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HomeMy WebLinkAboutBldsm-20-001626 RECEIVED , sE; 23 2019 Commonwealth of Massachusetts Bu— N • DE PAST ME NT By • Sheet Metal Permit Date: �._ ;3__ ( ? Permit# A LZ St1 -do "oo 416 Estimated Job Cost: $ 6 s G Permit Fee: $ Plans Submitted: YES NO Plans Reviewed: YES NO Business License# Llt- Applicant License# '¶> ( Business Information: Property Owner/Job Location Information: Name: / t)t)(v S)rs/cT /...r01444 Ar Name: / Sf-eo'✓9, ( `, Street: 30 447 4/lA-C Street: �,P1/ 44'j1"j (7i- & ict City/Town: 7--(..iii1ew '' 04 NO( City/Town: y "44 )4/oar Telephone: 97(-- 7/0 70) Telephone: c U/--- C? et- / 1-/eV Photo I.D.required/Copy of Photo I.D.attached: YES NO Staff Initial J-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or Iess and commercial up to 10,000 sq.ft./2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other ►/ Square Footage: under 10,000 sq.ft. over 10,000 sq. . Number of Stories: ;/ Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofmg Kitchen Exhaust System f/ Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: 4.1-44 11 wt Id-00 LyA4,/r,fr- (L(4-/ s- --j ,//f 140 p/ 1 lJ e�t,1ILr� l RESIDENTIAL DUCT TIGHTNESS ` TEST REQUIRED ` }4 ,/,4 j All`/1 44/ Section 403,2 of the Energy Code requires leak testing of ducts installed in Non Conditioned Spaces. Two options are provided: Post•consJLurtion Test or Rough In Test. An Approval Certification is required from an authorized testing agency before the Building_ Dept. will issue a Certificate of Occupancy or final approval of the work. Inspections shall be called for prior to the frame inspection on building - i INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes 0 No❑ If you have checked Yam,indicate t type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the Insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent • • By checking this box°,I hereby certify that all of the details and Information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections • Date Comments • Final Inspection Date Comments • Type tense: By aster . The • ❑Master-Restricted City/Town • QJoumeyperson Signature of Licensee Permit# QJoumeyperson-Restricted License Number: Fee$ 0 Check at www.mass.00v/dpi 4S'A Inspector Signature of Permit Approval The Commonwealth of Massachusetts '11 — 1, Department of Industrial Accidents _A_= 1 Congress Street, Suite 100 e E_=mooBoston, MA 02114-2017 5�•` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �Pllease Print Legibly Name (Business/Organization/Individual): �voj(�2 S/c.kt :C)C. / n)- /^ r,^� S- i'i t t Address: 3C) 3147v/• City/State/Zip: ��✓/4(' L y !'4 Phone #: Are you an plover?Check the appropriate box: r,J/ Type of project(required): I. am a employer with /�� employees(full and/or part-time).* 7. 0 W construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. t 9. ❑ Demolition ❑ y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on mYP roPrtY• e I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.; 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /it/'Cs (i9 r Policy#or Self-ins.Lic.#: L- -)eJ if©$-// I Expiration Date: ' Job Site Address: J fi/ City/State/Zip: 7�``'t0-) ' i4"1- 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 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 he pains and penalties of erjury that the information provided above is true and correct. Signature: Date: Phone#: C/7 - 7/0 - 7 4 ' 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#: • S . • Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,,association,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 trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the 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 number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the 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 number. In addition,an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia , PHILBROOK AENGINEERING & 107 BEACH STREET / DENNIS, MA 02638 CONSTRUCTION 1 508-385 8682 ENGINEERING DESIGN • CONSTRUCTION INSPECTIONS • BUILDING, ALTERATIONS & RENOVATIONS 26 September 2019 To: Town of Yarmouth attn: Mr. Tim Sears, Building Inspector 1146 Route 28 South Yarmouth, Massachusetts 02664 SEP 26 2019 re: Grease Duct Clearance - 1st Congregational Church 1, J, ,' 1 329 Route 6A, Yarmouth Port, MA ° w Dear Sir: v c') na7o -D-I K --0n < r..r -c r !TI m The installation of the ductwork and exhaust fan for the new r-' cl �D � mni -3 commercial kitchen hood as part of the general kitchen remodel t F o 0 required mounting this equipment externally to the rear of the Y m ? Tp church. In order to meet clearance and code requirements and c M �' _, c Z keep the equipment as close to the building support as possible ro ‘ _ a non-combustible assembly was installed. The assembly had to 2; S► 'T . t2 01 be at least 3" in width in order to meet the code standoff re- m - C. �� I quirement for distance. Cement board on metal studs with a OT '' u' z "a Z _- ate,, cement based stucco finish were constructed to allow the equip- c� ,. -- r•, ment to be mounted and held close to the building. r- z C: .".) This work is referenced from the 2015 Inter. Mechanical Code 6. l- o 'e� Sec. 506, Para. 506.3.6 - Grease Duct Clearances. In addition a rn m -a this type of assembly is specifically identified ... A 3-inch " m n clearance would be allowed for gypsum board attached to metal c R studs, for example... within the commentary. Due to the exterior y = r nature of the construction 1/2" Durock cement board was used rn instead of gypsum wall board. 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MA 02638 CONSTRUCTION 1-508-385-8682 ENGINEERING DESIGN • CONSTRUCTION INSPECTIONS • BUILDING, ALTERATIONS & RENOVATIONS 26 September 2019 To: Town of Yarmouth i y £ c _ . 1 attn: Mr. Tim Sears, Building Inspector 1146 Route 28 I ' South Yarmouth, Massachusetts 02664 E l SEP 2 6 2019 s € re: Grease Duct Clearance - 1st Congregational Church r3 ;; uH,..; _r_- RTt ENT 329 Route 6A, Yarmouth Port, MA By Dear Sir: o (- D '? U > Ovzrn The installation of the ductwork and exhaust fan for the new m o m F-i commercial kitchen hood as part of the general kitchen remodel r `,-' m ri ....3 required mounting this equipment externally to the rear of the % ' a church. In order to meet clearance and code requirements and 9-,!T' - keep the equipment as close to the building support as possible c k o ae a non-combustible assembly was installed. The assembly had to o be at least 3" in width in order to meet the code standoff re- ► v quirement for distance. 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