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`gid' ft/6 4r, • . r BUILDING PERMIT APPLICATION , APPUCATION TO CONSTRUCT,REPAIR.RENOVATE,CHANGE THE USE.OCCUPANCY OF, Ie____."/ �e OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. 0J: T nvii Ili l`arnidutII Building Drpannirnt, - r` C I I46 Rutile 29 • lannouth, MA1Ma'ti1 f{9? ---__ Tel. 508.39&-2231 ext. 1261 Fax 508-398-0826R EC. ' it � Cate Use 0. Ftimay m: Soar!Intotron Assessors 0eq^trxrt m Int F OF l793: e L .e! aanirre moo OCT 16 2018 Perr^1R Fee $j0 L O Endorsement Data /lit . Recordmq Ca`t Ney BUILDING DEPARTt_ENT PIa11 N0.. Deposit Recd. S Date t 4 P�Pey Dimerslort L°q — Net Due $ 100S Other Lot Arra 1st) Frortaps(1) Lot Coverapt This Sectfbn for OtAca Use Only Building Permit Number. Date Issued: Signature: /1'6-/J) Certificate of O upancy Bolding O; c4! Date is Is not rectokeC. Section t Site Information 1.1 Property•ddresst 1.2 Zoning inlorrnaborc 17 Long Pond Dr South Yarmouth,MA Usbtrt. . Zoning District Proposed Use 1.3 Building Setbacks(rt) Front Yard Side Yards Rear Yard Reautred I Provided Recurred Provided Redtared Provided , 1.4 Water Suppy(14.41.,0.40.S 541 1.5 Flood Zone 101u,,,.at.. Comments Public Private Zone BFE: Section 2• Property Ownership/Authorized Agent 21 Owna of R.ewdt.:.. - i. WGY,int ' 365 Boston Post Rd,Suite 384,Sudbury,MA 01176 Name(fit) r. Mailing Aodrew 617.770.6450 512nature Telephone Telephone -j 2.2 Authorized Agent r rail Address a It Name(print) Mail' . s e - I( f 7 �0 ntlt:e ha. __ sgna ure rnephone Fax - Em-- att Address: I Section 3-ConstructIon SeMen 3.1 Licensed Construction Sup.rvleon Not Applicable ❑ ID_ Si,t_'',` 9 Sc ,, 4 t,1,,_;,,t .3 Number •34 M+ /: Is�C C.t n Add s S" / . cs S�<<lns� :,: Expira$ Date &gnat-sr* 6% rneprcn. Ema' actress: q - :3--c)o/ 9 S4.e•r:Si-c;,z. bo;irtit .cern Gmcti -or coil wi-Fh 'du-es}-1`6,-1s or issuo- _ 77`11330=03 8 (F y tit4 "reR ,c.C_IIYVI ' - 13.2 Registered Home Irnpmvement Contractor.] • . i Cornp1a�nyN�a1rne ` NotAPplicaY* lK—I iiCj+t'` C'1t: .4 •x•i 1 C1 ;N3 Regtstebon Number k � cJ� r i n ea t. .:1"�,/y4«/ ^ •Y''J SD cE.-) tg ccs EcsnSan Das I ✓!Ss inamn v C 1 Taiepnorr )) 1 C t �( Section 4-Workers'Compensation Insurance Affidavit(M.G.L c. 152 S 25C(61 I Workers Compensation Insurance affidavit must be completed and submit ed with this application.-Failure • to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ...)(....- No `s Section 5` Professional Design and Construction Services-for Buildings and Structures Suolect e= P to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) I Section 5.1 Registered Architect i Daniel IC Mullin Nd Appkable 0 • iS Name(Reglshant$ a 517 S.Main Str et,Moscow ID 83843 Registration Number 30437 Address ~ t 208.892.8433 Eimiotbn Data 0613112019 i i Signature Telephone , a E Section 5.2 Registered Professional Engineer(s) Don Penn Consulting Engineer Mechanical/ElechicaV Plumbing ':_ ':. Aree d Responslbaay , . Nam• 1301 S na Blvd. idg.11 Suite 1420.Westlake,TX 76262 3993p9-Myu/33g9r742-E I Address : 817.410.2858 RVg)u/Lo/ ub139129 1Signature Telephone ErdiratCn Dais • .. Mee d ResPons41M I :: Name 1NumberRegistration Numb t Address " .� I Signature ' Telepttone Eimkatan Paw r Area at RaspormWiity � Nama AddressRegistration Number : Signature . . Telephone expiration Date ,.:1 iName Area d Responsibiiey j Registration Number Address Signature Telephone Eapkeeon Date i. 1 Section 5.3 General Contractor I Leibo Brothers Management Not Applicable 0 i Company Nama ' Person Responsible for ConsM.iction 142 Temple Street,Suute 301,New Haven,CT. 06511 1 Address 2034564465 . 4 s° • Signature telephone ! r ' t 2 d 4 -L Section 6- Description of Proposed Work(cheek nk applicable) New Constnletlete .0 floc mutriae raThy onyi No,of BeCrooms f (fx multiple trey linty) No.of Batnroorns Dimling Bldg. Pepa'.r(s) ❑ ! Alterations J AddPlon ❑ Accessory Bldg. 0 Type Demolition Other Specify: Brief Description of Proposed Work: Remodel of the Existing Planet Fitness to include new fixtures and finishes in the existing locker rooms and other areas throughout the • fitness center. New plumbing fixtures in existing locations in the locker rooms, Reconfiguration of the reception area and self serve tanning and self serve massage with new partition walls.electrical lighting.suspended accoustical tile ceiling.One existing RTU to be replaced In existing location riesling accoust cat tile ceiling in main workout area for new grid insert with new light fixtures.Existing highbay lighting to be replaced in existing locations. Section 7-Use Group and Construction Type Building Use Group(Check as appricapable) I Construction Type A A55EM9LY. (� A•1 ❑ A.2 i] ... A.0 a i :.1A 0 AI A-s ❑ : 10` ❑ 0 BUSINESS 0 2A ❑ E EOUCATIOVAL ❑ - `. M � F' FACTDriY C F•, ❑ F-2 ❑ 2c ❑ H HIGH HAZARD �❑ s- ❑ I INSTInrtIDNAL I] H ❑ 1.2 3 14 ❑ 7a.. ❑ M MERCHANTL E. ❑ 4 ❑ R..RESIDENfAL f> R•t r, R-2 t] 11-3 ❑ a I'] S.