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HomeMy WebLinkAboutBld-20-002665 r��I__ NUV rg /7% 4 N1�J•W!/N}�i�l/L V .d - (9fficeo/ili V✓3AM.my 1146 Reide 28, 5 p w✓✓J , OM 02664 APPLICATION FOR FIRE PROTECTION PERMIT Date t I-C A2/3 PERMIT NUMBER tU)--o? 17-' a (it,15 Projected Start Date: ,SSi9P Date of issue In accordance with the provisions of 780 CMR and M.G.L. Chapter 148, as provided in Section This a plication is ere y m e by CG �tarY\ (Full name,‹person,Firm or.C ooration) Address �09 01d ��owhytou5c oadA Yarr)--)0uxa-c (Contact#) 50 - 398-G3JC Email a LES (, CapECod aLCC rn - corn Owner of property VA V?d SO r SI i u,ed Wu rs i nc�(Q Job Location G5 A/o rTe JJ i n g' -re r ()&'2 a, 2ki (Street&City or Town) For permission to (state clearly purpose for which permit is requested) iloid SYroveE Dec ec -0r (719OUF_ 'crcW . FirE afar 12r1 COY-W lL r'hE L N rite 81/4a, ,E/2 /Zcoor-1 • Name of competent operator(if applicable) (gene Co rr 1%t er Cod ogLarm (.7 00 Cert. or''License No. /J 9k_C Estimated Cost of Construction: $ 3 4- /)By iN � t) (Signature of Applicant) Building Official: ��;• Date: 1 I - )` i FEE: $50.00 • The Commonwealth of Massachusetts ► _' Department of Industrial Accidents 1 Congress Street,Suite 100 '" Boston,M4 02114-2017 `Y. www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual):CAPE COD ALARM COMPANY,INC. Address:204 OLD TOWNHOUSE ROAD City/State/Zip..WEST YARMOUTH,MA 02673 Phone#:508-398-6316 Are you an employer?Check the appropriate box: Type of project(required): n Yp P j (t'e+9 �): 1. ✓D I am a employer with l/ . employees(full and/or part-time).• 7. ❑New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling any capacity.(No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself[No workers'comp.insurance required.)t 9. Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 a Building addition ensure that all contractors either have workers'compensation insurance or are sole MD Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I 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. 14.Q Other �1 Ol C Z 17IJ1Ce 152,11(4),and we have no employees.(No workers'comp.insurance required) p e4 L"QTO r d rvV E Fire caar► -) eA r-oZ era) ,h (1BDil.er *Any applicant that checks box/1 must also fill out the section below showing their workers'compensation policy information. rpp Vn 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 Insurance Company Policy#or Self-ins.Lic.#: WCC-500-5006433-2019A Expiration Date:SEPTEMBER 1,2020 . Job Site Address: 46. I v©6--tee? tU0Vk SreeT City/State/Zip:< US k CT?OwJd 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 certiff'un epains pen ofperjury that the information provided above is true and correct. Signature: Date: 11— p2019 Phone#:508-1-58-2624 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#: ..- - ".... • • • Rsiicr_411,t HiJSETTS'.. LTH nu, '''- uRE r.,:_. ocwomm,s,00n nowt eparolthteos sr,m,ansasi aLeicheuns:titrse COMMONWF .• DIVISION OF PROFESSIONAL . ,,- . 1, OFSSIONAL LICENS .'.'-'.ELECTRICIANS , .... . . . Securt,"...1 s(i.41n(114:6iS-.License/E. '...1..' '• LICENSE LI . ,gc .' . . ISSUES THE FOLLOWING TECHNICIAN F.< ', SSC 0-000248 ....,,, REGISTERED GENs.-1.0' - . .- SYSTEM z ,, „, :,-;''''', xpi..,rs,...: 11/07/202,./0, CAPE COP AL.I - '' \''' Ernlig9Ye*.'• ';- '-:::: ,--itt VN• . CORNIER . u) . ENEA‘CO ' ' z , SOUTH DENNIS,MA 11()TSS'.4:10` itOcitig 4:14. . ..2667, , i Commissioner e'L 683001 . - ....: .........,. . - :-:::.•••:: .;'. 'EXPIRATION DATE . , ,),...g LICENSE NUMBER SERIAL NUMBER .'.:,•...::::.-*... ' C'.'0 MM.. .i,.:r.. W!A......„-.,.... :•'.....O.,......F.., ffi'"':".— AC. H..„..........,U...„..-S..„...,...,,E,TT S DiyisicsOfpF0FEs1)",1LICEN7uRE oxi1,F, ... , .... ..-..... ..... ...:., — .::....'...: .:.-. '...::.ELECTRICIANS:,,n,.;:i:....,,... THE FOLLOWING LICENSE------- :-;''''' S : ISSUES, ", , CONTRACTOR7,' - . LU TEM REGISTERED!..kr...,::,i-..i...:•:::::;i].:-' .-1-..Niieti, -,:-... ..,,, 4 GENEA CO..P .., ..cA. ,.. \- on ,- RINGO 1N1.; .... --:. ,0,--(t.7.777.-7.,.. :ii:-;::;,- RD,.:.:,.:...i:•i].... :..:;,: \ v., ,-..,„,. ,,,,z,„, 0 ; 204 OLD TOWN HOUSE WEST YARMOUTH,MA L .......:....': '':.: .....'''''''........!:.:'... ... '' f,',: 655106 • ..„...,.,.iIii.11....:'&tj31,40;;::'..-'.:.-.:-;i..,:.:X. NUMBER 1592 q:::,.-....: :,.-, SERIAL ... LICENSE NUMBER EXPIRATION DATE ,.. . .. • • . . 1 •p4''YA - TOWN OF YARMOUTH Building Department BUILDING r_ (508) 398-2231 ext.1261 0 �,...�; ewit PERMIT NO BLD-20-002665 PERMIT JOB WEATHER CARD F ""'� '"r' ISSUE DATE :11/07/2019 APPLICANT Gene A Cormier .;......, PERMIT TO IAT(LOCATION) 1265 NORTH MAIN ST,SOUTH YARMOUTH,MA 0 I ZONING DISTRICT ! Bldg.Type: I II SUBDIVISION MAP BLOCK LOT 1090.4 jl BUILDING IS TO BE: ICONST TYPE 11 j USE GROUP I I REMARKS Fire Protection-Add smoke detector above the fire alarm control panel in the I boiler room.(508-258-2624) LICENSE CONTRACTOR `1507 (Electrician-Systems GENE A CORMIER Gene Cormier AREA(SQ FT) 10,113, 4-3,0 EST COST($) 1378.00 I PERMIT FEE($) 50.00 OWNER [FAIRVIEW EXT CARE SERVICE INC I ADDRESS I,PO BOX 2489 BUILDING DEP IPITTSFIELD IMA 101201 I PHONE I THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR IDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL MEMBERS(READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND COVERING)3)FINAL INSPECTION BEFORE REQUIRED,SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPANCY 4)REFER TO DETAILED INSPECTION OCCUPIED UNTIL FINAL INSPECTION HAS SCHEDULE BEEN MADE. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION NOTED ABOVE.