HomeMy WebLinkAboutCI 12-84w
J
CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section.408.15, this
CERTIFICATE OF INSPECTION
The building official shalt be notified within (10) days of any changes in the above information.
LOUIS.B. COLUMBO.
is issued to................................................................................................
COFFEE SHOP
BASS RIVER GOLF COURSE
TP1'hfl� that I
have inspected the ..•••••••.•..•.TOWN ........•... known as
...........................
' HIGH BANK ROAD SOUTH YARMOUTH
of........ ........... ........... ......6.
locatoi at........................................in
the... ..........
BARNSTABLE
..........
county Of .. .....
Commonwealth of Massachusetts. The means of egress are
sufficient for the following
number of persons:
BY STORY
Story Capacity
P.:
y
.. Capacity Story Capacity
Story
.. Story Capacity
• • '
BY PLACE OF'ASSEMBLY OR STRUCTURE
Place of Assembly
Place of Assembly
..
Location or Structure
Capacity : .Location
or Structure
Capacity
USE GROUP A-3
:73 PERSONS :13f. FLOOR
CLASS 4-B
Q i4
APRIL 109 1984 FEBRUARY 169 1985
Certificate Number
to Certificate Issued Atte Certificate Expires
Az f
Building Official
The building official shalt be notified within (10) days of any changes in the above information.
PERIODICINSPECTION REPORT
ns ruc ons: This form is to be completeg 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 forth
should be filed by street address.
Street and
Name of Pre
Certificate
Address
Owner of Re
Purpose
of
use croup UassszYcatlon or rremises
Changes Since Last Inspection (Requires
2.
3.
4.
5.
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 Massachusetts State Building Code and
the rules and regulations pursuant thereto.
l � fst
Date
Certificate Number /,Z `/ 9 FV
Date Certificate Issued
Date Certificate Expires
Recommended Next Periodic Inspection
FORM SBCC-4-74
t 1�
.,4eeAPP`0CATI0N FOR CERTIFICATE OF
FES L
INS?ECT IOL
,atel/31/1984 (X } Fee Reouired (Amouat)_S, Q.00
( ) No Fee Reouired
In accordance
lizh the e_ovisioas of the Massacausetts State 3uild_ng
�-108.15.,I a= -e z^ni' .or a Certificate of Insaection for
Code, Section i r_ i
tae be ov-named pre'locatedses located at the Lnolloving address:
HIGH BANK ROAD, SOUTH YARMOUTH, MASS.02664 —_
Stre-t and Number
a3 e o f Premises BASS RIVER GOLF COURSE -COFFEE SHOP -- ------
COFFEE SHOP
.or Which P.e
n s e s is Used
License(s) or Permit(S) Reouired for the Premises by Otber Governmental
Agencies:
P
License or Permit ,
Certificate to be issued tot/ zz C SS /tMll
-Address
Ovner of Record of Building litV4 0,
Address
lame of Present Holder of Certificate_
Name of Agent, if any
SIGNATURE OF PERSON TO WHOM _
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT
INSTRUCTIONS:
A9-ncy_
TITLE _
DATE
1) .•fake check payable to: MIT OF YARY.OUTH -
�EUT
2) Return this application with your check. to- BUILDIANP,�OUTECTOR'S DEP.".RT�rI
SO. YARrv1OUTH# M. ;
PLEASE NOTE: _
1) Application- form with accomnanying.fee must be submitted-for_each build
•,ing or structure or part thereof to be certified. �:;
2) Application and fee must be received before the certificate will be ass
The building official Shall ten (10) days of any chs
3) g ll be notified wit -
in the above information.
CERTIFICATE I
EXPIRATION 'DATE:
FORM SBCC-3-74