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, ,,„ " s„ 1146 Route 28, South % t°r aro th, MA 02664 08-398- 3 ext. 1260 ti
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APPLICATION FOR CERTIFICATE OF INSPECTION CV
I e y
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:
A.B. PIZZA II, INC.
Street and Number: Ala ROYAL II RESTAURANT & GRILLE
715 MAIN STREET (Route 6A)
Name of Premises: Yarmouth Port, MA 02675 Tel: 50g'�360-324
Purpose for which permit is used: t.,S 61 Uf I.AG e04 Ste._-
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit RECEIVED
Agency
fic r eIP In ,4b4 ; M . ' /,ppay
SEP 2 Q 2023
BUILDING DEPARTMENT
Certificate to be issued to c'.0 o OU 4.4 Gr." Tel: 508-36 Z-321//I
Address: t(1 _d__Aev end 0Z :3—
Owner of Record of Building �� 0
Address �v Ge v r i\le_ I/eui'Nev y✓t 4 7 2 4 3/
Present Holder of Ce ificate ag-
ig ature of person to whom Title
Certificate is issued or his agent //J-/2. 223
Date
Email Address: (.9100(L40 1(2S,� _/o _i D. , L\-D
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# ( 'O/—c —
12/31/2023-12/31/2024 �7�� 0