HomeMy WebLinkAboutBCOI-24-16 2026 -''g TOWN OF YARMOUTH
<, `. :'r0 Office of the Building Commissioner
o .,� -s: ,5 1146 Route 28, South Yarmouth, MA 02664
,� ti_4' ._,t►/ 508-398-2231 ext. 1260 Fax 508-398-0836
CHECS
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APPLICATION FOR CERTIFICATE OF INSPECTION
January 23, 2026 PAYABLE UPON RECEIPT
(X) Fee Required$150.00
( ) 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: i SCk,41 5hc Q- k 5 Y(Ar ,� ) no, G2t0V-i
Name of Premises: (RQc 75-oi L 61 i-R,Sor\ Tel: O r-3°19- (o°14
Purpose for which permit is used: 1--,
License(s) or Permit(s)required for the premises by other governmental agencies: j
License or Permit Agency / FEB ;
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Certificate to be issued to 5 GN uti,c- VR-e,c\- f2 o/L Tel: So(1,- 30 q,-6qL i
Address: 1 s 1),A GI,,,,- Dr-
Owner of Record of Building C 65 iA-1 ibl-y
Address 1 Su,\MA S 4,,e 1Y'
Present Holder of Certificate Fos 1-6 T i 1q1‘
K04 n 11Axiltf2%.R006__ C+z fv\G„.41,./
Signature of person to whom Title
Certificate is issued or his agent alto I av .-L'
Date
Email Address: Kroca0 rt�l.p4tCek 0c.%-C.Crk.
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 chan:e in the above information.
Certificate of Inspection# BCOI-24-16
04/01/2026-11/30/2026