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The Commonwealth of Massachusetts f
` & City\Town of
—��'= fif YARMOUTH
New and Renewal Certificate of Inspection
In accordance with 780 CMR,Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further
enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified.
Identify Name of Establishment Certificate No.
Issued to
Business Name: GRAND CAFE BLDCI-17-006523-03
Trade Name: GRAND CAFE
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
80 ROUTE 28 12/31/2020
WEST YARMOUTH, MA 02673
Use Group Floor Occupancy Use Group Other
Classifications(a)
A-2 01st Floor 92 A-2 Nightclub/Restaurant/Bar/Banquet Hall 92 PERSONS
Allowable
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 Philip Simonian III Name of Municipal Mark Grylls Date of
Fire Chief Building Commissioner Inspection /f /J
Signature of Municipal Signature of Municipal % Date of
Fire Chief Building Commissioner Issuance
Fee:$100.00
B L D_Certofl nspecti on.rpt
!n
R 4,0
TOWN OF YARMOUTH
o '. BUILDING DEPARTMENT
* � MATTA M CSf,!�
�, ..��•���°' �� 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
October 1, 2019 PAYABLE UPON RECEIPT
(X) Fee Required 100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and Number: ()90 0/ Ca#C (ee fir'Liy-r1T l v7 C
V
Name of Premises: gn P our' 9,? a/est y wifoeix( 7,4 Tel: 'l (a.-,, 70 62 1
Purpose for which permit is used: 8&5 r�Co 1,-,9,/ f
License(s) or Permit(s)required for the premises by, other governmental agencies: 1
License or Permit Agency f
o
1�2,2 6 5 ey v, c e /�ii < /l b yt) 0
Certificate to be issued to G 1-jn O Cc9 Pe. 8 6/2/ Wa n f Tel: ` /4-U 70-65‘`,2 c�
Address: g0 8DU to 2 wC5 t YA1/fj/koo74( /44v. a 6 73 A
Owner of Record of Building 690% ye D e/f7/c9rnr'd 5
Address2s5 5oot4/ c9mpfon 5 tfeJti ( v5?04 /fr,41
Present Holder of Certificate G1 d iy Q/ C 9 re /3r$t0,i_o 4 7 _ I n 6
Signature of erson o whom Title
Certificate is issued or his agent
Date
Email Address: l c/(5 pc99ugy 23 //ormq' /+Cori
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#
12/30/2019-12/30/2020