HomeMy WebLinkAboutBCOI-23-1772 01 Y 44 TOWN OF YARMOUTH
k.
44-
Office of the Building Commissioner
114Gy 6 Route 28,South Yarmouth,MA 02664
V4' 508-398-2231ext. 1260 Fax 508-398-0836
APPLICATION FOR CERTIFICATE OF INSPECTION
October I.2025 PAYABLE UPON RECEIPT
( ) Fee Required
(X) 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: 31 Dupont Avenue,South Yarmouth MA 02664
Town of Yarmouth Recreation Department (508)398-2231
Name of Premises: Flax Pond Recreation Area-Lorusso Lodge Tel: x-1520
Purpose for which permit is used: Assembly Space
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Fntertainmenr I it oca/Weekends Commonwealth of MA_ .
Entertainment License/Weekdays Town of Yarmouth
Camp License-Summer of 2026 Town of Yarmouth
Certificate to be issued to Town of Yarmouth Recreation Dept Tel:
Address: 424 Route 28,West Yarmouth,Massachusetts 02673
Owner of Record of Building Town of Yarmouth
Address 1146 Route 28 South Yarmouth Massachusetts 02664
Present Holder of Certificate Town of Yarmouth Recreation Department
Steve Reynolds Recreation Director
Signature of person to whom Title
Certificate is issued or his agent October 6,2025
Date RECEIVED
Email Addrr+� recreationCwarmouth.ma.us
OCT 06 2025
BUILDING DEPARTMENT
ay
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-23-1772_
' i' 'h