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HomeMy WebLinkAboutBLD-19-000248 COO TOWN OF YARMOUTH Building Department CERTIFICATE OF (508) 398-2231 ext.1261 OCCUPANCY O .iu.;,,, ,11y PERMIT NO BLD-19-000248 'H SY le, Ma;TrCL ' • MICHAEL DAVIS ADDRESS: 311 ROUTE 28, WEST YARMOUTH, MA 02673 ZONING DISTRICT Bldg. Type: Commercial SUBDIVISION MAP BLOCK LOT 030.26 BUILDING IS TO Use & Occupancy BE REMARKS Use & Occupancy— Bagels & Beyond—occupancy subject to ail final inspections. (508-364-4196) CERTIFICATE OF INSPECTION DATE: BUILDING OFFICIAL: CARVALHO JASON TR BUILDING DEPT BY 311 ROUTE 28 WEST YARMOUTH, MA PHONE iIS PERMIT CONVEYS NO RIGHT TO OCCUPOY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR ERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE. MUST BE APPROVED BY THE )RISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF JBLIC WORKS. CERTIFICATE OF OCCUPANCY BUILDING INSPECTIONS APPROVALS ELSE: 'Pi. 'OE trio K OTHER DATE: .3 5 " z Z DATE: INSPECTOR: C INSPECTOR: ELECTRICAL BOARD OF HEALTH z z � S-��5 DATE: (1 'l2 Z 51 DATE: 3/ /� INSPECTOR: I '`-�" INSPECTOR: A, D c , PLUMBING/GAS FINAL BUILDING DATE: / / / 2 DATE: INSPECTOR: ' INSPECTOR: COMMUNITY DEVELOPMENT: DATE NAME rL • • . 01 •YqR BUILDING PERMIT APPLICATION • . �c 'rr APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE, OCCUPANCY OF, ' • - la: C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. �, -- .� ,Z Town of Yarmouth Building Department V.;-.....-^•Gd' 1 146 Route 28 • Yarmouth. MA()`Gti-1:-1.192 , Tel: 508.398-2231 ext. 1261 Fax SO&39&083o ------- �° E-`, I Office Use Only Planning Board Information Assessors Department Iniormatio • d O 201 4 Pe�� J mit�o.�4 477).'")YIYate Plan Type_ Map �Lot j�0 ' Permit Fee $ (o0 Endorsement Date f,t,� L��rJ�°t�'A`z t"`E lr Recording Date Ne 0 Deposit Rec'd. $6 0 Date plan No 1.4 Property Dimensions: Net Due —$ 0- ' Other Lot Area(sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number. . Date Issued: Signature: s? j 71R Certificate of Occupancy //Building Official Date is Is nal required Section 1 - Site Information 1.1 Property Address: 1.2 Zoning Information: Vies Ifl.t'111A114, 11i 1 A Oa oil_ Zoning District Proposed Use 1.3 Building Setbacks(ft) • Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.4 Water Supply(M.Q.L c.40.S 54) 1.5 Flood Zone Information: Commenbr Public Private Zone: BFE ' • Section 2- Property Ownership/Authoriz Agent 2.1 Ot\AVotR Ici N . I M S. .0 (tiM Mtshpet Mg triKaMint) Marling Address: � 11i SO$ (o�41. — sd`6)�i I-i MbAV'S .mgOGnl�,c, ico'h Signature TeI hon Te! pphone Email Address: 2.2 Authoriz-• kgent: •„...... r O wPi Name Mailing Address: 03-g.1 ' Cr4" Signature Telephone Fax Email Address: 1 Section 3- Construction Services ' 3.1 Llesnsad Construction Supervisor Not Applicable License Number Address . Expiration Date Signature Telephone Email Address: • i 3.2 Registered Home Improvement Contractor. , - Company Hams Not Applicable U . ~ Registration Number Address Expiration Date Signature Telephone Section 4-Workers'Compensation Insurance Affidavit(M.G.L c. 152 S 25C(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No Section 5- Professional Design and Construction Services-for Buildings and Structures Subject to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f.of enclosed space) Section 5.1 Registered Architect 4 Not Applicable ❑ • Hams(Registrant): Registration Number Address Expiration Data Signature Telephone Section 5.2 Registered Professional Engineer(s) Hams Area of