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HomeMy WebLinkAboutBLD-23-006014 REv ED 1 1 MAY 0 1 2023 `4.,� '' f` .ARTMENT j BU U3 9 : E3 tf-1--.-- 0-:. '.... ." gite anunamgea id 4 orctuulachole& vs:.........„4,00,.,„....„ 0412a,r,tm4at ii Anye. r &baked. - 0 ide ouiting. amm42442,244 1146 gai44 28, e5014d P42,COLOWth GM 02664 APPLICATION FOR FIRE PROTECTION PERMIT Date L5NE PERMIT NUMBER I3U)--Z 3 mtao l l Projected Start Date: -5 / 7f3 Date of issue In accordance with the provisions of 780 CMR and M.G.L. Chapter 148,as provided in Section This application is hereby mad ,%74_1by --S s / a c /`7 �'�S /b'l L (Full name of person,Firm or Corporattiioo ) Address / lS� r6 1 am ps Y vKO( c '' C "1 C (Contact#)_7 2�`3Y '-Q5`9,Email / / c c, ( - 67--- -c---- Owner of property ( & �e- ,4 e c Job Location (QS 7 b J,//0t4} 3Y . C ArtiA (Street&City or Town) For permission to(state clearly purpose for which permit is requested) s/ ---// A7Ki /}/ 1 c SilA a/� (° //4 /1et) e o i-4_SA t 49,t Air e-��� Name of competent operator(if applicable) a0 && 2-A I.- Cert. or Lice o. j 7 C-- - timated Cost of Construction: laces�) By (Sin r ppli nt Building O icial: - Date: Y ) - ..Z.? FEE: $50.00 f a ; ✓n4, • ,;. , t rain • . , .. ,tom•.. � � ., • f 1 �g.y } • -Ili.- _ • ;',i h..... ; 'r, , \ _ < , 4. 2.1 • '0 ' 0 ,!.. es: V .•(f) ' • • 3.2 &'s 0 Lt Cji A/4 i 0 > ri- ',-•• ... . D gw ,,.. .i.2 • 1. _ n 1 • 0 0 ® 1 mi . gh iiiiitAilli 01 kb•- A.i... EN '--.- 7 '17 g g 641- '71 Illi111111111"11 _ w-ig D > 2 4 3 -1111111r4 .1riii-44.L.4.,92,- Lai .1 . 1 = jr010.. F_9 - -,,o, 4 -72 ---T g :;g IMZEN. IMMO •4 I , V H > -1. .... ./...\ oi 8 8 0 1 j.1 A: JJJ A, x, _ 0 1 Iii „ I „ „ '11 abort !! nusw.rala.,..x N.roc : u, I. Si §2 %. • .... g (4.•• .1 . , i: 1 — N) ln (I) 0 ''' •-i -,1 It F.F• PI 4§f. I '. 4' iii e,f 11 '41/4 i 1! 7! 1 _______s_ §a s c% : e,,-,, 7 Y I 1 " ° I 1. , — . r 1 .. 11111MO-8; - /- . . ---I . 4 0 si I 6.-9" .I._ e I Jr c ..,,1 <> 0 W .. to 2. ) "........ ELCr i i — /A / I 0 § § g g i ,... _, o (1)4 NI r --, ( • =* .11 4 a _ 2 5 m 0 0 CP Z 0 1 ti. —-—- Ai OP ,0 . ,\ g . x . 0.. .. ,, (A z e 0 o - -0 :71 1 si mx M fLuntj fn 1 1 C t— .41/ \ E •••• 0 m ... ' Eg / ,-, mi<25, 0 g Reg a : g r a CONTINUOUS 2x6 KO P.T. SILL PLATE/SILL INSUL. / &2x6 KO 2NO PLATE noonra w/5/8"CIA x12"L CALM.A.B. O 70'O.C.MAX&6"-12"FROM PER WFCM 110 MPH EXPOSURE B END OF PLATES w/3"x3"x4" PLATE WASHERS s� \ WIDTH s 24.-6" LENGTH • 1S-0" ASPECT RATIO(L/W) s,/2"C VC.FlLLED ANCHOR BOLT SCHEDULE i*1 DRILL&EPDXY STEEL LALLY COLUMN c ,F4 VERTICAL ON 3s'X36"x12' , ' PER WFCM 110 MPH EXPOSURE B V. 12"O.C.-TYP •• CONC.FTf;F1, ' r , • I I I 1.) ALL BOLTS TO BE r DIA. GALVINIZEO 60 """""••••• "•••• i Sr'b-" \ 2.) ALL BOLTS TO BE SECURED w/HEX HEAD NUTS w/3"x3"xt G ---� 3.) BOLT SPACING: caawT AP Fora MAX 70" O.C. III 2'CONC,DUST COVER OVER •• CELLAR SASH MAX 12" FROM CONCRETE CORNERS OR END OF PLATE t ` ,1 I �/}(,/y'{�i 11 6 MIL POLY VAPOR BARRIER G r/CALK ALUM MAX 7" FROM END OF PLATE AT SOJCE (, L CiP-� 1 Y�. !CI4D'.