74 ' Office of the BuildingCommissioner iA�; 1146 Route 28, South Yarmouth, MA 02664 y`a 508-398-2231 ext. 1260 Fax 508-398-0836 \ ,yc 7' NeORATE APPLICATION FOR CERTIFICATE OF INSPECTION August 01, 2025 R ® PAYABLE UPON RECEIPT 2 9 2�25 (X) Fee Required$100.00 AUG ( ) No Fee Required In accordance with the clitilAlciliNi)fltheMiMaiu etts State Building Code, Section 110.7, I hereby apply for a Certificate of Inspection ey "" ises located at the following address: Street and Number: "I tA cc4io n Av€ . , 50 qA(Md,)4 h .M A cc?,6?`I Name of Premises: 54 1 U$ X Lhvit k— PGICI k Araa_ Tel: 5 A ' '3 ' day ( P Reit6,0as Ed ad6. Purpose for which permit is used: 0 W u rc(^ Q c-4 ki,krt.c License(s)or Permit(s)required for tEe premises by other governmental agencies: License or Permit Agency Certificate to be issued to 5+ P 1 US X ChUit k^ Tel: S o$ 3`f K (9Q y V Address: 6 1P)Gi bocce Si , bpo z 14 'IANt0 u't 1-1, AAA- Ca 6-,(=,LI Owner of Record of Building --- P wU )C C 14 o rc t'l Address q'-( 5 T A-71 d Al A✓t , s a U'( if V 19_M di-4 t-f i /1.44 O to 6 ,/ Present Holder of Certificate 5 {- P, u s k C h tirc_A-- M //(4-44Ph-s r o Signs of pe son to whom T. le Certificate is issued or his agent ate S/it 2° 1 Email Address: lj�-p I us X O� C e co 'Y�CA,S 4-, Vl ` 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-23-1743 09/01/2025-09/01/2026 ACCM , CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 3/24/2025 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 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 (NC.No.Ext): (NC,No): Massachusetts Catholic Self Insurance Group ADDRESS: Certificates@Ratiorisk.com 66 Brooks Dr INSURER(S)AFFORDING COVERAGE NAIC# Braintree MA 02184 INSURER A: Massachusetts Catholic Self Insurance Group INSURED INSURER B: Diocese of Fall River,MA INSURER C: St.Pius X Parish Hall INSURER D: 94 Station Avenue 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. IY EXP NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER (MM//DCY EFF D/YYYY) (MM//DD//YYYY) LIMITS LTR INSD,WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE T LOC PRODUCTS-COMP/OP AGG $ 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 03/31/25 03/31/26 X PER STATUTE OERH AND EMPLOYERS'LIABILITY Y/N Commonwealth of ANYPR RPMEMBER RIETOR/PARTNE /EXECUTIVE NIA Massachusetts - E.L.EACH ACCIDENT $ 1,000,000 OFFIC /(Mandatory in NH) 3000001012025 E.L.DISEASE-EA EMPLOYEE!$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Workers Compensation Insurance for Town of Yarmouth Inspection of Parish Hall. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1146 Route 28 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN South Yarmouth, MA 02664 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Amanda Taillon ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD