HomeMy WebLinkAboutbldci-16-004159-03 The Commonwealth of Massachusetts
City\Town of
YARMOUTH
S~.
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: HOWARD LODGE MASONIC TRUST BLDCI-16-004159-03
Trade Name: HOWARD LODGE AF&AM
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
20 DAVIS RD 02/24/2021
SOUTH YARMOUTH,MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-3 01st Floor 100 A-3 Amusement/Church/Gym/Library/Museum FIXED SEATING
Allowable 01st Floor 125 A-3 Amusement/Church/Gym/Library/Museum ADDITIONAL SEATING
Occupant Load
01st Floor 175 A-3 Amusement/Church/Gym/Library/Museum FUNCTION
ROOM/TABLES&
CHAIRS
TOTAL: 225 PERSONS
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 G s Date of
Building Commissioner Inspection g-4:7
Signature of Municipal Signature of Municipal Date of
Building Commissioner Issuance / Z,*ZOZO
Fee:$100.00
BLD_Certofl nspectio n.rpt
,°Y.Y444 TOWN OF YARMOUTH
•o -H BUILDING DEPARTMENT
cc, IM xW 0(t>i�sEi
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
January 6, 2020 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 premisesC 14r4
loocated at the following address:
Street and Number: 20 ad w /n�[D 5 /Nee:A f1,(),Sd6
Name of Premises: //®ur6t/^I Z ea/y(�-1 r7/4/%4
Purpose for which permit is used: j/7"7/ Deg Aqvq/cAr// le;/2 i/evevtI hter°
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
/11 /7-4 1A/50PeC/AM' ,
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Certificate to be issued to Hp Wald iet/e/N/Sp vie jeJe'
Address: a0 /, 7AV/S / eW „Se v//, q cWT./,
Owner of Record of Building ffQw are/ �p cmast y/« 77Z vs 1
Address raa VA.✓(S , Orz .cot c azf�v 74 /vi N Q a(( y
Present Holder of Certificate �f Oi.�f Q( �pn/ F Mago/v/c T/z ', '7
Signatu a of person to whom Title
Certificate is issued or his agent
Date
Email Address: 4 , „j o7
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# /aI A PifA-64,6IC
2/24/2020—2/24/2021 ✓9/pas C a // It/v of / ,�2v p�e y /s7 3 e2 /1;'9
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