HomeMy WebLinkAboutBCOI-23-1776 2026 /- g A TOWN OF YARMOUTH
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Office of the Building Commissioner
„" 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 15, 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 located at the following address:
Street and Number: ',3'-I I (Z1f. e`Z
Name of Premises: 0 t iMP to Qt S vrG•�T Tel: c O? 3 11—Z i2.
Purpose for which permit is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
Licen a or Permit Agency
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Certificate to be issued to Op 04e. r� j i-6161G Tel: 5 0Y-,3 pi-. /,2
Address: 9 Nav\--tc.a\ ‘ Yt) ca;.kkk y , 0vl(,, Yea DQ y
Owner of Record of Building P14� .��n.rz,,� an b IA U'
Address 25- Te.1irac.e_ 8(1, \doi•ce4,r Al 0160q
Pres t Hol er of Certificate &ova\-r,Q %✓.045
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Signature of person to whom Title ,-
Certificate is issued or his agent CP /2 E )
Date
Email Address: C.51,or Act 5 7,Q 4 p"1a,\ . Cowl SEP 10 2025
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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-23-1776_
12/01/2025-12/3 l./2026