HomeMy WebLinkAboutBCOI-24-12 2027 wog 'YA \, TOWN OF YARMOUTH
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0\ Office of the Building Commissioner
�. 1146 Route 28, South Yarmouth, MA 02664
508-398-2231 ext• 1260 Fax 508-398-0836
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APPLICATION FOR CERTIFICATE OF INSPECTION
January 1, 2026 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: 1 S 7 4• A)' ‘("''I't 0%4I i it/A 0.)& 7 3
Name of Premises: ' 6t&C,Vi 6trn`IN/ sO tZ�" Tel: 0 IC'let
Purpose for which permit is used: L.d b a2f
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 `tatiA6Gt lY". Tel: $O 28b IO4'
Address: 167 Bt rrti 4w'-• W Ya, i i.v+k.,MA- 614'7 3
Owner of Record of Buifding W s4 '(w.er+evt'i. 64..eits L1.C.
Address ro 1501, Stift i.1k ►.6I ,62,4 D 1
Present Holder of Certificate eI
10-''u'' psi-4u 4e Vies LC-C- Abe'
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Signature of p on to om Title
Certificate is issued or his agent it l3 2a26'
Email Address: r�,all.c� w1� 01
a40 t .owlet Date
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-24-12�
02/18/2026-02/18/2027