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HomeMy WebLinkAboutBCOI-24-21 2026 g'Y9 TOWN OF YARMOUTH 0 �. Office of the Building Commissioner f 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1260 Fax 508-398-0836 y MATTACHEESE- CZPORATEV b ``_,--'� APPLICATION FOR CERTIFICATE OF INSPECTION February 03, 2025 PAYABLE UPON RECEIPT (X) Fee Required$160.00 ( ) 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: j /J ( J• 3 6 $01)T14 A \nv T(-4 •' (-elk- 0 . b 617 6 t4-5 5 t2,�v C-- ni o -Yc" L �^ iri Name of Premises: I) R� S WYd M v N /'17 L 1 L Tel: 5 O " 3 'W `� Purpose for which permit is used: d 76L License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency / , 0 frD Certificate to be issued to K O K X \ 13 Pi pi-7-i Tel: 0 - 3 q g-- -Z 4 W Address: d q I e.-b• Z( . go v-n-i y f /L tvtO t-r1-& m A•-p 26 6I .ITS° - C VJ — 6 t 7 7 Owner of Record of Building p K-LP g rnft•N eN:PF-A i IA A-TT ✓✓ 5,0 cc-3 gel, 4 s 0 7 Address cif i ¢2 t a w „so 0il-1 M0'� • /n•A• d"2 66 Present Holder of Certificate `© K"f c LIB, $, MAk15N� #/a 13#471 yrudppt (z- AO 0u>ti & Signature of person to whom ,ldK1�l4 r�-t•� • Title � �'ertificate is issued or his agent i kJ Email Address: 7 Date -T� �� REE: FEB 12 2025 BUILDING DEPARTMENT By — — 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)VIT THIS APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION. .5L L/— tn/(34-0. Certificate of Inspection# 6Co) _(-) 4,1 03/21/2025-03/21/2026