HomeMy WebLinkAboutBLDCI-16-007131-04 The Co \in nwealth of Massachusetts
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\JARMOUTH
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: MAPLEWOOD MAYFLOWER PLACE ALF, LLC BLDCI-16-007131-04
Trade Name: MAPLEWOOD DINING ROOM
Identify property address including street number, name,city or town and county Certificate Expiration
Located at
579 BUCK ISLAND RD 07/11/2023
WEST YARMOUTH, MA 02673
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-3 01st Floor 187 A-2 Nightclub/Restaurant/Bar/Banquet Hall 187 PERSONS
1ST FLOOR&DINING
ROOM
Allowable 02nd Floor 48 - A-2 Nightclub/Restaurant/Bar/Banquet Hall 48 PERSONS
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 f77.02sz
Signature of Municipal Signature of Municipal Date of
Building Commissioner C .- Issuance 8/ifVZL
iyy Fee:$150.00
BLD_Certofl nspection.rpt
BC,11, '( _c6, 7/3i -02
. REC.EIVED
°F• � TOWN OF YARNIOUT JUN 16 2022
$ T T7i 1 iOT�r T, A [� 1t/C1; c,{6-•�S 1/
O He BUILDING DEPARTME ILDING DEPARTME
� "� '� 1146 Route 28,South Yarmouth,MA 02664 508-39 -
APPLICATION FOR CERTIFICATE OF INSPECTION
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June 1,2022 PAYABLE UPON RECEIPT
(X) Fee Requir $150.00
. ( •) No Fee Requ --
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: ,tiv o „40 ^id d
Street and Number: 5 7l'l} 4. 0e// jiliknd ,.�e),/ 1 M-A4ct-
Name of Premises: /771 /Ol1-4/6 P/ai t 4'ICy/10 Tf'ie414e1: C0rqc9, -2 0) 021P I
Purpose for which permit is used: l"�/(. 1' 1 _' 4v I r
License(s)or Permits)required for the premises other g ernmental agencies:
License or Permit • Agency
S0 Ft-Le
Certificate to be issued to leli/OdGI 7Gt �jllff Per 5;68` 71,0 • c,VC)
Address: 3-7.9._. 0 E u (p7 3 •
Owner of Record of Building OS • in- a q7 ro fe ,_1_ l--,1 _, •
Addre 2 00 n if r !J-Q t4'1 f 3,6*-oz, fl ti n i•valley •Ni I) z/RFD
Pres t er ertificate in PII (,0id fft Dui pl fief S1l)F LIC
4)1) á )v _
operson to whom Title* 3 y
Certifica ' issued or his agent 6,
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Date •
Email Address: &jlJ r WMlr'n for(ITApit r d it , e fy)
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28,South Yarmouth,MA 02664
Return this application to: Building Inspector's Office
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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(.tX11- l(o-0(:)7/3/-0Cit .
07/11/2022-07/11/2023