HomeMy WebLinkAboutCI 68-79CITY/TOWN OF YARMOUTH
In accordance with. the Massachusetts State Building Code, Section 108.Z5, this
-
CERTIF1 CATE. OF INSPECTION
is issued to ...... IDUIS.B.SMMSO ...........................................................................
Trrfifjj that I have inspected the..COFFEE, SHOP..' .................. known asAW. RM11. QW. COMB. .
located at.HIGH BANK .ROAD
...................................... in the..TW.... *..'.of..P0uTF.P0W= ..................
County of TABLE ...... Co.mmonwealth of Massachusetts. The means of egress are sufficient for.the following,
number of. persons:
BY STORY
Sto=y 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 4-B
CLASS F-3 :73 PERSONS 1st. FLOOR
# 68 (FEBRUARY 3.6s, 1979 FEBRUARY 16, 19%
Certificate Number Date Certificate Issued Date Certificate Expires Building Ff—fi-c--zra—1
ti
I
The building, official shall be notified within *(ZO) days of any changes in the above information.
I
Date 3/13/79
due'date 2/16/79
2nd. notice
COMMOiiwEALTH OF MASSACHUSETTS
CITY/TOWN OF YARMOUTH
F-3
APPLICATION FOR CERTIFICATE OF INSPECTION
(X)- Fee Required (Amount) $25.00•
( ) No Fee Required
In accordance With the provisions of the Massachusetts State Building
Code, Section 108,15, I hereby apply for a Certificate of Inspection for
---the-belov-named--premises located at the following address:
Str•eet and Number HIGH BANK ROAD, SOUTH YARMOMT, MARS nPAA),
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
Address
Owner of Record of Building
Address
Name of Present Holder of Certificate
Name of -Agent. -if a
✓vim
SIGNATURE OF PRESON TO WHOM
CERTIFICATE IS ISSUED OR HIS
'AUTHORIZED AGENT
INSTRUCTIONS:
1) Make check payable to: 70M OF YARMOUTH
2) Return this application with your check. to:
-04
DA
S0. YARMOUTH, MASS. 02664
PLEASE NOTE:
1) Application form with accompanying fee must be submitted for each build-
ing or structure or part thereof to be certified. y.
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 dny change
in the above information.
CERTIFICATE 1�d 7/ EXPIRATION DATE:
FORM SBCC-3-74
iry
PERIODIC INSPECTION REPORTor r,
oo o com e e enc e a oro c ns oc on
ns ruc ns* a rm s e
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
I have this day inspected the above described premises,' and the same conforms
be stanped "PAID" prior to issuing the
certificate. Any changes
since the
the rules and regulations pursuant thereto..
last inspection are to be added to the
file card of the
promises.
This form
should be filed by street address.
Dae v Building Official...;
1:.;
' .. .. ..
..fir
Certificate Number
SIT
..
Street and Number
Date Certificate Issued
Name of Premises L sc ,E', VZ -A
G'v2C,6
Date Certificate Expires
"
Certificate to be Issued to aC'.
Roemnnnded Noxt Purlodlc Inopoetlon Dnto
Address
Owner of Record of Building
Address
Purpose for Which Premises Are Used
Cz/,eG
Use Group Classification of Premises
-3
Changes Since Last Inspection (Require
on Filo Card)dE•-
"r
1-::
Q
rri t
Date Order Issued
Order Issued To
Address
Date Violations Corrected
Remarks
FORM sBcc-4-74.
I have this day inspected the above described premises,' and the same conforms
;r
to the pertinent requirements of the Massachusetts State Building Code and
the rules and regulations pursuant thereto..
Dae v Building Official...;
1:.;
' .. .. ..
..fir
Certificate Number
SIT
..
•..
•line'••
Date Certificate Issued
Date Certificate Expires
Roemnnnded Noxt Purlodlc Inopoetlon Dnto
FORM sBcc-4-74.