HomeMy WebLinkAboutBCOI-23-1707 2024 a
N
e oU
o =
a ti ea v c -0
Z o N � V)
a - it N o, aa) M
coas i..5 q
1L CV v.. ., C, C a
re = CV
t O V c E N a) 0 -r t
( cop 0 1)
V ce co c
0 0)) a)a)
o FL' c.)6 0 a „,
-o•in o.aa
to O a)
c
o z c
0 t d C Q O w O. Co
w- V C N
c cod' aa) .�
asmu) , o u) o 0
'0 S O L c •y N m
y f0 w � .0 l0 co
Ts aco
O L O d p a
° � � Cu'L � a � 0--0
d v ` t' dcc
V�
N G . O V v O O0ECjs N-p CV
41)
.c fa 44 ° °r.c eili. 3 -1--. ..... ‘11,\ )
C O a `r. R U C O
al
8 a"
e0 =
2 � � C: Zw� Q cng
y � Z oN �
\
o
0 0 � to rn � QI-2 Ec
a) a)
0 v c
SI. ep ° .c
o 0a O a •
y � t
d O W v go U) 72
� a C C tz 0
Z ui c o >. u .0 CO e rn v_
3F" Q � p � N = ::I ,�,� Q
O 0 N. zcn 6 ; � c �o
d c hi e
O v c� s .., m a
o wE� v) Cl) ° � ° � L a
C •V y •V L ' L
(� C O CO CE °n zc ac
U al N al W ►a - O vi , y
Z a) (n a) a) a) 0 C N E
~ Z _ �0 N0 90
o 4 s w � zc� in c.)
0
rn
a)
a) pL •N O c
as O > c
0 L u- L
O
Y D C ' Ow
O 0 U
to
a) a F (0 C m d
_c 0. .I 0 wN LL
'fl H 7 0 c N
w d .5= as A U N _ V a
V 'd v
a) H O
O. a) F U)
as
41111) 12
Uococ .� O v w
U O 1
y •L a I- c rn V
gCz o
od cco
w
asm
z in 0 ,
r,'g Ya
ou
NC
NT
as\!A;T c.� .c 1 7 .,$ .. .. T ..
1146 Route 28, South Yarmouth youth, MA 02664 508-398-2231 ext. 1260
{ R_E, C - V- `:
APPLICATION FOR CERTIFICATE OF INSPECTION i6 2023
May 1, 2023 MAY
PAYABLE UPON RECEIPT
(X) Fe $ u d6mE NI
( ) No _e` t"
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: A,6 5 b arflt, S+ , &`. i2 m 6 A 62.40 (.0y
Name of Premises: 1.15\- a Q S f(p{a 4 Tel: JW " 3 �'f L ---q 3 3
Purpose for which permit is used: /tek ' 0 0 t i 71
License(s) or Permit(s)required for the premises by other govern enta agencies.
License or Permit Agency
Certificate to be issued to S"; •---- V1at
Address: �V� b '� �� S k . • el: S'(� �- 3 � LIP-9 ZZ Z
Cl/L-1 tl\S h -, Wl bZ Co
Owner of Record of B '1 in V
F• '" A �'"�
Address 90 S C)\d� � /y� S- TL�Il v�� a4ANl.ud
Present Holder of Certificate ��k 1)C'l kft n S `' .
Signature of person to whom Ti lV
tle r
Certificate is issued or his agent 6 I I a (d. 3
Date
Email Address: 0-el--
Instructions:
��c�,nc_eJ S d�,/;i S 4 ZZ 2- . Cw i C ets 4-b 1 .
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# Q-00/)3--17v7
06/18/2023-06/18/2024 0,-6 / Cpill //4