HomeMy WebLinkAboutBCOI-24-57 2026 (2) or Yam, TOWN OF YARMOUTH
`,
Office of the Building Commissioner
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext. 1260 Fax 508-398-0836
/ MATTACHEESE 9 .�
c°RP O R AT E0 1,.;,/
APPLICATION FOR CERTIFICATE OF INSPECTION
March 04, 2025 PAYABLE UPON RECEIPT
(X) Fee Required $205.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises located at the following address: /+�
Street and Number: 13 S Sou ►. stbI E J t kiiôo NIA, O2664
Name of Premises: S(C,5 l b afth6P
S Tel: C/104416- 5-(f 2
Purpose for which permit is used: LdOn 1A1 1 ()V
License(s)or Permit(s)required for the prerhisesbby other governmental agencies:
License or Permit Agency
Certificate to be issued t &< I b� p/l 'ts' Tel: 5 4g
Address: ,35 Soo, 7. P/ U p �,�G�7
Owner of Record V3,3Adin (LWIQiJ i d ,Q tv i c l(1S 1AVON)
Address (3$ d �!i- ph i , �� O Y
P e ent Ho de f Certificate ""��1,, fi -
iire
gnature of perso whom Tit ��
Certificate is issue or his agent y 2 D to
-/
_ ) f
Email Address: \1 rr vetorm Kdv OUR o\ ,Gon
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# BCOI-24-57
04/24/2025-04/24/2026