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HomeMy WebLinkAboutbld-23-001185 (2) .�. O •Y,; BUILDING PERMIT APPLICATION • . kellipto APPUCATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE ME USE,OCCUPANCY OF, it.„R OR DEMOUSH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWEWNG. 0 ""'• 4. Town of Yarmouth Building Department •' �' w.r+.cn : `�`-�-•� 40 11.16 Route 28 • Yarmouth, MA 02664- 492 Tel: 503-398-2231 ext. 1261 Fax 508-398-0836 41rD-13.Office Uu Only Planning Beard Information Assessors Oepartmetd Informitiw /� Permit No, l I DatePlan type map to .\ Permit Fee S\U' $pEndorsement Data /x\\)-7Recording Date New" Deposit Rec'd. $lot® Date plan No. 1.4 Property Dimension ��\?‘u Net Due 7kI � c`6n Other tntAfEl 1�I Frontage!K) i Ei ; i V E D This Section for Office Use On Building Permit Number/� Date issued: `~ signature: ../..-�— /v- )- �d. Certificate of Oc anry SEP' 1 2022 Building Olfisiel • Data is Is not t4G-CIEPARTMENT Section 1 -Site Information By •_ : • 1� / 1.1 Property Addressi 12 Zoning Information: 1 J{ 46.3 Station Ave r South Yarmouth,MA 02664 M no change Zoning District Proposed Use 1.3 Building Setbacks(rt) Front Yard Side Yards • Rear Yard Required Provided Required Provided Required Provided 1.4 Wats,Supply(M A L,c.40.S 54) 1.5 Rood Zane knfoemaiFon: NIA Cornunentx • Public X Private Zone: t3FE . Section 2-Property Ownership/Authorized Agent . 2.1 Owner at Recant 135 Jericho Turnpike SCP 2009 C/O Lawrence Kadish Real Estate Old Westbury,NY 11568 "ame ,pMailing Address: rFr 334-9730 516-334-9730 lawrencekadish@gmail.com Signature Telephone Telephone Email Address: l 2.2 Authorized Agent Adam Kerian(State Permits Inc.) 319)rlaines t - Dodgeville,WI 53533 Nem (print Magma Ass 608-407-9084 _ „N/A • adam@permit.com Signature Telephone Fax - Email Address: 1 . Section 3-Construction Se , 3.1 Licensed Construction Supervisor: Not Applicable (] Ile 1Ghe11. .apA 3 6( :r:dley Rd North Olmstead,OH 44070 License Number ai .liar CS-097703 ' Nay, • 440-716-4000 dsi:raka@fortneyweygandtEiginan Date sign —'t►. C ii S. Lariilftglorm Email Address: 03-02-2023 Jiiik-n — 6,,c-n Canfi , - . 3.2 Registered Home Improvement Contractor; cornpaey Nat AaPue to 5 Addnu Aschtratiet Nulrder Signature Telephone Section 4-Workers'Com tion Insurance Affidavit(M.G.L 0.1S28 25C(6)M Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit win result in the denial of the Issuance of the building permit. Signed Affidavit Attached lealt No - I ... 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 ended space) Section 5.1 R Isidt-d Architect Mtcolas f Velozo N p rm� . 126 Cove Street Fail River, MA 02720 t e tgli me & 508-679-5733 �` E�ior+data Teliiphorte 08/31/2022 Section 5.2 Registered Professional Engineerts) • Liam® Pam dR Addrossu Aepittnioet Nttnber Signature Tekphons Eacifstrun Data Name Am d Aestoomibiliry Address • Raviararton Nunsbor Sicrattue w llrtephons Expiration Ow* Karns Area of AesportdbHlty Address Negiacatiort fur ter Satatufe Itrlephtxt0 F�ltsp a MU • km. Alu or RiltsPIXISIIARY - Addling A ' Eignature Telephais Date 'Section 5.3 General Contractor J ' Oust-Bid Fortney&Weygandt,Inc Not Apparaible 0 Company . itchell S Lapin Pe .R.e R. .. , ... .r Ctxzrirt,enlan 3 69 , d ad North Olmstead,OH 44070 'SAP► -h SL r 1f s .d 44a-.1�-4000 , Section s-Description of Proposed Work(checka!t applicable)S New Construction 0 [ {tor multiple grotty orgy) No.a!Bedrooms {tor malupte family only) No.of$athrpprn3_ Existing Bldg. rx I Repairs) 0 { Alterations a 1 Addfion Q Accessory Bldg. (] Type 'Demolition Other Specify. ' Brief Description of Proposed Work: Interior alteration to the existing CVS Pharmacy.No change in use or occupancy.Modifications of the existing pharmacy,retail and checkout areas.New finishes. minor modification to electrical system. Section 7-Use Group and Constniction Type • Bullring Use Group(Check as appiicapable) Construction Type A ASSEMBLY D A 1 » ® A-2 0 A•3 0 to ❑ B BUSINESS © A 4 ® A3 Q tB ❑_ E EDUCATlCLNAI. F FACTORY F t 28 M H HIGH HAZARD 0 ® 3C A t I IHSiRtrnCMAI 0 Ft 34 ® IAMEACHA M ❑ t 2 ❑ M3 ❑ 3B A RESIDENTIAL + 0 ; ❑ S rnRA E 0 5.t 0 S-2 ® R 3 0 sA U /TY LA UIXiA USE CI SPECIFY: S SPECW USE ❑ SPECIFY: ❑ SPECIM Complete th1s section If existing building undergoing,renovation additions and/or change hi use.J Use amp; Mercantil Proposed Use Group; Mercantile-no change F.i Existing Hazard Index 78p CMR 34 Proposed Hazard Index 780 CMII 34 Section 8 Building Height and Area ! - Nurrtrer or Itooaf�'lodes Area Edstlng[d applicable) Proposed include basement levee 1 No change Floor Area per Floor(0) Total Area Ati Floors(sf) 11,838 No change Total Height(it) Section 9-STRUCTURAL PEER REVIEW(780CMR 110 11)1 Independent Structural Engineering Structural Peer Review Re quired Yes_.._.». No....»..» SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN ' OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT it Lawrence Kadish c/o Al:G Hite! D &ir aI kb .as Owner of the subject property, hereby authorize Adam Kerian(State Permits Inc.) my behalf,in all matters relative to work authorized bythis building to act on g permit(�appQtfcaatian. Signrsture Of Own Q—�/�4" Cote 'SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION Adam Kerian(State Permits Inc.) Owner/Authorized declare that the statements and information on the forgoing application andQ acurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Adam Kerian Print Name • 6 9444". 8/9/2022 Stgnaiura of OwnertAgent Date Section f 1 -ESTIMATED CONSTRUCTION COSTS rtam ' Estimated Cost IC ts)to be completed by permit applicant 1.SulpNq 80,000 2.teacarical 6,000 3.Pl untina t etas N/A a ued,.rilcat(VAC) N/A a Fre Pmtedion N/A e •t,•2+3+4+s1 86,000 ' 7.Total squats F1.I100w.rrrum..,s,up1,,,y 0 Check Below [� Conservation-Commission Filing (applicable) 0 Old longs Highway&Historical Commission approval Elf applicable) §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CAR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 453 Station Ave South Yarmouth, MA 02664 Work Address Is to be disposed of oat the following location: MJ Connolly Transfer Station Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. adellb,1 s4a/th 8-9-2022 Signature of Application Date Permit No. Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional 7 r for work per the ninth edition of the 'wow Massachusetts State Building Code, 780 CMR, Section 107 Project Title:CVS#00944 South Yarmouth,MA-Reset Date:08/08/2022 Property Address: 453 Station Avenue,South Yarmouth, MA 02664 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description:Interior remodel consisting of new finishes and millwork.Minor modifications to the electrical system. I Nicolas Velozo MA Registration Number: 951251 Expiration date: 08/31/2022 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerningl: Architectural Structural Mechanical Fire Protection Electrical X Other: Entire Project for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a'Final Construction Contro I ocument'. � ,FtED ARcy Enter in the space to the right a"wet" or o�5 mpg J fr electronic signature and seal: `,z° oF�� 951251 16:e Phone number: (508) 679-5733 Email:mtavares@starckarchitects.comFlir. ' Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,provide a description. Version Ol O1 2018 1�� Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons><rmttIbt; t7pfrvisor CS-097703 E;upires:03;02/2023 MITCHELL SIIAPJN 31269 BRADIEY ROAD NORTH OLMSJED OH 44070 Commissioner da t A' YEencick., Client#:22701 FORTNEY ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMIYY) 8/24/2022 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(les)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 NTA C CT N ME: Karen L.Moduli Althans Insurance Agency,Inc. PHONE FAX (AIC'No,Eat):440 247-6422 _(AIC,Noy 440-247-2394 543 East Washington St. E�ss: klmedurl@althans.com P.O.Box 570 INSURERS)AFFORDING COVERAGE NAIC a Chagrin Falls,OH 44022 INSURERA:National Fire of Hartford 20478 INSURED INSURER B:Continental Insurance Co 35289 Fortney&Weygandt, Inc. INSURER C:Valley Forge Insurance 20508 31269 Bradley Rd. North Olmsted,OH 44070 INSURER 0: 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, INSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER SMMIDDIYYYYI_OWDDITTYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 7018654167 07/01/2022 07/01/2023 EACH OCCURRENCE 51,000,000 CLAIMS-MADE Xl;OCCUR PREhU5E5QEaE rrenoq) S100,000 X PO Ded:5,000 MED EXP(Any one person) S 15,000 PERSONAL&ADV