HomeMy WebLinkAboutBld-20-004998 . ; 91 f '' ''''' C ;: -
v Z,. Li;
''''vt I. o'''''' Rte e0,02M494144eatig 4 orca . rf,-.,-
,- ..,,,,...ke
. LP..v/i2?
_t , ,
__,_, . ,
1146 Ramie 28, 504,44 p.dg, MI)02664 -.. ,
APPLICATION FOR FIRE PROTECTION PERMIT
Date 3 &/Z-0 PERMIT NUMBER 1,.E 90-ob y/9
Projected Start Date: 3 2%0 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 made
by ��e- c/ ciz: ,91r� • IACL
(Full name of person,Firm oar o►poration
Address /7 C 0S 7Q 1 2 4.- ^L -7,11 Pon a Z 66-y
(Contact#)/Gµ / 1 u.�.ro d Email `� <ee.:„sic .a_l ar s-"'k-s . C9 _
Owner of property M<G%e-/ i n -/a •
Job Location 3 Z/ 27 L� 441._-)14‹ t_k, ljc. rc<<'�
(Street&City or Town)
For permission to(state clearly purpose for which permit is
requested)
I A `�e__ 0-1,0-( de 0 i -61.s lie IA) Kes 7i..L.,,r,,,i/r/
4fLaj4Ar..C.--‘,--- 6. exi.si:vtel. ve._ /9/ JQ--i/te-1
Name of competent operator(if applicable) id,L lgo(AC-1't 6 t
Cert.or License No. /3I 7 C. -- Estimated Cost of Construction: 2—k-
By
(Signature ofpplicant) 1
Building Official: (..--/.,c„ J'3 Date: 41)
FEE: $50.00
The Commonwealth of Massachusetts
1 Department of Industrial Accidents
_;;,�= 1 Congress Street,Suite 100
a°°�1•= Boston,MA 02114-2017
.�,�,s"a www.mass.gov/dia
\Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aanlicant Information Please Print Legibly
Name(Business/Organization/Individual): Seaside Alarms Inc.
Address: 1265 Route 28
City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-394-0599
Are you an employer?Check the appropriate box: Type of project(required):
1.0 I am a employer with 19 employees(full and/or part-time).* 7. ❑New construction
2.0I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
9. El Demolition
10 Q Building addition
4.0I 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.[J Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof 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.[]Other security/fire 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.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Hartford insurance Co.
Policy#or Self-ins.Lic.#: 08WECAE7ZU7 Expiration Date: 2/25/21
Job Site Address: All sites in y ii a /t\ City/State/Zip:
Attach a copy of the workers'compensaton 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 certsjj'under� the pains and penalties of perjury that the information provided above is true and correct.
Sign /'1/4 ature: .s Date: Z/2A/Z0
Phone#: 508-394-0599
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#:
Client#:21641 2SEASIDEAL
ACORD. CERTIFICATE OF LIABILITY INSURANCE GATE(AAM/DDlYYYY)02252020
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR TIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POUCIES
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 condIions 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).
CONTACT
PRODUCER E:
The Hilb Group of N.E.dba FAT N,EA:508 775-1620 (FAX Na):5087781218
Dowling&O'Neil Insurance Agy E-MAIL
ADDRESS:
P.O.Box 1990 INSURER(S)AFFORDING COVERAGE NAIC a
Hyannis,MA 02601 INSURER A:Crum&Forster Specialty Insurance Co. 44520
INSURER B:Hartford Fire Insurance Company 19682
INSURED Seaside Alarms,Inc. INSURER C:Safety Indemnity insurance Company 33618
1265 Route 28 INSURER D:
South Yarmouth,MA 02664 INSURERS:
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. UNITS
L RR ADDLSUBR POLICY NUMBER (I ,r ) (MPMIdD� .
