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HomeMy WebLinkAboutBLD-19-2715 • 9.-2-, b//4 //1- • . . Of•YgR BUILDING PERMIT APPLICATION =E \tr0 .APPLICATION TO CONSTRUCT,REPAIR, RENOVATE, CHANGE THE USE,OCCUPANCY OF, I - • C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. �,,�..Cn..: S lei` Town of Barmouth Building Department t )\i+.... 1146 Route 28 . Yarmouth. MA 0266.1-14921 11 E C E�.,02 D Tel: 508-398-2231 ext. 1261 Fax 508-393-083��(6 (�l� 'P4') Office Use Only Planning Board Information Assessors Department into jatio)t°� 2 0 2010 l Permit No..j� /4OVAeS Plan Type Nr?g� DIN ItEpAR MENT Permit Fee $ 6 ‘ Endorsement Date J. iv=E _ 'wording Date New Deposit Recd. $ 39Z:Date/0b// n No. to Property Dimensions: Net Due $ Ce 1) • Other Lot Area(sf) Frontage(ft) Lot Coverage This Section for Office Use Only . Building Permit Number. Date Issued: /., Signature: . G. \_`iN- NS D Cert lcate of Occupancy Building- al Data is Is not required Section 1 - Site Information 1.1 Property Address: 1.2 Zoning Information: Zoning District Proposed Use 1.3 Building Setbacks(ft) Front Yard Side Yards r___RearYard Required Provided Required Provided pe4IirEd C E C Psovlde¢l 1.4 Water Supply(&Q.t_c.40.s 54) 1.5 Flood Zone Infornatiom conn enha: OCT 31 2018 Public Private Zone: BFE I - _yrs-s- CEPAHTME - . -Section 2 - Property Ownership/Authorized Agent I • "Y 2.1 Owner of Record: -V u t/G/JaurCr 2VVVSAVO') tie?)c W€rrw�aL . 6209° �,f Name(print) Mailing Address:Q \ 1/�J Z/X� 1(�'q� 7 /\ • C,rO$ J 6 3 -tt o .l Signature Telephone Telephone Email Address: 2.2 Authoriz gent: / It—I I �C 01 zl aryms fbrtot /It'll', 0/ 440.7 t- Name(p t) Mailing Address: -� (no) 'ZZ-S"/t w /fro) G /c•- 0377 k signator Telephone Fax Email Address: T Sectio 3 -Construction Services 3.1 Licensed Construction Supervisor, Not Applicable J - 54>m fzso T, R LCAtc-pt v< . • S4 M--P-141-11)00,0 &iDEP- G Nt---OW 20 LicenseceN/uummbeerr 'IP, j , ` -WJ (is - `{�3-ZI4-2`Iz.? 9da),cwi Expi ° Date re 1 Telephone J Email Address: vir`f r70Z0 • 3.2 Registered Home Improvement Contractor. ' Company Nam* /It /r Not Applicable ❑ r / /xe n (oNti-pc �t J cif cif Registration Number Address 'nr yf j� MCO , 040 j� S/Z Z I IJ{r'T/7 `olc ^ 'Jer�;7 c✓0l0 37 ExpiationDate Signature ?MAL.DA, I Telephone ftz ) 964... _7•I I7 OC/3v/,2o/9 Section 4-Wkers'Compensation Insurance Affidavit(M.G.L c.152 S 25C(6) Workers Compensation Insurance affidavit must be completed and submitted 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 . Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f. of enclosed space) Section 5.1 Registered Architect . Not Applicable ❑ Hams(Registrant)) //'' / . Registration Number !7G ILh e • t[f \�/yp u Address / ( S,�<�`.i C lc/i Dr:at (rrAre n 44. C`!7 Y/ (( /'V 770 Expiration Date Signature G Telephone Section 5.2 Registered Professional Engineer(s) ARC kd-.r);C4 1 i~Avlctr Area of Responsibility Name nrNna.s En5) irciif7, Co r/� • . Address ZZ � iv/her4�CTCr t1n;1''e. l 'I4me/ r 44. Registration Number Signature 1 Telephone Expiration Dale ,'/Cc /root( 411y?dcCI Area ol Responsibility Name,F / � / ✓w1)(./ per; 1cei ' ` . Fddresst.ft r+ / / !� // 1l ��N/,,,, Registration Number A375 'ill ell) •11%re^Fo ttk 1Cl tin • Signature Telephone Expiration Date Hams • Area of Responsibility • Address Registration Number Signature Telephone Expiration Date Hams Area of Responsibility • Address Registration Number • Signature Telephone Expiration Date Section 5.3 General Contractor • Not Applicable ❑ Company HamsTiLC�.v n 0%° Cons Scr'veGP Person Responsible for Cortstmction ,(I1G�,C p� /C-1 \' c/ rl ac-' Lr'�1 Address al !