HomeMy WebLinkAboutBldci-16-004963-06 (2) The Commonwealth of Massachusetts 1
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_. ` City\Town of
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YARMOUTH
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11111,
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: SEAFOOD SAM'S BLDCI-16-004963-05
Trade Name: SEAFOOD SAM'S
Identify property address including street number, name,city or town and county Certificate Expiration
Located at
1006 ROUTE 28 11/30/2021
SOUTH YARMOUTH, MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
01st Floor 97 auranVBar/Banquet Hall 97 PERSONS
A-2 A-2 Niahtc:hih/Rest
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 Ill Name of Municipal Mark Grylls Date of
Fire Chief Building Commissioner 3 ��-✓�� t
Inspection
Signature of Municipal Signature of MunicipalJ I
Date of +
Fire Chiefczi . Building Commissioner Issuance /
Fee: $100.00
BUILDING DEPARTNIENT
1.46 Route 28, South Yarmouth. MA 02664
508-398-2231 i xt. 1260 Fax 508-398-0836
LICENSE INSPECTION APPROVAL LOG - 2021
NAME: Seafood's Sam ADDRESS: 1006 Route 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
77,,,,,.. "002,
4iiiW No
Fire Department Rep. Date Comments Approved for
License Issuance
).\_ 4-\_,...--"- 3 - V-)( 4•0. No
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
i
4N, TOWN OF YARMOUTH
(O.CIVOt q• BUILDING DEPARTMENT R E C ,�`v\MA „;14 .! ,i` '1
1146 Route 28, South Yarmouth, MA 02664 508-398-22 1 xt 1260 -L
2021
APPLICATION FOR CERTIFICATE OF INSPECTION BUILDiNGBy r� ARrti ENr
Febuary 5, 2021 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: /0 0 tp Lou K Z Z
Name of Premises: 5)j
GZ f p 19 S &I 1I S Tel: 5D E -! 'Y -3
Purpose for which permit is used: S2 et/ &At I- tu< ,'ii ()tali
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Li et,,or (&AS&.
Certificate to be issued to ��-- Tel: `71 c( ' zo'1 -tits 8
Address: 35 9 QvMV r �i t-F►41 1-b,;� tel C. S dtt. tkA h A 6Z-531
Owner of Record of Building
Address
Present Holder of Certificate t\i(,l z�,(;e M&Sl n
W.11)t-r,LL:'( LAW(
Signature of person to whom Title I
Certificate is issued or his agent 2-1 12 UZI
Date
Email Address: S(Q1o6a SGUVI S l t it4 pi 4- 1 Lt �I . £e n
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 C RTIFICATE OF INSPECTION.
Certificate of Inspection# ,i( I� .,( —` (D —DO 41(0 3 --OS
4/1/2021 —11/30/21
so.