-STORAGE �Q s-1 ❑ S2 ❑. S0 . ❑ U diary $❑ SPfCFY:- '_ ..— ,. M. MIXED USE I] ,. StECrFY.:. S SPECIAL USE Q SPECIR Complete this section if existing building undergoing renovrations,additions and/or change In use. EXisthp Use Grpup: A•3 :: _orb tJsa Groam: . : '. Existing Hazan2 Index 790 CMR 34 ' Proposed Hazard Index 783 Cf li 34 Section 8 Building Height and Area ' Building Area EXiseng(it applicable) Prostate! Number al noon;or Slone; IrhtkxL basemerd as+•s I'.1 with existing mezzanine Floe Ana pet Flinn(s1 (14"767 sf main level.1 452 sf mezzanine Total Area Alt Floors(sf)- 16219 Total Het tt(It) i: Section 9•STRUCTURAL PEER REVIEW(780CMR 110 11) I Independent Stnxtlral Engineering Structural Peer Review Reouirad - Yes_..__ No SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I' ,as Owner of the subject property, hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Data 3044 OVER 0 4 U 2 p 0 F O Ci o E W c 9 o o N < hi cC dpa pp S < U o Y a O [T w tP g 0E W « 91 C ! �` N Z - . ,P Q . W p o f F U c 0 90 g 0 N a € 1° S ¢ ❑ ❑ fn E. , • • The Commonwealth ofifassachusetts =9 Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston MA 02111 www.mass.got/dia Workers' Compensation Insurance Affidavit: BuildersiContractorsfElectricians!Plumbers Applicant Information Please Print Legibly Name(Husmess'Orrnica:ion'Individtal) p e -1 i� I Address: `i 1 L c vi ck tr 4vr-t City/State/Zip: ( Ler 1 4t .ti. r`/1 crct '7 ?hone#: gat' -)4�'—r',.-- , 1 Are you an employer?Check the appropriate box: 4. Type of project(required): 1. I m p employer:h d"-} ❑ I am a g•neral coctnctor and I employees (5.iIl and/or part-time).* have Fired he sub-contractors 5. New construrion 2.❑ I am a sole proprietor or parnler- listed on the attached sheet 7. Q Remodel ng shipand have no employees These sub-contractors have S. ❑Demolition work�a forme in any capacity, employees and have workers' 9. ❑Bwldag addition No workers' comp, insurance comp.insurance.: required:] 5. ❑ We area corporation=d its l0.❑ Elect-ion repairs or additions 3.0 I am a homeowner doingall work officers have exercised their 11.0 Plumbing repairs or additions myself. No workers'comp, tight of exemption per MGL 12 ❑Roof repairs insurance required.]t c. 152, §I(d),and we have no 3a.LII am a homeowner acting as a employees.[No workers' 13.0 Other general Contractor(refer to#4) comp.insurance required.l. '-lay appticam that cheats box a1 muss also fill out the section bebw showing theirworkcs'contocusatiod3olicy information. T homeowners who submit:his a.'Sdavit indicating they are doing all work and then hire onside=net=ran submit a new affidavit indicating such. :Contaeasa that check this box must attached an additional sheet showing the name of the rabconuacw;s and state whether or not those entitles have employee. if the sub-coanctxs have employees,they must provide thenworkers'comp.pokey number, T !am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: 1 r-a. ye Le C t? Policy it or Self-ins. Lic.d: A r s-'( ; R t - c;S 741' ((�{ Expiration Date: I I ..;) 1 - 3 l+, 11 lob Site Address: I1 ( c. .:,i ('art,,,!: Ci iState/Zi :_ r.t( Attach a copy of the workers'compensation policy declaration page(showing e policy number�d expiration date). I I e Failure to secure coverage as required under Section 2SA of MGL c. 152 can lead to the imposition ofcrrninal penalties of a fine up to 51,500.00 and/or one-year irnprsorsnent, as well as civil penalties in:he form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. 9e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certifyunderr^the pains aired penalties of perjury that the information provided above is true and correct. ch.. 'rare: .:. t . r''3 A r _.'Ili Date. P-1 ^r!-1 ? ?hone 4: Cite' LI 4 - } 1 Official use only: Do nor write in this area, to be completed by city or rosin 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 4: 6 • a Y"R TOWN OF YARMOUTH • --- 0 DEPARTMENT • o BUILDING 1146 Route 28,South Yarmouth, MA 02664 r\ : r,�� •• 508.398-2231 est. 1261 Fax 508-398-0836 BUILDLNG DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.3, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Vi l_,. -s .rt c f Work-Address Is to be disposed of at the following location: 1 , 4 iG't-r. •,�.