Responsibility Address Registration Number • Signature Telephone Expiration Date Hama Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hams Area of Responsibility Address Registration Number Signature Telephone Expiration Date Hama Area of Responsibility Address Registration Number Signature Telephone Expiration Date Section 5.3 General Contractor 1 Not Applicable ❑ Company Hams Person Responsible for Construction Address Signature Telephone '1 ,.1 A • . Section 6- Description of Proposed Work(check all applicable) New Construction ❑ (tor multiple family ony) No.of Bedrooms (for multiple family only) NO.of Bathrooms - Existing Bldg.` Sepair(s) ❑ Alterations ❑ Addition ❑ • Accessory Bldg. ❑ Type Demolition Other Specify: Brief Description of Proposed Work: (2 - `P � 1VI' e --"g 43/0,f? 4-' -#. . n A ' 1 Section 7- Use Group and Construction Type _ Building Use Group(Check as appticapable) Construction Type • A ASSEMBLY ❑ A-1 0 A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-S ❑ 1 B ❑ — B BUSINESS ❑ 2A ❑ E EDUCATIONAL ❑ 28 I] F FACTORY ❑ F-1 D F-2 ❑ 2C ❑ H HIGH HAZARD ❑ 3A ❑ t INSTITUTIONAL ❑ I-1 ❑ 1-2 ❑ 1.3 ❑ 3B ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ P.3 ❑ SA ❑ S STORAGE ❑ S-1 ❑ S-2 ❑ SB ❑ ' U UTILITY i❑ SPECIFY: , • M MIXED USE ❑ SPECIFY: _ S SPECIAL USE ❑ SPECIFY: _ Complete this section if existing building undergoing renovations;additions and/or change in use. Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34 Section 8 Building Height and Area • Building Area Existing(i1 applicable) Proposed Number of floors or stories Include basement levels Floor Area per Floor(sI) Total Area All Floors (sf) Total Height(ft) Section 9 -STRUCTURAL PEER REVIEW (780CMR 110 11) I Independent Structural Engineering Structural Peer Review Required Yes No SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER'S AGENT OR CO TRACTORAPPLIES FOR BUILDING PERMIT t /I, , Q� V t I(a l ,as Owner of the subject property, `^� � ,1 `b ) hereby authorize \� C i " l_S to act on my behal ' matters relative to work authorized by this building permit application. Signature of Owner Dale ,2 1 3of4 OVER .} • SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION " I, - 6 - )AN 1 c , as Owner/Authorized Agent ' hereby declare that the statements and information on the forgoing application are true and acurate, to the best of my knowledge and belief. • Signed under the pains and penalties of perjury. 18/uA V- .ij°4a-viS Print \Name \kjj1/44C-L.C5-1) . cofg-ei) .% . Signature of Owner/Agent Date Section 11 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Building a Electrical 3.Plumbing/Gas 4.Mechanical(MVAC) • 5.Fire Protection 6.Total.(1+2+3+4+5) 7.Total Square Ft.Ow ma mixtures&Elite* Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) • • A nl A The Commonwealth of Massachusetts Department of Industrial Accidents r ,L �t Office of Investigations • _=at 1 Congress Street, Suite 100 •' Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information Please Print Legibly Business/Organization Name: g(7045ifle-rei CC CI Address: .S k = R-te,r 9j City/State/Zip: . 71007) �: ,�' , �1� .. nl{. ■- � Phone #: Are you an employer?Check the appropriate box: Business Type(required): rfliI am a employer with U employees(full and/ 5. ❑ Retail or part-time).* 6 Restaurant/Bar/Eating Establishment 2.