Loading...
HomeMy WebLinkAboutBCOI-23-1719 2024 c a 2 k 0 d c \ � \ , / \ T.') q a 0 o \ \ � � / / / / W . \ \ § / B c E ns \ j / a k a f t o a $ t @ 0 -c« \ coQ3 ( � E g aa % o % CO .03 @ % 2 o \ E a %2 £ a Cua = e ] , / & \99 \ ofc = 0 X. 0 = c El o 6 0 k\ @ o \ \ƒk02R ■ ■ B $ ram § § = m .0 I. « # � 45 » a77 £ ��� _ _ � RI LF EE0 z \ $ I k k \ k f \ Co Ca n co # \ § UJI \ / c) * I'l.c C u � § o � ® ® 0 � ° ail F 0 000 amaNg o § k § � % cc �% 3 — ƒ ƒ 0 :cl- ›< 7L> § \ _ / 0 > $ Co , / \ \ ) _\ \ / - \ ? 0 / \ c , \ 0 o $ = \ 2 f _ / § k c / \ § E , k % \ \ 0 \ / \ 2 & t _ _ � or ] \ 2 \ = $ / k § f § 4 / $ zone f a" > k \ . _ g c d a) 9 / 2 e 2 ti 7R ƒ as 2 >,2 c m = _0 _ / k7 2Rf a) 3 / § = ' f ' 3 O _ § ) / / \ \ 0 0 C0. f \ 2 m R a _ e \ ) \ � � \ / \ ° ® k 0 a 2 as k ƒ \ 2 -I 7 72 s 2 \ 2 f 2 ■ § / o (9 g c c 1.12 Q ° k % \ k ° � \ u f� a z eo \ ,, ` , : i _,,, 0: ,:,,„ , "AT" 1146 Route 28, South 'a -oath, :CIA 02664 508-3. -2231 ext. 126 APPLICATION FOR CERTIFICATE OF INSPECTIONREC 'E V E June 1, 2023 PAYABLE UPON RECEIPT # JUN n5 20231 ( ) Fee R ed B LDI EFARTMENT 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: l 14(4. R©o-re a$ Name of Premises: Y4fZ(iO(Int -htj J 6�4[L.. Tel: 57)e-3 ?-3/ Purpose for which permit is used: use- of T)+ -kuiG oiti License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit Agency 4 Certificate to be issued to Tel: Address: Owner of Record of Building t Address V Present Holder of Certificate i u.f1AliiKii r Signature of person to whom TitlKg' Certificate is issued or his agent Z 3 Dat Email Address: 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# Cc/—c 3 /7/,9 07/10/2023-07/10/2024 r t't dic