HomeMy WebLinkAboutBCOI-24-45 ("OC:-?---
`it. . TOWN OF YARMOUTH
Office of the BuildingCommissioner
a' * * 101 1146 Route 28, South Yarmouth, MA 02664
per _ - 4y
,N .- 441 508-398-2231 ext. 1260 Fax 508-398-0836
MATTACHEESE
/�C0RPORATE j34•f APPLICATION FOR CERTIFICATE OF INSPECTION
November 1, 2025 PAYABLE UPON RECEIPT
( ) Fee Required$100.00
( 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:
( ' Y-0-hon �Street and Number: 28
Name of Premises: iliViSpitmoufh Srrter iC(r� Tel: 5bg" I�7
qg 79.7 ci
Purpose for which permit is used: M i'Od I e I 'Ed 0(i4 I I'o 0
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Certificate to be j ss e to D\ 12 S) Tel: ____V - b 1 i
Address: L ci LP 54-rk-j['1 .A tin l.i air 16
Owner of Record of Building
Address
Prese ._.older of Certificate 'D 9 S C)
4 Q
_,
D 1 reclz a f- 166 I ties
Sign. s ' .e Title
Certificate is issued or his agent lk I(3) ZS
Date
Email Address: a uk,�'le 5 0' D I -'et' pool_ 1LIz< i'r" US __ , a- . . r _
NOV 17 1025
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-24-0- l
12/31/2025-12/31/2026
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