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' CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.15, this
CERTIFICATE OF INSPECTION
is issued to ........................ THOMAS........ B . KELLY & MICHAEL BEAN
........................................................
I Tertif U that I have inspected the...........SNACK
......,...SNACK BAR...... • BASS RIVER GOLF COURSE
located at.... HIGH BANK ROAD in the T.... of. SOUTH YARMOUTH
.... .. ........ ..... .. ...... ......... ... ... .,........
BARNSTABLE
County of ............ ..... Conywnwealth of Massachusetts. The means of egress are sufficient for the foZZomi.ng
number of persons:
BY STORY
Story Capacity Story. Capacity .. Story Capacity .. Story Capacity
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly 99 Place'ol Assembly
or Structure' Capacity Location or Structure Capacity Location
USE GROUP A-3 :73 PERSONS: 1ST FLOOR
CLASS 5-B '•
#26 �L-/ — Q Z' FEBRUARY 18, 1996
Certificate Number bate Certificate Issued Date Certificate Ezpzres Building Officutl
The building official shall be notified within (10) days of any changes in the above information.
PERIODIC INSPECTION REPORT
Instructions: This form is to be completed each -time a periodic inspectic
is made. At the time that a new certificate is issued, a receipt indicut_
that the 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 fc
should be filed by street address.
Street and number: HIGH BANK ROAD. SOUTH YARMOUTH,. -MA 02664
Name of Premises:' BASS RTVRR MT.F rQT1RRF.
Certificate to be Issued to: THOMAS B. KELLY/MICHAEL BEAN
Address:'
Owner of Record of Building: TOWN OF YARMQUTH
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.
Date Order Issued:
Order Issued to:
Address:
Date violations) corrected:
Remarks:
I have this day inspected the above described premises, and the same confo=
to the pertinent requirements of the Hassachsuetts State Building Code and
the rules and regulations pursuant thereto.
DATE BUILDING OFFICIAL
Certificate Number #26
Date Issued'
Date Expires FEBRUARY 18, 1996
Recommended next inspection date
COMMONWEALTH OF MASSACHUSETTS
/ City/Town-of YARMOUTH
APPLI
Date FEBRUARY 6, 1995
OF INSPECTION
PAYABLE UPON RECEIPT
(X ) 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 02664
Name of Premises BASS RIVER GOLF COURSE SNACK BAR Tpr,
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
-v Nr K, r. l i7 �`r %K f 3F't�
Certificate to be issued to_L�ft55 n'!Vf? swwk 51m Tpr yk-/cS.zG
Address: G9 74// 6,-i ?,N S _114114
Owner of Record of Building %OWW� of ye,p,4va1re
Address
Present Holder of Certificate_ j dor1(fz 1 fi/!Kf ZFF�
dA
Signature of Person t whom Certifi- Title
Cate is issued or his agent 2 z p 5
ate
Instructions: :fake Check Payable to Town of Yarmouth
1146 Route 28 S. Yarmouth, Ma 02664
Return this application to BUILDING INSPECTORS OFFICE
Please note:
application form with accompaning 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 information.
PLEASE SEND US A COPY OF YOUR
�1/_
WORKER'S COMPENSATION INSURANCE
Certificate 4
cG
/
FORM WITH THIS APPLICATION OR WE CANNOT
ISSUE YOUR CERTIFICATE OF INSPECTION.