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CITY/TOWN OF YARMOUTH
In accordance with the Massachusetts State Building Code, Section 108.Z5, this
CERTIFICATE OF INSPECTION
0
is issued to LOUIS . B.. COLU14B0
................................................................................
C fffitfg that I have inspected the ... COFFEE SHOP ................. known as.$�5, X1VA,$.GAIL. PAUV
located at.... HIGH . BANK , RD., , , , , , , , , , , , , in the .TQT( of XAiAU�B. .
... ... .. .. .... ... . .......................
County of. .... B....S...... ommoruweaZth of 6lassachusetta. 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 4—B
CLASS F-3 73 PEOPLE :1st FLOOR
#1 FEBRUARY 3, 1977 FEBRUARY 3, 1978
Certificate Number Atte Certificate Issued Date Certificate Expires Building Official
The building official shall be notified within (10) days of any changes in the above information.
PERIODIC INSPECTION INFORMATION SHEET
Instructions: This information sheet is not an inspection checklist. Each time
a permanent file card is typed for new building or a new card for an old build-
ing, this information sheet can be prepared by the building inspector as a work
sheet from which the file card can be typed. The items of information on this
sheet are identical to the items on the file card. If all the information on this
sheet cannot be entered on the file card, this sheet should be filled out and
not discarded.'
Street and Number &C&,
Name of Premises) nre- �,✓,f
Other Licenses or Permits Required
Owner of Record of Building �,� „� nF )/A4 14 e I
Address i,r/ S't fir. X53 ,
Certificate to be Issued to ,�,s 13 , L?,,, ,,,+/A
Address17 ."�rR/
Use Group Classification r'- 3 Purpose Used Ji I fr, C
Public or Private „=
Number of Stories / Class of Construction %1 Date Erected
Certified Capacity (By Story or Type)
'7 3 lw� ra cs
Number of Rooms - Hospitals, Schools, Hotels (By Story or Type)
Number of Dwelling Units Per Story.
Emergency Lighting System
Means of Detecting and Extinguish
L Hn A/ J> eX-F1Ilc0• foe, ,Cr
Fire Alarm System Allsiu
Number of Elevators' -4
How Heated d / G ,cL�r . A
Boiler or Other Heating Apparatus r• r ��r,.r,cic
How Lighted /ri CG TR, How Ventilated A1.jrders 4
Place of Assembly: Yes_.,.No Purpose Used_
In Which -Story - - - i r r- - -
Standard Booth Installed Location
Fixed Seating
Number of Aisles and Width of Each
Fire Resistance of Curtains or Draperies
Number of Sanitaries q Location 3 de.r llaoc. / ti'„er�ardT
Number of Grade Floor Means of Egress Doorways
1— 36 ' i- .13? 11
Number of Separate Stairways Accessible Per Story.
Number of Approved Independent Exitways Per Story
Remarks:
Date Certificate Issued 7.1Z477 Date Certificate Expires -2-1
Date Orders Is ued Date Orders Complied
Inspector 'xcd , Ge, Date Z 3 7 7
—�
FORM SBCC-1-74
COMMONWEALTH OF MASSACHUSETTS
CITY/TOWN OF YARMOUTH `
APPLICATION FOR CERTIFICATE OF ItNSPECTION r /
Date_1/17/Z7 (R) Fee Required (Amount)
( ) 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:
SOUTH
Street and Number_ HIGH BANK ROAD 'YARMOUTH, MASS. 02664
Name of Premises n PTVF.P COURSE
Purpose for Which Premises is Used
License(s) or Permit(a) Required for the Premises by,Other Governmental
Agencies:
Licensees or Permit
Certificate to be Issues to
Address /7
Owner of Record of Building
Address
Name of Present Holder of Certifies,
Name o b
Agent, if any
"/9. eo�:
SIGNATURE OF PERSON TO WHOM
CERTIFICATE IS ISSUED OR HIS
AUTHORIZED AGENT
INSTRUCTIONS:
U"
A &tnc
TITL
�47-OP
DATE
1) Make check payable to: T019N OF YARMOUTH
2) Return this application with your check to:-
IILDING INSPECTUR7MRT ENT --
PLEASE NOTE: YARMOUTH TUWN HALL
SO. 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 offi r a e pit �it in ten (10) days of anyi change
in the above info :a i U
CERTIFICATE H - tom% XPIR TION DATE:
FORM SBCC-3-Th