HomeMy WebLinkAboutBLD-20-003822 CO o ' TOWN OF YARMOUTH Building Department CERTIFICATE OF
xt
he. (508) 398-2231 ext.1261 OCCUPANCY
.,..� PERMIT NO BLD-20-003822
\ITT w•s
KINLIN GROVER REAL ESTATE
ADDRESS: 909 ROUTE 28, SOUTH YARMOUTH, MA 02664 ZONING DISTRICT Bldg.Type: Commercial
SUBDIVISION MAP BLOCK LOT 041.28.1
REMARKS Use&Occupancy—Kinlin Grover Real Estate—occup- cy s eject to -
inspections.
CERTIFICATE OF OCCUP• CY
DATE: �s BUILDING OFFICIAL: AI
�►
APFP-
WESTERLY HOLDINGS
BUILDING DEPT BY
4009 OLD POST RD
CHARLESTOWNL, RI
_.... ... . ,..._ PHONE
u S PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
ERMANENTLY.ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE
JRISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF
JBLIC WORKS.
CERTIFICATE OF OCCUPANCY
BUILDING INSPECTIONS APPROVALS
ERE: OTHER:
DATE: 7 /2 . 2 DATE:
INSPECTOR: L?-( INSPECTOR:
ELECTRICAL BOARD OF HEALTH
DATE: l '1 2 3 1 '3
DATE:
INSPECTOR: -�,�" INSPECTOR: 1C-A-c-,=90-.-09...-4---,
PLUMBING/GAS FINAL BUILDING
DATE: G (rt/Z DATE: 5
INSPECTOR: ' INSPECTOR:
COMMUNITY DEVELOPMENT: DATE NAME
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Town of Ys '8iair Department
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1146 Route 28,South Yarni' i A�c IO26Otel.SO8-398-2231 ext.1261
M 1 •I..1
Use and aP:: •,'e��� ikippiication
In accordance with the provisions or eMassa us‘itts State Building Code,section 105.1
Application for a certificate use and occupancy permit
Name of Business �v\ 11 ,, C-1 065_d 514 I-e
Property Address go , K ,c, veiv,"to.iivh ,//4 Unit#
Type of Business R61i Cs Lt 145 lgrm,if j o„ r •
*Square Footage to be occupied vZ/6 0 *attach fioo plan Fee:$60
The applicant is required to obtain approval sign-offs from the following departments as
checked off below:
,.._Health Department-508-398-2231 ext.1241
— - X Fire Department—Fire Prevention,96 Old Main Street,508-398-2212
Other
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Building owners Signature Applicant Signature
Please note:this permit is for use and occupancy sulk.Any work requiring a building permit
will require a licensed contractor to submit an additional application with all the required
information based on the scope of the project.
**Office use only**
Zoning District )5 Proposed Use Change of Use:Yes No !-
Allowed Use:Yes --"-No APD Waiver:Yes N_N/A
Bul in Officials Signature Date
RECEIVED
rDEC 27 2013 iMi'
`1 Mil-DING lice r. ! ,'�V
.
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. The Commonwealth ofMassachusetts
Department of,.
Industrial Accidents
'
�, Office of Investigations •
_ 1 Congress Street,Suite 100
' -` != r Boston,MA 02114 2017
w►iawmass gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers-
Analicant Information - Please Print Leeibly
Name($usineisfO ganiutton indjvtaual): 1-Mstb (;.A'PO' Two...
•
Address: %toy •Rp i4e G1 • .
City/State/Zip:C Paii40trrN imA deltn4fl Phone#: 508-a110-cal l q 1
Are you an employer?Check the appropriate box: r 'Type of project(required): ~
1.10 I am a employer with lax , 4. Q I am a general contractor and I 6. Q New construction
employees(full and/or part time).$ have hired the sub-contractors
2.Q I am a sole proprietor or partner • fisted on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ID Demolition
working !tor me hi any capacity, employees and have workers'
[No workers'comp.insurance comp.insurance.: 9. 0 Building addition
required.] 5.0 We area corporation and its 10.0 Electrical repairs or additions
• 3.❑ I am a homeowner'doing all work officers haVe exercised their 11.0 Plumbing repairs or additions
atysel£[No workers'comp. right of exemption per MGL 12.0
insurance required.]t c.152,§1(4),and we have no Roof repairsi
employees.[No workers' 13.0 Other
comp.insurance required] .
*Any applicant that ehecb box tit must also off out the section below ibowmg their workers'compeasadon policy information.
t Homeowners who submit this affidavit indicating they are doing all wait and then hire outside contras:Ws nmst submit a new stlidavit Indicating such.
