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HomeMy WebLinkAboutBld-20-3867 • 4 8 jj ; .5 CAZAt5 . ;4;3'1 ? let„r.. :'?7 D 4A , 6 - (Vice 1. . 1146 g(2444 28, £ ,:purtauti, glif 02664 APPLICATION FOR FIRE PROTECTION PERMIT Date ///3' Zd PERMIT NUMBER j: j 0 - .9( 7 7 Projected Start Date: / r5-- r O Date of issue In accordance with the provisions of 780 CMR and M.G.L. Chapter 148,as provided in Section This application is herby mad / by Sty, 'e ///&K/4 S /st L (Full name of person,Firm or Corpor tion) Address /Z(t S /2`f -z - _S yc:rr►4.Pt-1 (Contact#) A Email Owner of property / -C c�el Ac7 S Job Location y,/ /tea i�- 1 ycci i7 0 2'/; /W/ / ,O t i /' ?J 6C f r4 (Street&City or Town) For permission to(state clearly purpose for which permit is requested) 1%e ii:4 46)kti gel -.tr' / 1,1-0-- il&A,11 Cile e&-PC-7 Name of competent operator(if applicable) Cert. or License No. )J 7 C Estimated Cost of Construction: /OQC By Y (Sign a Applicant) .i : : '.1: /--4, Date: I. 13- Jo FEE: $50.00 The Commonwealth of Massachusetts :Fr_* _ /, Department of Industrial Accidents _? II_ 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. Annlicant Information Please Print Legibly Name(Business/Organization/Individual): Seaside Alarms Inc. Address: 1265 Route 28 City/State/Zip: South Yarmouth, MA Phone#: 508-394-0599 Are you an employer?Cheek the appropriate box: Type of project(required): 1.0 I am a employer with 19 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. 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 10 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 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 5.0 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.❑We area corporation and its officers have exercised their right of exemption per MGL c. 14.0Othersecurity 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. tContractors 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. 1 am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name: Associated Employers Policy#or Self-ins.Lic.#: VNCC50050128332019A Expiration Date: 2/25/20 Job Site Address: All sites in ye,,y,et p U.g. 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 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 u er he pains and jjpenalties of pedury that the information provided above is true and correct Signature: r, 7.- Date: 7/ / Phone#: 508-394-0599 Official use only. Do not write in this area,to be completed by city or town of r"nl 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#: Client#: 21641 2SEASIDEAL ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 02/20/2019 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(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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT The Hiib Group of N.E.dba PHONE Fax (A/C,No, ):508 775-1620 (A�,No): 5087781218 Dowling&O'Neil Insurance Agy E-MAIL P.O.Box 1990 ADDRESS: Hyannis,MA 02601 Crum INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: &Forster Specialty Insurance Co. 44520 INSURED Seaside Alarms,Inc. INSURER 8:Associated Employers Insurance Company 11104 1265 Route 28 INSURER C:Safety Indemnity Insurance Company 33618 South Yarmouth,MA 02664 INSURER D: 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. TYPE OF INSURANCE SUBR NSR D POLICY NUMBER PQLICY EFF POLICY EXP UMITS (M D/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY GL0582133 02/25/2019 02/25/2020 ppEAAqCC�H��OEECCCUURRENCE $1,000,000 CLAIMS-MADE X OCCUR PREMISES(EaErrence) $50,000 X BI/PD Ded:1,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ C AUTOMOBILE LIABILITY 6222107COM06 02125/2019 02125/2020 CO (EaMBINED SINGLE LIMIT 1,000,000 acadent) $ ANY AUTO BODILY INJURY(Per person) $ AOUTOS ONLY VVNED )( SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIREDNON-OWNED PROPERTY DAMAGE X AUTOS ONLY v AUTOS ONLY (Per acadent) A X UMBRELLA LIAB X OCCUR SE0103960 02/25/2019 02/25/2020 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION WCC50050128332019A 02/25/2019 02/25/2020 X PER OTH- AND EMPLOYERS'UABIUTY STATUTE ER , ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBEREXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes, be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liab GL0582133 02/25/2019 02/25/2020 $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Yarmouth SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD #S230264/M230244 LS1 pc_ Commonwealth of Massachusetts �!l Unit sion of Protessional Licensure Security,*stelYtst/fS-License r SSCO-000046 4 x pires: 01/05/2021 iK ,s. �` F`IROBER a ( _EmP9Yed by SEASIDE ALARMS , iF' `N Commissioner Ch COMMONWEA►LTH.:�OF. tS .S . DIVISION OF PROFESS IONAL LICENSURE - T , ELECTRICIANS I ES,3� OLLOWINO UCENSE- REC,GI RED SYSTEM CONTRAC1 )R ig #PERT K BOUCHER , [ 'SEASIDE A-.. : . . —INC 1265 RTE28 �` S YARMOUTH,MA 02664-4455 I° 1317 C 071311.2022_; 694246 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER COMMONW, LTH'=OF.M..,, 'HUS S.'