�9 . :n C Cp'A 5Pr �i 4 e i rt o - /6•C ^r 1 l Signature rJ v,•,`/ �j]� _ Telephone • . • j • • •a Section 6- Description of Proposed Work(check all applicable) ' New Construction ❑ (lor multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms Existing Bldg. g( Repair(s) ❑ Alterations Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: 7-4 Tee wn///�erl:.,fr Brief Description of Proposed Work: /fir, FA , s1.74 kort"tr 'rep an a•fci Rcn c dr[ /4-(1Kr E•><:r7 tty moon i2 e, OC-C;cc po.e Section 7- Use Group and Construction Type Building Use Group(Check as appricapable) Construction Type • A ASSEMBLY ❑ A.1 ❑ A-2 ❑ A-3 ❑ IA ❑ A-4 ❑ A-5 ❑ 151 ❑ B BUSINESS 2A ❑ E EDUCATIONAL ❑ 28 ❑ F FACTORY ❑ F-1 ❑ . F-2 ❑ 2C ❑ H HIGH HAZARD ❑ 3A ❑ t INSTRUTIONAL ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 315 ❑ M MERCHANTILE ❑ 4 0 R RESIDENTIAL 0 R-1 ❑ R-2 ❑ R-3 ❑ SA ❑ S STORAGE ❑ 5.1 ❑ 5-2 ❑ 53 ❑ U UTILITY SPECIFY: • M MIXED USE ❑ SPECIFY: S SPECIAL USE 0 SPECIFY: Complete thissection if existing building undergoingrenovations;additions and/or change Iri use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area • Building Area - Existing(1 applicable) Proposed Number of floors or stories include basement levels 0 11•1 C Floor Area per Floor(sf) Total Area All Floors (sf) Total Height(ft) • /51 -` ' Section 9 -STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT i. Firtil)SA1dhLt, ,as Owner of the subject property, hereby authorize Of-g L,L./Sttw D10W X --tJ( to act on my behalf, ' all pis! lative to rk authorized by this building permit application. Ile DA tottef- 2.53 Signature f weer Da S a nla nate-, I. SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION • I, I� TI?�G , as Owner/Authorized Agent hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print ra'' Ott 2-57 243(S Signature ofort:241... teiet ent Date Section 11 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Buading 835 t58 2.Electrical 704 3.Plumbing/Gas t q,�C 3Q 4.Mechanical(HVAC) t./{, 55t S.Fire Protection LOO 6.Total-(1+2.3+4+5) k 2t eL to S8 tine' 7.Total Square FL sna cana.aamal Y Check Below ❑ Conservation-Commission Fling (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) • . • The Commonwealth of Massachusetts tt �;w-=It Department of Industrial Accidents =ili1.=- Office of Investigations ==....- 600 Washington Street ___,J=. • `I t Y Boston,MA 02111 •www.masstgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business Oro e e ninuion/Individuat): 01scn `otlslr•to.iia n �,Iv,ees LIZ Address: P Q , T:f nc 7278 City/State/Zi.: ♦ Cr1 _ 3 n T n i 06631hone#: o ,rOS% p Are you an employer?Check the app priate bon 4. I am a Type of project(required): I.❑ I am a employer with general contractor and I employees(full and/or part-time).* have hired the sub-contractors . 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ®Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.instnance.2 9• 0 Building addition required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0Roof repairs insurance required.)t c. 152, §1(4),and we have no - 3a.❑ I am a homeowner acting as a employees.[No workers' 13.0 Other general contractor(refer to#4) comp.insurance required]. *Any applicant that checks box#1 most also fill am the section below showing their workers'compensatio4olicy information. Homeowners who submit this af5davit indicating they are doing all wok and then hire outside contactors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contactors sad state whether or not those entities have employees. If the sub-contact=have employees,they must provide their workers'comp.policy min t I ain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. !!77 Insurance Company Name: Sn, h &o rry e/f TTT't t4dlt( ce ct r L LC Policy#or Self-ins.LiLc.