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Home My WebLink AboutBld-20-001785 ` r' " OCT 01 201 le I*.; N'a.,, ft - Mtn N'.4/ Dyer 4g, , S — Office e0014,14.41410,144 1146 go444 28, sawa P , g&02664 APPLICATION FOR FIRE PROTECTION PERMIT Date /0 )// PERMIT NUMBER BLD--aD OC 7 S Projected Start Date: /0 ////2 Date of issue In accordance with the provisions of 780 CMR and M.G.L. Chapter 148,as provided in Section This application is hereby made by ce-c�/G4--- / o.eryvi S ,L vt C (Full name of person,Firm or Corporation) Address /ZC9.S Y— 7R i S Ya r IA-we--77 (contact it) ,. /3*y 0.5*mail ,"G-cA.. Scc�s,cizccLlc�"1 € Cv v Owner of property 76,r/vtoc. Pii/ i /4e,&7 its / v..1'eA Job Location 3( 0 cf /i l tAi •A -Sr- (Street&City or Town) For permission to(state clearly purpose for which permit is requested) S // a n cj cc"14.4e- de Gky 9 Mc / *ohc. /NI iN i7 J )e'_ ?"/ Z O/1 ,c,u19/146, e fooTO , Co K/)e✓,j t r U Name of competent operator(if applicable) 46o A dgc-,e,Ae v9 C- "c:�s'/e1 G- 4//41 S Cert. or LicenssNo. /_ /7 c-- Estimated Cost of Construction: /7c- - By in e Applicant Building Official: c% Date: 10 ' d� -)5 FEE: $50.00 • • The Commonwealth of Massachusetts ►. Department of Industrial Accidents ABA_ 1 Congress Street,Suite 100 Boston,MA 02114 2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Seaside Alarms Inc. Address: 1265 Route 28 City/State/Zip: South Yarmouth, MA Phone#: 508-3944599 Are you an employer?Check the appropriate boa: Type of project(required): 1.0 ram a employer with 19 employees(full and/or part-time).* 7. 0 New construction 2.0 I am a sole proprietor or partnership and Bade no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 3.01 am a homeowner doing all work myself[No workers'comp.insurance required]t 9. ❑Demolition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 D Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.1: l am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs 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. l7 14. Other security 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 of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below Is the policy and job site information. Insurance Company Name: Associated Employers Policy#or Self-ins.Lic.#: WCC50050128332019A Expiration Date: 2/25/20 Job Site Address: All sites In 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 under MGL c. 152,§25A is a criminal violation punishable by a fine up o$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 u er he pans Jand penalties ofperjury that the information provided above is true and correct Signature: ✓ a�...�.. Date: l� / 7p Phone*: 508-394-0599 Official use only. Do not write in this area,to be completed by city or town eclat City or Town: Permit/License# 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#: Fold.Then Detach Along All Perforations :.COMMONU .TH OF MSC CHOSE S, \M• • E_E •I- '......i...:.�.•« ki6AlaS ems'_-:.x.••S�K lL:i�G[vi ISSUES TtiE.ROLLOWING U�RSS AS A z, RECGb SYS�iEINTRACTORgY -x -`.:-rckFY ctr., :4• RIZE ERT K BOUCHER ' ` f 1265 R ;tt ` jatffitirri S YARIVIOUTH,MA 0- -..,�t.�.� j-'•"�`;...c'��G K is se d ram.'N• M:Y' aC.. f—#.317 { .'~': OI3112019 117771'-` s Commonwealth of Massachusetts Division of Protessional Licensure SecuritySysternSl-.S-License SSCO-000046 . Expires 01/05/2021 ROBERT;K BOUCHER • Employed by: "3 r SEASIDE ALARMS INC L L_ Commissioner V COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE ELECTRICIANS ISSUES THE FOLLOWING LICENSE AS A +:� REGISTERED SYSTEM CONTRACTOR J= ROBERT K BOUCHER _5 SEASIDE ALARMS INC 1265 ROUTE 28 S YARMOUTH,MA 02864.4455 t-•3 • —J 1317 07/31/2019 117771 "1 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER . . . ,........ 11 i i H s , . f f a 1i 11 - I .1111 S 1i I 1 1 'r i j I- (.. rityi- I-. r j i"tT € �r— 1 • ", ; I f j - � f 1 I 1 1 } _ : - i io +-} i i ,` « --, r _ 1-1---l-4--- Q 1 `- ;!!5 :4fv Y ,t r --- i t m ,4I 1Erg i _i • 10. _ ' 4 1 \ II it tt \ - -- -``---- - - lip_ i i \ -i—I. i 1 3 sat rts ! I I - ,': 1 _.. ... ..__._.__ — — — —— r \ i 1 h. i1 i i ..1 / \ it 0 y�'w' .- it ri o ;I; r rr 1 irk � 7' /7 ki . 11. i tr�i tLIP \ I -- - - .--- N. N. liNF 5. N a N. Si fil! Ill 11 hi 4 a .m §£, as 1:11 S$gs& r m111 211! .� z£ 1!1 11110 FOR CONSTRUCTIC Ihi i it Rv, 11 i , 4 -.‘ int i ti co a 2 o ... .. Is r U1.4 { ill W 1/1/ 11 1E P ' 1 1 ___. _- -_ ___._l ,r • t y II t ILA tea:-_ _ - ...""� __-. t. . 4 N M„..*,..;,............:,.......,...........,_=.2./4;4.4.!-..7.-..a.-...r......r.,,,,,,,.. ..-4. 111 I _ ii l a ill H 1.4 W !! 4! k .0 tit 1 ir. 11 aS i .1 .n met ffi ii if ti ...4 i 1 its Id1 1 i MA MI I .cw.r .. q v� — . --�-- -- Vw..i- -___ iiii__ pl ..",,til I • , /1111 i a: NI 1111 : ' 4 \ . . • . . ... —4\,,,,ss\l' . +W./0,MA. 'ON •11•6 I, $ •s ' • I. ,, .. Y. ligta il i 1, , . , i! , 1 ia bx , ig 1 ', ' ." ../!• -• --: . a g g z V ' :- i. 1 AIN-1 5 g . lit: 1 SYSTEM SENSOR Photoelectric Smoke Detectors System Sensor i3-series smoke detectors represent • significant advancement in conventional detection. 