HomeMy WebLinkAboutCI 70-8141
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CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section Z08.Z6, this
CERTIFICATE OF INSPECTION
LOUIS B. COLUMBO
is issued to....................................................................... 0......... 0..............
Trrtif g that I have inspected the ..... COFFEE. SHOP . .. . . . ......... knozon as. BASS. RIVER GOLF. COURSE
located at.... ,HIGH, ..BANK ROAD . , , .. .. , , . in the.. , TOWN.... , of ....SOUTH.YARMOUTH
..... .......................
BARNSTABLE
County of. .......... 0 ..... 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-8
CLASS 4—B. :73 PEOPLE .. .
# 70 JULY 61 1981 FEBRUARY 16, 1982 I
Certificate Number Atte Certificate Issued Atte Certificate Expires ^s;j- Building Official
The building official shall be notified within (10) days of any changes in the above information.
PERIODIC INSPECTION REPORT -
ns ructions: T I his form is to be completed each time a periodic nspec ion
is made. At the time that a new certificate is issued, a receipt indicating
-.-'that-the fee ha§ -been paid hill be attached to this form or this form will
best miped "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 -' G
Name of Premises
Certificate to_be-Issued
Address
Owner of Record of Building
Purpose for Which Premises -Are Used
',_Use Group Classification of Premises
=` Change§-Since`Last Inspection (Req v3red-on File Card
20 c ln1_ /i_..,CE _
_ 3.
4.
5.'
6.
Date Order Issued
Order Issued To
Address
Date Violations Corrected
Remarks
Z 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 purniiant thrrPto.
D(ato —
Certificate Number 77 '� U /%e
Date Certificate Issued
Date Certificate Expires 02 -/(o— cF2-
Recoacnended Next Periodic Inspection Date .- -/(a- Fl �
FORM SBCC-4-74
1-6
n7 APPLICATION FOR CERTIFICATE OF INSPECTION
Date 3/4/81 Fee Required (Amount)
2n-& NOTICE. ( ) No Fee Required
DATE DUE 2/16/81
COMMONWEALTH EALTH OF MASSACHUSETTS
CITY/TOWN OF Yarmouth
$40.00
.In accordance with the provisions of the Massachusetts State Building
Code, Section 108,15,'! here:" apply for a Certificate of Inspection for
the below -named premises located at the following address:
Street and Number LiIGH BATIK ROAD SOUTH YAIUMUTH, :".LASS. 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 to V
..Address
Sed -
Owner of Recor f Bu-lding
Address
Name of _Present Holder of Certif tate
Name of Agent, if any
SIGNATURE OF PERSON TO WHOM
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT
INSTRUCTIONS•
1) Make check payable to:
TITLE
3
DATE
2) Return this application with your check. to: BUILDING INSPECTOR'S DEPARTMENT
YARMOUTH
t S0. YARMOUTH, MASS. 0265T-
PLEASE NOTE
-1) Application -form with accompanying 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 issued
3) The building official shall be notified within ten (10) days of &ny change'
in the above information.
CERTIFICATE #
�7d l EXPIRATION DATE:
FORM SBCC-3-74