HomeMy WebLinkAboutBCOI-23-1751 application YA of___' �.� ., TOWN OF YARMOUTH
, Office of the Building Commissioner
.4' " yA 1146 Route 28, South Yarmouth, MA 02664
f . = ---4, 508-398-2231 ext. 1260 Fax 508-398-0836
MATTACHEESE
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APPLICATION FOR CERTIFICATE OF INSPECTION
August 24, 2026 PAYABLE UPON
(X) Fee Requir d$150.00
( ) No Fee Require
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:/ 3/4 POU fe 6/4 7wmo V A Poi-I HA O 2-6 .__c
Name of Premises: ‘c� {an (..k,to, p ego it-Yet:
Purpose for which permit is used: A / D
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
RECEIVE ®
Certificate to be issued to Tel:
SEP 2 8 2026
Address:
BUILDING DEPARTMENT
Owner of Record of Building By -----
Address -------
Pr r of Certificate
Signatur person to whom Title
Certificate is issued or his agent Di— Z. $,Z6
Email Address: 6.0 L43 4 L /7'i v / D'- M5, tate,
)AltL, C
p00 . Oh
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-23-1751
12/31/2026-12/31/2027