HomeMy WebLinkAboutBLDCI-17-000934-06 2023 The Commonwealth of Massachusetts
:7. 1iftw. City\Town of
M' YARMOUTH
New and Renewal Certificate of Inspection
In accordance with the Massachusetts State Building Code,Section 110.7
Identify Name of Establishment Certificate No.
Issued to
Business Name:STATION AVE ELEMENTARY SCHOOL BLDCI-17-000934-06
Trade Name:GYMNASIUM/CLASSROOMS/CAFETERIA
Identify property address including street number,name,city or town and county Certificate Expiration
Located at
276 STATION AVE 12/31/2023
SOUTH YARMOUTH,MA 02664
Use Group Floor Occupancy Use Group Other
Classifications(s)
A-3otst Floor 363 A-3 Amusement/Church/Gym/Library/Museum CAFETERIA-363
PERSONS
Allowable 01st Floor 958 A-3 Amusement/Church/Gym/Library/Museum GYMNASIUM-958
Occupant Load PERSONS
01st Floor 964 A-3 Amusement/Church/Gym/Library/Museum 23 CLASSROOMS-964
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 life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed
by the undersigned.Failure to pose or tampering with the contents of the certificate is strictly prohibited.
Name of Municipal
Name of Municipal Mark Grylls Date of
Building Commissioner Inspection
Signature of Municipal Signature of Municipal Date of
Building Commissioner Issuance
Fee:$0.00
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g,, _ " 1•-?N BUILDING DEPARTMENT
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t ",;�' ,� : ` 1146 Route 28, South Yarmouth, MA. 02664 508-398-2 231 e t. § t__ .......-.
- � NGV 2 i 2022
APPLICATION FOR CERTIFICATE OF INSPECTION
BUILDING DEPARTMENT
November 1 , 2022 PAYABLE UPON RECEIP By: ____
( ) Fee Required
(X) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address:
Street and. Number: 02 7 5 cp .000 A 1i, bf`
'42 6 - `
Name of Premises: ..t r € )'' '` v _ ' Tel:
Purpose for which permit is used: c +-k % >f
License(s) or Permit(s) required for the premises by other governmental agencies:
License or Permit Agency
�' *. a Tel: 3---el 7 76 f3 .��C
Certificate to be issued to - '-1 [2. � i u��.\�-
Address: . 15 i A fir ? ` A ;/e a c -...._.
Owner of Record of Building C /1 r -mot} is 01 d 4„"„- , -e P'rz t I Ai eti 141 A, t"
4 L`i_y f i h- /1 /n. Al A . 6.)" e 6 V
Address ��- � > `"� ������
Present Holder of Certificate
(-I— (/)-. - --
y if 4, ,
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Signature of person to whom Title
e is issued or his a ent / , '�
Certificat g
Date
/=:Xlic.�$- Q /Dto --/.1. e d 4' C . r ..i2. . 'Of, 4) s
Email Address: ._.. .
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 USA COPY OF YOUR WORKER'S COMPENSATION INSURANCE FORM WITII THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection #
12/31/2022-12/31/2023