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1146 gaate 28, e5oug paznaoattR, oZZ&02664
APPLICATION FOR FIRE PROTECTION PERMIT
Date A 0 I 10c PERMIT NUMBER 6l-b'I9-db3at(
Projected Start Date: ,0//[0// 8 Date of issue
In accordance with the provisions of 780 CMR and M.G.L. Chapter 148, as provided in
Section •/
application is hereby made by S'e.—S'/role airivts ivi C.
_ (Full name of person,Firm or Cor oration)
Address / 163 / &' Z9 5 _ S Yat/AA° t
/� - n/ii wn (Contact#) ... .FCi... .FC39 4' 0-,
Job Location I 7_3 /t oc, /2,7--
(Street&City or T
For permission to (state clearly purpose for which permit is
requested) r g704-r)
i&-,est// _,r(�fwC sma de/eL /464
9Aarn-5 //1 e- Scum a- lac 19/4s a-4 7'.
2H d C/Aor 000a)j efl* re-MO del
g-/ec i G/�vt/Ye i ast..,// /zo v 14,1i,-64-71 s oil ale�t cis
Name of competent operator(if applicable) e. A /moo Cr
Cert. or License No. /...5/7Z-- Estimated Cost of Construction: I i 000
i
By (Si8"natuIg Applica t)
PERMIT# FEE: $50.00
7.%..4--.: /(7IS-)
13/ 7e,
•
• The Commonwealth of Massachusetts
= its. Department ofIndustrial Accidents
•
6e'all= a 1 Congress Street,Suite 100
;=at_f= � Boston,MA 02114-2017
`Y a wwwmassgov/dia
\Yorkers'Compensation Insurance Affidavit Buildere/Contractors/Elech3clans/Plumbers.
TO BE FILED WITH THE PERhIITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organimtionttndividaal): Seaside Alarms Inc
Address: 1265 Route 28
City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-3940599
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 19 employees(fall andforpart-time).• 7. 0 New construction
2.01 am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.No workers'comp.insurance required.]
3.01 anta homeowner doing all work myself[No workers'comp.insurance required]r 9. Demolition❑
4.01 am a homeowner and will be hiring contractors to conduct all wodc on my property. 1 wall ]0 0 Building addition
ensure that all contractors either have workers'compensation insurance or are sole I 1M Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13 QRoofrep airs
These sub-contractors have employees and have workers'comp.insurance.:
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.QOther alarms
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
•Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name oldie sub-contractors and state whether ornot those entities have
employees. If the sub-contractors have employee;they must provide their workers'comp.policy number.
I am an employer that is pratdding workers'compensation Insurance for my employees. Below is the policy and fob site
information.
Insurance Company Name:Associated Employers
Policy#or Self-ins.Lie.#: WCC50050128332018A .. � Expiration Date: X5119
Job Site Address: All sites in yeter]aA o H/g` City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required underMOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and comet.
/K
Signature: 4/4.51—.5<, PRr5fDate: 07-4.3
phone#: 508-394-0599
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector.
6.Other
Contact Person: Phone#:
C: Ili I j riss
1265 Route 28 • South Yarmouth, MA 02664 • 508-394-0599 • MA LIC. #1317C
24 HOUR PROTECTION
October 16, 2018
Yarmouth Building and Fire Department
1146 Route 28
South Yarmouth MA 02664
Re: Second Floor Remodel @ Happy Fish— 173 Route 6A, Yarmouth Port, MA
Dear Inspectors,
The owner is remodeling the second floor owner's apartment at the above address.The new floor
plan is only slightly different than old plan. A new building wide fire alarm system was installed
in 2011 that covers all levels. 120 volt multi station devices were also was installed in the
owner's apartment at the same time.
The as-built fire plan along with the new apartment plan are attached. I do not see any need to
modify the fire protection layout but if I missed something let me know. The new floor plan is
shown with the devices re-installed in the same locations. I am recommending the electrician
install a smoke/CO combo unit in the bedroom since the closet has a gas dryer.
Since some the fire alarm wiring has be damaged and/or removed during construction we will
pull an electrical permit for the rewire.
Seaside Alarms will continue to monitor the fire alarm and provide routine and emergency
service as required.
Sincerely, 404
P Haygo d
Seaside Alarms Inc.
---
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>±:COMMONWEAtTH OF M4SSGgit9SE t> S
1r r B9M1?-4F •
• =Lys= ISSUES THEFoOLLOWING LICENSE AS A
R S SYSQM.CONTRACTOR c
5ERT K BOUCHER! 4
:= 1 4S IDE AC 4 $<
1265 R.
SYA ,. OUTH,MA 0'46.; 9 ~
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v.r 'f317 O:�d3412049 117771``=
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Commonwealth of Massachusetts
War
Department of Public Safety
License:SSCO.000048 •
Security Systems-S-License
E
ROBERT K BOUCHER
IpZe
Employer:
SEASIDE ALARMS INC'
'_ 1 CJ 01/14A— Expiration:
• Commissioner 01/05/2019
o COMMONWEALTH OF MASSACHUSETTS
J:DIVISION,.OF PROFESSIONAL LICENSURE
• ELECTRICIANS
ISSUES THE FOLLOWING LICENSE AS A t:
REGISTERED SYSTEM CONTRACTOR i
ROBERT K BOUCHER _a o
SEASIDE ALARMS INC a
1265 ROUTE 28
S YARMOUTH,MA 02864.4455
1317 07131/2019 117771