`#: 0 r-CO r7O y.�L ooa —7/4 ../g Expiration Date: .ti A Al9 IobSiteAddress: e9Y tJ;/fetj S'ni'tet/w.Arnonl., 32 City/State/Zip: 61G73 ' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. 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 cent, and the pains and penalties of perjury that the information provided above is true and correct Si:mature: .4.444.- V / d/ye n y Date: /t -23-/Fe . Phone#: ( fGo) y42 - 57517 . Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: . Permit)Ldcense# Issuing Authority(circle one): • I.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions .` •• `' ' Massachusetts General las chapter 152 requires,all employers to :cans'compensation for their eac{oyees, provide contact of hire, Pursuant to this statute,an esplger is defined as"...every person in S service of another under am express or implied,oral or written." An entry .is defined:ran individual,partnership,usoeiation,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or tastes of an individual,psriaastip,association a other legal entity,employing employers' However the owner of a dwelling hoose having not more than three apartments and who resides t5aei ,or the occupant of the dwelling hoose of another who employs person to do ts+tetnt'^v ,construction or repair wont on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employnrat be deemed to be an employer" MGL chspta 152, 125C(6)also states that"every state or local licensing:grog shall withhold the issnsan or renewal of a knee or permit to operate a budneae or to coo:trod ba0diap la the commonwealth for say applicant whe has not produced acceptable evidence of compliance with the lasarnses age required." Additinoally.MGL chapter 152,125C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the pa5xmsace of public work nervi acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contacting authority." • Appllaata I , Please Ell out S workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone D11*a(s)along with their certificate(s)of inatam= Limited Liability Complain(LLC)of Limited I t.hitity Permashipa(LLP)with no empbyea other than the members or partners,are not required to carry workers'compentatlon insurance. If an LLC a LLP does have -employees,a policy is required- Be advised fust this affidavit may be submitted to the Department of Industrial • ' Accidents far confirmation of insurance coverage. Abe be sure to sip and data the affidavit The affidavit should be returned to the city or town that the applicsdoa for the permit or license is being reverted,not tun Dep:Ctmcot of Industrial Accidents. Should you have any questions regarding the law ce if you are required to obtain a watts' compensation policy,please call the Departs at the member listed below. Self-insured des should enter their self-bum-ace license rent on the a;Qcopriate lice City or Taws Offdala . Please be stat:that the affidavit is complete and printed legibly. The Department has provided a space at the beton of the affidavit for you to fill out in rhe event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference Dumber. In addition,an applicant • that must submit multiple permitlEittase applications in any given year,need only submit one affidavit indicating cur= policy infxmhtioa(if necessary)and order"rob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped a marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for Inhere permit or licenses. A new affidavit mint be filled out each year.When a home owner or citizen