HomeMy WebLinkAboutBLDSM-23-000150 . TOWN OF YARMOUTHBuilding Department �rY�'�� IIIG�G�,
BUILDING
(508) 398-2231 ext.1261
.,,. ....M a PERMIT NO..,. PERMIT
p ), ,4 PERMIT
�, '� 41 PriPm...�,0VOIONR� >Mp JOB WEATHER CARD
M.. 0 ISSUE DATE u07/12/2022 w ...- -- -.. - �.m.M
APPLICANT :NORMAN J BROTHERS PERMIT TO -
AT(LOCATION) 296 STATION AVE, SOUTH YARMOUTH, MA 0266 7 ZONING DISTRICT M ! Bldg.Type Commercial
A.P. , L.„, ___...a,.„.__
SUBDIVISION MAP BLOCK LOT 078.315 BUILDING IS TO BE: CONST TYPE E USE GROUP f
. . _ ._______________
� � r CONTRACTOR
REMARKS Sheet Metal-Installation of mechanical ductwork and associated ductwork at 1
DY Intermediate Middle School 401-365-1573 LICENSE 1570
Sheet Metal Workers-
UNIQUE METAL WORKS LLC
� � I NORMAN BROTHERS
" 1 489 NARRAGANSETT PK DR
AREA(SQ FT) 41515,995,88 EST COST($) 2- 74488.00 PERMIT FEE($) 60.00
- - ---- --- iPAWTUCKET, RI 02861
OWNER IDENNIS-YARMOUTH REG SCHOOL IL-
BUILDING DEPT BY
ADDRESS 210 STATION AVE
!SOUTH YARMOUTH MA 02664 3000ill)/Ise
/a11� /61/ PHONE
:.... T.. ...,N .. Mi %)
THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWAL OR ANY PART THEREOF, EITHER TEMPORARILY C
PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST E
APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY E
OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM
MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE SEPARATE
CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL PERMITS ARE REQUIRED FOR
FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE.WHERE ELECTRICAL PLUMBING/GAS
MEMBERS(READY FOR LATH OR FINISH COVERING) A CERTIFICATE OF OCCUPANCY IS AND MECHANICAL
3)FINAL INSPECTION BEFORE OCCUPANCY 4) REQUIRED,SUCH BUILDING SHALL NOT BE INSTALLATIONS.
REFER TO DETAILED INSPECTION SCHEDULE OCCUPIED UNTIL FINAL INSPECTION HAS
BEEN MADE.
POST THIS CARD SO IT IS VISIBLE FROM STREET
BUILDING INSPECTIONS APPROVALS
OTHER:
NORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD
UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN SIX CAN BE ARRANGED FOR BY TELEPHONE
APPROVED THE VARIOUS MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED OR WRITTEN NOTIFICATION.
STAGES OF CONSTRUCTION AROVF
SHEET METAL PERMIT
44, z Commonwealth of Massachusetts
fl
Town of Yarmouth Building Department
1146 Route 28, South Yarmouth, MA 02664-4492
Date: 71 8 / 202Z. Permit#: fj( I fl-.23-00015 D
Estimated Job Cost: $ a I oly , LiggPermit Fee: $
Plans Submitted: (® NO Plans Reviewed: YES/ NO
Business License # Application License #
Business Information Property Owner/Job Location Information
Name: unlgfre Metal Works at, Name:
Street: t $q Warragans googols,Street:
City/Town: PA W1U rdc f City/Town:
Telephone: Telephone:
Photo I.D. required/Copy of Photo I.D. attached: )/ NO Staff Initial:
J-1/ M-1 unrestricted license
1-2/ M-2 restricted to dwellings 3 stories or less and commercial up to 10,000 sq. ft./2
stories or less
Residential: 1-2 family_ Multi-family_ Condo/Townhouses_ Other_
Commercial: Office Retail Industrial Educational V Institutional Other
Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of stories: a"'
Sheet metal work to be completed:
New work Renovation: HVAC: Metal Watershed Roofing:
Kitchen Exhaust System: Metal Chimney/Vents: Air Balancing:
Provide detailed description of work to be done:
tnStauaboin of MeciumiteJ cluC4-work. and asSocaakd
clu.alARO- a— �et�x�/,, yo Merl o 411 Th tAxn ed i4k
M,tddl. Schoo 1 .
INSURANCE COVERAGE:
I have a current liability insur nce policy or its equivalent which meets the requirements of
M.G.L. Ch. 112 Yes V No
If you have checked Yes, indicate the type of coverage by checking the appropriate box below:
A liability insurance policy ✓ Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this
requirement.
