HomeMy WebLinkAboutCI 12-80• ' :• ..c���e �(��rutnuarixvi��li�r ��a�'��tt���.r}i����• •�; � � , . ! -
RE
:CITY/TOWNs JOF.r YAli MUTH ?.
:. -,.
In'accordance Uiith the Massachusetts State Bucldzng; Code,' Section ;Z08. Z5, this > '.
t. t.:
CERT•IFjICATE OF� I-NSPyEeCTLON
L.OUIB B.COLU?IEO : <
is issued to :........ .:. .. .........".....::........... :..'.:..r.. .'................:........
ay, 4i .. ,a ..i •. fr ! : "a•{ f' ..
j
.'•�, ..err a '- '/ r .> , ,. ,.-• 1 . .r z,. a o' '�. ., �, `, ,
l � f erldy that. I have inspectid:the...::...... SHOP .... ..... ...
... :. Imomn as BassCOFM . R7
. HIGH BANK ROAD . =1 TOF1!? o f M1 ' .SOUTH YAES' '
Zocated •at• ::...... .. .................:imthe... .:..:.:...... F
County .of. ST 'E...::Commomoeatth'of Massaehus'tts.,L The means of,egress?are:suffici.ent'for'the•foZZoming,
number of Persons. I .
r� BY; STORY
Story Capacity .. Story,` Capacity: Story'j Capacity Story', .Capacity;
•
• r • f. _
BY.PLACE:OF ASSEMBLY.OR STRUCTURE;
P.bly :_ f Placerof'Assembly
Place',of Assem,
or"Structure Capacity.,':` ,Lo`cation• -` " or.Stiiicture '.. Capacity, ..NLocation
USE GROUP. A-3 i,`_? .•.•;, t
J
Czass . k-B :.73 PERSONS.:.: _ let:. FL40OR
#,12 r 1 FEBRUARY 16, r 1980 "r `FTMARYr 16,=.1981' _ .
Certzfieate Nwnber .,Date. Certificate Issued; Rite Certificate E�ptres Bu�ldtng Offtccat
.. -
The buiZding officiaZ'shaZt'be-notified-within, M)�days;oflany changes'in'the.above-information.
t ;,
P7RIO)')IC T`,3PTC`f1011 RBFORT
n rue ons:i' �s�`om is to iia co.nplete3 sac i ina a perxoc c nspec on
is made. At the tLne that a new certificate is issued, a receipt indicating
that the fee has be -n ,)aid will be attnched to this form or this form will
be stamped "PAID" prior to issuing tho.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 Numbe
Name of Premises
Certificate to b
Owner of Record of Building
Address
Purpose for Which Premises Are Used L
use croup utassiiYcati.on or rremises A-0
Changes Since Last Inspection (Required on rile Card
1.
2.
3-
4.
5.
6.
Date Order Issued
Order Issued To
Address
Date Violations Corrected
R"eraarks
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.
a— /3- &o
Date
Certificate Number
Date Certificate Issued o�2 �� — F
Date Certificate Expires
Recoa`mended Next Periodic Inspection Date
FORM SBCC-4-74
D a t e 1/24/80
=M:• -:.,:WEALTH OF MASSACHUSETTS
CI"-'Y/TOW:: OF Yarnouth
APPLICATION FOR CERTIFICATE OF INSPECTION
(x) Fee Reouired (Amount)_$_?,5,00 "
( ) IJo Fee Reouired •
DATE DQE 2/16/80
In accordance with the provisions of the Massachusetts State Building
Code, Section 108,15, I here -2j, apply for a Certificate of Inspection for
the below -named premises located at the following address:
Street and Number H3tHBANK-RO_AlLSOU=ARMoum,,_ms,,_02664
Name of Premises BASS RIPER GOIF COURSE
Purpose for Which Premises is Used COFFEE SHOP
License(s) or Permit(s) Recuired for the Premises by Other Governmental .
gencies:
License or Permit Agency
C tificate.to be issued to
d rens =
Ow of Record of Building
dress
Nam of Present Holder of Certificate
Na a of Agent, if any
SIGNATURE OF PERSON TO WHOM 1 TITLE
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT
_. DATE -
INSTRUCTIONS:
J
1) ;lake check payable to: T(X:'N OF YAR211OUTH
2) Return this application with your check..to: BUILDING INSPECTOR'S DEPARTMENT
- YARMOUTH
i S0. YARMOUTH,• MASS. MB54_ -
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.Zny change
in the above information. -
CERTIFICATE I EXPIRATION DATE:
FORM SBCC-3-74
0