❑ I am a sole proprietor or partnership and have no 7. ❑ Office and/or Sales(incl. real estate,auto, etc.) employees working for me in any capacity. [No workers' comp.insurance required] 8. ❑ Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑ Entertainment their right of exemption per c. 152, §1(4), and we have 10.0 Manufacturing no employees. [No workers' comp.insurance required]** 11.0 Health Care 4.❑ We are a non-profit organization, staffed by volunteers, with no employees. [No workers' comp. insurance req.] 12•❑ Other 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box#1. I am an employer that isprovid'n work rs;compensation in rance or my employees. Below is the policy information. Insurance Company Name: r © K • Insurer's Address: aaa 4IV1Q,S City/State/Zip: DCA ! a0,940 Policy#or Self-ins.Lic.# N 11 W J L'A Expiration Date: '47I 3 11 Attach a copy of the workers' compensation policy declaration page(showing the policy number and a piration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ify,under the pains pgnnalti perjury that the information provided abo is true and correct. Signature: V_. titia Date: V( Phone#: 40 9 Li I q(,01 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.Licensing Board 5. Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia 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 your insurance company's name,address and phone number along with a certificate 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 tine. 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). 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02 1 14-20 17 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE _ Fax# 617-727-7749 www.mass.gov/dia Form Revised 7/2010 4 ® DATE(MMrOD�yYYY) . AC Ro CERTIFICATE OF LIABILITY INSURANCE o7/05/2018 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 policyhes)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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMEAQT Elysia Moreis The Ins Agency Of Cape Cad PHONE L6 G NO Fx1I (508)888-2766 FAX (A G.No) (508)833-0909 28 Route 6A' ADDRESS ellysia@insuranceofcapecod.com FC Bat 1053 INSURERS)AFFORDING COVERAGE NAIC Y Sandwich i MA 02563 INSURER A• Norfolk&Dedham Group 23965 INSURED INSURER e. Norfolk&Dedham Group 23965 Bagels Beyond CC LLC INSURER C 311 Route 28 INSURER D INSURER E West Yarmouth MA 02673 INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOAl HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDTION 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. INSR TYPE OF INSURANCE ADDI SUBRl 'D POLICY EFF POLICY EXP LIMITS LTR INSD wvr11 POLICY NUMBER (MMD�YYYY1 (RMM'DDYYYYl, COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RLN rED CLAIMS-MADE X OCCUR PREMISES(Eeoccurrence) ,$ 100,000 . MED EXP(Anyone person) $ 10,000 A N N R1834654A 07/062018 07/06/2019 PERSONAL&ADVINJURY $ 1.000,000 GENT AGGREGATE LIMIT APPI IFS PER GENERAL AGGREGATE 4 2,000,000 X I POLICY JECT n LOC PRODUCTS-COMM PACC $ 2,000,000 Il OTHER $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) i ' OWNED —I SCHEDULED BODILY INJURY(Per accdent) $ AUTOS ONLY _� AUTOS HIRED NON-OYNJED PROPtN1YDANMAGE $ AUTOS ONLY AUTOS ONLY (Per eccdenl) I I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESSLIAO ~ CLAIMS-MADE AGGREGATE $ DED RETENTION; $ WORKERS COMPENSATION `X PLR OTH- STATUTE FR AND EMPLOYERS'LIABILITY ANY PROPRI£TOR'PARTNER,EXECUTIVE Y/N E L EACH ACCIOENr E 100,000 B OFFICER,MEMBEREXCLUDED? Y NIA N WE187314A 07/062018 07/06/2019 EL DISEASE-EAEAIPLOYEE t 100,000 (Mandetoryin NH) II yes,describe under DESCRIPTION OF OPERATIONS baton E L DISEASE-POLICY LIMIT $ 500.000 DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of Yarmouth 1146 Route 28 AU IHONIZEO REPRESENTATIVE.0 *. IL. ,,rir1/442..1 I S.Yarmouth MA 02664 Fax: (508)398-0836 Email: I 0 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and 'ago are registered marks of ACORD 11111 . \_-5U-q S 1 -"Ft ]i I-- \ , 1 .3 cl- I a f?2 Z Yi.r_ o - Q cl, - -)10\,)). Qd \ s73- (. /. .) ._e ;/2i trt\w-ot6-7 OLT c. 4, p.)