TYPE OF INSURANCE INSB__yrV•
A X COMMERCIAL GENERAL LIABILITY GL0062591 02/25/2020 02/25/2021 EACHoccpuRRENCE $1,000,000
RRi ISES(Ea rrence) $50,000
J CD Ded:1,000dADE X OCCUR MED EXP(Any one paten) $5,000
X BUPD PERSONAL&ADV INJURY S 1,000,000
GENERAL AGGREGATE s2,000,000
GEM_AGGREGATE LIMIT APPLIES PER:
PRODUCTS-COMP/OP AGG $2,000,000
POLICY I Xl EPRC LOC $
OTHER: COMBINED SINGLE LIMIT
AUTOMOBILE UABILITY 6222107 02/25/2020 02/25/2021 (Ea aBINEDt s1+�'�
C BODILY INJURY(Per poison) $
ANY AUTOOWNED BODILY INJURY(Per accident) $
AUTOS ONLY X AUTOS ULED PROPERTY DAMAGE
AU AUTOS N LY (Per accident $
X qUl pS ONLY X OS ONLY $
A UMBRELLA UAB OCCUR SE0107286 02/25/2020 02/25/2021 EACH OCCURRENCE $1,000,000
— AGGREGATE S1,000,000
X EXCESS LIAR X CLAms-MADE $
DED I I RETENTIONS
B WORKERS COMPENSATION 08WECAE7ZU7 02252020 02/25/2021 X lafA UrE I I°RH •
AND EMPLOYERS'LIABILITY Y/N EL EACH ACCIDENT $1,000,000
ANY PROPRIETORMARTNER/EXECUrivE
OFFICER/MEMBER EXCLUDED? N N/A E.L DISEASE-EA EMPLOYEE E1,000,000
(Mandatory In NH) E.L DISEASE-POLICY LIMIT $1,000,000
If yes deacnb N OF OPERATIONS below e under
DESCRIPTIO
A Professional Llab GL0062591 02/252020 02252021 91,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It moil 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
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Yarmouth THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
1146 Route 28 ACCORDANCE WITH THE POLICY PROVISIONS.
South Yarmouth,MA 02664
AUTHORIZED REPRESENTATIVE
--Tar C.,,�,a.. � .
I
01988-2015 ACORD CORPORATION.All rights reserved.
ACORD 25(2016/03) 1 of 1 The ACORD name and logo are registered marks of ACORD LS1
#S254614/M254444
• �„ ,Wi
lk Inc.Wilk
r
1265 Route 28 • South Yarmouth, MA 02664 • 508-394-0599 • MA LIC. #1317C
24 HOUR PROTECTION
March 6, 2020
Building & Fire departments
Town of Yarmouth
1146 Route 28
South Yarmouth, MA 02664
Fire Alarm Narrative—West Yarmouth Center
Tenant: Saga Fusion Restaurant, 521 Route 28, West Yarmouth, MA
Landlord: Michel Mangalo 508-776-2144
Overviewsystem
This building is a multi-tenant retail strip mall. A building wide fire sprinkler add essects the
e
entire property. The sprinkler system is monitored/supervised by an approved
alarm system installed in 2019.
A new tenant is building out one of the vacant units to be a small sushi/Asian restaurant. There
are no previously installed commercial fire alarm detection or notification devices observed in
this space. Occupancy classification is A-2. This use group and occupancy load is not required
to have a manual fire alarm. However, audio and visual notification is required on sprinkler flow
and if present a hood suppression system must be connected to the fire alarm.
Scope of Work—per plan
- 3 Hom/strobes in the restaurant and kitchen.
- 2 two strobe lights in the bathrooms.
- 2 pull manual pull station at the front and rear exits (non-required).
- 1 kitchen hood supervision module.
- Replace the exterior hom/strobe removed for construction.
- Connect all devices to the Silent Knight 6808 addressable fire alarm control panel.
- Carbon monoxide detection for gas shutdown is not in Seaside's scope of work.
Operation
Upon alarm, all building wide horns will sound a temporal 3 pattern and the strobe lights will
flash. Alarm signals by point/area will be transmitted to central station for retransmission to
Yarmouth Fire Department. The FACP and annunciator will tone and show the device in alarm.
The system can be silenced or reset by a touchpad on the fire panel or at the annunciator at the
front of the building. A"FIRE ALARM PANEL" sign is posted on the rear door to mark the
location. An operations sheet with site plan is posted with the FACP
Monitoring and Service
The system is monitored by our UL certified central station. Daily tests are sent via cellular and
landline to ensure a communications path.
Seaside Alarms will provide routine maintenance, annual inspections, and emergency service.
/ gr ,r/ r it'd l" (G,-/ l �/
F /01'\ —�2 r R 8-) LA) k(,)^T : '
/ )44141
!
/ /
i
mole
150. //// //j%/' \ \
0-Nnr-) --- '1141. irt DIFT3'
alas wn BMPirresz -Q ///////.,//4_-- \
I_Ib-m• � --I `s_ evrm t \
45)
c0� —\RAIN MARIE BELVIi.-_.
