HomeMy WebLinkAboutCAPE COD YOGA RETREAT - CERTIFICATES OF INSPECTION I
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�` CAPE COD YOGA RETREAT
1HE � The State of Massachusetts -
rfumrrmu.
a Town of Barnstable
New and Renewal Certificate of Inspection Application
Date 4/20/2016 Fee Required 50.00
In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, hereby apply,
for a Certificate of Inspection for the below-named premises located at the following address:
Street and Number: 2415 MEETINGHOUSE WAY/RTE 149,WEST BARNSTABLE
Name of Premises: Cape Cod Yoga Retreat&Bed&Breakfast
Purpose for which premises is used:
License(s) or Permit(s) required for the premises by other governmental agencies:
Certificate to be Issued to: �
Address: 2415 Meetinghouse Way W.Barnstable MA 02668
Telephone: 9- 6,q49 11, "
Owner of Record of Building: —T—OCK)t i fir) ) S
Address: 2415 Meetinghouse Way W.Barnstable MA 02668
Name of Present Certificate Holder: T.O.B.
Name of Agent, if an
crz
M
NO
SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED'
OR AUTH RIZED AGENT
Ac—
PLEASE PRINT NAME
INSTRUCTIONS: 1) Make check payable to:TOWN OF BARNSTABLE 2) Return this application with your check to:
BUILDING COMMISSIONER, 200 MAIN STREET, HYANNIS, MA 02601
PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part
thereof to be certified.2)Application and fee must be received before the certificate will be issued. 3)The building
official shall be notified within ten (10)days of any change in the above information.
FOR OFFICE USE ONLY:
CERTIFICATE# IC-16 6 EXPIRATION DATE 4/8/ 017
tr The Commonwealth of Massachusetts
Town of Barnstable
2017
Certificate of Inspection .: ��
Cape Cod Yoga Retreat & Bed & Breakfast Certificate No.
Issued to Ed Conture Type: Certificate of Inspection IC-16-86
Identify property address including street number, name, city or town and country Certificate Expiration
Located at Map/Lot 155-018-A01 4/8/2017
2415 MEETINGHOUSE WAY/RTE 149, WEST in the Town of Barnstable
BARNSTABLE
Location Use Group Classification(s) Allowable Occupant Load
1st R-1: Boarding houses(transient), hotels, motels 4
Restrictions 2 Lodging Rooms
(4) Lodgers
This Certificate of inspection is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been
inspected for general fire and life safety features. This certificate shall be framed.behind clear glass and\or laminated and posted in a conspicious place
within the space as directed by the undersigned, Failure to post or tampering with the contents of the certificate is strictly prohibited.
Name of Municipal Building Commissioner Thomas Perry Date of Inspection 4/20/2016
Signature of Municipal Building j �._ Date of Issuance
Commissioner 4/8/2016
COMMONWEALTH OF MASSACHUSETTS - --
TOWN OF BARNSTABLE
APPLICATION FOR CERTIFICATE OF INSPECTION
Date (X) Fee Required$50.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I hereby apply for a Certificate of
Inspection for the below-named premises located at the following address:
Street and Number. s l�
Name of Premises:
Purpose for which premises Jused.
"
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit A
gen
Certificate to be Issued to: - �G
Address:
Telephone:
Owner of Record of Building-
Address: 64 1
' li.
Name of Present Holder of Certificate:
G14
Name of Agent,if any:
r.� M .
SIGNATURE OF PERSON TO WHOM CERTIFICATE
IS ISSUED OR AUT•H, RIM D •GENT
PLEASE PRINT NAME El I 1CM
INSTRUCTIONS:
1)Make check payable to: TOWN OF BARNSTABLE .
2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified,
2)Application and fee must be received before the certificate will be issued.
3)The building official'shall be notified within ten(10)days of any change in the above information.
