HomeMy WebLinkAboutBLDCI-16-006825-06 The Commonwealth of Massachusetts
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YARMOUTH
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-16-006825-06
Trade Name:ST. DAVID'S EPISCOPAL CHURCH NURSERY SCHOOL
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Identify property address including street number,name,city or town and county Certificate
Located at - 06/18/2023
205 OLD MAIN ST
SOUTH YARMOUTH, MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
01st Floor 27 1-4 Institutional Day Care(More than 5) 15 CHILDREN-
1-4 INFANT/TODDLERS
12 CHILDREN(2.9 yrs.-
Allowable
5 yrs.)
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 i--i
:(,,,.
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Signature of Municipal Signature of Municipal Date of
Building Commissioner - % z' Issuance ? ,,
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e:$100.00
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BLD Certoflnspection.rpt
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. . TOWN OF YARMOUTH
o' -H1 BUILDING DEPARTMENT
�P: 3L x 1146 Route 28, South Yarmouth, MA 02664 .508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
May 1, 2022 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: 8 `5' r\c I a`t Ln 4 .'i a ok '- i ` '. v2.10�2
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Name of Premises: p�C T (Y+ S `>L; n a alto, el•
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Purpose for which permit is used: VLQJ SCE�TQ k. C ) pl flO QQ .
License(s) or Permit(s) required for the premises by other governmental ag ies:
License or Permit Agency
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Certificate to be issued to ErAoeC e . i WI �j(il -3`1 tf-1-1 Z z Z__,
Address: `Z—OS 0 ivY cLuL, ± • S--I ttewt(s (mil T ZK V
Owner of Record of Buildin c-1 --_� i3
Address 2 0 O Id a vl - 56 lW) L1,1-t, ( r .`/ I O24 6 V
Present Holder of Certificate cj� -` ��act � q -
FU S . o„iot 6� yv:� Q.cj `
Signature of person to whom Title
Certificate is issued or his agent `j( (�( ?-
Date ,� (�
Email Address. ACPV1 CSt--C 5�( �f�(� SL1 ' C 1�C6x 46\ • �-�--1
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# B /-4,-,066,FC D,
06/18/2022-06/18/2023