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BCOI-23-1764 2 d \ / / .2 f I.5 % 0 \ a / § / \ @ ' ■ E : . ; k CO \ U \ a) 0 o =k Ctf N � \ \ -0 ) / /@ / E SRag § 2 a as kk � § / CC_D 5 \ 0 § o = q 2 * E 0 5S % / ) § 22 \ % 0 e £ • ® 0 ) / 1\ o - 2 ~ q § fl \ 0 / \\ 0 c 21 \ \ k8 ■ ■ - ^ « /_ / I £ a � \ 6- 0cr, \ \ \ o RS % k32i < � / \ t 2 § 25 / 2 / � // 0 2 I— 2 77 E ? i E7 ° V. O 0 Wo ? 02 \ \ m . © o % � \ ) 0 og \ 4.2 M w § k % 2 / �� $ O0 � � � m ? E C a" G / i k � 7 § % - c _ = ? \ • t2E 0 E \ � � tz� � qk \ f R & _ (4 o $ 2 � 0 03 0- \ — E Q - . § C . 2 0 7 c CD EQ \ } .- k ea o0 ■ RI / 2 .0) as t $ \\ I- ■ r 2 2 2 m a k e 2 § ƒ§ o \ \ \ / zoeo 0 JZk. = \ E . _ . m a) = 't � a k - c e a 2 >2 : _ 4. e 7 \ $ / f § / � a / § � \ )d .) \ \ / \ 0 aciL —oocca co k f $ e / R . t = % C / 3 2 2 / \ a / \ \ u o A = \ . ■ F_ m ] ) \ kf \ % 2 c t g 8 \ . _ as / 9 a WN F VA UT y 1 cp ca r . ._ ENT• Fz 1146Route 28, Yarmouth, MA� South , 02664 08- 9 - 21 ext. 126f) APPLICATION FOR CERTIFICATE OF INSPECTION September 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: ( 2 �- u Tow Hit Ea Ea ` Name of Premises: ko i ll ow' P uI Tel:, -7 7 1'' RECEIVED- Purpose for which permit is used: ?'e 5"laU, f License(s) or Permit(s)required for the premises by other governmental agencies: OCT 05 ZOZ License or Permit Agency BUILD T ctou /-ec 6 GO ^ leiU— Jam" fthU L l une L.I em Pam .- Certificate to be issued to VCR. fli to'141 - 1 n U. Tel: 3 d 5-- 314 - 3 Q, 3 Address: / 02- OL 7)t4'/u' HCTaSte: /Z/0 . 09- Owner of Record of Building '9 1 e t4te Address ( ?Z. (>1 'rvwr o fex. Present Holder of Certificate ' ..C%Z. �ynd n-�- 1()C. 10- Pm Signature of pers to whom Title Certificate is issued or his agent L'�' )`Z/ Z' , ^� - (('' ,,,, II '',,,, - FF yy� a , , i Date Email Address: 1_0( t -c-e 6'LW�-S ° fro 1 l'J6..„ 000 U04_ . COW` 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 CA NOT ISSUE YOUR CERTIFICATE OF INSPECTION. Certificate of Inspection# 12/31/2023-12/31/2024