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Building Dept. and Fire Dept. Certifications
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I T_ _� i - � � Ifi_I 1�- = I I -� a I f i i ��oW� �' � �r, QI ���,i I ; 3„5� �� `� I�, � , ,J o � � - i'------- °�'�,--- '� � - c�------------�---�-- ---i-' , ,—�---�--- �� Q , �h;---=y ��---------�� - I I I I �7 , z I I �Q I I I I I I a.� I I i i .�.� � I ; .,-.,� .�--.� ,-,z ,-. ,a °.,� ,� � �� � `� �, � YARMOUTH FIRE DEPARTMENT �` ` 96 OLD MAIN STREET �" SOUTH YARMOUTH, MA 02664 PH.:508-398-2212 /FAX:508-760-4861 FIRE AND SAFETY INSPECTION REPORT ADDRESS OF INSPECTION: ;;1 f U U (�V�I 1 ��C � YARMOUTH PORT. � SOUTH YARMOUTH � WEST YARMOUTH NAME: I=LA ?C 1�0.•1 � � OWNER � MANAGER � TENANT OTHER(explain): � ���, �� �_�`��.J�f ��� DATE: �f - 3 - �� TIME: lcf�`� PHONE: NAME: PHONE: .� �T� ' z L ,� �iR�/�.S�ZC) OWNERS MAILING ADDRESS: An inspection of the above captioned property was conducted by the undersigned during which the following fire or safety deficiencies (D) or violations (v)were observed and noted for correction: c� 'A �.i=/Ci�,�c�S n;:�T�a C.�QCK � _v � G,—�� �n cz�. You are hereby ordered to abate or correct the deficiencies or violations within days. Failure to do so may result in civil and /or criminal complaints being filed. Signed: 6r �,l',L_._-- Title: � �t����� G � Copy Recei ev d By: ./� !� �'~/ f , - � ;(�L _,J'` � `1�---__._._. Original-Owner/Tenant Yellow Copy-Fire Department FBP 99-1 . ,A�•x,�R 1� : �� : _ ��� TC�WN ()F' �.A�R.I�I�U'I'H o(A - - -y BLTILDIN(� I�EP'�.I2.7�'IYIE��I' ��C.Q--S � � ` MATTN n ST� �""'�'—�� `�'°�������'���� 1146 Route 28, South Yarmouth,lVlA 02664 508-398-2231 ext. 1260 APPLICATION FOR C�RTIFICATC OF INSPECTION November 4, 2016 PAYABLE UPON RECEIPT ( X ) fee Required $N/C ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, I hereby apply for a Certificate of Inspeclion for the below-named premises located at the following address: Street and Nurnber: 31 Dupont Ave, South Yarmouth, MA 026664 Name of Premises: Town of Yarmouth/Flax Pond Lodge Building Tel: 508-398-2231 x-1520 Purpose for which permit is used: Assembly Space License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Entertainment License/Sunday Commonwealth of MA ' Entertainment License/Weekdays Town of Yarmouth Camp License Town of Yarmouth Certificat:e to be issued to Town of Yarmouth Parks& Recreation DeptTel: 508-398-2231 x-1520 Address: 424 Route 28,West Yarmouth, MA 02673 Owner of Record of Building Town of Yarmouth Address 1146 Route 28, South Yarmouth, MA 02664 Present Elolder of Certilicate Town ofYarmouth,Parks&Recreation Director Signature of person to whom Title Certificate is issued or his agent 11-7-2016 ' Date Instructiens: Make check payable to: Town of Yarmouth ' 1 ]46 Route 28, South Yarmouth, MA 02664 , Return this application to: Building Inspector's Office ; Please note: Application form with accompanyirtg fee must be submitted for cach building or structure or part thereof to be certified. Application must be received before the certificate will be issued. The building official shall be notified within ten (l 0) days of any change in the above information. PLEASE SEND US/1 COPY OF YOUR WORKER'S C�MPENSATION INSURANCE FORM WITH THIS APPLIC��TION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate# ' 11/04/20l 6— 11/04/20 I 7 �r � , � !'.4:;�. �-3t_)�: ��3�;� * N1',�.1`�f?�IIS, ivl�,, (}?(��)1 • it'��'-775-��7� M�-C'R#,�fll7 � C�C�T C'CRT ��i�-��;{) F`]I2� �FiC)'�'�C'�'I�IV �N�1'Is�'i'�f��IZia,�'4)�"i'I��()��k� () ���; # _._..____ ._ _ - ._ .___.... .�_.. _ , : "��__��� ��-;�� _ . _.� _ .___.. �v�a.n2� ' _... � _ ,G����.�� <� � _ _.. __ _---- - � � -��rt�f-�_..������ � �� � �€�t.�a�,����e_. 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