HomeMy WebLinkAboutCI 13-78i
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s o CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.15, this
CERTIFICATE OF INSPECTION
LOUIS B. COMBO
is issued to ............................................................... ,
RIVER
I C4Pr1ifj that I have inspected the ...COFFEE SHOP.•.•••.::•••,.•••••Pnomn as SS...... GOLF COURSE
located at.... HIGH BANK ROAD ...................in the.. T0M :..:,of. SOUTH YARMOUTH
BARNSTABLE
'County of.................Commonwealth of Massachusetts.. The means .of egress are sufficient,for the following
number of persons:
BY STORY
StoryCapacity 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 •:
#_13 FEBRUARY 16, 1978 FEBRUARY 163 1979
Certificate. Number. Date Certificate Issued Date Certificate Expires Building Official
The buiZding.officiaZ shaZZ be notified within (ZO) days of any.changes in the above information.
l -•
PERIODIC INSPECTION REFJRT
Instructions: This form is to be completed each time a periodic inspection
is made. At the time that a new certificate is issued, a receipt indicating
I that the fee has been paid will be attached to -this form or this.form will
it 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 Numbe
:Jame of Premises
Certificate to b
A:::i"ess 5---T-
Owner of Record of Building
Address ¢r /;_�,7y
Purpose for Which Premises Are Used
Use Group Classification of Premises F 3
Changes. Since Last Inspection (Required on File Card)
2.
Z.
L.
5•
6.
Date Order Issued
Order Issued To
Address
Date Violation(s) Corrected
Remarks
I have this day inspected the above describes premises;
to the pertinent requirements of the Massachtsetts State
the rules and regulations rursuant thereto.
Date
and the same conforms
Building Code and
Csrtificate Number
Nate Certificate Issued
Date Certificate Expires
Recommended Next Periodi
FORM SBCC-b-74
t COMMONWEALTH OF MASSACHUSETTS '
CITY/TOWN OF YARMOUTH CLASS F-3
APPLICATION FOR CERTIFICATE OF I1iSPECTION
Date2/1/78 f (x) Fee Required (Amount) p4� 4
No Fee Required
D d-"7�% -
In accordance with the provisions of the Massachusetts State Building
Code, Section 108,15, I hereby apply for a Certificate of lnspecfio.for
the below -named premises located at the following address:
Street and Number High Bank Eoad (COFFEE SHOP) SOUTH YARMOUTH, MASS. 02661
flame of Premises BASS RIVER GOLF COURSE
Purpose for Which Premises is Used
License(s) or Permit(s) Required for the Pre
Agencies: mises by Other Governmental
License or Permit A enc
Certificate to be Issued to
Address
Owner of Record of Building
Address
Name of Present Holder of Certificate
flame of Agent, if any 11
7 A
SIGNATURE OF PERSON TO WHOM
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT.
INSTRUCTIONS•
1) Make check payable to: TOV11 OF YARMOUTH
DATE
2) Return this application with your check togDfLDt- INSPECT 9R'S DEPARTMENT
YAR AeUTH TOWN HAI I
PLEASE NOTE: S0. YARMOUTH, MASS.. 02664
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 any change
in the above information.
CERTIFICATE E' 13. /7,9-' EXPIRATION DATE: j
FORM SBCC-3-74
TI
E
DATE
2) Return this application with your check togDfLDt- INSPECT 9R'S DEPARTMENT
YAR AeUTH TOWN HAI I
PLEASE NOTE: S0. YARMOUTH, MASS.. 02664
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 any change
in the above information.
CERTIFICATE E' 13. /7,9-' EXPIRATION DATE: j
FORM SBCC-3-74