is obtaining a license or permit not related to any business oe commercial venture (i.e.a dog license or permit to burn leaves etc.)said pawn is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give m e call. the Department's address,telephone and fax= hen The Commonwealth of Massachusetts Department of Industrial Accidents Ot1k.of Investigations • 600 Washington Street Boston,MA 02111 Tel. it 617-727-'4900 ext 406 or 1-877-MASSAFE. Fax 4 617-727-7749 • Revised 11-22-06 www.mass.gov/dia Aicr _ TOWN OF YARMOUTH 'C".t ., G� BUILDING DEPARTMENT o «�. y, 1146 Route 28,South Yarmouth,MA 02664 -a 2 3 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1113, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at Work Address Is to be disposed of at the following location: �( Said disposal site shall be a licensed solid waste facility as defined by m.61. Chapter 111, Section 150A. — 4Asc-Pb6 =lSigna re of Application Date Permit No. 1/1 it AU -21-119247d 1911-RTY ?q °n • MGL AND FIRE TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE. I ERRORS OR OMMISSIONS DO NOT RELIEVE . THE APPLICANT FROM THE RESPONSIBILITY • � OF"AS BUILT"COMPLIANCE. `,4:40 / DATE: JO • 11-/ INSPECTOR YARMOUTH FIRE PREVENTION Commercial Construction Building Transmittal Project Name: Eversource/Locker room Address: 484 Willow St. Contact Name: Jesse Palin Phone: 860-462-5147 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-I 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.7Ceain Nadi ate: 10-17-2018 Copy for Applicant 0 Copy to Building Department l I Copy to Fire Prevention Entered in Firehouse [l Final Inspection scy TOWN OF YARMOUTH °� HEALTH DEPARTMENT ori PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: L / , // I Building Site Location:1 �� Si 4"PY �l //06✓ S feel j ff/ �✓,w vitt 02673 t. Proposed Improvement hoc ice/ roat`t re nova on t D6 tC Spc or 1,/ Aous C TCN, I•Cl Applicant: ©/scri lan friLt J 70'7 Tel. No.: 1r6o3 yez•,57t/7 Address: 2 / Qftit fl f fbca 731!, fri, er 060y7 Date Filed: /O •MU?. **If you would like e-mail notification ofsign off please provide e-mail address: APier, o lftrl e s • Cosi Owner Name: D Sen (CC J/ te- 17 on S rd;CGS Owner Address: Owner Tel. No.: 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: t / DATE: /0/3 ///8% PLEASE NOTE COMMENTS/CONDITIONS: /l�Zc� — 5epr$'c Sift to4a.w— fo/31 // 8 • Qy•vgR TOWN OF YARMOUTH 3} ; %. WATER DEPARTMENT l�� i 99 Buck Island Road West Yarmouth, MA 02673 Telephone: (508) 771-7921 • Fax: (508) 771-7998 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF TRANSMITTAL SHEET Bldg. Site Location 9 ' ' hAVew Map #: Lot #: Proposed Improvement: ywe ear coon r 4-1-4 '4"Pe wotC Applicant: 0 SGI dol)sr nAtJ ) OVL. J`eridef Address 2/_tay,15•4,( 64;4P/ Tel. #: F(60 4Gz 5/t2 Date Filed: AO •grit RESIDENTIAL AND / OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water Availability and or Existing Location Engineering Department: Determines Compliance for Parking and Drainage Conservation Commission: Determines Compliance to Wetlands Acts; i.e. If Lot(s) Border any Type of Wetlands, Streams, Ponds, Rivers, Ocean, Bogs, Bays, Marshland, Etc... Health Department: Determines Compliance to State and Town Regulations;i.e., Requirements for Septage Disposal and other Public Health Activities Fire Department: Determines Compliance to State and Town Requirements for Personal, / Safety, Property Protection;, i.e. Smoke Detectors, Sprinkler Systems, Etc... /to• asi it Signature of appl cant Date PLEASE NOTE: COMMENTS: RevieWealiy: Water a rvision Date a ZO • ES t; Cunt r" 7\710 to b.- 51 }Pid y if9 Y 75 • • • /...