FOR OFFICE USE ONLY:
CERTIFICATE# K! EXPIRATION DATE: O D I
J020115c
o� Town of Barnstable
r Ci
�Err 200 Main Street Tel. 508 862-4038
AEOMa� `0� INSPECTION REPORT
l s
Date: 4128/2017,11:21 AM Inspector: mckechnr Permit Number: TIC-17-77
Name: T.O.B. ---C,�,tpBB ccd 7 U jcL� +-,reaA
Address: 2415 MEETINGHOUSE WAY/RTE 149,WEST BARNSTABLE
Inspection Type Inspection Item Status Comment
Certificate of Inspection A- Inspection Results FAIL No one on site
Inspection Overall Comment:
Overall Inspection Status: Not Reviewed Re-Inspection Date: 4/28/2017
Inspector Initials: Person in Charge Initials: Total Score: 100
IL
The Commonwealth of Massachusetts
TOWN OF BARNSTABLE
In accordance with the Massachusetts State Building Code, Section 106.5, this
CERTIFICATE OF INSPECTION
is issued to ED CONTURE
Certify that 1 have inspected the premises known as:
CAPE COD YOGA RETREAT& BED& BREAKFAST
located at 2415 MEETINGHOUSE WAY in the Village of W BARNSTABLE
County of Barnstable Commonwealth of Massachusetts.
Construction Type:
Use Group(s): RI
The means of egress are suff cient for the following number ofpersons:
f Location . Capacity Location Capacity
2 LODGING ROOMS
(4)LODGERS
Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel
201501253 4/8/2015 4/8/2016 018 AA1
The building official shall be notified within(10) days of any ZA
changes in the above information.
Building Official
COMMONWEALTH OF MASSACHUSETTS
TOWN OF BARNSTABLE
APPLICATION FOR CERTIFICATE OF INSPECTION `
Date 2�/1� (X) Fee Required$ 50.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I hereby apply for a Certificate of
Inspection for the below-named premises located at the following address:
Street and Number: S
Name of Premises:
1
Purpose for which premises is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agengy
Certificate to be Issued to:
Address: / 5
Telephoner !D �1 • �, . •� �.
�1
Owner of Record of Building:.
Address:
Name of Present Holder of Certificate:
Name of Agent, if any: 7y
SIGNATURE OF PERSON TO WHOM CERTIFICATE
IS ISSUED OR AUTHORIZED AGENT L�j
ct Y"L_0-
PLEASE PRINT NAME
INSTRUCTIONS: r;r,
1)Make check payable to: TOWN OF BARNSTABLE
2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified.
2)Application and fee must be received before the certificate will be issued.
3)The building official shall be notified within ten(10)days of any change in the above information.
FOR OFFICE USE ONLY:
CERTIFICATE# ails EXPIRATION DATE: ZI �v
t J081210
i
I
11
The Commonwealth of Massachusetts
TOWN OF BARNSTABLE
In accordance with the Massachusetts State Building Code, Section 106.5, this
CERTIFICATE OF INSPECTION
is issued to ED CONTURE
Certify that I have inspected the premises known as:
CAPE COD YOGA RETREAT& BED& BREAKFAST
located at 2415 MEETINGHOUSE WAY . in the Village of W BARNSTABLE
County of Barnstable Commonwealth of Massachusetts.
Construction Type:
Use Group(s): Rl
The means of egress are suff cient for the following number ofpersons:
Location Capacity Location Capacity
2 LODGING ROOMS
(4)LODGERS.
Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel
201402885 4/8/2014 4/8/2015 5 018 A01
The building official shall be notified within (10) days of any �
changes in the above information. Building Official
t/"
COMMONWEALTH OF MASSACHUSETTS
TOWN OF BARNSTABLE
APPLICATION FOR CERTIFICATE OF INSPECTION _ a
(X) Fee Required$ 50.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I hereby apply for a Certificate of
Inspection for the below-named pr'aAemiises located at the following address: ( �
Street and Number. `"' W�
Name of Premises:
Purpose for which premises is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit AgencX
Certificate to be Issued to:
Address:
Telephone:
Owner of Reco )f Building: f
.i Address:
Name of Present- r of Certificate:
Name of Agent,if an `'
9
SIGNATURE OF PERSON TO WHOM CERTIFICATE r
IS ISSUED OR AUTHORIZED AGENT s'
PLEASE PRINT NAME
INSTRUCTIONS:
1)Make check payable to: TOWN OF B.ARNSTABLE
2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified.
.2)Application and fee must be received before the certificate will be issued.
3)The building official shall be notified within ten(10)days of any change in the above information.
FOR OFFICE USE ONLY:
QQ �
CERTIFICATE# O CJ EXPIRATION DATE:
J081210
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Coyle, Brenda
From: Niemi, Maureen
Sent: Wednesday,, May 07, 2014 9:36 AM
To: Coyle, Brenda
Cc: Niemi, Maureen
Subject: Parcel 155-018-A01 2415 Meetinghouse Way, West Barnstable
Good morning, Brenda,
Please be advised that Edmond Couture is on a payment plan for delinquent Real Estate taxes on the above property.