'Contractors that check this box must attached an additional sheet showing die name of the sub-contactors and state whether or not those entities have
employees. lithe sub-contractors have ernployees.they must provide**waters'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employee. Below Is the policy and Job site
information.
Insurance Company Name: fi.1-,M; tt4SILR�r vn 1J Y .
Policy. #br Self ins.tic.#: Uj v — )0 0— (ap lest. j.80i9. Expiration Date: 1113 K 1a0 A;o
Job Site Address: . 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
. •fine up to S 1,S00.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.
do hereby certify under the pain nd penafties ofperjury that the information provided above is true and correct
,Signature:
)S: /2 /15//
Phone#: 508 -aLv>a11a • . .
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.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person:
— Phone 0:
RECEIYED
*..1-.4,J` 4, TOWN OF YARMOUTHtot HEALTH DEPARTMENT. DEC 2'O201�
o �
TM oar.
�u'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SlicE
To be completed by Applicant:
Building Site Location: 'O 7 ' 'Ji rti. 441-e ag 9 '/cvvi,ievJL /tl1 ow,cy
Proposed Improvement: 0Gc4-, ~ C, `k _
Applicant: Yit,itn. CI5Vc&.' gecAl gcle---142- Tel.No.. /267 -?
� 1
Address:if/it/16.mm 1 V5l't/'v11f� Aik Date Filed: //�j
o��
•'lfyou would like e-mail notification of sign aft please provide e-mail address_01 CIA 1041-e. k)- I i h vf< Co't
t
Owner Name: S rt``y401c/ c
Owner Address:00d 1 O k go. Q (we f)o vim+ 0413 Owner Tel.No.:/bl ` .0''7'39/1/
BESIDENTIALAND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings,water line location,
and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all existing and proposed)—
Note:Floor plans not required for decks,sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: P DATE: t� 7 I c(.
!v�
COMMENTS/CONDITIONS: PLEASE NOTE
GEC ta. a.7 Pi.
o 4 �L$4.IJf rtntus G t R.c w t r/ R ecJ.ec) 4. i -e l'`�°1$�t q
o' 1 .Cl/c „IQ,
4
MGL AND FIRE
i Wit TOWN OF YARMOUTH
REVIEWED FOR CODE COMPLIANCE.
C:Zlir) ' ERRORS OR OMMISSIONS DO NOT RELIEVE
dtZgb THE APPLICANT FROM THE
: OF'AS BU! COMPLIANCEESPONSfBlLITY
DATE: ri
'SPEC 0
YARMOUTH FIRE PREVENTION '
New Business Transmittal
Project Name: Kinlin Grover Real Estate Address:909 Route 28
Contact Name:Mike Schlott Phone:401-207-3771
Y N NA Subject Regulation
ES 0
X Building Numbers MGL Chapter 148;sec 59
X Fire Lanes 527 CMR 1;223
X Extinguishers 527 CMR 1; 13.6.Chapter 148;sec 28
X Maintence of any equipment,system relating to 527CMR1 1.1.4
_ Fire Protection.
X *Hazardous Materials Storage -527 CMR 1;60.1
X Emergency Plan Required 527CMRl 10.9.1
X Commercial cooking,Hood systems 527CMR1 50.2.1.1
X Commercial Cooking Hood Systems Cleaning 527CMR150.5.4
X *Commercial Cooking Extinguishment System 527CMRl 50.43
X *Candles,open flames,and portable cooking 527CMR1 17.3.2,20.1.1.1
X Blocking electrical panel 527CMR1 10.19.5.1
X Blocking exits 527CMR1 14.4.1
Extension cords shall not be used as a ' 527CMR1 11.1.7.6, 11.1.7.1
X substitute to permanent wiring
X Limit storage heights to 24 inches below 527CMR1
ceiling without sprinklers 18 inches with
X Maintain Aisle width of 36 Inch's(3 Feet) 780CMR 1101.1
X Storage inside/outside Buildings 527 CMR 1; I0.19.4,4.4.3.1.1,19.12,34.1.1
X The right to inspect MGL Chapter 148 Sec.4
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 Chapter 148;sec 28
X *Curtains,Draperies,Blinds 527 CMR 1; 12.62
Description of planned project/other requirements:
The YFD support the application,subject to applicable submissions,permits
and inspections.
A Permit from YFD is required any time a fire protection system is shut down.
* YFD permit required-depending on occupancy and submittal
Plan Reviewed By: Captain Kevin Huck Date:09-302019
Copy for Applicant CA Copy to Building Department L1 Copy to Fire Prevention I i
Entered in Firehouse['Z ' Final Inspection 1 i
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