HomeMy WebLinkAboutCI-16-1516-02 •
_= The Commonwi:alt . of Massachusetts
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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: SUNFLOWER SCHOOL BLDCI-16-001516-02 ;
Trade Name:SUNFLOWER SCHOOL
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
923 ROUTE 6A UNIT F 07/01/2019 ,
YARMOUTH PORT, MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s)
E E 01st Floor 19 E Educational School to 12th Grade/Child Care(More than 5) from 2.9 years&older
Allowable 01st Floor 13 E Educational School to 12th Grade/Child Care(More than 5) from 2.9 years&older
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 Grylls Date of
Building Commissioner Inspection /0-3/1-47 I
Signature of Municipal - - Signature of Municipal / / Date of
Building Commissioner /I.' i�� Issuance / '.. Z tato
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Fee:$100.00
BLD_Certofl nspection.rpt
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TOWN OF YARMOUTH
a( y BUILDING DEPARTMENT
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�%:: 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION •
June 5, 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: /6123 e, 6 A (in t+ f' 7 dr•(Ail lnb a
Name of Premises: gunCloWG✓ '4,a, ) Tel: en-662. "5439 ext.. 113
Purpose for which permit is used: C.i t I Dtc r-eC-4e4- ntes
License(s)or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
21 )a I b3 1 c*.occ CaA1 e►o., a»S?C.M.
Certificate to be issued to . , Tel: 50i—34a 2 54 %
3°1 a , 113
Address: St. _ . : _ ,.._. ..
. . .. • .- A • a
Owner of Record of :wilding , i
Address c1• '4_ _ ' Ne v: ie. . —
Present Holder of Certificate .... CFP 9 8 2018
(� BUILDING DEPARTMENT
-.Fa,�, WIK,✓ By_____-----
Signa• :rfpersont. horn Title
C•-+ e t ' • • or his agent 9 /a+7 A Se
Date
Email Address: GJaswtQ Gw+,t ft✓on cot. Calm
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(JO)days of any change in the above information.
PLE.}.SE 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#BL1X!J •//11/S/t) —01--
7/1/2018-7/1/2019
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