HomeMy WebLinkAboutCI 39-87is issued to
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CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.15, this
CERTIFICATE OF INSPECTION
LOUIS COLUMBO
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Y uPl`�lll� that I have inspected the ... COFFEE.SHOP...................known as. BASS. RIVER GOLF .COURSE...
located at.. HIGH.BANK ROAD. .......... ., in the TOWN,, of, SOUTH YARMOUTH
:... ... ... .. .... .. .... . ........!.
............
County of.. ARNW W....Commonwealth of Massachusetts. The means of egress are sufficient for the following
number of persons:
The building. officiaZ shall be notified within (i0) days of any changes in the above information.
BY STORY
Story Capacity
Story
Capacity
.. Story
Capacity
..y
Capacity
Stor p y
BY PLACE
OF ASSEMBLY
OR STRUCTURE
Plaqe of Assembly
.. Place of
Assembly
or Structure
Capacity
Location
:: or Structure
Capacity : Location
USE CROUP A-3
:73 PERSONS
1ST FLOOR
CLASS 4-B
.
1139
JUN 2 9 190
..
FEBRUARY 16,
1988
.
Certificate Number
Date Certificate Issued
Date Certificate
Expiresilding
ffictal
The building. officiaZ shall be notified within (i0) days of any changes in the above information.
PERIODIC INSPECTION REPORT
INSTRUCTIONS: THIS FORM IS TO BE COMPLETED EASH TIME A PERIODIC INSPECTION IS MADE
ATiTHE TIME THAT A NEW CERTIFICATE IS ISSUED, A RECEIPT INDICATING THAT THE FEE HAS 1
BEEN PAID WILL BE ATTACHED TO THIS FORM OR THIS WILL BE STAMPED "PAID" PRIOR TO ISS-
UING 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
NAME OF PREMISES BASS RIVER GOLF COURSE
CERTIFICATE TO BE ISSUED TO LOUIS B. COLUMBO
ADDRESS 19 TERN ROAD,SOUTH YARMOUTH
OWNER OF RECORD OF BUILDING YARMOUTH TOWN
ADDRESS
PURPOSE FOR UliICH PREMISES ARE USED COFFEE SHOP
USE GROUP CLASSIFICATION OF PREMISES
A-3
CHANGES SINCE LAST INSPECTION (REQUIRED ON FILE) /
2.
3.
4.
S.
6.
DATE ORDER ISSUED
ORDER ISSUED TO
ADDRES
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.
23 of 7 q4
DTE BUILD NG OFFICAL
CERTIFICATE NUMBER 413l�
DATE CERTIFICATE ISSUED DATE EXPIRES
MM
Date VTA_W1ARr-9; 1987
CO:SXQ!;WFAL111 OF K,SSACHUSETTS
own of YARMOUTH . Mi
1111 �
CATION FOR CERTIFICATE OF INSPECTION
( 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 Number. HIGH BANK ROAD
Name of Premises'_ BASS RIVER GOLF COURSE
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 ,�yi/ �.�Lontr3n
!Address:
Owner of Record of Building
.Address
Present Holder of Certificate .Co
Signatof Person to -whom Certifi-_ Titl
tate is issued or his agent 2-//t 9_7
Date
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