HomeMy WebLinkAboutCI 38-82L
LOUIS B. COLUMBO '.
is issued to..........•..................................:..:.........:.:.................:.....'...::.......
]l frtBASS RIVER GOLF
vPitifl� that I have inspected the..... COFFEE SHOP .......known as ............... . COURSE..... 0 0 00
HIGH BANK ROAD TOWN SOUTH YARMOUTH
located at ........... the........,....of...,................. ....'..�.......�.
y f. f f g
Count o ..,. BARNSTABLE .......,,Commonwealth o Massachusetts. The means.o a resa are sufficient for the foZtowing.
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 Capacitq _:_.Location
.
USE GROUP A-3 ,; to PERSONS 1st. FLOOR ;
CLASS 4-B ..
# 38 MARCH 18, 1982 FEBRUARY 16, 1983___
LCJ
certificate Number Date Certificate Issued Date Certificate Fspirea Budding official
The building. official shalt be notified within (ZO) days of any changes in the above information.
y
PERIODIC INSPECTION REPORT
,
ns ruc ions: T s orm is to be comp e e each ame 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 27umber
Nae of Premises
Certificate to be Issued to
Address n�
Owner of Record of Building
Address
Purpose for Which Premises Are Used
Use Group Classification of Premises 77- 3
Changes Since Last Inspection (Required on File Card
1. 0 o cff-�r
2.
3•
4.
5.
6.
Date Order Issued
Order Issued To
Address
Date Violations Corrected
Ri :marks
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
-f-Doe Building Ofi
Certificate Nmber-�
Date Certificate Issued 311 /211 q F �tj
Date Certificate Expire
Recommended Next Periodic Inspection Date c7,1-'/ / (n/ O
FORM SBCc-4-74
COMMONWEALTH OF MASSACHUSETTS
•r
�r�• Yarmouth
CITY/TOWNOF
�c APPLICATION FOR CERTIFICATE OF INSPECTION
Date 1/26/82
DATE DUE 2/16/82
A-3
(XX) Fee Required (Amount) -$40.00
( ) No Fee Required
In accordance with the rrovisions of the Massachusetts State Building
Code, Section 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. -MASS. 02664
Name of Premises BASS RIVER GOLF COURSE.
Purpose for Which Premises is Used COFFEE SHOP
License(s) or Permit(s) Recuired for the Premises by Other Governmental
Agencies:
License or Permit. Agency
Certificate to be Issued toN1
-Address
Owner of Record o Buildin ' a• -L-..,., —
Address
Name of Present Holder of Certificate
Namef Agent, if any
SrGNATUR .OF PERSON -TO WHOM ITLE....
CERTIFICATE IS ISSUED OR HIS -
AUTHORIZED AGENT
J DATE
INSTRUCTIONS:
1) Make check payable to:' M11 OF YARMOUTH
2) Return this application with your check, to: BUILDING INSPECTOR'S DEPARTMENT
YARMOUTH
S0.. YARMOUTH, •
PLEASE NOTE: 7.
-1) Application -form with accompanying.fee-must be submit ted for,.each build -
thereof ing or structure or part. . to be certified.
--.-2) Application and fee must be received before the ,certificate 'will be issued
-3) The building official shall be notified within ten (10) days o'f dny change
in the above information.
CERTIFICATE I
2- EXPIRATION DATE: -
FORM SBCC-3-Th