•<.•' Said disposal site shall be a licensed solid waste facility as defined by M.G.L, ChapterjI 11, Section 1/5r0A. ` :'i, .✓ ,rj off ° "/Signature of application Date Permit No. II•_ --. Office m Consumer Affair B Bua;ness Reguianon NOME IMPROVEMENT CONTRACTOR HYPE LLC 0.31915•ra 0 . .i 161:%6€ - 11 C52010 SNe na i:dlnc Stephentep LancrySte3u • 99 island Dr, Charter), MA O15C7 unae-----g ecretary .:.•,,,n.,r tarn 104W of Bi.Ading Rego,atons ems Slandans% r 249715 !zones 002122,2019 STEPHEN DIANDRY 12 SPRING STREET JI SOUTHBRIDGE MA 01560 ♦ _ CDennrttsWMr COMMERCIAL ONLY-BUILDING PERMIT APPLICATION REGULA TORY APPROVALS NOTICE Address of Proposed Work: Planet fitness.17 Long Pond Or,South Yarmouth,MA 02684 Scope of Proposed Work: Remodel of the Existing Planet Fitness to include new fixtures and finishes in the existing locker rooms and other areas throughout the ftness center, New plumbing fixtures in existing locations in the locker rooms Reconfiguration of the reception area and self serve tanning and self serve massage with new partition walls,electrical,lightingsuspended accoustical tile ceiling.One existing RTU to be replaced in existing location.Existing accoustical tile ceiling in main workout area for new grid insert with new light fixtures Existing highboy lighting to be replaced in existing locations Based on the scope of work described abos•e,the applicant is required to obtain approval sign- ffs from the following departments as checked-off below: INirtA1,S Health Dept, —508-398-2231 ext. 1241 Conservation Comm.--508-398-2231 ext. 1288 _flirter Dept.-- 99 Buck Island Rd. phone no.508-771-7921 Old Kings hfs7t !list Comm.--508-398-2231 ext, 1292 MEngineering Dept.-508-398-2231 ext 1250 ire Dept,—Kevin Hucl./James Armstrong,96 Old %lain St.SY )0 " H-49Note, Please call Fire Department for an appointment.508-398-2212 Kl Other Appropriate plans and/or application shall be provided to each of the departments checked-off abol e. Each of these regulatory authorities has their own requirements outside the jurisdiction of the Building Department, Ml applicable approvals shall be obtained prior to submitting a building permit application to the Building Dept. Thank you for cooperation. Receipt Acknm�ledgement: Applicant's Signature 4,.."'" Date Rev.Dec 2015 • pf.Y_�trr TOWN OF YARMOUTH RE����ED ' c HEALTH DEPARTMENT 't 17 Z11R •. ,y ALTH DEPT. PERMIT APPLICATION SIGN OFF TRANSMITTAL S To be completed by Applicant: Building Site Location: n12 2o�tc� �ay.d` Dr ProposedeppImprovement: t�erne-I c�cTcti�.t Q\- -o)- RA c , new gkIt,�cS �^ tBt4Ln7e r... c , le-se rbrA3 "r-C rt_ Pn e Applicant: M;dLJ LA"-11._ 1 r Tel. No.:?7`F-al-3o-ogar Address: 99 ala S r C \oars/ e-4 14 O l5b7 Date Filed: I o **If" ou would like e-mail notification of sign off please provide e-mail address: M a v.c f r` e S'TreAC&Ae CoM V Owner Name: g-V Tint. Owner Address: 3 k.S 'os Ova pas'} RA 54 38"I Su ofL ur1 Owner Tel. No.: 61.7-170 - 0-1C0 rivbr ott ?fo RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings, water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed)- Note:Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: pAttey /f/L���,,./�„r.I DATE: Ay/ 7/r? PLEASE NOTE / ` COMMENTS/CONDITIONS: MGL AND FIRE TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE. .f.cris 4ERRORS OR OMMISSIONS DO NOT RELIEVE ,, THE APPLICANT FROM THE RESPONSIBILITY b i OF"AS BUILT"C PLIANCE. ,, / DATE: • INSPECTOR YARMOUTH FIRE PREVENTION Commercial Construction Building Transmittal Project Name: Planet Fitness Address: 17 Long Pond Drive Contact Name: Michael Landry Phone: 774-230-0328 Y NO NA Subject Regulation E S X Access for Fire Apparatus 527 CMR 1; 18.2.4.1 X Building Numbers MGL Chapter 148;sec 59 X *Flammable gas/liquid storage 527 CMR 1;42.2.2.1 X Fire Lanes 527 CMR 1;22.3 X *Service Stations 527 CMR 1 ;16.2.3,16.2.3.1,30.3.2 X *Hazardous Materials Storage 527 CMR 1;60.1 X *Kitchen Exhaust Systems* 780 CMR,527 1;50.1 X Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28 X Fire Alarm Systems/CO detection* 780 CMR,Chapter 148;,527 CMR 1; 13.7 X *LPG Storage Chapter 148;sec 9,10,28&527 CMR 1;69.1 X Use and Occupancy(FH Building Class) 780 CMR;302.1 X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-1 X Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.1.2,34.1.1 X *Upholstery 527 CMR 1;20.6.2.5 X *Trash Containers 527 CMR 1; 19.1.1, 1.12 X _ Any Hazard to the Public Chapter 148;sec 28 X *Curtains,Draperies,Blinds 527 CMR 1; 12.6.2 *YFD permit required-depending on occupancy and submittal *Per 527 CMR 