7I I WORK TABLE LLV®OY i
— p D® Saves,.: / 3'-6' ® WALK-IN WALK-IN cu
II 3' �■■n.
,��•' -\ OJ1 - COOLER FREZZER
KITCHEN Tom D''{'
` ` COIRM 5PL/81 4. • m OMR RINSE in rite- Od 421
t POT
laill �' m a. MAMA 4ASNe� Slerle \ �x
Law 3- j \
MOH �( ®� waN
TABLES n l TAKE � S
N WORK TABLE REFRIGERATOR
WAITER me
/ 3 / 3' 16'_4.: \ // \ 4._6,. / 11._5" STATION ! In
PD SUSHI BAR in �►
in ►I` `-ate+ EWA AREA `n '-
\ /GPI• Il'-4„ Byt�I - \ I/^� ImNACt1•E ieA ust \
II GOOIER II tl GQxGI 11 .�� Ate. M_ N __
1• , '1 UNDER II 11 01091 II
/ 3' / I`_ �.AW ; L.._susrxrnS�_.I \ rras�I .
in limy[ P
MI r PD V -_"-'
T
v) 'A - 1 `�-' I 4� TgLET S
ia
IIIIIII
l.LC /f 9 3n /-�~ oo' \
N um J iffl
olio ® }� g
3•_6" n ri 4.-6" I'/ 4'-2" ;f —
JIETTS
Tni r FD.® ilb
\ i 2.6"/ DINING a •\- g r
_a
m y
AREA cl
ry \
\ .....
\_I PQaPi " \
~ 2'_a" gu DINING
f /• • i SW TANG I`1. in (1i AREA#2
ais in
Vt;
VESTIBULE
Op 4 4 4 4 V/e/
IZI
, 4 -dal M
o
B 2 / 31'-I0"
/ 38'-8" /
FLOOR PLAN Ft8S'YisTEN Lewin
SCALE: I/4"=I'-O" MAN sTA PULL Op
SIGNAL UGHT-S ROBE X
HORN+LIGHT 1104
*Th, SYSTEM
SENSOR ' '1'I1'
F
Indoor Selectable-
Output Horns, �_ E
Strobes, and
Horn Strobes for
Wall Applications
System Sensor L-Series audible visible notification
t
products are rich with features guaranteed to cut - E '7 .�`
installation times and maximize profits with lower -
current draw and modern aesthetics.
Features
• Updated Modern Aesthetics The System Sensor L-Series offers the most versatile and
• Small profile devices for Horns and Horn Strobes easy-to-use line of horns,strobes,and horn strobes in the industry
with lower current draws and modern aesthetics.With white and red
• Plug-in design with minimal intrusion into the back box plastic housings,standard and compact devices,and plain,FIRE,
• Tamper-resistant construction and FUEGO-printed devices,System Sensor L-Series can
• Automatic selection of 12-or 24-volt operation at 15 and 30 meet virtually any application requirement.
candela
The L-Series line of wall-mount horns,strobes,and horn strobes
• Field-selectable candela settings on wall units: include a variety of features that increase their application versatility
15,30,75,95, 110, 135,and 185 while simplifying installation.All devices feature plug-in designs
• Horn rated at 88+dBA at 16 volts with minimal intrusion into the back box,making installations fast
• Rotary switch for horn tone and two volume selections and foolproof while virtually eliminating costly and time-consuming
ground faults.
• Mounting plate for all standard and all compact wall units
• Mounting plate shorting spring checks wiring continuity before To further simplify installation and protect devices from construction
device installation damage,the L-Series utilizes a universal mounting plate for all
• Electrically Compatible with legacy SpectrAlert and SpectAlert models with an onboard shorting spring,so 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
• Listed for wall mounting only of 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
swum= ry
LISTED APMWVEO ir'.�_I
S5512 FM approved except 7125-1653:QSC.-
S4C11 for ALERT models 7135-1653 05:3
3057;83.3057072
l',T !_LIK' I• _
SILENT SK-Monitor
NI KNIGHT
by Honeywell Intelligent Monitor Module
The SK-Monitor module provides an interface to contact devices, such as security contacts,waterfiow switches,
or pull stations.
For more information about the IntelliKnight system, or to locate you nearest source, please call
1-800-328-0103.
Description
The SK-Monitor is an addressable monitor module for use
with Silent Knight IntelliKnight series fire alarm control
panels (FACPs).The SK-Monitor is intended for use in
intelligent, two-wire systems, where individual address of Mj
each module is selected using the built-in rotary switches. - '
The SK-Monitor supports Class A supervised or Class B
supervised wiring to the load device. Conventional 4-wire
smoke detectors can be monitored for alarm and trouble
conditions.
