HomeMy WebLinkAboutBLDCI-17-005862-04 The Commonwealth of Massachusetts
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tom. 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:WEST YARMOUTH CONGREGATIONAL CHURCH BLDCI-17-005862-04
Trade Name:THRIFT STORE
Identify property address includingstreet number, name,city or town and county Certificate Expiration
Located at 383 ROUTE 28 05/01/2022
WEST YARMOUTH, MA 02673
Other
Use Group Floor Occupancy Use Group
Classifications(s)A-3 Basement/Lower 30 A-3 Amusement/Church/Gym/Library/Museum 30 PERSONS
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 Grylls Date of /��/��I
Signature of Municipal
Building Commissioner Inspection (9
Li2d Issuance WPAf
Signature of Municipal Date of
Building Commissioner
Fee:$100.00
BLD Certoflnspection.rpt
,,, ` k;. TOWN OF YARMOUTH
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1l BUILDING DEPARTMENT
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s .t m,, 1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
DATE: 03/17/2021
�� Ar� 115 26�.1 1 PAYABLE UPON RECEIPT
(X) Fee Required $100.00
1 C 3-) /Ci ( ) No Fee Required
1
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: c_3 3-3 4 G p2 (,),ya rwi 0 0 42• mil 0., /r�
Slop Name of Premises: uy. coo,. . Ch V `�J,,,,,. Tel: 60 - 7 75..Q�C�J
Purpose for which permit is used: 4. 1.0,i {- 51.eic
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
tor' toycc.
Certificate to be issued to,30);R - C 1,J r• 1404 Ci.0or Tel: 45-(g•7 4. 8aV D cc)/ Ur- e h ti''C4
Address: ok3 "N'i.e. 02k, t<) , Q * o a('?, 6O?- 771- )
Owner of Record of Building 6,...). . c aka 4-1• bra.) Clod rdj
Address g 3 e 0. J• ar % 7'yy� IA o 23
Present Ho der of Certificate 4 J c
dh)r Actooc d frescoh
Si ture of person to whom Title
rtificate is issued or his agent ()c - 02/
Date
Email Address: all e. (Jk 1.)11 1'. CO M
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# /Vd p t id e h1,0/Oyee — Kiwi iee ri,
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05/01/2021- - 05/01/2022
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