HomeMy WebLinkAboutBLD-23-004053 '11 g/i74�
• OF•Y.�,4 BUILDING PERMIT APPLICATION
. o APPLICATION TO CONSTRUCT, REPAIR, RENOVATE , CHANGE THE USE, OCCUPANCY OF,
o C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
$ Town uflarnlouth Building Department
M..T...,,,j
t'..- .• ( 146 Route 28 • Yarmouth, MA 02664-4499
Tel: 508-398-22.31 ext. 1261 Fax 508-398-0836
Office Use Dnty Planning Board Information Assessors Department Information:
6Lb 23— 0L-LS3
Permit No. Date Plan Type_ Map Lot
Permit Fee $1- 0(.1 Endorsement Date /
Recording Date New
Deposit Rec'd. $ ^0 Date Plan No._ 1.4 Property Dimensions:
CO
Net Due $ '.g f_1
4 8 0SI Other Lot Area(sf) Frontage(ft) Lot Coverage
This Section for Office Use Only
Building Permit Number. Date Issued:
Signature: -- . /5 �? Certificate of Occupancy
Building fficial Date is Is not required
Section 1 - Site Information
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 Provided Required I Provided
30 606 10 135 50 761
1.4 Water Supply(M.Q.L e.40.S 54) 1.5 Flood Zone information: Comments
Cubli Private Zone: _NA SFE NA Not in a Flood. ZOne
Section 2 - Property Ownership/Authorized Agent I
2.1 Owner of Record:
Boston Gas Company, D.B. National Grid
Name (print) 40 Sylvan Rd, Waltham, MA 02451
C7 Mailing Address:
LGQ/1.LyL
781-907-1000
Signature Telephone P Telephone /
Email Address:
2.2 Authorized Agent:
Michael E Guerin _ 170 Data Dr Waltham, MA 02451
Nam ,(pr nt i Mailing Address:
c-----yzzgAzof..
Signature Telephone Fax Email Address: )
Section 3 - Construction Services
3.1 Licensed Construction Supervisor. Not Applicable D
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 Ham* Not Applicable
Address Registration Number
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 7.) 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:
Not Applicable
Name (Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
Section 5.2 Registered Professional Engineer(s)
Rea A. Huston
Nam. y
8204 Balata Dr.,Ooltewah,TN 37363 Area or Re Process es
Ps/Mechanical
Address Q 7 _ Registration Number
(,� C C!n-
912 330 5264 46010 Chemical
Signature Telephone Expiration Date 06/30/2024
Randy Maccaferri
Hamel Area of Responsibility
440 S Church St, Suite 1200 Charlotte,NC 28202 Structural
Address n Registration Number
rar+ /(facca/ei,r-i (704)338-6819 309493
Signature Telephone Expiration Date 06/30/2024
Paul K. Davila
Hama Area of Responsibility
613 NW Loop 410, Suite 700 San Antonio, TX 78216 Electrical
Address luau nafri a (210)841-2902 Registration Number 52518
Signature Telephone Expiration Date 06/30/2024
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Section 5.3 General Contractor
United Civil Not Applicable ❑
Company Name
Arianna Jesi
Person Responsible for Construction
240 Newbury St, Danvers MA 01923
Address 978-778-8411
Signature Telephone •
Section 6 - Description of Proposed Work (check all applicable)I
New Construction ID (tor multiple family only) No.of Bedrooms (for multiple family only) No. of Bathrooms
• Existing Bldg. ❑ I Repair(s) ❑ Alterations I❑ Addition ❑
Accessory Bldg. ❑ Type Demolition Other Specify:p fy:
I
Brief Description of Proposed Work:
South yarmouth boil off compressor Upgrades .
Cam-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
Building Use Group (Check as appficapable) Construction Type
A ASSEMBLY ❑ A-1 0 A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B BUSINESS I ❑ 0 —
E EDUCATIONAL ❑
F FACTORY
❑ F-1 ❑ F-2 ❑ 2C ❑
H HIGH HAZARD ❑ 3A ❑
I INSTITUTIONAL ❑ 1-1 ❑ 1-2 ❑ 1.3 ❑ 38 ❑
M MERCHANTILE ❑ 4 ❑
R RESIDENTIAL ❑ R-1 ❑ R-2 ❑ R-3 ❑ SA ❑
S STORAGE
u UTILITY ® s-1 ❑ s_z ❑ se ❑
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.
Existing UseGroup:Boston Gas Company D.B . National Grid Public Utility
Proposed Use Group:
Existing Hazard Index 780 CMR 34 Proposed Hazard Index 7E10 CN1R 34
Section 8 Building Height and Area Electrical/MCC Building
Building Area Existing (if applicable) • Proposed
Number of floors or stories
include basement levels 1 Floor
Floor Area per Roar(sf) 630 SF
Total Area All Floors (sf) 630 SF
Total Height (ft) 15 ' 9
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
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.
�,. 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
c�� uezAuv January 18, 2023
Signature of Owner/Age 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(I4VAC)
5.Fire Protection
6.Total=(1 +2+3+4+5)
7.Total Square Ft.(IQ new smc¢ims 6 additions)
Check Below
D Conservation-Commission Filing
(if applicable)
❑ Old Kings Highway& Historical •
Commission approval
•
(if applicable)
\ The Commonwealth of Massachusetts
r Department of Industrial Accidents
I Congress Street, Suite 100
Boston, MA 02114-2017
_ • www.mass.gov/dia
\orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH TEIE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
—T-
Name (Business/Organization/Individual): ..) \A<l C \.;
Address: Li G v e uV 6 r'-7/
City/State/Zip: 1 C /(e,� /9 Phone r:
Are you an employer? Check the appropriate box: Type of project (required):
1. I am a employer with employees(full and/or part-time:r.' 7. I"1 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. I am a homeowner doing all work myself. [No workers'comp. insurance required.]t
9. ❑ Demolition
LJ
10 E 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.Q Plumbing repairs or additions
5.❑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 arc a corporation and its of icers have exercised their right of exemption per MGL c.
14.El Other
152,§1(4),and we have no employees.[No workers'comp. insurance required.]
'Any applicant that checks box#1 must also f111 out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all wo:k 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: LC 1 },nl,�x�` vL' t'� >�� �, �j C c_
Policy# or Self-ins.Lic. #: bV-�Lt S 3 Expiration Date: 1 t / l/ / k)
Job Site Address: 137 Whites Paths ( City/State/ZipS out h 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.
Signature: Date: 12/2 8/2 2
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 m
Issuing Authority (circle one):
1. Board of Health 2. Building Depat tutent 3. City/Town Clerk 4. ElectricaI 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: b(4,0,{) si-er
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
I11d3
Si ature of App ' i Date
Permit No.
• 1
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Consrtfttl+iat5pprvisor
CS-111131 4 j res 02/28/2023
ARIANNA JESI
36 WATKINS-WAY
MIDDLETON MA 01
O
Commissioner daeria BiFmcb&.
- MGL AND FIRE
t RMrlI4,% TOWN OF YARMOUTH
�� REVIEWED FOR GOOF COMP, AHII;E
\ , t t ERRORS OR OMISSIONS OO P OT HLU'Fit
" THE AF'PLIC/tNT FROM THE RESPONSIBIt!ri
OF"AS BUIL"COMPLIANCE.
DATE:,f..
s/' _ L7.
INSPECTOR r
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
iY 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 I;22.3
' X *Service Stations 527 CMR I ;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 1;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-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 EJ Copy to Building Department Copy to Fire Prevention I I
Entered in Firehouse(-1 Final Inspection I I