1 13.1.8, a permit is required from the Fire Department to shut down any fire protection system. Fire Alarm system to be evaluated and conform to existing Codes Description of planned project/other requirements: The YFD supports the applications, subject to applicable submissions,permits and inspections. Plan Reviewed By: Captain/Inspector 9Ceuin 3Eucll Date: 10-17-2018 Copy for Applicant 0 Copy to Building Department II Copy to Fire Prevention Entered in Firehouse 0 Final Inspection 166 Grove Street Franklin,MA 02038 October 17,2018 To Whom It May Concern: I authorize Step N'Stone Builders and Leibowitz Brothers General Contracting to pull all necessary permits for our proposed tenant improvements at Planet Fitness located at 17 Long Pond Drive in South Yarmouth. Respectfully, Bill Whelan COO Core Management&Development Sears, Tim From: Sears,Tim Sent: Friday, November 2, 2018 9:04 AM To: 'mlandry@stepnstonebuilding.com' Subject 17 Long Pond Drive Attachments: existing building evaluation.PDF Mike, I have reviewed your application for 17 Long pond Drive, and we are going to need an existing building evaluation to complete your application. Please submit this item for review Thank you Timothy Sears CB0 Building Inspector Town of Yarmouth 508-398-2231 Ext. 1259 mailtoasears@varmouth.ma.us 1 DKMUiii11ARCHITECTS ARCHITECTURE I INTERIORS I PUNNING 517 S.MAIN ST. ow... 208 892 8433 MOSCOW,ID83843 F.. 208.892.8533 November 2,2018 USA www.dkmullin.com To: Yarmouth Building Department Town Hall 1146 Route 28 South Yarmouth, MA 02664 Re: Planet Fitness 17 Long Pond Dr, South Yarmouth,MA To Whom it May Concern: Building Investigation and Evaluation Narrative 104.2.2.1"The investigation and evaluation shall be in sufficient detail to ascertain the effects of the proposed work on at least these systems: structural, means of egress, fire protection, energy conservation, lighting, hazardous materials, accessibility, and ventilation for the space under consideration and, where necessary,the entire building or structure and its foundation if impacted by the proposed work" STRUCTURAL: For this project there is no structural work included in the scope of work. A single RTU will be replaced for which a structural engineer was consulted. As the scheduled new RTU weighs less than the unit it will replace, no structural work has been included. A note directing the contractor to verify the weight of the existing unit compared to the new unit and contact the architect in the event the new unit weighs more than the existing is on the drawings. MEANS OF EGRESS: The means of egress are not impacted by this remodel project as the existing egress locations will remain and the travel distances to the means of egress are unchanged. The only area where the space has been reconfigured is in the new Black Card Spa area. The egress travel distance is around 52' to the existing main entrance(egress). FIRE PROTECTION: The existing fire protection system will remain in place. The Black Card Spa area has been reconfigured and will require modifications to the fire protection system per code. The existing ACT ceiling will receive new light fixtures and metal grid infill.Notes indicate the existing fire sprinkler system to remain. Any modifications to the system to be coordinated with a licensed fire sprinkler contractor to meet code. ENERGY CONSERVATION AND LIGHTING: An Existing RTU will be replaced with a new more energy efficient model to service the new Black Card Spa area. In the main open gym space, the existing high bays lights will be replaced with new energy efficiency LED Highbay light fixtures in the existing locations. The covered areas with ACT suspended ceilings will also receive new energy efficient down can lights to replace existing light fixtures. Additional new lights have been included. See the reflected ceiling plan. Occupancy sensors are included for the individual rooms in the Black Card Spa. DKMUIIInARCHITECTs ARCHITECTURE I INTERIORS I PLANNING 517 5.MAIN 5T. *Nn 208.892.8433 MOSCOW,ID 83843 r.. 208.8922533 The Stretching#103A and Abs #10311 will receive new energy efficient LED USA www.dkmullin.com panel fixture to replace existing fixtures in existing locations. HAZARDOUS MATERIAL: Not applicable. All construction debris will be disposed of in accordance with state and local regulations and ordinances. ACCESSIBILITY: All existing accessible building elements will remain (accessible entrances, lift to mezzanine level, parking,etc). The existing locker rooms will be renovated for new fixtures and finishes in existing locations