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HomeMy WebLinkAboutBCOI-23-1807 ifir-A�`�.. TOWN OF YARMOUTH ©. Office of the Building Commissioner ..; - rf �. 1146 Route 28, South Yarmouth, MA 02664 ',se = 4v, 508 398 2231 ext. 1260 Fax 508 398 0836 MATTAGHEESE APPLICATION FOR CERTIFICATE OF INSPECTION November 1, 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: ?/ d 11+ ��8 S Q U 1 Q(✓vJ 0✓7 L 1 Name of Premises: S e(k St de Ink) Tel: —Qv( 2 (pc/ (/ 6 (p Purpose for which permit is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be issued to Tel: Address: Owner of Record of Building La viA✓I1 kt/( j1 1-1,, Address Li VI C vo,ci C',- SG 5 ,,U ,e P.ecc.1-1 lit.<< ( 'i) itf t? So,,ilk YGt/v"t/ Present older of Certificate . A ef d'Zilci-e6L-ef ()Loner Signature of person to whom Title Certificate is issued or his agent /(//j 2 Date Email Address: /V, k' /CC,its V b ( Li 11 (OS , 0( f DEC 05 2025 Instructions: Make check payable to: Town of Yarmouth C V 4 \C l O 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-23-1807 12/21/2025-12/21/2026 i