3 The i3 family is founded on three principles:installation ease,intelligence,and instant inspection. Features Installation ease.The i3 line redefines installation ease with its •Plug in detector line,mounting base included plug-in design.This allows an installer to pre-wire bases(included with heads).The large wire entry port and in-line terminals provide •Large wire entry port ample room for neatly routing the wiring inside the base.The base •In-line terminals with SEMS screws accommodates a variety of back box mounting methods as well as •Mounts to octagonal and single-gang back boxes,4-square back direct mounting with drywall anchors.To complete the installation,i3 boxes,or direct to ceiling heads plug into the base with a simple Stop-Drop'N Lock' action. •Stop-Drop'N Lock attachment to base Intelligence.i3 detectors offer a number of intelligent features •Removable detector cover and chamber to simplify testing and maintenance.Drift compensation and Built-in remote maintenance signaling smoothing algorithms are standard with the i3 line to minimize • nuisance alarms.2-wire i3 detectors can generate a remote LED- •Drift compensation and smoothing algorithms indicated maintenance signal when connected to the 2W-MOD2 •Simplified sensitivity measurement loop test/maintenance module or a panel equipped with the i3 •Wide-angle,dual color LED indication protocol.The SENS-RDR,a wireless device,displays the sensitivityof i3 detectors in terms of percent-per-foot obscuration. •Loop testing via EZ Walk feature •Built-in test switch Instant inspection.The i3 series provides wide-angle red and green LED indicators for instant inspection of the detector's condition:normal standby,out-of-sensitivity,alarm,or freeze trouble. When connected to the 2W-MOD2 loop test/maintenance module or a panel with the i3 protocol,the EZ Walk loop test feature is available on 2-wire i3 detectors.This feature verifies the initiating loop wiring by providing LED status indication at each detector. Agency Listings T ® (0) R EA MSFM �r LISTED APPROVEDiji approved approved ° us 5911 3011446 7272-1653:152 290-01-E 2093 3180932 SYSTEM �$ SENSOR „ilaN Indoor Selectable- Output Strobes and Horn Strobes for --- Ceiling Applications a s�5 System Sensor L-Series audible visible notification products are rich with features guaranteed to cut Dif installation times and maximize profits with lower 07, current draw and modern aesthetics. Features The System Sensor L•Series offers the most versatile and • Plug-in design with minimal intrusion into the back box easy-to-use line of horns,strobes,and horn strobes in the industry with lower current draws and modern aesthetics.With white and red • Tamper-resistant construction plastic housings,wall and ceiling mounting options,System Sensor • Automatic selection of 12-or 24-volt operation L-Series can meet virtually any application requirement. at 15 and 30 candela The entire L-Series product line of ceiling-mount strobes and horn • Field-selectable candela settings on ceiling units: 15,30,75,95, 115, 150,and 177 strobes include a variety of features that increase their application versatility while simplifying installation.All devices feature a plug-in • Horn rated at 88+dBA at 16 volts design with minimal intrusion into the back box,making installations • Rotary switch for horn tone and two volume selections fast and foolproof while virtually eliminating costly and time- consuming ground faults. • Universal mounting plate for ceiling units • Mounting plate shorting spring feature checks wiring continuity To further simplify installation,the L-Series utilizes a universal before device installation mounting plate so installers can mount them to a wide array of back • Electrically Compatible with legacy SpectrAlert and SpectrAlert boxes.With an onboard shorting spring,installers can test wiring Advance devices continuity before the device is installed. • Compatible with MDL3 sync module Installers can also easily adapt devices to a suit a wide range of • Listed for ceiling mounting only application requirements using field-selectable candela settings, automatic selection of 12-or 24-volt operation,and a rotary switch for horn tones with two volume selections. Agency Listings SWAMI LISTED APPROVED r t 85512 FM approved except 7125-1653:0534 S4011 for ALERT models 7135-1653:0533 3057383 • c_ Commonwealth of Massachusetts Division of Professional Licensure Security-tljte frf-S7L ice nse /r SSCO-000046 "-,.xpires: 01/05/2021 ROBERf K EIC34444. ErTIPT.9Yed bY, ;17 SEASIDE ISLARMSINC • 1(i/cv 1:10 Commissioner /14- dOMMONW DIVISION OF PROFESSIONAL LICENSUREB • • ELECTRICIANSIMEAM.r' 1660044**OLLOWING*LICEP,I,SE-- kyaTEM:obtifiiiititit ...... JR: • - g . . RostoRT.K BOUCHER 46iijoi.*****Iiko - - •- 126.4ACIOTE:''23 S YARMOUTH,MA 626444445 • 1317 C 07/311202garkt 694246,-- LICENSE NUMBER EiPIRATION DATE SERIAL NUMBER DIVISION OF PROFESSIONAL LICENSURE, • FOLLOWING REGISTERED wormilitpHOOAri , . • BOUCHER 1265 ROUTE ggr-,4 sYAFINIOUTt(i'llk-'0266444515 463 D 0713.1174.24AP V. 694240 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER •• •