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• _� \r TOWN OF YAR OUT
BUILDING 1
iG HAT ThG. ESC J .. E ..
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
October 6, 2023 PAYABLE UPO CEI
(X) Fee Requi d 300.00
( ) No Fee Require
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: 7 7 AL-0 /4Afri f £je5
Name of Premises: L11 ± t I' /1 4/ Tel: cU c 3 k- 112
3�7
Purpose for which permit is used: la r-��
License(s) or Permit(s) required for the premises by other governmental agencies: d A°
License or Permit Agency
(10 o4/ 14, 4 #L.P31
Certificate to be issued to 4.sire,7` /(11//J� Tel: ,2.3,7k,
Address:
Owner of Record of Building '
Address 77 /2te Ye/z O't "970 1.), _,C,7_5
Present older of Certificate SOW/C.
g ure of person to om Title
ificate is issued or his agent /o „�
Date
Email Address: 46 rh -f2L40ct
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 #
09/09/2021-9/09/2024 Carriage House \ �'L)
2 C'v/- .3-/7 7/ CC I'rt 0(4 J
Igo t,
'°F•YaR TOWN OF YARMOUTH
:� -f� BUILDING. M�..�,. , DEPARTMENT
" �:`PE�`�•' 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
August 1,2019 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: 77 ? CA /hl V i n/�
,S
Name of Premises: ,&j�ex � /Y/
4 �/✓,� Tel: .;��' APO6323
Purpose for which permit is used: Aid ate( 62i40--'
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
C i).70, mAi lam[ c Tr-1 i44 Alt//4 4"."-j"*.-
Certificate to be issued/�to,..-
Address: /mil �f} iL ac Tel:•• ��' �flD 6� '
Owner of Record of Building J-Ad t ,i e (e,./5t,,� :s
Address 7 7' 47c ) �� c, /I /ic �� lj h,Ps
Present Holder of Certificate S6207r'
4 DWL
Si re of person to whom Title RECEIVED
Ce ficate is issued or his agent
Date DEC 14 2; !
Email Address: Ty �• f-- / `��-
y BUILD �„
By NT
Instructions: Make check payable to: Town of Yarmouth
Return this application to: 1146 Route 28, South Yarmouth,MA 02664
Building Inspectors Office
Please note Application form with accompanying fee must be submitted for each building or structure or
to be certified.-Application must be received before the certificate will be issued. The building official shall e ereof
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# $GI-C J-17-C+j -02___
9/9/20 1 9-9/9/2020