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HomeMy WebLinkAboutCI-23-006042 V. CO m ° = ,y 0 CD 8 r `i, iinl0 C 0 OD a - frar.iNiiThiii�! I ° N �IN�� III N I� 0 q 0 r a 0 0 O. a o A' N 0 CD a 0. Cit 0 CD 5• N CA CA AD 'CS 7' �• C O O Oy• M O Ca . m O fn 9. CO a � � W ° 0 0 a 7 �q G _ N IQ O . 0 A L* m N R 0 a �,C. W to W Z ° R a 0 V g' \\ c c °' M. ° w AD aali am .1 0 o -� W a D C °CO " IFUIHI D t'D y WI .:::: `-rz co a 'IOOy 5Nyy o N � w IVXI a co v. CD to 4 HI co y c x � m C ortb FBIrolD WO LI `b m a fD A 0 GM m g fD '• m '0 W ° 'C 0 N N ' . 7 N 0 7 7 ' (D C 0 . 14'14. (" Z ro C W 1V•�\ 3 ° Y4,. etil.0,steNottiTOWN OF YARMOUTH 4 Mx BUILDING DEPARTMENT �,�4k••«� _' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 • APPLICATION FOR CERTIFICATE OF INSPECTION April 1,2023 PAYABLE UPON RECEIPT (X) Fee Required$202.00 ( ) 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: 37 A/EPrv,JE 1-4,v E Name of Premises: u-,'w Ei,`, E-su2T Tel: .5 7" 3' 9- 9 a•D I Purpose for which permit is used: w�M ES 1-41.44 C ZeS orez " License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to VI vc?12wCvJ (C..csat-'f Tel: so'F- 39 y - 9 g) I Address: 31 /(IE/rv,,F L..4 'Ef So,rrf} yq,,.,nwrii, M9 oz-6644 Owner of Record of Building SZ i vErz.v, Ew IZEso•ta - coA,,.of,"1,.,),,,.. .ty.441/_ Address Y• ©. 13 o,‘c 3 q q µ YA,JAi► c M4 0 z. cp a Present Holder of Certificate J EFf riri L..LW)J - G.EN EetAL M4 (,e-p Signatur erson to whom Title i irate is issued or his agent %/t"0 23 Date Email Address: J r yr 11:, S G tin o_r:very e.,,.l rg..)o r-j- 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# / .L)(J--2?` moQcioZ 05/01/2023-05/01/2024