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44
TOWN OF YA OUTH
,±.. 1. %
�/1 q -y BUILDING DEPARTMENT
MATTA M CSE 4"
%, o.„,.,�o,�r,ra 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
June 11, 2019 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: 1 2.O(t1
Name of Premises: V 1 tilk 6t I N t eAfe £O Tel: CD .36 2 3 (82
Purpose for which permit is used:
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
JUN 24 2019
Certificate to be issued to Tel:
Address:
Owner of Record of Building W o' ''Q 1 f ((..(N t iU LA U C R.:01
Address (---• 'Q Lt-(6 6 A e Gi AlavieLt1-1 lib1?-1 Iv\A j c
Present Holder d f Certificate 5 -
It
4 , OW -
Signature of person tar hom Title
Certificate is issue 1 1is agent
C1/2,-.17////
Date
Email Address: V 1 LLA t 1'4Ni atiVi6CDt 4.rbtRiu•0
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# , C/ <- /C- UQ 20/7'03
7/16/2019-7/16/2020
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•
°F �q = TOWN OF YARMOUTH BUILDING
ELECTRICAL
431N,
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451
=+Il Telephone (508) 398-2231, Ext. 261 —Fax (508) 398-0836 PLUMBING
PAATTACHEESE SIGNS
'moo BUILDING DEPARTMENT
Inspection and License Report
Date
Address � SG �' Business Name i'iI r
Contact xs�7�C� ! Phone
During the Annual Inspection of your premises,performed in accordance with the provisions of Section 110.7 of 780 CMR(Massachusetts
State Building Code),the Board of Selectmen,and/or the Board of Health rules,the following violation(s)were observed:
Egress
❑ Emergency egress signage Location
❑Emergency egress lighting Location
•
❑Maintenance of exits Location
❑ Guards/handrails Location
Zoning
LI Signs Location
❑ Parking Location
❑ Other Location
Mechanical
❑ Combustion Air Location
❑Storage in Boiler Room Location
❑Vents Location
❑Automatic door closures
on boiler room doors Location
❑ Clothes dryer vents Location
Other Location
The State Building Code,Section 1001.3-Maintenance,provides that the owner as defined in Section 780 CMR shall be
responsible for proper maintenance.
In order to abate the above violation(s)you must:
o Make corrections immediately and contact this office for a follow-up inspection.
o Make corrections prior to opening and contact this office for a follow-up inspection.
o.Make corrections prior to your next annual inspection.
o Make corrections within days and contact this office for a follow-up inspection.
Local OFficial/Inspec4/
Received By Tide
Revised 2/8/13