.. `. DIVISION OF PROFESSIONAL LICENSURE ELECTRICIANS ` HE-FOLLOWING LICENSIi. ... REGISTERED SYSTTECHNICIAN Ia iz #OBERT K BOUCHER , - 1F365 RQUTE•2# j I. S YARTH MA 02664- la 463 D 0713112022` _ 694240 4,_ LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER • 1265 Route 28 • South Yarmouth, MA 02664 • 508.394.0599 • MA LIC. #1317C 24 HOUR PROTECTION January 13,2020 Yarmouth Building and Fire Department 1146 Route 28 South Yarmouth MA 02664 Fire alarm additions to monitor: Fountain Place Building# 6 411 Main Street 6A, Yarmouth Port, MA Owner—Michael Kalis 781-461-0030 Design obiective Monitor the existing standalone FCI 72 Series fire alarm control panel (FACP)that protects building#6 (habitat for humanity) utilizing the Silent Knight FACP located in building# 1. The Silent Knight addressable panel was recently installed and protects all the other buildings in the complex. The Silent Knight panel will serve as a slave communicator transmitting alarm signals to central station. The panel will beep and show that a trouble or fire alarm module is actively engaged and then auto reset without user intervention when the condition clears. The"SILENCE" button can stop the beeping if required. Notification devices will not sound in the unaffected buildings. All silencing and resetting for building#6 will be done at the old FACP in the basement of building#6. Fire alarm devices, locations, and protection levels in building#6 will remain unchanged as originally installed. Installation Two new Silent Knight addressable input modules will be installed next to the FCI panel in building#6 to supervise the general fire alarm and trouble relay outputs from the old system. When the relay/module triggers the Silent Knight FACP will report the alarm or trouble condition in building#6 to central station. Seaside will perform a 100% inspection and test of all existing devices in building#6 and make any repairs/replacements necessary. Repairs are not included and will be billed at time plus materials. Replace the two batteries in the FCI FACP (included). New cabling to be run in the existing conduit to building#6 to supervise the system. Full supervision of the communications paths and daily tests will be provided by the Silent Knight FACP. Building#6 will be monitored under the existing contract at no additional charge. Seaside Alarms will provide emergency and routine service for all buildings as needed. ID I : "..m..11 2 1i71 itcz.t0 1265 Route 28 • South Yarmouth, MA 02664 • 508.394-0599 • MA LIC. #1317C �� 24 HOUR PROTECTION • �� \�G~ December 22, 2015 ik()PBuilding& Fire Inspector 'r� Town of Yarmouth 1146 Route 28 , rt South Yarmouth, MA 02664 O Fire Alarm Narrative—Fountain Place 411 Route 28, Yarmouth Port,MA Owner: Michael Kalis 781-461-0030 Overview r �i V lCk This property consist of four two story wood buildings that are being used as office space �c~� by multiple tenants. Occupancy use group is business&mercantile. Three of the buildings ���!C� have fire alarms that are in disrepair and will be upgraded. The fourth building, Habitat for Humanity,has a newer system in good order and will not be included in this permit. The buildings are not sprinkled and do not have an elevator. There are no high hazards or other conditions for design consideration. No fire alarm protection is required by code for this building or use group. The owner would like to a voluntary upgrade the fire alarm system to increases tenant safety and provide better property protection when the building is vacant. To this end smoke detectors will be installed in the common areas and the larger tenant spaces. Hallway horn/strobes and bathroom strobes will be installed to alert the tenants. The design is not intended to protect all offices or spaces but provides an affordable level of protection for the larger areas. Additional detection devices can be added for by the owner increased protection. Fire Alarm Panel The system will consist of an addressable commercial fire alarm control panel(FACP) with battery back-up and integrated two line digital alarm communicator. The single FACP will control the entire complex with selective signaling that will sound only in the building that is in alarm. The FACP will be located in the hallway of building#1. An exterior strobe will mark the panel and lock box location. Equipment and Installation The majority of detection devices are in existing locations and will be upgraded to addressable detectors. Most of the notification devices will be in new locations.New wires will only be run to new devices or to replace damaged wiring. The attached plans show the approximate new and existing device locations. Installation notes 1. Installation and equipment will be in accordance with NFPA 72. 