Thus far, he has.kept the payment agreement; therefore, I would authorize you to release the certificate we discussed
today.
If you need additional information, please do not hesitate to contact me.
Very truly yours;.
Maureen
Maureen E. Niemi
Town Collector
Town of Barnstable
P.O. Box 40
Hyannis, MA 02601-0040
Tel: 508-862-4055
Fax: 508-790-6310
Email: maureen.niemi@town.barnstable.ma.us
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4'Jarnin6 TypejrDescription Reference
Restricttton.;" BARNSTABL, •i: C19}01 2005
Restriction OLD KINGS... 09/0112005
Prior Applic... GAS RESIDE... COMPLETE,'CLOSED APP 08!02/2001
Prior Applic... CERTIFICAT... COMPLETE%APPRV COl 05/22/2013
Prior Applic... CERTIFICAT... ACTIVE/ACTIVE APP 04/2 51 2 01 2 '
Prior Applic... HOME.00CU... ACTIVE f ACTIVE APP 10118;2011
Prior Applic... CERTIFICAT:.. COMPLETE/APPRV COI 05/02.12011
Prior Applic... GAS RESIDE... ACTIVE/ACTIVE.APP 11/14/2008
Overdue Bill REAL ESTATE 2014 20 00002335 54,737 07,101/2013
Overdue Bill REAL ESTATE 2013 20 00002331 54,840 0T102,i2012 OW, 0 00Overdue Bill REAL ESTATE 2012 20 00002296 5697 07/01;2011Overdue.Bill REAL ESTATE 2009 20 00029443 SS,OIU OSJ30/2012
Overdue.Bill REAL ESTATE 2008 20 00029244 $42.1 05/30.12012
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197 = 00 T
`l112 11 • 00 +
15 = 755 • �0 .
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eommouwealtb of Aa.5.5arbu!6CR5
TOWN OF BARNSTABLE
In accordance with the Massachusetts State Building Code, Section 106.5, this
CERTIFICATE OF INSPECTION
is issued to ED CONTURE
QLErtffp that 1 have inspected the premises known as:
CAPE COD YOGA RETREAT& BED& BREAKFAST
located at 2415 MEETINGHOUSE WAY in the pillage of W BARNSTABLE
County of Barnstable Commonwealth of Massachusetts:
Construction Type:
Use Group(s): RI
The means of egress are sufficient for the following number of persons:
Location Capacity Location Capacity
2 LODGING ROOMS
(4)LODGERS
5
Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel
201303324 4/8/2013 4/8/2014 155 01 , 01
The building official shall be notified within(10) days of any
changes in the above information. Building Official
mfl
� k COMMONWEALTH OF MASSACHUSETTS
,_
'TOWN OFBARNSTABLE =-
APPLICATION FOR CERTIFICATE OF INSPECTION
Date hij . ("X) Fee Required$ 50.00
( ) No Fee Required .
In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I hereby apply for a Certificate of '
Inspection for the below-named premises located at the following add,r ss:
Street and Number: !�!�•
Name of Premises: YAK MA&
Purpose for which premises is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency.
Certificate to be Issued to:
Address:
Telephone: S
.Owner of Record of Building: l
Address: / sk
Name of Present Holder of Certificate:
4 Y
A .
Name of Agent, if any: ' v
SIGNATURE OF PERSON TO WHOM CERTIFICATE �a
IS ISSUED OR AUTHORIZED AGENT %
PLEASE PRINT NAME
INSTRUCTIONS:
1)Make check payable to: TOWN OF BARNSTABLE
2).Return this application with your check.to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS,MA 02601
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified.
2)Application and fee must be received before the certificate will be issued.
3)The building official shall.be notified within-ten(10) days of any change in the above information.
FOR OFFICE USE ONLY:
CERTIFICATE 4015 /I EXPIRATION DATE:
J081210
CommonWeaftb of Aa.5.5arbuoetto
TOWN OF BARNSTABLE
In accordance with the Massachusetts State Building Code, Section 106.5, this
CERTIFICATE OF INSPECTION
is issued to ED CONTURE
3 QLUMP that I have inspected the premises known as:
CAPE COD YOGA RETREAT&BED&BREAKFAST
located at 2415 MEETINGHOUSE WAY in the Village of W BARNSTABLE
County of Barnstable Commonwealth of Massachusetts.
