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TOWN OF YARMOUTH
ial` 1 H»- BUILDING DLPARTM
,, ;" 1146 Route 28, South 'Yarmouth, NIA 02664 S08-39 2 31 ext. 12f()�__
,� I MAR 0 8 2023
APPLICATION FOR CERTIFICATE OF INSPECTION'. BuWLD(NG !DEPARTMENT I
By._
March 1, 2023 PAYABLE UPON RECEIPT
(X) Fee Required$180.00
( ) 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: 79 WHITE ROCK ROAD
Name of Premises: CAMP WINGATE*KIRKLAND Tel: 508.362.3798
Purpose for which permit is used: CHILDRENS SUMMER CAMP
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Certificate to be issued to CAMP WINGATE*KIRKLAND Tel: 508.362.3798
Address: 79 WHITE ROCK ROAD
Owner of Record of Building WINGATE KIRKLAND REAL ESTATE LLC
Address 20 LINNELL LANE YARMOUTH PORT. MA 02675
P ent older of Certificate CAMP WINGATE*KIRKLAND
Owner & Director
nai-Z�g of person to whom Title
Certificate is issued or his agent MARCH 6, 2023
Date
Email Address: HEYSANDY@CAMPWK.COM
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#
04/01/2023-04/01/2024
i
.,...
.. •
Camp Wingate/Kirldand
• Location Capacity Use Group
Assembly Hall 310 ting w/Center Aisle /A-3)
200 ables&Chairs G-
15 ge
Dining Room 150 ersons
Computer/Office 20 Persons—Annex R-2
Lodge#1 37 Persons R-2
Lodge#2 =Persons R-2
Lodge#3 20 Persons R-2
Lodge#4 22 Persons R-2
• Lodge#5 22 Persons R-2
•Lodge#6 18 Persons R-2
Lodge#7 18 Persons R-2
Lodge#8 18 Persons R-2
Lodge#9 18 Persons R-2
Lodge Hilltop 15 Persons R-2
Lodge Motel 15 Persons R-2
Lodge Bunk C 15 Persons R-2
Lodge Bunk]) 15 Persons R-2
..-