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TOWN OF YARIVIOUT
.t
BUILDING DEPART ENT
'. ` ;7
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 eat. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
October 6, 2023 PAYABLE UPON RE�--)
(X) Fee Req ired 300.00
( ) No Fee Rirfui -
J
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 4 ti,e1 -- ,kr 54
Name of Premises:
- Tel: ,j vy ---39X
Purpose for which permit is used: Ad at Z,,efr*--9(.7--
zvei
License(s) or Permit(s) required for the premises by of er governmental agencies:
License�orr Permit Agency
an t c-/�-o-/ Y�/IfJly ( A /. 4q
Certificate to be issued to Z._4,4 #1 .5y, Tel: Sdg--- ,j(-)� 3'/76
Address: 7 4 7 Arc- � Y0 'rw At, a 2S
Owner of Record of Building
Address
Present Ho -: of Certificate
atriliZi Ir, na4vb:e-
Si. ( e of person o whom Title
ificate is issued or his agent Title //
Date
Email Address: 4n �i� �, co/ A-' 7
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 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 Main House
O�r•Y9/Q
r
'... , ! "po TOWN OF YARMOUTH
° �;R '9 BUILDING DEPARTMENT
!� 1146 Route 28, South Yarmouth,MA 02664 50$-398-2231 ext. 1260
APPLICATION FOR CERTIFICATE OF INSPECTION
August I,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: T ;g " r^rt0•
Name of Premises:_ .�;y '
'p Tel:�-,��' 6 3
Purpose for which permit is used: �tZf , . —�-r
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit
/�' �� Agency
v»�ardiz Ye c Tom/
47--
Certificate to be issued to�� � � .
Address: 1 Tel:
Owner of Record of Building
Address r
Present Holder of Certificate 5 ,6- a
s E 41 20t 27 D
OkiipSi ie of perso to whom -
ficate is issued or his agent Title
flL Z
_• .. _ Date
, Bt11LDrN _ .
7 Email Address: 8r�-__-� - [,y
Instructions: Make check payable to: Town of Yarmouth
Return this application to: 1146 Route 28,South Yarmouth,MA 02664
Building Inspector's Office
Please note: Application form with accompanying fee must be submitted for each buildingor
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, structure or part thereof
PLEASE SEND US A COPY OF YOUR WORKER'S COMPENSATION INSURANCE11111
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. FORM WITH THIS
Certificate of Inspection# C- IS l�
9/9/2019-9/9/2020 �—~arm pZ