Construction Type:
Use Group(s): R1
The means of egress are suff cient for the following number of persons:
Location Capacity Location Capacity
2 LODGING ROOMS
(4)LODGERS
Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel
201202390 4/8/2012 4/8/2013 155 018 1
The building official shall be notified within(10) days of any
changes in the above information. Building Off cial
" COMMONWEALTH OF MASSACHUSETTS
TOWN,OF BARNSTABLE.
APPLICATION FOR CERTIFICATE OF INSPECTION
` 2
Date_ J zi (X) Fee Required $ 50.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, 1 hereby apply for a Certificate of
Inspection for the below-named premises located at the following address:
Street and Number:
/5
Name of Premises:
Purpose for which premises is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit A
Certificate to be Issued to: /1
Address: r .Q
Telephone: 12Dd (p X
Owner of Record of Building: F
Address:
aI �IZ4'tllName of Present Holder of Certificate: (,
Name of Agent, if any:
CD
SIGNATURE OF PERSON TO WHOM CERTIFICATE T
IS ISSUED OR AUTHOR}}ZED AGENT
PLEASE PRINT NAME co r`°
INSTRUCTIONS:
1)Make check payable to: TOWN OF BARNSTABLE
2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS,MA 02601 I
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified.
2)Application and fee must be received before the certificate will be issued. L
3)The building official shall be notified within ten(10)days of any change in the above information.
FOR OFFICE USE ONLY:
CERTIFICATE# I EXPIRATION DATE: 2 (�D
k5
� I
J081210
ti -
s
i
TOWN OF BARNSTABLE Date: ... ill .✓.�
El New Application
s�xivsr�aie �: LICENSE APPL,�CATION renewal:
200 Main Street
1639. A ❑.Transfer
Hyannis,MA 02601
(508) 862-4674 El Other
—� NO BUSINESS MAY, OPERATE WITHOUT A VALID LICENSE ON THE PREAUSES f—
PP Poration/LLCM
Name of a Home phone IicanUcor _ ___�—.___._.—._.__ _.__._ ___._.—._—___ ` �
Address of applicanUcorparation/L.LC ------ -- ,— - - Business phone#: ...: s, °
........ ......
I
Business location: .Business mailing address_if_difterent from iabove} - _
License Type: `-... ..... -� ........ Annual-'� --- -- Seasonal— '----�
Hours of Operation: _ Federal ID#:
Hours of Entertainment: Hours of Alcohol Service:
Name of Manager: _ �iet8- --- ema �,� i r, h✓�� �� a• I
_ '
Manager's permanent mailing address / --f ;` `= -` �- ` ,- 1' - -------------- ----'-'-- ---home'ers --
Mana hone#: 66 j
9 P _._.....____ uslness phone .�'`' �iF�_-_PS_. _�..___
Name of property owner: P
ASSESSORS tMP/PARCEL'# M ` ., ,,.-.,._,,, PARCEL ` 00' �'t�/„
a
List any flammable,substance or haazardouss waste-used in bustness�ispecifyy7 ,,,-, r E
IV
;Applicants must ONLY contact the Building Commissioners offie, (508) 8,62-
4038, : the Board of Health office, (508) 862-4644, and the appropriate Fire i
District office to schedule inspections IF YOU ARE .NOT OPEN OFFICE BUSINESS
HOURS (8 :30 — 4 :30 daily) .
/Ir j
Signature of applicant
........................................................................ ........ ..... f ... ..... ....... ............. .........................................................................
J F,6r own,use only
REAL ESTATE TAXES PAID IN FULL :s
PAYMENT AGREEMENT IN EFFECT ON.
IS THIS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES ❑ AO ❑
INSPECTORS APPROVAL Capacity set by Building Division
_......._.—.__..........
_______..____
j
Building/Zoning 41 -- Date _ -23��3 Board of Health_ _.__ Date ... _..._. --
Fire District Date Comments:
-'-'---'-'—'—'-'----"---'---"---._.._..._... _-----' ....-----"----- _...--...__...--'-......._.........._._...................._...'--'-- .-..__._._.._................_........._._....---'-'-...