including new accessible lockers as indicated on the plans. A new accessible changing room in the men's locker room will round out the accessible amenities. Accessible water closet stalls and showers will remain in their existing locations with new fixtures per code and new finishes. In the new Black Card Spa area, accessible amenities include self serve massage loungers,tanning beds, and self serve massage chairs. The new reception desk includes an accessible counter area per accessibility requirements. The new service counter in the reception area also includes an accessible area per code. VENTILATION: The newly reconfigured Black Card Spa area mechanical and duct work is included in the scope of work for this project. Existing RTU 3 will be replaced with a new RTU to accommodate the ventilation needs of the new self serve tanning units and self serve massage loungers and chairs and the covered areas of the Reception area. See the Mechanical drawings. No other changes are planned for the mechanical system for this renovation. Let us know if you have any additional questions about the submitted plans for review. Thank you for your time and consideration. Res -ctfully, tiXEtiNEty .J i .4.<>" �Mk 30497 z Daniel K. Mullin,AIA,NCARB Principal/Architect '' � ► ' , G girn OF tAtk TOW►�'n , A ,� IUTH 1146 Route 2 :' �rA t th, MA 02664�ig C: 508-398-223; "Trak"Tra F 08-398-0836 Office of t'.• tit 1,' missioner • Massachusetts Existing Building Code Checklist Based on 2015 IEBC w/Massachusetts Amendments To be submitted with Building Permit Application Address:Planet Fitness, 17 Long Pond Drive, South Yarmouth ,MA (Street number,name) (City/Town) Unit Suite(location within building) Risk Category: (Check one), 0 Risk Category 1, © Risk Category 11, 0 RC III, 0 RC IV. Work proposed: Remodel of the Existing Planet Fitness to Include new fixtures and finishes In the existing locker rooms and other areas throughout the fitness -center. New plumbing fixtures in existing locations in the locker moms. Reconfiguration of the reception area and self serve tanning and self serve massage with new partition walls,electrical,lighting,suspended accoustical tile ceiling.One existing RTU to be replaced In existing location.Existing accoustical tile ceiling in main workout area for new grid Insert with new light fixtures.Existing highbay lighting to be replaced In existing locations. Construction Control, building at 35,000 c.f. or greater 0 Yes 0 No If Yes then "Investigation & Evaluation Report" is required (780 CMR 34, 104.2.2.1.) Compliance Method: [Only one method to be used] (Check all boxes that apply) Prescriptive Work area Performance (Chapter 4) (Chapters 5— 13) (Chapter 14) ❑ Repairs 0 Repairs:Chapter 5 0 Repairs ❑ Alteration M Alteration: (check only one box) 0 Alteration ❑ Addition 0 Level 1: Chapter 7 0 Addition O Change of Occupancy M Level 2: Chapter 7& 8 0 Change of Occupancy ❑ Level 3: Chapter 7, 8 & 9 ❑ Change of Occupancy: Chapter 10 ❑ Additions: Chapter 11 ❑ Historic Buildings: Chapter 12 ❑ Relocated or Moved Buildings: Chapter 13 Note: Chapter 15 applies to all compliance methods. Applicant's Name: (print) Signature: Date: Initial Construction Control Document r!/ To be submitted with the building permit application by a ", Registered Design Professional • for work per the 8th edition of the cy� Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Planet Fitness South Yarmouth_Remodel_MA Date: 05/29/2018 Property Address: 17 Long Pond Dr, South Yarmouth MA 02664 Project: Check(x)one or both as applicable: New construction x Existing Construction Project description:Remodel of Existing Planet Fitness I Daniel K.Mullin MA Registration Number.30437 Expiration date: 8/31/2019 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'. Enter in the space to the right a"wet"or %StE�EnnEry aEO AACy V /r electronic signature and seal: �� E�� oilp 3049 2 Phone number.208.892.8433 Email: debra@dkmullin.com 2l'40 4UNOFM103S Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, provide a description. Version 06_11_2013 :YA Ci.. SC. TOWN OF YARMOUTH (O . :17 al MATTA 1,;,2_ ,• 1146 ROUTE 28 SOUTH YARMOUTII MASSACHUSETTS 02664-4451 `•, '%erne+pf 6L' Telephone(508)398-2231,Ext. 1250—Fax (508)760-4830. Engineering and Surveying Division Building Permit Review Residential and /or Commercial Buildings Name of Applicant: Leibo Brothers Management Telephone or Email Address: 203456-4465 Remodel of existing Planet Fitness Proposed Building Location: 17 Long Pond Dr, South Yarmouth, MA 02664 Date Submitted: 9-28-18 Requirements for review: Please submit one(1)copy of plans, to include: 1. For Residential: Site Plan showing proposed and/or existing buildings, proposed contours with bench mark,water service location,and septic system location. For Commercial: Site Plan showing details required by the Zoning By-law and revisions required by Site Plan review, if any. Note: Site plans must be signed and stamped by a Licensed Professional Land Surveyor and Engineer or Sanitarian. 