HomeMy WebLinkAboutBLDCI-16-007007-06 The Commonwealth of Massachusetts
► .r. City\Town of
.11 .11MYARMOUTH
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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: ST. DAVID'S EPISCOPAL CHURCH BLDCI-16-007007-06
Trade Name:SANTUARY/MEETING ROOMS
Identify property address including street number, name,city or town and county Certificate Expiration
Located at
205 OLD MAIN ST 06/18/2023
SOUTH YARMOUTH, MA 02664
GroupUse Floor Occupancy Use Group Other
01st Floor 79 A-3 Amusement/Church/Gym/Library/Museum 49 PERSONS
ROOM 1 -10
STUDENTS
Allowable ROOM 2-20
Occupant STUDENTS
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 2-,AR
Signature of Municipal Signature of Municipal Date of
Building Commissioner Issuance
7 1� Z�
ee: $50.00
BLD_Certofl nspection.rpt
• . • _, V, TOWN OF YARMOUTH
o, BUILDING DEPARTMENT
°:� \MAT'14.-:;:2
vst_ :' 1146 Route 28, South Yarmouth, MA 02664 508-398-22311E I \i' E D
MAY 16 2022
APPLICATION FOR CERTIFICATE OF INSPECTION __
BUILDING DEPARTMENT
By ___ _
May 1, 2022 PAYABLE UPON RECEIPT
(X) Fee Required $50.00
( ) 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:
imi Street and Number: a b5 00,, mOLNS� • S, O M►VT U2 o1D
Ic 2
Name of Premises: S: ,mil;f S C 2 `�L C uA t( Tel: 6l�Z —J1q—q4" -A
Purpose for which permit is used: P�1),At i-IQ�I •-€U-QA� 'M500'RAM
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
illei\l/WIV
Certificate to be issued to liv s Fp,0 C di Tel: . 0"2 " � -03--(3.
Address: ,j1\QciA VIA. +1 • .10r'l,M(t_oA 'i I MA-u21www 1
Owner of Record of Building
Address o1US O\c viol l a1
Present Holder of Certificate -, 1.j,,ijA rs •
41 1;joatetis Ams-un 1/3A ya ---
Signa re o person to whom VTitle
Certificate is issued or his agent 'S ( g 3- '
1 Date
,� @ vies d--�` Com C vy1 h i , 1 L -1---
Email Address: •� d
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# g L JC/—/(,- 06 701)7 e,
06/18/2022-06/18/2023
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