% OLSECON-CL PATRA3 ACORO' CERTIFICATE OF LIABILITY INSURANCE °02J2ATE 3/2018"' • �� 02/23/2018 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 pollcy(ies)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 suchC�MEAeTndorsement(s). PRODUCER NACT Kim L Eckstrom Smith Brothers Insurance,LLC. PHONE BB National Drive (A/C,No,Est):(860)430-3358 I FAX (A /c,Nob Glastonbury,CT 06033 Robs;ktwerdy@smithbrothersusa.com INSURERS)AFFORDING COVERAGE NAIC e INSyRERA:Travelers Indemnity Co of Amer 25666 INSURED INSURER B:Travelers Property Casualty Company of America 25674 Olsen Construction Services LLC INSURER c:Charter Oak Fire Insurance Co 25615 PO Box 7278 INSURER o:Travelers Casualty and Surety Company of America 31194 Kensington,CT 06037 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE JN DDL"UDR POLICY NUMBER IM ?YPOLICY YYYI IMMMMI(DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE n OCCUR DT-CO-9045L008-1IA-18 01/31/2018 01/31/2019 DAMAGE TOREMISES fEeENTEe nce) $ 300,000 PRxarre _ _, MED EXP(Am one person) $ 15'000 PERSONAL 6ADV INJURY $ 1,000'000 GEN'L AGGREGATE APPLIES PER: - GENERAL AGGREGATE 2,000,000 POLICY n JpECT []LOC PRODUCTS-COMP/OP AGO i 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY (EaMaccOleDD SINGLE LIMIT $ 1,000,000 X ANY AUTO DT-810-9045L008-TIL-18 01/31/2018 01/31/2019 BODILY INJURY(Per personl S OWNED SCHEDULED . _ AUTOSgq���� ONLY _ AUTOSBODILY pBOODILY INJURY(Peraccident) $ _ AUTOS ONLY — AUUTOS ONLY (PerOaw�) GE i $ B X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 10,000,000 EXCESSLAB CLAIMS-MADE CUP-0J325884-17-27 01/31/2018 01/3112019 AGGREGATE $ 10,000,000 DED X RETENTIONS 10,000 i C WORKERS COMPENSATION AND EMPLOYERS'LIABIUTYX STATUTE FR ANY PROPRIETOR/PARTNER,EXECUfNE Y/x UB9J509260 01131/2018 01/31/2019 ELL EACH ACCIDENT $ 1,000,000 OFFICEM FIMaEREXCLUDED? �N x/A 1,000,000 E.L.DISEASE-EA EMPLOYEE $ Ifges,deellbe ender 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i D Employee Dishonesty 105883482 01/31/2018 01/31/2019 Limit 5,000,000 D Crime 105883482 01/31/2016 01/31/2019 Ded. 15,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACOR)101,Add/Ronal Remarks Schedule,may be attaehad If more pace Is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE Evidence of insurance ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE f(aVibUtelif.Sddr I ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Comnvnveaen of Llassacfiusefts fi• Division of Professional Licensors Board of Budding Regidafions and Standards Constncettbn%ripentisor CS-033125 •..':,'",,,tom Expires:09142020 EDWARD J POLCHLOPEK 5 64FERNWOODSTREET.J ' 1 CHICOPEE MA 01020 ' � �r � • 1tSW"Alfa (:)hti})1.`�J1 Commissioner G -- - a• HELENE • KARL Architects, Inc. MEMORANDUM To: Yarmouth Building Department RE: Yarmouth Service Center-Locker Rooms and Office Eversource Yarmouth,MA INVESTIGATION AND EVALUATION REPORT Date: 29 October 2018 Comments: The Project consists of converting an existing storage area into office space and renovating the men's locker room[3858 SF total]. The Work consists of limited demolition,patching,new walls,new door and hardware,new finishes(acoustical tile,flooring and painting),and modifications to the HVAC,fire protection,electrical and tele/data systems.Only the project areas will be vacated during construction. The remainder of the building will remain occupied. The following is a code assessment of the work to be performed as part of the Project. This assessment is based on 780 CMR 9m Edition,including 2015 IBC,2015 IEBC and Massachusetts Amendments. Use Group: Business Group B(2015 IBC 304). Type of Construction: Type IIB(2015 IBC Table 601). Area