HomeMy WebLinkAboutBCOI-23-1745 2024 )
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O; :) . UILDING ! EPA T ENT
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1146 Route 28, South Yarmouth, MA 02664 50 -3 8-2231 ext. 1260
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APPLICATION FOR CERTIFICATE OF INSPECTION
July 13, 2023 PAYABLE UPON RECEIPT
(X) Fee Required$50.00
( ) 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: SQ &A n (o€r S}r£ t'-' . 1611-1 401s1.-1-h Po Q g (O IS
Name of Premises:SCICrfd -ii rn r--1j C ha_ i1 Tel:(50 17 8 I-lP
Purpose for which permit is used: °SS t b f
License(s) or Permit(s) required for the premises by otheijovemmental agencies: R E C • @ V E. 0
License or Permit Agency AUG 2 8 2023
BU1Lf IN D ,�
Certificate to be issued to ,,SCI+C r`LC.I�:- f Cx�''f _ 1 i ei.
Address: ' a i��i� N�y ' 3g (SUM k r k ar�-1oo+heor`}-}'1 f °Ric-g
Owner of Record offf BB� ing ILA!,
Coking 1 ! A6k i-icp of C- e.4 v`C u 8
Address LI 3 'rl t ' h fanc1 AV G Paze, n\[t fl a s-1 a® t 1
Prese Holder of Certi cate r(" �C& -ht ct • Cfr\ - ( i
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proen--iA, HcAnctIA-r- -
Signature of person to whom Title , •,,
Certificate is issued or his agent kr
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Date \, ,.
Email Address: Ernt; 1 R 1O kO t & kj o f(/L-
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Instructions: Make check payable to: Town of Yarmouth ' 1
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 CANN T ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection# ' _ �7 ,`
05/01/2023-05/01/2024 ,%17P(1
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