HomeMy WebLinkAboutBCOI-23-1792 2024 The Commonwealth of Massachusetts
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Town of .44
YARMOUTH ;3&L
New and Renewal Certification of Inspection
In accordance with the Massachusetts State Building Code, Section 110.7
Identify Name of Establishment Certificate No.
Issued to Business Name:Town of Yarmouth
Trade Name:Yarmouth Senior Center BCOI-23-1792
Identify property address including street number, name, city or town, and county Certificate Expiration
Located at 528 FOREST RD December 4,2024
SOUTH YARMOUTH, MA 02664
Floor Occupancy_ Use Group Other
Use Group Classification(s) 01 st Floor 430 A-3 Lecture halls,dance halls, 49 Person-Solarium
churches and places of religious 100 Person-Front Ballroom
Allowable Occupant Load worship,recreational centers, 200 Person-Rear Ballroom
terminals,etc. MAXIMUM CAPACITY-430 PERSONS
This certificate of inspection is hereby issued by the undersigned to certify that the premise, structure,or portion thereof as herein specified has been inspected
for general fire and line safety features.This certificate shall be framed behind clear glass and/or laminated and posted in a conspicuous place within the space
as directed by the undersigned. Failure to post or tampering with the contents of the certificate is strictly prohibited.
Name of Municipal Chief Enrique Arrascue Name of Municipal Building Mark G s Date of Inspection kOACgS—
Commissioner
Signature of Municipal Fire Signature of Municipal Building ate of Issuance Z 2 Z ,r--
Chief Commissioner
5083989866 Yarmouth 11:40:21 a.m. 11-08-2023 1 /1
of ``�R`Noirt o: TOWN OF YARMOUTH
�, N BUILDING DEPARTMENT
r'�` M ��)�,cs. __° .— 1 146 Route 28, South Yarmouth, MA 02664 508-39t3- �ev �1.2
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APPLICATION FOR CERTIFICATE OF INSPECTION 1 NOV 08 2023
November 1, 2023 PAYABLE UPON RECEIPT, DEPARTMENT
(X) 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: �0 I Qx5 ' /'-mac,
Name of Premises: /y)0 & JY Settv;(QA Tel: ja.39 y 7�Od(v
Purpose for which per it is used: l 1 6)-)
License(s) or Permit(s)required for the premises by other governmental agencies: 1
License or Permit Agency \?1,. . \N
Certificate to be issued to ojj �ipy� Tel: t J/
> y 7 466
Address: 5 0 f iy, .)-��c.� ( 614.7
Owner of Record of Building `r yN ev) 3
dU
Address ))N/ iek AS SO- ,A 02b45'
Present Holder of Certificate 4
LittT� &I) ' ' e /��
Signature of erson to whom G� � Title '
p
Certificate is issued or his agent )//81 9 3
Date
Email Address: N. 8QmCL4) 4.U� n 1„,ane_� hies i-4. ,14A• OS
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# ;- : 3 _ 17 ci2
12/04/2023-12/04/2024