2. House or Building-Floor Plan(s)and Elevation Plan(s) 3. One(1) copy of application. Reviewed By: Date: PLEASE NOTE Comments/Conditions: 0 Printed on Recycled Paper The Commonwealth oplassachusetts • Department of Industrial Accidents mit,=y Office of Investigations • re_2 600 Washington Street -� Boston,MA 02111 . •www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Brsmess'Otratn;sindivi : sere k2 9r.o.%a ✓t Address: ri el L: 5 c et o.A Dr eve City/State/Zip: •t-t .�f ,v lr et cc"7 Phone# .5.27-,?-4 F-0 S S Are you an employer?Check the appropriate box: 4. Type of project(required): 1.5Izmaemployer a h t} ❑ I am a g eaerai cotwaetor and I » have hired etre sub-contractors 6. ❑New rnnstrtraioa employees(.full and/or part-.:me), 2. 0 I am a sole proprietor or partner- listed or the attached sheet 7. gRemodeliag ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity, employees and have workers n [No workms'camp.insurance comp.instrance.t 9. 0 Btildiag addition requi d] 5. ❑ Vie area corporation and its 10.0 Electical repairs or additions officers have exercised their . 11.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself No worker,'comp, right of exemption per MOL 12.0 Roof repairs insurance required)t c. I5Z §I(4),and we have no 3a.LII am a homeowner acting as a employees.[No worker' 13.0 Offer general contractor(refer to Ad) comp.insurance required.} Ary applies=that ebeeb boa al sunt also III out the section below shoats emir worsens cot easatiodisoacy infeceaioa. Homeowttm who submit Pals t5Avit tric'inr.g they re doing as week and then hhe ou rids eoaaeton ems submit a new af5davit io4rages act. :coons:o to that chock this box must leached an aMi•innel sheet.bowing the name of Ss sub-tong and state wbedta or not those eu itin have employees. If the sub-co=atmea have employers,they umat provide their emit?comp.polity timber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: T r c; n Lr...r S Policy#or Self-ins.Lie:#: '] F",3, u g C S ?Fs "7'4 (I X' Expiration Date: q -. lob Site Address: i 7 Le{,5 Pc nr r- City/State/Zip:�.AL, `f.r.,w-! , y 11 Attach a copy of the workers'compensation policy declaration page(shorting the policy zpirafl number and e / l te)f L(.'I Failure to sectile coverage asoti elate). required tads Section 25A of MGL a. 152 can lead to the imposition of criminala penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fern of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern)"under the paint a rd perldes of perjury that the information provided above is true and correct . i t: 1• altel nate. _ -1? nano*: SLS- :}g-o sc 5 I OffCial use only. Do not write in this area, to be completed by city or town official City or Town: • Permit/License 4 Issuing Authority(circle one): I.Board of Health 2.Building Department 3.Clty!Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#t t, -,--_ '`�C o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIODNYYY) `...--- 10/042018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME:ACT Susan LaFleur THOMAS J WOODS INSURANCE AGENCY INC IIAIC.N Earp (508)755-5944 FAX WC. E-MAIL ADDRESS: slafleurG woodsinsurance.com 20 PARK AVENUE INSURER(S)AFFORDING COVERAGE NAJC0 WORCESTER MA 01613 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER 8: STEP N STONE BUILDING CONCEPTS INC INSURERC: INSURER D: 99 LELAND DRIVE INSURER E: CHARLTON MA 01507 INSURERF: COVERAGES - CERTIFICATE NUMBER: 321774 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IY EXP LTR TYPE OF INSURANCE ANBD WVD POLICY NUMBER IMM/DDL SUBR POLICY EFF IMM/DO/YYYY7 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ CLAIMS-MADE 0 OCCUR PREMISES(E occurrence) _ S MED EXP(Any one person) S N/A PERSONAL&ADV INJURY $ GENt AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S RPOLICY El]Tef 0 LOC PRODUCTS-COMP/OP AGG S OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULEDN/A BODILY INJURY Per acddent S AUTOS _ AUTOS ( ) HIRED AUTOS AUTOSNON-OED PROPERTY DAMAGE S _ AUTOS (Per accident) _ S UMBRELLA LIAB _ OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE N/A AGGREGATE . S _ DED RETENTIONS S WORKERS COMPENSATIONPER