-L-1 M-1 # ----- 1 t f:1,, 1-1 TYT - -- 9- i o __ ci_ 16---0 -"" Al ( -5A _.1 i s - - i 1 a 0 --VQ, _ {'Ilk rd ___ 76-: Q 0 ° 1-- p a, ---ScI. 4 0 t1--- o / --------.--P-1.Q . .; . • :t ,„ TOWN OF YARMOUTH . 4g HEALTH DEPARTMENT • • PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: J L\ k�-3� (�% Vif�� �� vc !_7 Proposed Improvement: use + -9cc 44 seri fiM Applicant: i\4lV C\AW Dj-i 1S Tel.No.: 50T 3(t / 111 c Address: J. ftV\ Rat PA(16*.(&) Ljepate Filed: (.Q J K **Ifyou would like e-mail notification of sign off please provide e-mail address: Owner Name: :::VAS CSIA (Cli,V( v& L0 Owner Address: 3S E4k v wb O er Tel. No.:Sag ,R�D c _....._....._......__..�_.__ iJ c�1�da�b. c( e_ .y........(AA_.. °a3 a RESIDENTIAL AND/OR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.,Requirements For Septage Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: (1.) Site Plan showing existing buildings,water line location, and septic system location; (2.) Floor plan labeling ALL rooms within building (all existing and proposed) — Note:Floor plans not required for decks, sheds, windows, roofing; (3.) If necessary,Title 5 application signed by licensed installer with fee. REVIEWED BY: DATE: /7/3/je PLEASE NOTE COMMENTS/CONDITIONS: , , S_ , .4i/ -s y - Ceti 2 pAelJrzan N;S + Vie'�Grfi ran RE 0144,41TOWN OF YARND �MOUTH EEVIEWED FOR CODE COMPLIANCE. a RRORS OR OMMISSIONS DO NOT RELIEVE , � THE APPLICANT FROM THE RESPONSIBILITY OF"ASB LTY DATE: , /@ INSPECTOR YARMOUTH FIRE PREVENTION New Business Transmittal Project Name: Bagels & Beyond Address: 311 Rt.28 Contact Name: Michael Davis Phone: 508-364-4196 Y N NA Subject Regulation ES 0 X Building Numbers MGL Chapter 148;sec 59 X Fire Lanes 527 CMR 1;22.3 X Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28 X Maintence of any equipment,system relating to 527CMR1 1.1.4 Fire Protection. X *Hazardous Materials Storage 527 CMR 1;60.1 X Emergency Plan Required 527CMR1 10.9.1 X Commercial cooking,Hood systems 527CMR1 50.2.1.1 X Commercial Cooking Hood Systems Cleaning 527CMR1 50.5.4 X *Commercial Cooking Extinguishment System 527CMR1 50.4.3 X *Candles,open flames,and portable cooking 527CMR1 17.3.2,20.1.1.1 X Blocking electrical panel 527CMR1 10.19.5.1 _X Blocking exits 527CMR1 14.4.1 Extension cords shall not be used as a 527CMR1 11.1.7.6, 11.1.7.1 X substitute to permanent wiring X Limit storage heights to 24 inches below 527CMR1 ceiling without sprinklers 18 inches with X Maintain Aisle width of 36 Inch's(3 Feet) 780CMR 1101.1 X Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.12,34.1.1 _ X The right to inspect MGL Chapter 148 Sec.4 X *Upholstery 527 CMR 1;20.6.2.5 X *Trash Containers 527 CMR 1; 19.1.1, 1.12 X Any Hazard to the Public Chapter 148;sec 28 X *Curtains, Draperies,Blinds 527 CMR 1; 12.6.2 Description of planned project/other requirements: Change of ownership. The YFD supports the application, subject to applicable submissions,permits and inspections. * YFD permit required-depending on occupancy and submittal Plan Reviewed By: Captain Huck Date: 06/28/2018 Copy for Applicant 0 Copy to Building Department II Copy to Fire Prevention I I Entered in Firehouse = Final Inspection I 1