HomeMy WebLinkAboutBCOI-23-1747 2026 g' 'YA TOWN OF YARMOUTH
', � :_ ; Office of the Building Commissioner
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i A�; 1146 Route 28, South Yarmouth, MA 02664
y. 508-398-2231 ext. 1260 Fax 508-398-0836
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APPLICATION FOR CERTIFICATE OF INSPECTION
August 01, 2025 PAYABLE UPON RECEIPT
(X) Fee Required$100.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, I hereby apply for a
Certificate of Inspection for the below-named premises
ises located at the following address:
Street and Number: 3329 /`.l& St (P_4e1 A' 'f os M o r1 _
Name of Premises:CAW'c Of 1/40tlr Ko tkft... Tel: 5J'O 362- 6 C 7 7
Purpose for which permit is used: W 0 rS�� f
License(s) or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
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Certificate to be issued to i -c.t& o F Al OLA1-,` Tel: 5Oa`-3 b 2 - 69 7 7
Address: 32'( Ml11 S+ ( b ) ,$ ptzt1• Por1- mic-626-7 S
Owner of Record of Building
Address - �_.
Present Holder of Certificate (z: � � yMk
"MI�l sa /1 AUK 19 2025
e of perso to who Title 1
Certificate is issued or his agent �'�-as E' yT
Date � �
j Email Address: advK.t A "itLy cArMO t t.• d 1.3 0 ,
LAUG 1 2 2025
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Instructions: Make check payable to: Town of Yarmouth l S& S
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-23-1747
09/01/2025-09/01/2026
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