2. Three line isolation modules will protect against a short circuit in one building from disabling the protection in the other buildings. 3. All devices will be located per 521 CMR and ADA requirements. 4. All new devices will be "listed and approved"and comply with CMR 527-12.00. 5. The FACP with be supplied with surge protection on the house power. 6. Detection and notification circuits will be supervised class B. Operation Upon alarm activation the horns/strobes will pulse a temporal 3 evacuation tone and the strobe lights will flash in the effected building. The exterior strobe at the FACP will flash. The panel will display which building and device is in alarm. A floor plan of the property showing all device locations will be posted at the panel. Central station will be notified of the alarm and dispatch by building and device to the Yarmouth Fire Department. Local property caretakers will be notified after dispatch. The system can be silenced or reset by a touchpad or key switch at the panel location in building#1. An operations sheet with floor plans showing all detection devices will be posted next to the FACP. Monitoring and Service The system will be monitored by our UL listed central station. Daily phone and/or cellular test signals will be sent to central station to ensure operation and a signal path. Seaside Alarms will provide routine maintenance and emergency repairs for this system. . . • - •- , • • Fountain Place—Fire Alarm Plan 411 Route 28,Yarmouth Port,MA __,_ . • ... I f, . _,,,Ism ELIVESYSTEM MEM , i •_J P 14. $4 )4. '""r •=. . -.______--.--1 - .- • tz.... .. ;"wisal MI COIntolaxar--.70„71 E4 . , a, Y.s........1 WP , 4. AM MIDICIADET piE (1)/, BUILDING Ott ,,,, c-- , . ttioAqi ..,• --•-• _ NOR.Iii.uaN7 04 4 4 I ;',. cvd 4,= OM uffirmaDaE ):( Mk r ;;;;1=ir4or .--'71----- L - r-----,-- =.' , . ,•,. !,,,,,,,e i 'r.-fittreiglal 1 == • ...._r.,,,, - -Jr:I...TA-v.1, . _...., 41) i a. V4 _ itea.1.410 1 ......71, -... li IP . *rit . i _s MON.( NOME 0) • ill "-A . =F.-.2.: 1 •/ n.... il --- - 6.11=1, IM, .. ....•• 4,- Op _A1 /- ....., nil //P4A'(63A i 7 I g "•i;" ..4 4' , ).1 . h1111111111r440 ' '.. 7.4.Filli r•Inivilimb- ir .pv.1 5,....=5-,4t 1 .Bu ‘ , ) I 5 iDINC 15 1 1111i • w"Ab.ri.: P,11 . IIIIIPTAIIIIIIN , kidt_Ailli,r47rellt .1 414 Ara% , 411141i,T ),I.,.., -11 ' q 1 7410,. .4,741tA- A' _11 I 1 - , 1 T--- ,...i _____..... 11111E_____ - ... 1 - , . • gl .0 mr:0111 a il jj 1265 Route 28 • South Yarmouth, MA 02664 • 508-394-0599 • MA LIC. #1317C 24 HOUR PROTECTION January 22,2020 Yarmouth Building and Fire Department 1146 Route 28 South Yarmouth MA 02664 Re: Fire Alarm Permit BLD-20-3867 Fountain Place Building#6—411 Main Street, Yarmouth Port, MA Dear Inspectors, Seaside Alarms has connected the standalone fire alarm in Habitat for Humanity(Bld#6)to the main FACP that protects the rest of the property per the submitted permit and narrative. The standalone system is monitored for general fire and trouble conditions (see attached report). In conjunction with this work a 100%test of every devices on the property was performed. All devices and functions are working correctly. Seaside Alarms will continue to provide monitoring and routine/emergency service as required. Sincerely, Paul Haygood Seaside Alarms Inc. SEASIDE ALARMS 1265 ROUTE 28 SOUTH YARMOUTH,MA 02664 FIRE PROTECTION TEST REPORT Name of Premises: Fountain Place SSA#7257-1 Address: 411 Main Street Yarmouth Port,MA 02675 Telephone Number: 781-460-0030 Contact: Mike Kalis Control Panel Locations: Building 1(Entry door) & Building 6 (Basement utility rm) Date of Service Control Panel SK 5808(Bldng 1) YES OK 1/14/20 Annunciator Stand-by Battery YES OK 1/14/20 Smoke Detectors YES OK 1/14/20 Heat Detectors YES OK 1/14/20 Pull Stations YES OK 1/14/20 Bells/Horns YES OK 1/14/20 Sprinkler Tamper Switch FCI Panel(Building 6) YES OK 1/14/20 Service Comments: I,Matt Maynard, inspected Fountain Place on 1/14/20 and the above tested items are working according to manufact er's recommendations. 7-2 0 i natur Date Company Name and Address Seaside Alarms 1265 Route 28, South Yarmouth MA 02664 Received Yarmouth Fire Department 01/22/2020 12:52 ID:D610PDH Customer Activity Report All Activity Include Test Signals Fountain Place Customer ID: 61006727 Monitoring Status:Pending,Inactive,Active,Deactivated 01/22/2020 11:30:00 Thru 01/22/2020 11:35:59 [Customer's Local Time Zone] 61006727 [610/6727] Fountain Place 411 Main Street misox@verizon.net West Yarmouth MA 02675 Date Day Time Log Description 01/22/2020 Wed 11:30:55 Fire Supervisory Tbl'FIRE-BLDG.6 FIRE TROUBLE' 11:30:58 Fire Supervisory Res'FIRE-BLDG.6 FIRE TROUBLE' 11:33:02 Fire Alarm'FIRE-BLDG.6 FIRE ALARM' 11:33:06 Fire Supervisory Tbl'FIRE-BLDG.6 FIRE TROUBLE' 11:33:09 Fire Restore'FIRE-BLDG.6 FIRE ALARM' 11:33:11 Fire Supervisory Res'FIRE-BLDG.6 FIRE TROUBLE' Customer Activity Report Page 1/1