DTH. AND EMPLOYERS'LIABILITY Y/N X STATUTE ER . ANYPROPRIETOWPARTNER/EXECUTNE E.L.EACH ACCIDENT S 500,000 A OFFICEFUMEMBEREXCLUDEDT WA N/A WA 7PJUB2E58874118 04/21/2018 04/21/2019 (Mandatory M NH) E.L.DISEASE-EA EMPLOYEES 500,000 Nyes, IPTIgi OFO DESCRIPTION OF OPERATIONS beION E.L.DISEASE•POLICY LIMIT S 500,000 N/A • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be inched If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization Is given to pay claims for benefits to employees In states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensatioMnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of South Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 Daniel M.O�rq�y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Accmcs CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OD,NYY)) 10/03/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Debra Crookston NAME: L H Brenner Inc PHONE (203)389-2156 I FAX (203)392-2807 A1C No Esn: 4AIC,No): 1412 Whalley Avenue E-MAIL dcrookston�lhbrennedns.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAM* New Haven CT 06515-1131 INSURER A Admiral Insurance Company 003026 INSURED INSURERS: Hudson Specialty Insurance Leibo Brothers Management LLC INSURER C: 39 New Haven Road INSURER D: INSURER E: Seymour CT 06493 INSURER F: COVERAGES CERTIFICATE NUMBER: 2017 to 2018 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSU&H POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYY'r)) NM/DOM/TY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 IDAMAGE TO REN 100,000 CLAIMS-MADE OCCUR PREMISES(Es occurrence) S MED EXP(Any one parson) $ 5,000 A • CA00002854401 10/21/2017 10/21/2018 PERSONAL d ADV INJURY _ $ 1,000,000 GENT AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY DE T LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ms accident) ANY AUTO BODILY INJURY(Per Rerun) S OWNED SCHEDULED BODILY INJURY(Per anions S AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE s AUTOS ONLY _ AUTOS ONLY (Per accident) _ s UMBRELLA LAB OCCUR EACH OCCURRENCE $ 3,000,000 B X EXCESS LAB CLAIMS-MADE HXS100002101 10/21/2017 10/21/2018 AGGREGATE s 3,000,000 DED I RETENTION S S WORKERS COMPENSATION I PEnTUTE I I ETµ AND EMPLOYERS'LIABILITY YI ANY PROPRIETORIPARTNERIEXECUTNE ❑ NIA E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE S It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD let,Additional Remarks Schedule,may be attached R more spear Ie required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Yarmouth Building Department ATP"Rosa Fallon ACCORDANCE WITH THE POLICY PROVISIONS. • Town Hall 1146 Route 28 AUTHORIZED REPRESENTATIVE yy//�+ South Yarmouth MA 02664 (5an,a - — ®1988-2015ACORD CORPORATION. All rights reserved. ACORD 25(2018/03) The ACORD name and logo are registered marks of ACORD f _ COMcheck Software Version 4.0.8.0 ii Interior Lighting Compliance Certificate Project Information Energy Code: 2015 IECC Project Title: Planet Fitness Project Type: Alteration Construction Site: Owner/Agent: Designer/Contractor: 17 Long Pond Dr. DON PENN CONSULTING ENGINEER South Yarmouth, MA 02664 1301 Solana Blvd. Suite 1420 Westlake,TX 76262 817.410.2858 Allowed Interior Lighting Power A B C D Area Category Floor Area Allowed Allowed Watts (82) Watts/ft2 (B X C) 1-Gymnasium/Fitness Center:Exercise Area 13252 0.72 9541 Total Allowed Watts= 9541 Proposed Interior Lighting Power A B C D E Fixture ID :Description!Lamp I Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Gymnasium/Exercise Center:Exercise Area(13252 sat.). LED 3:A:High Bay:Other: 1 21 112 2352 LED 3 copy 1:D:Oval Mirror:Other: 1 6 26 156 LED 3 copy 3:G:6'Recessed Downlight:Other: 1 229 16 3664 LED 3 copy 4:H:6"Recessed Downlight-Dim:Other: 1 5 16 80 LED 3 copy 6:.12:2X2:Other: 1 12 36 432 LED 3 copy 7:K1:2X4:Other: 1 1 50 50 LED 3 copy 8:Ml:Kichler Wall Sconce:Other: 1 5 52 260 Total Proposed Watts- 6994 Interior Clghting PASSES r; a . 4 .«.._:.t__ a�,...,..b.._. .' .r`� ^.�. 'i�3 °rx -�a t� •:,r y, ,� interior Lighting Compliance Statement Compliance Statement: The proposed Interior lighting alteration r •5 -'resented in this document is consistent with the building plans,specifications, and other calculations submitt- ta, it application.The proposed interior lighting systems have been designed to meet the 2015 IECC requir- -sal Version 4.0.8.0 and to comply with any applicable mandatory requirements listed in the lnspectio ,¢ "+�t�'qy DON PENN, P.E. � ..... ,,• ;�,:::41 09/27/18 Name-Title Si''•, a toed R Date t.est- Project Title: Planet Fitness Report date: 09/27/18 Data filename: R:\Planet Fitness\DKM\2018\18.3848.South Yarmouth.MA(Remodel)\Design\COMCHECK.DKM.o Page 1 of 5 • COMcheck Software Version 4.0.8.0 Inspection CCChecklist irliA 1 Energy Code: 2015 IEC Requirements: 29.