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White-Licensing.Authority Gold-Building Commissioner Pink-Fire Department Canary-Health Division
The Corr monwea ltb of Aamsarbuott!6
TOWN OF BARNSTABLE
In accordance with the Massachusetts State Building Code, Section 106.5, this
CERTIFICATE OF INSPECTION
is issued to ED CONTURE
Qtertifp that I have inspected the premises known as:
CAPE COD YOGA RETREAT&BED&BREAKFAST
located at 2415 MEETINGHOUSE WAY in the Village of W BARNSTABLE
County of Barnstable Commonwealth of Massachusetts.
Construction Type:
Use Group(s): Rl
The means of egress are sufficient for the following number of persons:
Location Capacity Location Capacity
2 LODGING ROOMS
(4)LODGERS
Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel
201102248 4/8/2011 .4/8/2012 155 018 A01
The building official shall be notified within.(10)days of any _
changes in the above information. Building Official
COMMONWEALTH OF MASSACHUSETTS
+" •' TOWN OF BARNSTABLE �.
APPLICATION FOR CERTIFICATE OF INSPECTION
Date X) Fee Required$ 50.00
( ) No Fee Required
In accordance with the provisions of the Massachusetts State Building Code, Section.106.5, I hereby apply for a Certificate of.
Inspection for the below-named premises located at the following address:
Street and Number: i�' �' ..�-►�_ �..�/
Name of Premises:
' 1edL
Purpose for which premises is used:
License(s)or Permit(s)required for the premises by other governmental agencies:
License or Permit Agency
Certificate to be Issued to: Ej .�.-lc�r'�
Address:
Telephone:
Owner of Record of Building: i
Address: llpl I
Name of Present Holder of Certificate: ✓�:
Name of Agent, if any: ri
SIGNATURE OF PERSON TO WHOM CERTIFICATE e
IS ISSUED OR AUTHORIZED AGENT.
&714- C
PLEASE PRINT NAME CIO
INSTRUCTIONS:
1)Make check payable to: TOWN OF BARNSTABLE —;
2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS,MA 02601
PLEASE NOTE:
1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified.
2)Application and fee must be received before the certificate will be issued. ,
3)The building official shall be notified within ten(10)days of any change in the above information.
FOR OFFICE USE ONLY:
, 'n - 41 j19)
CERTIFICATE# Q EXPIRATION DATE: ��
J081210
I -
y �1lIE1 i�.��TOWN OF BARNSTABLE Date: .._... .................... ......
� ❑ New Application
LICENSE APPLICATION ®..Renewal
M� � 200 Main Street El Transfer
63 Hyannis,MA 02601
508 862-4674 ❑ Other
o NO BUSINESS MAY OPERATE WITHOUT A VALID LICENSE ON THE PREMISES -4
Name of applicanticorporation:
d&4 v-n /42— Home phone#:
Address of applicant/corpora6on:..�_�i-_._ '..,�� . .�.._ ..--...._.... ..._.. ._. .. �.... .. ..... p .S Lb ..........................
— -- Business hone#: ................... . �
_..............----_----...-� -----.._.._ ....__ _.. .... _.__... .._......_......_ � -.._.. _ ...__ -- _ .._._.. _._..__...__._..... -.._.. ...... -
D/BIA - ._.._ .. ��__. ... _..... r' ..._.. Business phone#: ... ' .. ' .��
Business loca'on: —--...._......__...._. }`, - .. _.. _._. �`, ' ....._..._......_....__.........._._...._..... _..._.__.........._........
...._....._.._......_..._...-
Business mailing address: ......_..._..._.. - ....__ .. ..__ .........:.:.._ r -...._....._� .-........... «. .. -- ...
Local business address:
_... .. ._.__.._..__.......___.__..._._._........._........_.....
—..__._._._:_.......----....__._._-_.._._...._...------....__.___.___—______..___...—...—.__..__._...__......_..._
Local mailing address: —--..... ..__.....-—----..__._....-...._._._.__...._..._......_._....._..._......— -- --........- ....... -....._..........._.:_..._........__... - -----_-.—._.._Annual Seasonal
___._._...---._......_._..._...
LICENSETYPE: ......, 11 .1, ...................................................................................................:.........:....... 0
HOURS OF OPERATION _
Name of manager: � ' . ......__ .__...-----._._.. ......._... ._..._..._ entail: wd' �PsyGc GaiCJl '°5S�vwxoa-�d'
Localmailing address: y.. .. ,. .. ................ �..........., .. .. .' ...................................................................................................................................
Manager's'permanent mailing address: °_._.. .._..._._.._ .-.__..... __...................... ._..._.__._..................