`Y.�'r I tl I•/ ApEA1VELL / ' fP�✓ 4.) BOLT EMBEDMENT MINIMUN 7" DEPTH FXISTING BAFMENT '•1 I 3L2x1 OR . I I f I • 6 B" / i 11 e. is i • III H :iSS:•:Q: V PI J e: MIME 8"CONC,WALL ON 16'00'KEYED o CONC.FTC 1 110 MPH E7CPOSJIRE E • ` Joint Description ADDITION 0 Riot Framing Bociing to Naar Fen Board to Plater(End-nailed) °FOUNDATION PLAN SCALE:1/4"-1'-0' Vtpl Faming Top Rites at Inter ectbns(Face-neted Bud to Bud(Face-nabd) 2x8 a IN"o.c. Headerlo Header(Face-naiad) TO MATCH EXISTING R'borAwmng Joist to Si by Rate or Odder(Toe-naik SocMng to Jost(Toe-naffed) PROVIDE SOLD BLOCKING O 4e'O.C. Boding to Si or Top Nate(Toe-nated) -- "�- - - - - no_ FIRST(2)JOIST SPACES Ledger 9dpto Seam or Gilder pace-no FROM END WALL-TYP. Joist on(Edger to Beam(Toe-naiad) i0 MEET CODE Find Joist to Joist(End-naiad) I I , ' ' __'_ REQUIREMENTS 1 Band Joist to 91 or Top Plate(Toe•naiec '--+'_���+ -�-� _ _ _ _ _ Spot Swathing rr 3.2.,i GILT BL01' 1-1 ] VWod 3ructural Panels • rafters or busses spaced up to 1st'o.c. teem orttuasos spaced over 16"o.c. I I II I II I ( gable endwai rate or rake irussw/o gal �--J I- -� gable endwaI race or rale trsset/eruct EXISTING 1ST FLOOR gable endwaI tale orraletrusaw/bolo / I Ceiig Swathing Wallboard_ _ _1I 4I1 V1A19teathil,g IHs z' Cll i apse( I- 1Abod 9lucturat Panels I studs spaced up to 24"o.c. 1/2"and 25/32"Fbelboad Rinele I I I I I I I I- I I 1/2"Gypsum VW boa d I 1 1 1 1 I 1 I-11 AC 02/2 /202 CERTIFICATE OF LIABILITY INSURANCE DATE(M3/2023 YYY) �---- 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(ies)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 CONTACT Emily Montgomery NAME: The Hilb GroupEngland,New 9 land,LLC (A/CC,No,Eat): (800)640-1620 I(A/C,No: dba Dowling&O'Neil E-MAIL emontgomery@hilbgroup.com ADDRESS: 973 lyannough Road INSURERS)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURER A: Crum&Forster Specialty Ins 44520 INSURED INSURERS: Safety Indemnity Insurance Co 33618 Seaside Alarms,Inc. INSURER C: Hartford Fire Insurance Co 19682 1265 Route 28 INSURER D: INSURER E South Yarmouth MA 02664 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2322138979 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 ADDL SUER POUCY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD!YYYY) (MM/OD/YYYY), LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 MAGE-ICCLAIMS-MADE X OCCUR PREM PREMISES EaEccA rence) $ 50,000 MED EXP(Any one person) S 5,000 A GL0095222 02/25/2023 02/25/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY X PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,o0Q000 OTHER PROFESSIONAL LAB s 1,000.000 AUTOMOBILE UABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED 622210710 02/25/2023 02/25/2024 BODILY INJURY(Per accident) $ ,_ AUTOS ONLY _ AUTOS X HIRED Ne NON-OWNED PROPERTY DAMAGE S AUTOS ONLY , AUTOS ONLY (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A X EXCESS UAB CLAIMS-MADE SE0122668 02/25/2023 