Being Renovated: 3,858 s.f. Gross Floor Area: 31,981 s.f. Classification of Work: Alteration—Level 2(2015 IEBC 504.1)—All new work shall also conform to Alterations—Level 1 (2015 IEBC Chapter 7)as required by 2015 IEBC 801.2. To the best of my knowledge,the plans,computations and specifications meet the provisions of the Massachusetts State Building Code for Level 2 alterations and the applicable laws and ordinances for the proposed use and occupancy. Note:The renovation will not increase the number of occupants in the building(unchanged)and will not increase the number of plumbing fixtures in the men's locker room(elimination of one urinal). Please contact our office at 978449-070 if you have any questions. HELENS KARL rchitects,Inc.�� 1,11/r '`EaEo w f� . i l%' GREGORY Grego Yanchenko,AIA ` * rruacK. • Vice President No.7490 GR,M G cc: John Pietrella—Eversource Jesse Palen-Olsen °1Morw• . ARCHITECTURE • DESIGN MANAGEMENT 61 Skyfields Drive,Groton,Massachusetts 01450 (978)449-0470 FAX (978)449-0469 • 631479 CPL•03 Rev 0613 No STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION This is your registration certificate. Such registration shall be shown to any properly interested person on request.Do not attempt to make any changes or alter this certificate in any way. This registration is not transferable. In an effort to be more efficient and Go Green,the department asks that you keep your email information with our office current to receive correspondence. Questions regarding this registration can be directed to the Occupational&Professional Licensing Division at dcp.occupationa]professional@ct.gov. Mailing address: Email on Ale to be used for receiving all notices from this office; OLSEN CONSTRUCTION SERVICES LLC jtaglialavore@olsencs.com olsencs.com PO BOX 7278 KENSINGTON,CT 06037-7278 r'S : F n ,' raj ' s r..;: .cCloe' I.:.to'^,.w is-1 ' 4e�+.'"eu,< v 4d , 1 f> , N n..rr --`44. ' �•nF r i'" ' '" .�a >, �' a '�" S• 2Z4 � S.�i* yyµµ4 � et Wry �:A� '�� -'S� /v lY' a: }ib�$ � ...,, i �, “ Al K "^. " z .j1'L' 1-& ' •'.w'^ ,, w '.o-,- .w .^t1J�. • 0) STATE OF CONNECTICUT + DEPARTMENT OF CONSUMER PROTECTION . 'y'. >r� 4. Be it known thatfr'y y OLSEN CONSTRUCTION SERVICES LLC 5 d' %„ 21 DEMING RD is. € 9 KENSINGTON, CT, 06037-1512 FnR f f res II 4/ 4 w i � a, p. �C I has been certified by the Department of Consumer Protection as a T R ' . u) r.,.. { ...,..,. . . 11 MAJOR.CONTRACTOR • p::x° "fhti I l,llr I.r- ,; i rv,; Registration #: MCO.0902042 s ` 3 U e -, Effective Date: 07/01/2018 Expiration Date: 06/30/2019 'Lid �" �• Ai;ikverify online at www.elicense.ct. .• Michelle Seagull,Commissioner .i 4i8a, a - 1 -7(A:1-, ;1 ; ll.•.,1 1 TY "•r M� v. w t , u,,,;s,, -, 7, v gTrSl.l r,„'K ,,a,,: ,q.ki!r A?n i 2e,-,, a..vb'�e7s.,_,:v51 , .;i , ,,,:sv,.r $,5,. ,,t,. e,, i. .i cR,,,((.` ,,,,,, , ,,°�,ldlr�t,,!,zp,,,3'c.e�;,_,.w . +' • • Sears, Tim From: Sears,Tim Sent: Tuesday, November 13,2018 1:10 PM To: 'green204@yahoo.com' Subject: 484 Willow St Ed, I have reviewed your application for 484 Willow St,and we are going to need Construction Control Affidavits for this project submitted to complete your application. Thank you Timothy Sears CBO Building Inspector Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us t • RECEIVED Initial Construction Control Docume t t= � To be submitted with the building permit application b a\ NOV 15 2018 Registered Design Professional HUILD c oEPAR tNr for work per the 9th edition of the aY. .�. Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Eversource Yarmouth Service Center,Warehouse Locker Rooms and Office Date: 10/12/18 Property Address: 484 Willow Street,West Yarmouth,MA 02673 Project: Check(x)one or both as applicable: New construction I Existing Construction Project description:Converting an existing storage area into office space and renovating the men's locker room[3858 SF total]. The Work consists of limited demolition,patching,new walls,new door and hardware,new finishes(acoustical tile,flooring and painting),and modifications to the HVAC,fire protection,electrical and tele/data systems. I,Gregory K.Yanchenko,MA Registration Number:7480 Expiration date:8/31/19,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': I 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 1EaEoeqoi, Control Document'. / t`' GREGORY t°-• * K k Enter in the space to the right a"wet"or ! ruacNEN:o „ electronic signature and seal: !� l /, 1t GROra� w 4171 OF tif61. Phone number:978449-0470 Email:hka@npv.com Building Official Use Only Building Official Name: Permit No.: Date: Note I.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 • Initial Construction Control Document 1i To be submitted with the building permit application by a y Registered Design Professional • for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Eversource Yarmouth Service Center,Warehouse Locker Rooms and Office Date:10/12/18 Property Address: 484 Willow Street,West Yarmouth,MA 02673 Project: Check(x)one or both as applicable: New construction ✓ Existing Construction Project description:Converting an existing storage area into office space and renovating the men's locker room[3858 SF total]. The Work consists of limited demolition,patching,new walls,new door and hardware,new finishes(acoustical file,flooring and painting),and modifications to the HVAC,plumbing, fire protection,electrical and tele/data systems. I Kevin R. Seaman MA Registration Number: 38130 Expiration date: Tune 30, 2020, am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concemingt: Architectural Structural X Mechanical X Fire Protection Electrical X Other. Plumbing 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 Y�PCta OF lrs c electronic signature and seal: �°a KEVIN R. +c SEAMANca ¶. Phone number.508-865-1400 Email:kevinin?seamanen$tneers.com MECHA No.30130 133 " 9 in Ct. Building Official Use Only '°9C�FSFGIsj ,, `�t Building Official Name Permit No.: Date: F �Version Ol012018 Initial Construction Control Document I' R el To be submitted with the building,�, permit application by a Who Registered Design Professional % c d' for work per the 9th edition of the Massachusetts State Building Code,780 CMR,Section 107 Project Title:Eversource Yarmouth Service Center,Warehouse Locker Rooms and Office Date: 10/12/18 Property Address: 484 Willow Street,West Yarmouth,MA 02673 Project: Check(x)one or both as applicable: New construction I Existing Construction Project description:Converting an existing storage area into office space and renovating the men's locker room[3858 SF total]. The Work consists of limited demolition,patching,new walls,new door and hardware,new finishes(acoustical tile,flooring and painting),and modifications to the HVAC,fire protection,electrical and tele/data systems. I John Murphy,Jr.,MA Registration Number.46498 Expiration date:6/30/20,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': 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: I. 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 Constru '.n Control Document'. Enter in the space to the right a"wet"or o qor west ry� c electronic signature and seal: 2, I:•, Q a.vo,'9 "t (po; Phone number.781-792-0059 Email:jmurphyelectric@aol.com / \isrFRED EP `~~ 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