HomeMy WebLinkAboutCI-16-005195-07 0
n co
4 0r. PI 0 �,
a in
a c.4
O NI Ma W N 0 d I
w
V 0 r V U W t_ °
m X °' .5 „ Vl ar
LL Q co U
_— Et . C.G O V O c J
CO
N f6
N '- Q C O N
wto' •3
a
V) a s�. :a
pco °a a
I
0 Ii
Iti'
0.
.' a
Cill
2 CD
O I.i 0 Q Z m re Q I
a i
U W Q W C O I a O V N N N
G� w > C9 « d c w c a o
.� o d a O O E o. 0 3 •
c co 0 v > > Q
Q cZ C O '� ° v
co) at
n m � es
b g $ Z m co 5 Cl)
44 a EL � o
as
E, c Z .� o
aQ. x. S y
F C a 'S i ,t
ai vcIii
m
S
co °o 4
co 8 IT
y T. E, U
c y tFi
U fj
o
L v 15 aU+ g
w $ To Is p m J N a
�Iiiroolli #
rifial .§
mcos
C7 v 3 taco a
4 ..., ...ill,
in o
,.-.. Z
TOWN OF YARMOUTH
ri .} BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, NIA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
March 1, 2023 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: � LT-tot
Name of Premises:, = ` " , .y .
® > , Tel: ,
77
Purpose for which permit is used: � �
License(s) or Permit(s)required for the premises by other gone mental agencies: , V
License or Permit Agency L.. AR 2 2013
BUILDING DEPART
By _- MENT
PCertificate to be issued tot AV Tel;
' ` '
Address: "' t > '
Owner of Record of Bui din S
Address 1 r1 � �. �i ° ' "`� C"�- .-'�,
°� `=
Lic
Present Holder ofcertificate / ' ` Gzi 1
o x 1
o
Signa a of person to whom
Certificate is issued or his agent Tit
Date
Email Address. ;i,, "
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 buildin
be notified within ten (10) days,of any change in the above information. g official shall
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITH
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. THIS
Certificate of Inspection#
04/16/2023-04/16/2024 `�5�-0