02/25/2024 AGGREGATE $ 1,000,000 _ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE EORH AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA 08WECAE7ZU7 02/25/2023 02/25/2024EL EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ , DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,otherlimitations and endorsements. Nothing contained in the certificate ofinsurance shall be deemed to have altered,waived.or extended thecoverage provided by the po icy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS. 1146 Route 28 AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 ' '1I .,,ems ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts * '` Department of Industrial Accidents = 1 Congress Street,Suite 100 Boston,MA 02114-2017 r = A 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): Seaside Alarms Inc Address: 1265 Route 28 City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-394-0599 Are you an employer?Check the appropriate box: Type of project(required): 1.E✓ I am a employer with 19 employees(full and/or part-time).* 7. New construction 2.0 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.]` 9. El Demolition 10 Q Building addition 4.O 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 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions in I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.El Other SecuritY&Fire Alarm 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 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: Hartford Fire Insurance Co. Policy#or Self-ins.Lic.#: O8WECAE7ZU7 Expiration Date: 2/25/24 Job Site Address: All site in 76._(171-A c_-- !� City/State/Zip: 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: �Ri S,4.)4 N� Date: c/il 7 J? 3 Phone#: 508-394-0599 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 6.Other Contact Person: Phone#: / Commonwealth of Massachusetts '‘` 0 COMMONWEALTH OF MASSACHUSETTS it Division of Occupational Licensure DIVISION OF OCCUPATIONAL LICENSURE BOARD OF Securit stegn's1- S�' License ELECTRICIANS y ISSUES THE FOLLOWING LICENSE SSCO-000046 4 spires:01/05/2025 REGISTERED SYSTEM CONTRACTOR cc ROBERT4 BMX"; • i, o ROBERT K BOUCHER Emp1 ed by:. - - 1265 ROUTE 28 SEASIDE APARMS INC' Q `'' S YARMOUTH,MA 02664-4455 vj rG4 �r.Lva:l��` F;� Z' Commissioner cSat /_ b „ 1317 C 07/31/2025 291777 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER it COMMONWEALTH OF MASSACHUS S 0 COMMONWEALTH OF MASSACHUSETTS.. DIVISION OF OCCUPATIONAL LICENSURE DIVISION OF OCCUPATIONAL LICENSURE BOARD OF BOARD OF ; ELECTRICIANS ELECTRICIANS �, ISSUES THE FOLLOWING LICENSE ISSUES THE FOLLOWING LICENSE REG • REGISTERED SYSTEM TECHNICIAN m SYSTEMS CONTRACTOR BUSINESS T ROBERT K BOUCHER _6 z 1265 ROUTE 28 W SEASIDE ALARMS INC W w 1265 ROUTE 28 S YARMOUTH,MA 02664-4455 �' 0, S YARMOUTH,MA 02664-4455 W J U y J 463 D 07/3112025 291784 4177 Cl 07/31/2025 391646 LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER LICENSE NUMBER EXPIRATION DATE SERIAL NUMBER