HomeMy WebLinkAboutBldci-16-004717-04 e mmonwealth of Massachusetts
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City\Town of
} 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 BLDCI-16-004717-04
Business Name: CAPE COD ARTIFICIAL KIDNEY CENTER
Trade Name: CAPE COD ARTIFICAIL KIDNEY CENTER-OUTPATIENT DIALYSIS
Identify property address including street number, name,city or town and county Certificate Expiration
Located at 02/08/2023
241 WILLOW ST
YARMOUTH PORT, MA 02675
Use Group Floor Occupancy Use Group Other
Classifications(s) 21 STATIONS
B B 01st Floor 21 B Business
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 Name of Municipal Mark Gryl Date of
Building Commissioner Inspection �(Ol
Signature of Municipal Signature of Municipal •
Date of
Building Commissioner G r' Issuance 2(1?
Fee: ;100.00
BLD Certoflnspection.rpt
£v°r akL TOWN OF YARMOUTH
IA,, a BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
January 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 0
Certificate of Inspection for the below-named premises located at the following address: b(� �aa4
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Street and Number: XV Ji' OGc>
Name of Premises: Aiity- el: cIqB� .z_..Ys',3C.-
Purpose for which permit is used: dUi 4TIurf 444.... 5t 3 Ce44.11L
License(s) or Permit(s) required for the premises by other governmental agencies: RECEIVED
License or Permit Agency JAN 18
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Certificate to be issued to Ca:04C— Tel: ce,g- zz-'46-3S'
Address: Zy/ J// /jj k) 57, 00,Pve4,04 /31247; Mi5 O 24
Owner of R9cord of Building FPI 744.1wrkt pow' Au- /Qrs4j.r1( l L G
Address e0 S'v,)741157 144tZy cauDi Q 3353 P zip -gam Ng A k"v0�,
Present Holder of Certificate I 1*TJJ,$44 A 34P 324
.050 T ,1
Sign ture of person to whom Title
Certificate is issued or his agent //DAOZD
Email Address: Cb/A/k4 Lei G 7`'/Y1 G -MO , CO/14
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#
02/08/2022-02/08/2023