HomeMy WebLinkAboutBCOI-23-1764 application Y44 ` TOWN OF YARMOUTH
,� , Office of the Building Commissioner
ii.- 1146 Route 28, South Yarmouth, MA 02664
y 508-398-2231 ext. 1260 Fax 508-398-0836
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APPLICATION FOR CERTIFICATE OF INSPECTION
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August 24, 2026 r�___ _ " L.;' ' PAYABLE UPON RECEIPT
ISEP 1 1 1��6 (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: v 2_ e
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Name of Premises: LOYIJR itcW Fu VD Tel: 56&-2z -t&1/--
Purpose for which permit is used: �S rai„,(1•f-
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
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Certificate to he issued to (2.�`Z. Nko vw.}- t a C_ Tel: CZ-ZZ)-C16 i?-
Address: 1 d t l& 'TG o.st=
Owner of Record of Building be,b PCB; I
Address (3 Z n‘c t- \ Nc cs S-c__ r ck
Present Holder of Certificate RC_ PA6.1 M_ 4- I Yl C.
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ignature person to whom Title
Certificate is issued or his agent 9 / 11 1 24
Date
Email Address: monk)f roy®3 cis l ,cool
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-23-1764
12/31/2026-12/3 l/2027