HomeMy WebLinkAboutbldci-22-002570 I
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The Com o I ealth of Massachusetts
n f'ity\Town of
i
' L/ARMOUTH
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:Yarmouth Lodge 2270 BLDCI-22-002570
Trade Name: Loyal Order of Moose
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
769 ROUTE 28 12/31/2022
SOUTH YARMOUTH, MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-2 01st Floor :8(9/i
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A-2 Nightclub/Restaurant/Bar/Banquet Hall
Allowable
Occupant Load
1 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 Ill Name of Municipal Mark Grylls Date of //, Z.
^G/
Fire Chief Building Commissioner InspectionZ
-7
Signature of Municipal Signature of Municipal (1Date of
Fire Chief Building Commissioner G` Issuance fi.x, . Z/Fee: $150.00
•
BLD Certoflnspection.rpt
UILDING DEPARTMENT
EN
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1260 Fax 508-398-0836
LICENSE INSPECTION APPROVAL LOG - 2022
NAME: Loyal Order of the Moose ADDRESS: 769 RTE 28
This log is to be signed by the appropriate inspectors upon a satisfactory inspection of your
building/premises. When all signatures are obtained, this log shall be presented to the License &
Permits office and/or the Health Department in order to obtain your license. Licenses will be
withheld until all inspectors have signed.
Building Commissioner Re . Date Comments Approved for
License Issuance
/f7/1 /A
Fire Department Rep. Date Comments Approved for
Li se Issuance
Yes No
19
Board of Health Rep. Date Comments Approved for
License Issuance
Yes No
Plumbing/Gas Inspector Date Comments Approved for
License Issuance
Yes No
Electrical Inspector Date Comments Approved for
License Issuance
Yes No
Taxes Paid Yes No
Rev.Sept.2003
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�;4; TOWN OF YARMOUTH
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BUILDING DEPARTMENT
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1146 Route 28, South Yarmouth, MA 02664 508-398-22t.: dt I V E D
APPLICATION FOR CERTIFICATE OF INSPECTION [Nj1ji
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October 1, 2021 PAYABLE UPCIARTMtNT
(X)Fee Required 150.00
( )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:10 O Zo
Name of Premises: L a '/ -(, O4/et ID /fioasE Tel: _ 0 G" 732 ,'W
Purpose for which permit is used: / ,7 O5L% '<(J E /J J�o2. f O1a4 V,LC 7U /2 Sett/y
License(s) or Permit(s)required for the premises by other gove4nmental agencies:
License or Permit /kAgency
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L. J ide LI c C ietf 5g-1_e CT/17"/
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00
Certificate to be issued to 0)i di P1 / b ,41211- Tel: soe-1 76'-- 6
Address: a4-1 a vTC e.f) sodtA 4O C., U26,6
Owner of Record of Building ,)14-)A 49 /er e A
Address /11 (, RM< L/liv&- 57-.6 F C)
Present Holder of Certificate 6- Os je /7
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Signature of person to whom Title
Certificate is issued or his agent /d//.2,.11
Date
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*-Email Address: ,�C-0 ,� 70 i Qaf e(�1/4 f D/e f
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# eat 1- -c 70- /9", ,
12/31/21-12/31/2022
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