INJURY $1,000,000 GENT.AGGREGATE LIMIT APPUEySPER- GENERAL AGGREGATE $2 000 000 POLICY �XI JECT X I LOC PRODUCTS-COMP/OP AGO s2,000,000 OTHER S C AUTOMOBILE UABIUTY 7018654170 07/01/2022 07/01/2023 COMBINED SINGLE LIMIT tEaacddent) $1,000,000 X ANY AUTO BODILY INJURY(Per person) S AUTOS ONLY SCHEDULED BODILY INJURY(Per accident S AUTOS ) X AUTOS ONLY X ALTVOI pN DD PROPERTY DAMAGE S (Per accident) S B x UMBRELLA UAB X OCCUR 7018654203 O7/01/2O221 O7/O1/2023(EACH OCCURRENCE S10,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE S10,000,000 DEO X RETENTION S10,000 S B I AND EMPLWORXERS OYERS'UABIUTY 7018654184 07/01/2022 07►0112023 X SiaTUTE I FRI " ANYI PROPRIETOR/PARTNER/EXECUTIVE(R / P YN'-1 NIA E.L.EACH ACCIDENT 31,000,000 (Mandatory in NH) "-J E L.DISEASE-EA EMPLOYEE $1,000,000 If yes, under DESCRIPTION OF OPERATIONS allow E.L.DISEASE•POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may he attached if more space is required) Job 42214 CVS Reset#00382 1453 Station Avenue South Yarmouth,MA 02664 Town of South Yarmouth Is named as an additional insured for General Liability when required by written contract with the named Insured. CERTIFICATE HOLDER CANCELLATION Town of South 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 I 'r!w 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 Of 1 The ACORD name and logo are registered marks of ACORD #5879244/M870528 RLH The Commonwealth of Massachusetts t - 1� f Department of Industrial Accidents , i11= 1 Congress Street,Suite 100 €='�f_{_c Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name [Business/Organization/Individual): Fortney & Weygandt, Inc. Address: 31269 Bradley Road City/State/Zip: North Olmsted, OH 4407()phone#: 440-716-4000 Are you an employer?Check the appropriate box: Type of project(required): IJ®I sin a employer wail 2 employees(full and/or pan-tune)" 7. ❑New construction 2.0 I aro a sole proprietor or partnership and have no employees working for me in 8.2e Remodeling any capacity.(No workers'comp.insurance required.) 3 O 1 am a homeowner doing all work myself(No workers'comp,insurance required.) 9 Demolition 4.0 lain a homeowner and will be hiring contractors to conduet all work on my property. I will ]0 El Building addition ensure that all contractors either have workers'compensation insurance or arc sole 11.❑Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5,El I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance 13.❑Roof repairs 6.0 We arc a corporation and its officers have exercised their right of exemption per MCI,c. 14 ❑Other 152,t 1(4),and we have no employees (No workers'comp.insurance required.) 'Any applicant that checks box g!must also fill out the section bclov:showing their workers'compensation policy information. t Homeowners who subunit 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 on 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: Continental Insurance Co. Policy#or Self-ins.Lic.#: 7018654184 Expiration Date: 7-1-2023 Job Site Address: CVS #00382 — 453 Station Avenue City/State/Zip: Sollth Yarmouth, MA 02664 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 im•risonment,as well as civil.penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day again violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage icati n. I do here. cer w r • r the pains and penalties of perjury that the information provided above is true and correct. ftt Signature: �" /ii1 I,... Mitchell S. Lapin Date: 8-24-2022 Phone#: 440-716-4000 President Official use only. Do not write in this area,to be completer!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 S.Plumbing Inspector 6.Other Contact Person: Phone#: Sears, Tim From: Sears, Tim Sent: Monday, Septembe- 12, 2022 2:23 PM To: 'dstraka@fortneyweygand.com' Cc: Slack, Christine; Bearse, Matt Subject: 465 Station Ave Mitchell, I have reviewed your application and there are some items needed. 41. Health Department sign off 2. Fire Department sign off } (-` , vc Please submit these items for review This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in pars:that "an application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100, within 45 days of this notice. Timothy Sears CB0 Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us 1