HomeMy WebLinkAboutBCOI-23-1792 2025 The Commonwealth of Massachusetts
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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
SOUTH YARMOUTH, MA 02664 December 5, 2025
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 Name of Municipal Building Mark Date of Inspection 1110:7
Commissioner I
Signature of Municipal Fire Signature of Municipal Buildin
Chief Commissioner Date of Issuance 126272-
7TOWN OF YARMOUTH
Office of the BuildingCommissioner
1%,,-_-_ '---1*.
J, 1146 Route 28, South Yarmouth, MA 02664
0 �"` - � `�'yj� 508-398-2231 ext. 1260 Fax 508-398-0836
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RPORASED•S''''
` APPLICATION FOR CERTIFICATE OF INSPECTION
November 01, 2024 PAYABLE UPON RECEIPT
( ) 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 premisesVauniltit,-
, located at the following address:
Street and Number: �28 Ydr 1rd Name of Premises: Qrl hLit/id/L. (c .td Tel` 4-76
Purpose for which permit is used: ?tc ( 1 —
License(s) or Permit(s)required for the premises by other governmental agencies: RECEIVED
License or Permit Agency NOV 04 2024
BUILDING DEPARTMENT
Certificate to be issue to a Tel: 5c8,3741?G,c
Address: ,52$ ( 0"2L r,/ pay LiA,
Owner of Record of Buildin
Address //V4) Auk ,, f
Present Holder of Certificate •� , fl I+//L 6/Nat
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nature of person to whom itl
Certificate is issued or his agent /cIile
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Date
Email Address: O' "4 e_(O lj&/70 -%fit, /6"
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#
12/04/2024-12/04/2025
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