Features
• Single contact monitor
• Support for Class A and Class B wiring
• Fully supervised
• Panel controlled status LED that flashes green in
normal state and is solid red in alarm
• Attractive ivory cover plate SK-Monitor
• Rotary address switches for fast installation
• SEMS screws for easy wiring Specifications
• UL Listed Physical
Installation Height:4.5" (11.4 cm)
The SK Monitor mounts directly into a 4"square electrical
Width:4" (10.2 cm)
box.The box must have a minimum depth of 2-1/8".A Depth: 1.25" (3 cm)
surface mount electrical box (System Sensor®PN Shipping Weight: 6.3 oz (196 g)
SMB500)is available from Silent Knight. Electrical
Compatibility Operating Voltage: 15—32 VDC
The SK-Monitor is compatible with the following Current Draw (LED on): 5.0 mA max
IntelliKnight FACP's: Operating Current(LED flashing): 375 NA
5700
5808
5820XL
5820XL-EVS
A.
IiNTELLIK ILI 47 ,,-: r_
Itik SILENT SK-Pull-SA and SK-Pull-DA
Np KNIGHT
Intelligent Pull Stations
by Honeywell
The SK-PuII-SA and SK-PulI-DA are a single action or dual action addressable fire alarm pull station for use with
Silent Knight's IntelliKnight fire control panel. Extremely easy to operate,the SK-Pull-DA and SK-Pull-SA
provide a fast and practical means of manually initiating a fire alarm signal. The IntelliKnight panel recognizes
each manual pull station by its specific address saving precious seconds in determining the location of an alarm.
For more information about the IntelliKnight system, or to locate you nearest source, please call
1-800-328-0103.
Description ---
The SK-Pull-SA is a single action pull station requiring only 1 F
one motion to activate the station.The SK-Pull-DA is a dual IRE !
action pull station requiring two motions to active the station.
Both pull stations are designed to work with Silent Knight PULL
4' DOWN ir
1
Intelliknight series fire alarm control panels (FACPs).
Features
• Installer can open station without causing an alarm
condition 1.
• Dual-color LED is visible through handle of station blinks °
green to indicate normal operation and remains steady red
in an alarm condition SK-Pull-SA
• Key operated test and reset lock using lock plate actuator "� "
• Key matches compatible FACP locks F
I R E
• Meets the Americans with Disabilities Act Accessibility
Guidelines(ADAAG)controls and operating mechanisms f PusN IN
PULLaowN1
guidelines (Section 4.1.3[13])
• Meets ADA requirement for 5 lbs maximum pull force to
active
• Shell, door, and handle molded from durable LEXAN® CI"` .'
• Reliable analog communications for trouble-free operation i.:
• Braille text on station handle SK-Pull-DA
• Handle latches in down position and the word Activated Compatibility
appears, clearly indicating the station has been pulled The SK-Pull-SA and SK-Pull-DA are compatible
• Rotary address switches for fast installation with the following IntelliKnight FACP's:
5600
• UL Listed, including UL 38, Standard of Manually Actuated 5700
Signaling System 5808
5820XL
5820XL-EVS
Commonwealth of Massachusetts
Division of Prottessional Licensure
Sec urit ste ,S-License
r
SSCO-000046 i Ixpires: 01/05/2021
ROBERK SO
UQFI'
Em149Yed byi v •
SEASIDE ARMS INN
Commissioner ,L
„COMMONW TH.OF:-MA HUS S.
DIVISION OF PROFESSIONAL LICENSURE
• B P Q
ELECTRICIANS
ISSUESE FOLLOWING UCENSE-
REGISTERED sYST ONTRACTOR
RO RT K BOUCHER
SEASIQEc INC
1265 ROU E 28
S YARMOUTH,MA 026644455
- 1317 C 0713112022 694
LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER
. COMMONW 'THOE '." HuS � :
DIVISION OF PROFESSIONAL LICENSURE
BOARD.; •
ELECTRICIANS •
ISSUES`' HE-FOLLOWING LICENSE
REGISTERED SYST ECHNICIAN ,,, `
OBERT K BOUCH.ER
1265 ROtUTE $
S YARMOUTM MA 02664r io
463 D Q J3111 Q23 694240 <,
LICENSE NUMBER EXPIRATION DATE • SERIAL NUMBER