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HomeMy WebLinkAboutBCOI-23-1776 2024 2 $ - / ) k CD - a � % 2 \ 0) 0 N @ a) .0 • E 5 ® a> ON k CO k k / k / ƒ _ \ ) ƒ @ § / o_ as / 2f \ q2 0 k � a / 0 q C 13 % EL § i- t / .- & _ r , 2f k awn u +a o 0 § COri, 0 E 0-\ % I %0 J ! I £. 0 AS I c � \ eu = k . � � k '. / I ai CO �/O = l c C) � �� � k / A � / / a0 § B / 2 / ty / 5\ ■ O \ L- m = o # « C CO ) Zb }- ,'\ / / \ E 7 / f 2 / I \ k / E w - 2 g % ® © < 2 I o ° ) o C 03 § _ $ \ ƒ� \ 0 C 00 k EES E \ § @ k CD t k \ / 2 \ \ m \ _ . Z & o a \ / \\ �� 6 _c 0 cr)k �kk . . . d \ \ 2 $ 2 % Sf 3 § 'g § § . :■ / k \ k � / - t 1 E 2 . ) m f f ) \ 1.4'. 15 § § \ rdi $ § � % � / E ss. E0 w , / 0 a \ § / \ ,(12 i _ goE % ® 2 2 Sa = / k co Cu 5 00C \ \ a) f 0 0. 0 f m / § 2if 'a z 2 ■ ° 12 o D o 2 2 e § $ / E / ]4- « E o a) ®ca &ƒ 2 ® 2 7e Ici 1146 Route 28, South If' trn ottth, MA 0266 08-3 S-2231 ext. 1260 APPLICATION FOR CERTIFICATE OF INSPECTION September 1, 2023 PAYABLE UPON RECEIPT (X) Fee Requ ed$100.00 ( ) No Fee Requi 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: SI-17 14 xi. 772.)Z_r7 I j J Name of Premises: OV/vs1)1& Qes\cAurc4 Tel: 50q-30Py_a61.2 . Purpose for which permit is used: ` i q©t R \—AC ea-St- License(s)or Permit(s)required for the premises by other governmental agencies: RECEIVED License or Permit Agency OCT 19 2023 i F2 ou R �,�c�n5� B I �1 �A TMENT Certificate to be is ued to p SkOr010.5 Tel: 5rfl Address: 'S 1.,,2 AAA i v>ue r 14- 0 9c 3 Owner of Record of Building `(Y1O ,. ft AC I CA.V Address aS --liner«. '©t'tv \11Ortt4er t_6t44 D)��Present Holder of Certificate ' Q er S ar�aS /0.**V7 OtrvilVer Signature of person to whom Title 74 ),)11 Certificate is issued or his agent ! " ' Date Email Address: (:), S .0 rdkas 72G1 yam` 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 CANNOTYOUR �2-- 77‘0 12/31/2023-12/31/2024 13G0