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HomeMy WebLinkAboutBLD-23-004058 • 0F•YA4,i, BUILDING PERMIT APPLICATION APPLICATION TO CONSTRUCT, REPAIR, RENOVATE , CHANGE THE USE, OCCUPANCY OF, o C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. E' — .... Town of-Yarmouth Building Department 11* ATT4C M CC `"•-•A1•'* 1 146 Route 28 • Ytirmouth, MA 09664-4499 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 Ortj u6-2� Office Use Only Planning Board Information Assessors Department Information: Permit No. � ��Date Plan Type_ Map Lot Permit Fee $ a.6 Endorsement Date / rie"F Recording Date Ne Deposit Rec'd. $—I� Date 1.4 Property Dimensions: w ilig Plan No._ Net Due $ I c/ e other /; tf j 7 Lot Area(sf) Frontage(ft) Lot Coverage This Section for Office Use Only Building Permit Number. Date Issued: Certificate of Occupancy Signature: j f.. � � ," 3 P cY Building Official Date is Is not required I Section 1 - Site Information 1 1.1 Property Address: 1.2 Zoning Information: 127 Whites Path South Yamrouth MA B3 Public Utility . Zoning District Proposed Use 1.3 Building Setbacks (ft) ' i Front Yard Side Yards Rear Yard Required Provided Required I Provided Required 3 0 670 q 1 Provided 10 131 50 670 1.4 water Supply(IA.Q.L c.40.S 54) 1.5 Rood Zone Information: Comments (1;ubli) Private Zone: —NA BFE NA Not in a Flood. Zone Section 2 - Property Ownership/Authorized Agent 2.1 Owner of Record: Boston Gas Company, D.B. National Grid Name (print) — 4Q Sylvan Rd, Waltham, MA 02451 Cv Mailing Address: 781-907-1000 Signature Telephone Telephone Email Address: / 2.2 Authorized Agent:I Michael E Guerin 170 Data Dr Waltham, MA 02451 Hams (print) Mailing Address: ��� Signature Telephone Fax Email Address Section 3 - Construction Services 3.1 Licensed Construction Supervisor. Not Applicable Arianna Jesi 240 Newbury St, Danvers MA 01923 License Number Ad ress C S—111131 978'-778-8411 ajesi@united—civil.com Expiration Date Signature Telephone Email Address: 2/2 8/2 3 3.2 Registered Home Improvement Contracto-I Company Name Not Applicable © _ Address Registration Number Expiation 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 I Not Applicable Name (Registrant): 1 Registration Number Address Expiration Date Signature Telephone Section 5.2 Registered Professional Engineer(s)1 Rea A.Huston Name Area ot Responsibility 8204 Balata Dr.,Ooltewah,TN 37363 Process/Mechanical Address Registration Number u 912 330 5264 46010 Chemical Signature Telephone Expiration Date 06/30/2024 Randy Maccaferri Name 440 S Church St, Suite 1200 Charlotte,NC 28202 Area ot Responsibility Structural Address 7 /� if t Registration Number , d /[�lacca etv-i (704)338-6819 309493 Signature Telephone Expiration Date 06/30/2024 Paul K. Davila Name 613 NW Loop 410, Suite 700 San Antonio, TX 78216 Area of Responsibility Electrical Address Pad 4 n Registration Number 52518 au au�� a (210)841-2902 Signature Telephone Expiration Date 06/30/2024 Hama Area of Responsibility Address Registration Number • Signature Telephone I Expiration Date Section 5.3 General Contractor United Civil Not Applicable ❑ Company Name Arianna Jesi Person Responsible for Construction 240 Newbury St, Danvers MA C1923 . Address f 978-778-8411 Signature Telephone r • Section 6 - Description of Proposed Work (check all applicable) New Construction ® (for multiple family only) NO.of Bedrooms (for multiple family only) No.of Bathrooms Existing Bldg. [] Repair(s) ❑ Alterations ❑ Addition ❑ Accessory Bldg. ❑ Type Demolition Other Specify: P fY: Brief Description of Proposed Work: South Yarmouth boil off compressor Upgrades . • - . :• S stem. Work includes foundations, structural steel, piping, Instrument and control, electrical and integration of new BOG system. •Section 7- Use Group and Construction Type J Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A_1 ❑ A-2 ❑ A-3 ❑ ❑ to A-4 ❑ A-5 ❑ 1 B ❑ B BUSINESS j ❑ ❑ _ 2A E EDUCATIONAL2B it ❑ F FACTORY ❑ F-1 ❑ F-2 ❑ 2C ❑ H HIGH HAZARD ❑ 3A ❑ I INSTITUTIONAL ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M MERCHANTILE ❑ 4 ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑ S STORAGE U UTILITY s-1 ❑ S_z ❑ sr3 ❑ ® SPECIFY: Public Utility M MIXED USE ❑ SPECIFY: S SPECIAL USE ❑ SPECIFY, [Complete this section if existing building undergoing renovations;additions and/or change in use.1 Existing UseGroup:Boston Gas Company D.B. National Grid Public Utility Existing Hazard Index 780 CMR 34 Proposed Hazard Index 750 CMR 34 Section 8 Building Height and Area I Compressor Building #1 Building Area Existing (if applicable) Proposed Number of floors or stones include basement levels 1 Floor Floor Area per Roar(sf) 433 SF Total Area All Floors (sf) 433 SF Total Height (ft) 11 ' 10" Section 9 - STRUCTURAL PEER REVIEW (780CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes No SECTION 10a OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT j. Michael E Guerin , as Owner of the subject property, hereby authorize United Civil to act on my behalf, in all matters relative to work authorized by this building permit application. January 18, 2023 Signature of Owner Date SECTION 10b OWNER/AUTHORIZED AGENT DECLARATION Michael E Guerin , 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. Michael E Guerin • Print Name rya(ruz January 18, 2023 Signature of Owner/Agent Date Section 11 - ESTIMATED CONSTRUCTION CCSTS Item Estimated Cost(Dollars)to be completed by permit applicant 1.Building 2.Electrical 3.Plumbing/Gas 4.Mechanical(HVAC) 5.Fire Protection 6.Total-11+2+3+4+5) 7.Total Square Ft.