HomeMy WebLinkAboutBCOI-24-21 'YA.�� TOWN OF YARMOUTHe _
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*if - 0. Office of the Building Commissioner 1
'; 4 r 1146 Route 28, South Yarmouth, MA 26614iR 13 2026 5
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=r 508-398-2231 ext. 1260 Fax 508-398-0 6 -
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APPLICATION FOR CERTIFICATE OF INSPECTION
Feburary 1, 2026 PAYABLE UPON RECEIPT
(X) Fee Required$160.00
( ) 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:' / / k-(-- - g • ot1 rki yRarh U tat,. , �- 2 64
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Name of Premises: /3A St,/ N(4- ,A y✓/n/ L Gt Tel: S b " y �— 4
Purpose for which permit is used: r 0 i L— its( c3 'T 6L_
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
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Certificate to be issued to 1)1J j-FAJ) )2A 1. q/./A-Yj Tel: S U cam— ci6ri—2-7 if 9 J e 177
Address:Wi g/ !2. . .L fv t)j 1 a N./fl L l t b L3-r t . NI4 . o -2, 444 -t'5 -_3 �
Owner of Record of Building / )A a L�/V i k 6,
Address -9/ /2 E --le . 5,01-7-(.l �' r3 t11 LI. j 7/ . c) - 6 64
Present Holder of Certificate / i ,�„) ,�J^ p ,4,/ 77
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Signature of person to whom Title
Certificate is issued or his agent 3 /3 -Lc
Date
Email Address:
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 an change in the above information.
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Certificate of Inspection# BCOI-24-21
03/21/2026-03/21/2027