HomeMy WebLinkAboutBCOI-24-5 application Og YA(\,,
i . K TOWNK OF YARMOUTH
/ 64 Office of the Building Commissioner
1146 Route 28, South Yarmouth, MA 02664
C y� y1 508-398-2231 ext. 1260 Fax 508-398-0836
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`� APPLICATION FOR CERTIFICATE OF INSPECTION
January 1, 2026 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: 02.4C9 lea- ,!
Name of Premises: �,�/"/ c1-4"'1 Tel:id e-, f ei. 1''J
Purpose for which permit is used: ,9�ini:// /G7 (' 7 n� o*
License(s)or Permit(s)required for the premises by other vermnental agencies:
License or Pe it Agency
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Certificate to be issued to '4)1rit. % Tel:&U yfir-Wpmiaii-soq-)7?3!q-i
Address: ;#'L7-6`4 Se �T�'1 �io ea av
Owner of Record of Building 09= yi-e `i—Pt
Address ie /C4-a .S,O' ar4Ad GR.�46"1�
Present Holder of Certificate (4/ /1i/, -itk. L1
iStfil-G4111/. 1-,6 ries-lee
Signature of person to whom Title
Certificate is issued or his agent /4/M
Date Email Address:4,F/i 'Rise/4/k Le-7-441-4, Arp7-- RECEIVED
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1 JAN 0 9 2026
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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 WITH THIS
APPLICATION OR WE CANNOT ISSUE YOUR CERTIFICATE OF INSPECTION.
Certificate of Inspection#_BCOI-24-5_
02/24/2026-02/24/2027
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