.._� .. _.. __._.........._._.__.
Managers home phone#: LIW_.. ._ '" Business phone#: _.._..___._..._._._..._...._-____...__.
Name of property owner: `_ ..' .'�_�..-- (r_u.t- y-- W
ASSESSOR'S MAP/PARCEL M MAP - ................................- PARCEL _.
.;��...
List any flammable substance or hazardous waste used in business (specify):
Applicants must ONLY contact the Building Commissioner' s office, (508) 862-
4038, the Board of Health office, (508) 862-4644, and the appropriate Fire
District office to schedule inspections IF YOU ARE NOT OPEN OFFICE BUSINESS
HOURS (8:30 - 4 :30 daily) .
Signature of applicant
.............. ...................................................................:.....................................e...o....nly.............
...........
...........
..........
...............
....................
............................
- � � Fo "T wn us
REAL ESTATE TAXES PAID IN FULL
PAYMENT AGREEMENT IN EFFECT ON
IS THIS USE PERMITTED WITHIN THIS ZONING DISTRICT? YES ❑ NO ❑
INSPECTORS APPROVAL " Capacity set by Building Division..-...........
.....__........
__.._.__._-.____..._.__.......__...
Buildingl Wing f _ c__......__...---........___. Date .......:_1.0. a_6_.......l..l..._...._.... Board of Health_..._.__._...___.....—...---.___.._.__._.........._..............._. Date ._......._._.___._..—.._.__....__...--
Fire District ...........----..........._._................_............................._.......Date........._..........._.......-.....--........................._..Comments:_.__.......__._......__......._......_..._... ..._._.._.... --.......-------._........_.............._......_...__.......
__......_.._.._.
White-Licensing Authority Gold-Building Commissioner Pink-Fire Department Canary-Health Division
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• ;: : LICENSE�AP�PLICATION
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, k n200 Main Street.P „ . : ,.:,. ,�
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NO BiJSINES5L ;AY'OPER'ATE WITHOUT rA 'VALID�'LICENSE fON,THE PREMISES a-- 4
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j:Name of;applicanticorpoeahon r L7 `� .'t j __ __ Home phone# } _
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Address of appI int/corporataon -.R1�` !f "�"` Business phone#
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DIBIA .... _ _ 4 _. -' Business phone# 6._`�g..-Y..7 -
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Business location: -._.___ -- �7 _...... _ - - --- -.._ ..-- -- -
Business mailing address:- - 5$/ "� -------- ---= --._::. --- - --' -: - ---- - - -- - --
Local business address"'
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;:Local mailing address: _-- -, _ - ---- -y __.._ _... - - - ----
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LICENSE TYPE: . g ,
� � al Annu Seasonal
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HOURS OF OPERATION: ! F { .� }.FIQ 4r
Name of manager: ` $ . _._ entail IL
t ocal mailing address ... f..�' _. I t":L :•• '
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g P ing address � -� ._.'""Mana er s ermanent mail
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Name of roe owner __ _
P P rty. _._._........ --....,._ _._...._ .._...,..`[ -
ASSESSOR'S MAP/PARCEL# MAP ...f .. ,,,, PARCEL .....D 1 .......A .::I
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`List-any flammable substance or hazardous waste used in business (specify):
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Appli'cani s must ONLY contact' the Building `Commissioner'`s office,: (. ..8) I. .
.403.8, the Board of Health. office, (508) 862 4'6.44, ;`and the agxi`dpriate -Fire
District. office to schedule inspection's IF YOU 'ARE:.'NOT `OPEN/OFFICE BUSINESS r
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1. /' F'r Town use only_
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'REAL ESTATE,TA7CE. PA D fiN FULL . .
PAYMENT AGREEMENT IN EFFECT ON .
IS THIS USE PERMITTED WITHIN'�THIS ZONING DISTRICT? YES ��}'� NO
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` INSPECTORS APPROVAL r'>' L Capacity set by Bwldmg Dyislon .... 1! .:_ C _
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Buildin /Zonin _-_.. Date � __ ......�_< ......- .Board of Health....._ -- --- -- Date .::.. _ - -
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. Fire District ._.........._.._..._-- --_...._ .........._.-.......Date.... ......._....__._................ Comments .__._..._. _.._._.._. -- - ......... .... ..
. White-Licensing Autirority, Gold-Building Commissioner Pink-Fire Department Canary-Health Division
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