(ter new sa,ca,res&additxn) Check Below ❑ Conservation-Commission Filing (if applicable) ❑ Old Kings Highway&Historical Commission approval (if applicable) • The Commonwealth of Massachusetts Department of Industrial Accidents = � 1 Congress Street, Suite 100 ;I(= Boston, MA 02114-2017 www.mass.gov/dia \orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): D k���- C Address: G c,U 'r-7/ S firs - Y City/State/Zip: (11 Ci i/f 7,0 ma Phone #: Are you an employer? Check the appropriate box: Type of project (required): 2.0 I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. — Remodeling any capacity. [No workers'comp. insurance required.] 3.0 I am a homeowner doing all work myself.[No workers'comp. insurance required.]t 9. ❑ Demolition 10 n Building addition 4.0 I 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,❑ 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.❑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 152,§I(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. fi 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: Cc 14trkt,\,)`/-t` vL' t' r C Policy# or Self-ins. Lie.#: Yv-c 4t S 31 S-D ti Expiration Date: I 1 / Job Site Address: 137 Whites Paths City/State/ZipSouth Yarmouth, MA 026E 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 ir.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 under the pains and penalties of perjury that the information provided above is true and correct. Si ature: Date: 12/28/22 Phone#: 978-778-8411 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 i 6. Other Phone#: Contact Person:_ §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223!1 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 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 127 Whites Path, South Yarmouth MA Work Address Is to be disposed of oat the following location: OIAM psver Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. / // qJ3 inature of App ion te Permit No. Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Consft tl ttillStip rvIsar CS-111131 expires:02/2B/2023 ARIANNA JEESI 35 WATKINS WAY MIDDLETON -? Commissioner da a ' FiFi„cba_. VIOL AND FOIE RMO'11 TOWN OF YARMOUTH REVIEWED FOR CODE COMPLIANCE ERRORS OR WOWSAIONS 00 NOT REi Flit t THE AF'PLICANT FROM THE RESPONSIBILITY ,/// OF"AS BURT COMPLIANCE DATE:a'IS•a 3 . INSPECTOR YARMOUTH FIRE PREVENTION Commercial Construction Building Transmittal Project Name: National Grid Address: 127 Whites Path Contact Name:Sophie Forde Phone:617-823-7523 Description of planned project: replace and add steel building and Y N NA Subject Regulation X Access for Fire Apparatus 527 CMR 1;18.2.4.1 X Building Numbers MGL C 148;sec 59 X *Flammable gas/liquid storage 527 CMR 1;42.2.2.1 X Fire Lanes 527 CMR 1;22.3 X *Service Stations 527 CMR 1 ;16.2.3,16.2.3.1,30.3.2 X *Hazardous Materials Storage 527 CMR 1;60.1 X *Kitchen Exhaust Systems* 780 CMR,527 I;50.1 X Extinguishers 527 CMR l;13.6,MGL C 148;sec 28 X Fire Alarm Systems/CO detection* 780 CMR,MGL C 148;,527 CMR I;13.7 X *LPG Storage Chapter 148;sec 9,10,28&527 CMR 1;69.1 X Use and Occupancy(FH Building Class) 780 CMR;302.1 X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-1 Storage inside/outside Buildings 527 CMR 1;10.19.4,4.4.3.1.1,19.1.2,34.1.1 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 MGL Chapter 148;sec 28 X *Curtains,Draperies,Blinds 527 CMR 1;12.6.2 X Safeguarding Construction NFPA 241,527 CMR 1 Ch 16, 16.3.1,2; 16.3.4.1 X Hot Works Permit,where required 527 CMR 41.1.5.3 *YFD permit required-depending on occupancy and submittal Regulations based on NFPA 1(2021 edition)with Mass amendments adopted 12/09/22 Compliance with the following:527 CMR 1 Chapter 16"Safeguarding Construction, Alteration,and Demolition Operations."780 CMR Chapter 33 *Permit is required for temporary shutdown,alterations or proposed removal of fire protection systems. Yarmouth Fire Department supports the application,subject to applicable submissions, permits and inspections. Plan Reviewed By:Lieutenant Matthew Bearse Date:February 15,2023 Copy for Applicant CI Copy to Building Department Copy to Fire Prevention l I Entered in Firehouse(-1 Final Inspection