HomeMy WebLinkAboutBLDCI-18-006942-04 The Comm aw ;alth of Massachusetts
r4 /Cyy\Town of
!r'� Y 4RMOUTH
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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:TIDEWATER INN BLDCI-18-006942-04
Trade Name:TIDEWATER INN-COFFEE SHOP
Identify property address including street number,name,city or town and county Certificate Expiration
Located at 05/20/2023
135 ROUTE 28
WEST YARMOUTH, MA 02673
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2
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 (�
Signature of Municipal
Signature of Municipal Date of
6 •►
Fire Chief Building Commissioner Issuance
/ Fee: $100.00
BLD Certoflnspection.rpt
TOWN OF YARMOUTH
BUILDING DEPARTMENT
so, . 04,
V F D 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
Apy 29 2422 PPLICATION FOR CERTIFICATE OF INSPECTION
���BUCLENT
GINU UkNART __ PAYABLE UPON RECEIPT
A rid =-� (X) Fee Required $100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building
e following Section
10 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located t
Street and Number: 5Zc 13 o v
Name of Premises:7":31
»h � � n� D; Tel: c�� 7��� z
C L5 V1 O 2
Purpose for which permit is used:
License(s) or Permit(s)required for the premises by other governmental agencies:
Agency
License or Permit
�t1 biP)er‘%
�rJC '� �'a$^ � 'S'-632
Certificate to be issued to�4r i N's l q Tel: 2
Address: a
Owner of Record of Building A Mr i sl^
Address 6j •
Present Holder of Certificate /�'
Title
Signature of person to whom
Certificate is issued or his agent Date
Email Address' l
Instructions: Make check payable to: Town of Yarmouth
1146 Route 28, South Yarmouth, MA 02664
Return this application to: Building Inspector's Office
or
Please note: Application form with accompanying fee must be submitted
db for
iss each
ed. The bng or struc g offturecial shall part thereof
to be certified. Application must be received before the certificate will
e
notified within ten(10) days of any change in the above information.
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION
OF INSPECTION.CE FORM WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE
Certificate of Inspection# UJC/a-D WG-z
05/20/2022-05/20/2023
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