HomeMy WebLinkAboutCI 15-99M
0lp Tommunwralf4 of Aassar4usrtts
CITY/TOWN OF
YARMOUTH -
In accordance with the Massachusetts State Building Code, Section 108. Z5, this
CERTIFICATE OF INSPECTION
THOMAS B. KELLY
is issued to
........................................................................ ....................
(ertif ll that I have inspected the...... SNACK BAR .. • • .. • • ... • .. • as, . BASS RIVER GOLF COURSE
............
located A ....... HIGH. BANK.ROAD........:......in the.. .TOWN ..... of. 0....... SOUTH• YARMOUTH...........
Count of.. f..BARNSTABLE.. Commonwealth of Massachusetts. The means of egress are sufficient for the following
.............
number of persons:
BY STORY
Story Capacity
.
Story .' Capacity
:. .
Story Capacity
.: .
.. Story Capacity
.. .
.
.. : .. .
BY PLACE OF ASSEMBLY OR STRUCTURE
.. .
Place of Assembly
.. Place of Assembly
or Structure
Capacity Location
or Structure
Capacity : Location
USE GROUP A-3
:73 PERSONS: IST FLOOR
CLASS 5—B
••
#15
FEBRUARY 18, 2000`
Certificate Number
Date Certificate Issued
Date Certificate F,zpires
Building Offical
The building official shall be notified within
(10) days of any changes in
the above information.
PERIODIC INSPECTION REPORT
1 -
INSTRUCTIONS: THIS FORM IS TO BE COMPLETED EACH TIME A PERIODIC INSPECTION IS MADE. AT
THE TIME THAT A NEW CERTIFICATE IS ISSUED, A RECEIPT INDICATES THAT A FEE HAS BEEN PAID ,
WILL BE ATTACHED TO THIS FORM OR THIS FORM WILL BE STAMPED "PAID" PRIOR TO ISSUING THE
CERTIFICATE. ANY CHANGES SINCE THE LAST INSPECTION ARE TO BE ADDED TO THE FILE CARD OF
THE PREMISES. THIS SHOULD BE FILED BY STREET ADDRESS.
STREET AND NUMBER: HIGH BANK ROAD
NAME OF PREMISES: BASS RIVER GOLF COURSE
CERTIFICATE TO BE ISSUED TO: THOMAS B. KELLY
ADDRESS:
OWNER OF RECORD OF BUILDING: TOWN OF YARMOUTH
ADDRESS:
PURPOSE FOR WHICH PREMISES ARE USED: SNACK BAR
USE GROUP CLASSIFICATION OF PREMISES: A-3
CHANGES SINCE LAST INSPECTION (REQUIRED ON FILE CARD):
1.
2.
3.
4.
5.
DATE: ORDER ISSUED:
ORDER ISSUED TO:
ADDRESS:
DATE VIOLATION (S) CORRECTED:
REMARKS:
I HAVE THIS DAY INSPECTED THE ABOVE DESCRIBED PREMISES, AND THE SAME CONFORMS TO THE PERTINENT
REQUIREMENTS OF THE MASSACHUSETTS STATE BUILDING CODE AND THE RULES AND REGULATIONS
PURSUANT THERETO.
DATE
CERTIFICATE NUMBER: #15
DATE ISSUED:
DATE EXPIRES: FEBRUARY 18, 2000
RECOMMENDED NEXT INSPECTION DATE:
ALJZ;z
BUILDING OFFICIAL
COMMONWEALTH OF MASSACHUSETTS
City/Town
APPL
Date JANUARY 26, 1999
TION FbO Toff
FEB
CERTIFICATE EXPIRES FEBRUARY 18, 1999
FICATE OF INSPECTION
PAYABLE UPON RECEIPT
$XX),Fee Required $ 40.00
( ) NO Fee Required
In accordance with the provisions of the Massachusetts State
Building Code, Sec. 108,15, I hereby apply for a Certificate of
Inspection for the below -named premises located at the following
address:
Street and :lumber 62 HIGHBANK ROAD, SOUTH YARMOUTH, MA
Name of PremisesBASS RIVER GOLF COURSE SNACK BAR TFT._
Purpose for which premises is used SNACK BAR
License (s) or Permits (s) required for the presises by other govermental
Agencies:
License or Permit Agency
Certificate to be issued to
Address: 1�P H/G11,6ervk
/y TVT
Owner of Record of Building �UCc/.!i of Yl9i�jcfp�ljfir
Address
Present Holder of Certificate
L � 4/2a gl"e
Si nature of Person to Aihom Certifi- Tit e
cate is issued or his agent
ate
**********************************************************************************
Instructions: ;fake Check Payable to
Town of Yarmouth
1156 Route 28 S. Yarmouth, Ma 02664
Return this application to BUILDING INSPECTORS OFFICE
I.
r
Please note:
Application form with acconpaning fee must be submitted for each building or
structure or part thereof to be certified.
Application and fee must be received before the certificate will be ussued.
The building offical shall be notified within ten (10) days ofany change in
the above. iformation. PLEASE SEND US A COPY OF YOUR
41_ 19191 WORKER'S COMPENSATION INSURANCE
Cartif_cate I "/vJ FORM WITH THIS APPLICATION OR WE CANNOT
ISSUE YOUR CERTIFICATE OF INSPECTION.