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HomeMy WebLinkAboutBCOI-24-9 2027 g 'Y'A�� TOWN OF YARMOUTH f/ O f : 'Y_\ /'� - -?r$s Office of the Building Commissioner ' 1146 Route 28, South Yarmouth, MA 02664 } a t� =4' 508-398-2231 ext. 1260 Fax 508-398-0836 mg. ,1,c°RpoRA. O`b94 f APPLICATION FOR CERTIFICATE OF INSPECTION January 1, 2026 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: 273 Station Ave. Name of Premises: Hallett Funeral Home Inc. Tel: 508-398-2285 Purpose for which permit is used: Funeral Home License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued toHallett Funeral Home Inc. Tel: 508-398-2285 Address: 273 Station Ave. , South Yarmouth, MA 02664 Owner of Record of Building Hallett Family Trust Address 273 Station Ave. , South Yarmouth, MA 02664 Pr sent Holder of Certifi to same --- President & Treasurer Si nature of person to whom Title Certificate is issued or his agent February 2026 Date Email Address: fahallett@ballettfuneralhome.com 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)da s of any change in the above information. du Certificate of Inspection#_BCOI-24-9 02/25/2026-02/25/2027 1 r, ------"ms HALLFUN-01 KRALSTON ACORO CERTIFICATE OF LIABILITY INSURANCE DATDIYYYY) `� 2/10/2026 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: Bryden&Sullivan Insurance Agency of Dennis,Inc. PHONE No,Ext):(508)398-6060 FAX 508 3942267 PO Box 1497 (A/C,No):( ) South Dennis,MA 02660-1602 E-MAIL SS: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Mapfre Ins Co 23876 INSURED INSURER B:Commerce Ins Co 34754 Hallett Funeral Home Inc INSURER C:The Hartford 19682 c/o Faith Hallett 273 Station Avenue INSURER D: South Yarmouth,MA 02664 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 INSD WVD (MM/DD/YYYY) (MM/DDIYYYYI A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR 8008030018782 11/1/2025 11/1/2026 PRM EE OER EoTuErcDe nce) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY VT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 500,000 (Ea accident) $ — ANY AUTO L05768 11/1/2025 11/1/2026 BODILY INJURY(Per person) $ _ AUTO ONLY X SCHEDULED BODILY INJURYp (Per accident) $ X AUTOS ONLY X AUTOS ONLY (Perr accident)AMAGE $ $ UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 08WECAY2LPK 7/17/2025 7/17/2026 1,000,000 FFICER/MIMBER EXCLUDED? N N/A E.L.EACH ACCIDENT $ andatory in NH) 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD r_ i