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Home My WebLink AboutBLD-23-004030 r 0 2/z .7/2 3 of }'�,4 BUILDING PERMIT APPLICATION • . APPLICATION TO CONSTRUCT, REPAIR, RENOVATE , CHANGE THE USE, OCCUPAN o 4, •, C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING. CY OF, r »,rT;.- „ct `Z' Town of Yarmouth Building Department � `"'- 's,0' 114fi Route 2i • Yarmouth, MA 09664.-1-192 Tel: 508-398-2231 ext. 1261 Fax 508-398-0836 — g/ OfficeID Use Only Planning Board Information Assessors Department Information: ��3—�i3D Permit No. Permit Fee $�$� Date Plan Type Net DueOther _ Map Lot Endorsement Date / w Recording Date New Deposit Rec'd. $ v Date Plan No.— 1.4 Property Dimensions: $I Q CJ\(- C6P � Ot Other Lot Area(sf) Frontage(tt) Lot Coverage (//-it J?1-Lkt_ This Section for Office Use Only Building Permit Number. Date issued: Signature: 5- Certificate of Occupancy Buil rig Official Date is is not required Section 1 - Site Information I 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) Front Yard Side Yards Rear Yard Required Provided Required I Provided Required I Provided 30 670 10 131 50 670 1.4 Water Supply (M.Q.L c.40.S 54) 1.5 Rood Zone information: Comments Cubli> 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) 40 Sylvan Rd, Waltham, MA 02451 (v Mailing Address: 781-907-1000 Signature Telephone Telephone Email Address: / 2.2 Authorized Agent:I Michael E Guerin 170 Data Dr Waltham, MA 02451 Name (print) Mailing Address: �U ezemze.. Signature Telephone Fax Entail Address: ! Section 3 - Construction Services I 3.1 Licensed Construction Supervisor: Not Applicable I] 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 Contractor. Company Nam• Not Applicable Address Registration Number Expitation 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 cps , 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 Kama (Registrant): Registration Number Address Expiration Date Signature 'Telephone Section 5.2 Registered Professional Engineer(s)1 Rea A.Huston Hams Area of Responsibility 8204 Balata Dr.,Ooltewah,TN 37363 Process/Mechanical Address ,p Y„(/u _� 912 330 5264 Registration Number 46010 Chemical Signature Telephone Expiration Date 06/30/2024 Randy Maccaferri Name 440 S Church St, Suite 1200 Charlotte,NC 28202 Area of Responsibility Structural Address Registration Number A-aird, ACCaitCw1`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 Daigle (210)841-2902 Registration Number 52518 Signature Telephone Expiration Date 06/30/2024 Name Area of Responsibility Address Registration Number Signature Telephone lExpiration Date 1 Section 5.3 General Contractor United Civil Not Applicable ❑ Company Hams Arianna Jesi Person Responsible for Construction 240 Newbury St, Danvers MA 01923 Address 1 �•••. 978-778-8411 Signature Telephone r Section 6 - Description of Proposed Work (check all applicable)I • , New Construction I (tor multiple family only) No. of Bedrooms 1 (for multiple family only) No.of Bathrooms ' ®Existing Bldg. Repair(s)❑ Alterations I ❑ I ❑ I Addition ❑ Accessory Bldg. ❑ Type I Demolition Other Specify:P fY: I Brief Description of Proposed Work: South yarmouth boil off compressor Upgrades . Ce-struct nPw ROG System. Work includes foundations, structural steel, piping, Instrument and control, electrical and integration of new BOG system. Section 7- Use Group and Construction Type 1 Building Use Group (Check as applicapable) Construction Type A ASSEMBLY ❑ A-1 ❑ ❑ A-2 ❑ A-3 ❑ 1 A A-4 ❑ A-5 ❑ 113 ❑ B BUSINESS ❑ ❑ - 2A E EDUCATIONAL ❑ 2B id F FACTORY ❑ F-1 ❑ F-2 ❑ 2C 0 H HIGH HAZARD ❑ _ 3A ❑ I INSTITUTIONAL ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 38 D M MERCHANTILE ❑ ❑ R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ 4 SA ❑ S STORAGE ❑ 5-1 0 S-2 ❑ 59 ❑ U UTILITY I ES SPECIFY: Public Utility _ M MIXED USE ❑ SPECIFY: _ S SPECIAL USE ❑ SPECIFY. Complete this section if existing building undergoing.renovations;additions and/or change iri use.j Existing UseGroup:Boston Gas Company D .B. National Grid Public Utility Existing Hazard Index 780 CMR 34 Proposed Hazard Index 7B0 CMR 34 Section 8 Building Height and Area I Compressor Building #2 Building Area Existing (ii applicable) Proposed Number of floors or stories include basement levels 1 Floor Floor Area per Floor(st) 433 SF Total Area All Floors (sf) 433 SF Total Height (ft) 11 ' 10" Section 9 - STRUCTURAL PEER REVIEW (78OCMR 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 i. 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. C7.c2/1 uL 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 y� January 18, 2023 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(FR/AC) 5.Fire Protection 6.Total=(1 +2+3+4+5) - 7.Total Square FL(ler new sc,rn,ms&additions) 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 ;;;!(_ _ Boston, MA 02114-2017 www.mass.gov/dla «Yorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): L2 -\-A C t n � Address: 1 C IU e,V 4...Liry City/State/Zip: l 1(1 `/ /(a ,/) ma _ Phone #: Are you an employer? Check the appropriate box: Type of project (required): i._ I am a employer with employees(full and/or pan-time).; 7, 0 New construction ?.E 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 I am a homeowner doingall work myself. 9. ❑ Demolition ❑ Y [No workers'comp. insurance required.) 4.0 I am a homeowner and will be hiring contractors to conduct all work on m y p roPttY.e I will 10 [] Building addition 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. These sub-contractors have employees and have workers'comp. insurance. 13.n Roof repairs 6.D We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.10 Other 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. 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 thei- 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: ec r," C c_ Policy# or Self-ins.Lic.#: W-c Lk S 3/ �l [� Expiration Date: t 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$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 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone#: Contact Person: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 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: p 5` Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. l i / a3 ignature of Ap 'cat' Date Permit No. Commonwealth of Massachusetts • Division of Professional Licensure Board of Building Regulations and Standards Consrttc titl5prvsor CS-111131 6pires:02/2B/2023 ARIANNA JE$1 r 35 WATKINS WAY - • MIDDLETON MA 01949 •- f C /1Jf4'•, I:l1,8‘\4 Commissioner d.•! R. t76nr41n 8.101.AND FOFIE • �CtS�1�il;:l.; TOWN O YARh+60 11"H REV1EWFD FOR C)DF Ci,MPLi2r1�f ( ERRORS OR OMMISSI0NS 00 N0T REE'E=/[ °t J THE APR.JCANT FROM THE,RE;PONSHH(IIT7 OF'AS BUILT'GOMPHANCE. l DATE: `I 2 id. p 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 1;50.1 X Extinguishers 527 CMR 1;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 I;69.1 X Use and Occupancy(FH Building Class) 780 CMR;302.1 X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-I 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 Entered in Firehouse El Final Inspection I I