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CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.15, this
CERTIFICATE OF INSPECTION
THOMAS B. KELLY & MICHAEL BEAN
is issued to............................................................0.................0..0...
7� �tT t �G�'�i �i-c�✓t�
]l �1'1'tIf l� that I have inspected the ........ ......................... i9syn as.. ,BASS • RIVERS GOLF COURSE
located at........... HIGH. BANK ROAD ........ , • , in the.. TOW1 .. , . , of SOUTH YARMOUTH
............ .................YARM ...............
County of.. BUFAT-WA ..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 ••
#21 FEBRUARY 16, 1993 •`
Certificate Number Atte Certificate Issued Date Certificate Expires Zding Officzal
The building official shall be notified within (10) days of any changes in the above information.
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 indicating
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 form
should be filed by street address.
Street and number: HIGH BANK ROAD. SOUTH YARMOUTH. MA 02664
Name of Premises: gACC DTVPUGQT P CGWRSE
Certificate to be Issued to: THOMAS B. KELLY/MICHAEL BEAN
Address: 12 MORNING DRIVE, SOUTH YARMOUTH, MA 02664
Owner of Record of.Bu_ilding: TOWN OF YARMOUTH
Address:
Purpose for which premises are used: rnFFF.F. SHOP
Use Group Classification of Premises: A-3
Changes since last inspection (Required on File Card)
2.
3.
4.
S.
Date Or -der Issued:
.Order Issued to:
Address:
Date violations) corrected:
Remarks:
I have this day inspected the above described premises, and the same conforms
to the pertinent requirements of the Massachsuetts State Building Code and
the rules and regulations pursuant thereto.
DATE MLDING OFFICIAL
Certificate Number 21
Date Issued
Date Expires FEBRUARY 18, 1993
Recommended next inspection date
COMMONWEALTH OF MASSACHUSETTS
City/Town of YARMOUTH
APPLICATION FOR CERTIFICATE OF INSPECTION
CERTIFICATE EXPIR
Date JANUARY 10, 1992
(X ) Fee Required $ 40.00
FEB I 2M UJI ( ) NO Fee Required
In accordance witL"*he, 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 Number HIGH BANK ROAD, SOUTH YARMOUTH, MA 02664
Name of Premises BASS RIVER GOLF COURSE TF.i.
Purpose for which premises is used COFFEE SHOP
License (s) or Permits (s) required for the presises by other govermental
Agencies:
License or Permit Agency
Certificate to be issued to TFT.
Address:
Owner of Record of Building
Address
Present Holder of Certificate
Signature of Persono whom Certifi- Title
cate is issued or hs agent y
ate
**********************************************************************************
Instructions: Make 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.
Certificate U IJ