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance Is itemized in a separate table, a reference to that table is provided. Section # Plan Review Complies? Comments/Assumptions & Req.ID C103.2 Plans, specifications,and/or ❑Complies Requirement will be met. (PR4)1 calculations provide all Information ❑Does Not with which compliance can be ❑Not Observable determined for the interior lighting ❑Not Applicable and electrical systems and equipment pP and document where exceptions to the standard are claimed. Information provided should Include Interior lighting power calculations,wattage of bulbs and ballasts,transformers and control devices. Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Planet Fitness Report date: 09/27/18 Data filename: R:\Planet Fitness\DKM\2018\18-3848.5outh Yarmouth.MA(Remodel)\Design\COMCHECK.DKM.o Page 2 of 5 • Section # Rough-In Electrical Inspection Complies? Comments/Assumptions & Req.ID C405.2.1 :Lighting controls installed to uniformly Dcomplies Requirement will be met. [EL15]' :reduce the lighting load by at least ODoes Not 50%. ONot Observable ONot Applicable C405.2.1 Occupancy sensors Installed in ❑Complies Requirement will be met. [EL113]' required spaces. ODoes Not ;❑Not Observable ONot Applicable C405.2.1, Independent lighting controls Installed ❑Complies Requirement will be met. C405.2.2. per approved lighting plans and all ❑Does Not 3 manual controls readily accessible and [EL23]' visible to occupants. ['Not Observable ONot Applicable C405.2.2. Automatic controls to shut off all ❑Complies Requirement will be met. 1 building lighting Installed In all ODoes Not (EL22]2 ibuildings. ONot Observable ❑Not Applicable C405.2.3 ;Daylight zones provided with ❑Complies Requirement will be met. [EL1612 individual controls that control the ODoes Not lights independent of general area ONot Observable ;lighting. ONot Applicable C405.2.3, Primary sidelighted areas are ❑Complies Requirement will be met. C405.2.3. equipped with required lighting ODoes Not 1, controls. ❑Not Observable 0405.2.3. 2 ONot Applicable [EL20]' C405.2.3, Enclosed spaces with daylight area ❑Complies Exception: Requirement does not apply. • C405.2.3. under skylights and rooftop monitors EDoes Not 1, are equipped with required lighting 0405.2.3. controls. ONot Observable 3 ONot Applicable [EL21]' C405.2.4 Separate lighting control devices for ❑Complies Requirement will be met. [EL4I' specific uses installed per approved ODoes Not lighting plans. ❑Not Observable ONot Applicable C405.2.4 Additional Interior lighting power ❑Complies Requirement will be met. [EL8]' allowed for special functions per the ODoes Not approved lighting plans and is ❑Not Observable automatically controlled and separated from general lighting. ONot Applicable C405.3 Exit signs do not exceed 5 watts per ;❑Complies Requirement will be met. [EL61' face. :❑Does Not ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Planet Fitness Report date: 09/27/18 Data filename: R:\Planet Fitness\DKM\2018\18-3848.South Yarmouth.MA(Remodel\Design\COMCHECK.DKM.o Page 3 of 5 Section # Final Inspection Complies? Comments/Assumptions & Req.ID C303.3, Furnished O&M instructions for ❑Complies Requirement will be met. C408.2.5. systems and equipment to the ❑Does Not 2 building owner or designated Not Observable (F117]3 representative. ❑ ❑Not Applicable C405.4.1 Interior installed lamp and fixture ❑Complies See the Interior Lighting fixture schedule for values. [F118]1 lighting power Is consistent with what ❑Does Not Is shown on the approved lighting ❑Not Observable plans,demonstrating proposed watts are less than or equal to allowed ❑Not Applicable watts. C408.2.5. Furnished as-built drawings for ❑Complies Requirement will be met. 1 electric power systems within 90 days ODoes Not [FI16]3 of system acceptance. ❑Not Observable ❑Not Applicable C408.3 Lighting systems have been tested to ❑Complies Requirement will be met. [FI33]1 ensure proper calibration,adjustment, ❑Does Not programming, and operation. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Planet Fitness Report date: 09/27/18 Data filename: R:\Planet Fitness\DKM\2018\18-3848.South Yarmouth.MA(Remodel)\Design\COMCHECK.DKM.o Page 4 of 5 Project Title: Planet Fitness Report date: 09/27/18 Data filename: R:\Planet Fitness\DKM\2018\18-3848.South Yarmouth.MA(Remodel)\Design\COMCHECK.DKM.c Page 5 of 5