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044e (�pututnn�u�ettii of tt �t t�Px�n
CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.Z5, this
CERTIFICATE OF INSPECTION
is issued to ....................... . . THOMAS .B...KELLY . &. MICHAEL. BEAN
..................................
$ SNACK BAR
( 9dif l] that I have inspected the ................................. known as.. SASS. RLVER .GOLE .COURSE
located at ........ HIWH. WN..40P...............in the..TQM...... of. ...... SPAT$.XAMUT8............
..
County of. ..$AMUMDA .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 p q Location
USE GROUP A-3 73 PERSONS' IST FLOOR '
CLASS 5-B
#12 �% /9 �%• FEBRUARY 18, 1995 ~
Certificate Number Date Cdrtificatli issued Rate Certificate Expires ing Official,
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
is made. At the time that a nese certificate is issued, a receipt
that the fee has been paid will be attached to this form or this
be stamped "PAID" prior to issuing the certificate. --Any changes
last inspection are to be added to the file card of.the premises.
should be filed by street address.
Street and number: HIGH BANK ROAD, SOUTH YARMOUTH., MA 02664
Name of Premises: RASR RTVRR MT.F MTTRRF.
Certificate to be Issued to: THOMAS B. KELLY/MICHAEL BEAN
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 ispect' (Required on File Card)
3.
4.
5.
Date Order Issued:
Order Issued to:
Address:
Date viclation(s) corrected:
Remarks:
inspection
indicating
form will
since •the
This form
I have this day inspected the above described premises, and the same conforms
to the pertinent requirements of the Hassachsuetts State Building Code and
the rules and regulations pursuant thereto.
'l 1 l �`i
DATE
Certificate Number #12
Date Issued
Date Expires FEBRUARY 18, 1995
Recommended next inspection date
UILDING OFFICIAL
CO1%DiON14EALTII OF MASSACHUSETTS
City/Town of YARMOUTH
APPLICATION FOR CE�CATE OF INSPECTION
PAYABLE UPON RECEIPT
Date JANUARY 19, 1994 (X) Fee Required $ 40.00
JAN
34 OA
( ) NO Fee Required
In accordance with a 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 nASS RTVFR rOT.P _ nr7i7?gF. GNACK RAiiF.T._
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 bV-1
ssued to C/ ��{/��/�
Address: (o,2- J
Owner of Record of Building .V
Address J&ii t�
Present Holder of Certificate 'Ej 2(.
Qgniature of Perso to whom Certifi- Tit e
cate is issued or is'agent
9 ela
Instructions: cake Check Payable to
Return this application to
Town of Yarmouth
1146 Route 28 S. Yarmouth, ma 02664
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
/ dWORKER'S COMPENSATION INSURANCE
Cartificate 7 FORM WITH THIS APPLICATION OR WE CANNO'
•ISSUE YOUR CERTIFICATE OF INSPECTION.