HomeMy WebLinkAboutBLDCI-16-003133-02 •J.
The Commonwealth of Massachusetts
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;s, __ City\Town of
W24/1- YARMOUTH
New and Renewal Certificate of Inspection
In accordance with the Massachusetts State Building Code,Section 110.7
Identify Name of Establishment Certificate No.
Issued to
Business Name:WINDSOR NURSING HOME BLDCI-16-003133-02
Trade Name: DINIn76 j2capt
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
265 NORTH MAIN ST 10/902019
SOUTH YARMOUTH,MA 02664 -
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-3 01st Floor 162 A-3 Amusement/Church/Gym/Library/Museum DINING ROOM
Allowable 01st Floor 141 A-3 Amusement/Church/Gym/Library/Museum LOUNGE
Occupant Load
This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed
by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited
Name of Municipal Name of Municipal Mark Gryl - Date of
Building Commissioner Inspection /617g.3767
Signature of Municipal Signature of Municipal Date of
Building Commissioner , / 'I, Issuance 1/1.9.r6tt�'
Fee:$100.00
BLD_Certoflnspection.ryt
°f YgRo TOWN OF YARMOUTH
• `"` "¢ y BUILDING DEPARTMENT
fi 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
September 1, 2018 PAYABLE UPON RECEIPT
(X) Fee Required $100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: Z 4e,r /l//oma )'Z Qta r� ,f , C�j y o ci7 /i,¢ O 24
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Name of Premises e Li4,7( / 4-t- tee�,,J Tel: JW T7 y,jsy y
Purpose for which permit is used: v
License(s) or Permit(s) required for the premises by other governmental agencies:
�) License or
Permit Agency
cel/,/1)2 /lam
Certificate to be issued to Cd,- N /or Tel: 777-267_ yr
Address: Z6,)"4/. GC(di,, Tom, /.1. )�.,,,y,,,17, N,4 net6 '
Owner of Record of Building tie eki icv. t74. #_ tte,z
Address
Present Holder of Certificate / r4f%,.%c ✓t,r-
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C a �1�/• �,.e -r
Signature of person to whom Title
Certificate is issued or his agent Q- Q 6—Lc/f
/ Date
Email Address: C/v/lei 1!j / I , y;
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth, MA 02664
Return this application to: Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each 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 (10) days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. —
Certificate of Inspection#& /-aa3 1 37 ' 0 Z
10/10/2018-10/10/2019