Check One Only
'1! 6144 I 1 V V Owner Agent
Signature of Owner or Owner's Agent
By checking here-i ,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true
and accurate to the best of my knowledge and that all sheet metal work and installation performed under the permit issued for this application
will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Inspections shall be called for prior to insulation installation.
Duct inspection required prior to insulation installation: Yes No
Progress Inspections
Date: Comments:
Final Inspections
Date: Comments:
Type of license:
By: Master
Title: Master-Restricted 1` Signature of Licensee 'I`
City/Town: Journeyperson
Permit#: Journeyperson-Restricted License Number:
Fee: $ Check at www.mass.gov/dpl
I` Inspector Signature of Permit '1`
of Permit Approval
The Commonwealth of Massachusetts
Department of Industrial Accidents
r=a1mt Office of Investigations
_• 600 Washington Street
?'E 1 Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /� r�/ Please Print Legibly
Name(Business/Organization/Individual): n I1�/ Ue !'�1 I W�! tl 1
Address: q Marra Gt.n S t ft PGt.fK d r i vti. •
City/State/Zip: pa whA c if tpj Phone-#: LI O I }2lr!i a 95 q
Are you an employer?Check the appropriate box: Type of project(required):.
1.❑ I am a employer with 4. Q I am a general contractor and I
6. EgNew construction
employees(full and/or part-time)_ have hired the sub-contractors
listed on the attached sheet. 7. Q Remodeling
2.❑ I am a sole proprietor or partner-
ship and have no employees These sub-contractors have g. Q Demolition
workingfor me in anycapacity. employees and have workers'
P tY• 9. Q Building addition
[No workers'comp.insurance Comp.rnsurance.t
required_] 5. Q We are a corporation and its 10.Q Electrical repairs or additions
officers have exercised their 11.Q Plumbing repairs or additions
3.El I am a homeowner doing all work
myself.[No workers'comp. right of exemption per MGL 12_0 Roof repairs
insurance required_]t c. 152,§1(4),and we have no
employees.[No workers' 13.0 Other
comp.insurance required.]
'My applicant that checks box Ill must also fill out the section below showing their workers'compensation policy information_
t Homeowners who submit this affidavit indicating they arc 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: T(Q v�Qi/�('G rs I n S(.i rarl a
Policy#or Self-ins.Lic.#: LA R v Q'v` 3 0 3/z 0 I ZI 2. c ( Expiratiop I ( 2I 202
•
Job Site Address: 402q Sf Hon on Ave City/State/Zip: g• Yarrnon4' s MA
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Faiiure.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$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. Be advised that 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
/offpp�erjury that the information provided above is true and correct
Signature: ..• �� e d]17,6t Date: "I 6 ! 20 22
Phone#: �I " 24V 13q s Y
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#:
•
' •
SECTION tab OWNER/AUTHORIZED AGENT DECLARATION
, as Owner/Authorized Agent
hereby declare that the statements and information on the forgoing application are true and emirate,to
the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
• •
Print Name
!graattire of Owner/Agent - Date
Section 11 - ESTIMATED CONSTRUCTION COSTS
item Estimated Cost(Dollars)to be
completed by permit applicant
1.Boiltding
2..Electrical
3.Plumbing/Gas
4.Mechanical(KVAC) CR I a•I'l (7I 0 Oa
5,Am Protection
•
S.Total--.11 4-2+3+4+5)
•
rutel.Souere ttormtvistaL-tutu&Ostia*
Check Below •
Consenration-Cornmission Filing
it applicable)
121 Old Kings Highway&Historical
Commission approval
(if applicable)
•
•
. .• QT.-y-4k BUILDING PERMIT APPLICATION
• . - 'tr APPLICATION TO CONSTRUCT;REPAIR,RENOVATE,CHANGE THE USE,OCCUPANCY OF,
o ' OL" OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
Town of`�arntouth Building Department
mu.TrAcncLt
�;t�--.,,••° 1146 Route 28 • Yarmouth, MA i12(6+-1492
Tel: 508-398-2231 ext. 1261 Fax 508-398-0836
Office Use only Planning Board Information Assessors Department Information:
Permit No. Date Plan Type • Map Lot
Permit Fee $ Endorsement Date
Recording Date New
Deposit Reed. $ Date Plan No. 1.4 Property Dimensions:
Net Due $ Other Lot Area(st) Frontage(It) Lot Coverage
This Section for Office Use Only
Building Permit Number. Date Issued:
Signature: , Certificate of Occupancy.
Building Official Date is Is not required
Section 1 - Site Information
1.1 Property Address: 1.2 Zoning Information
t•q.61C S tA4O Ave
41./• ll y/9121�18i/1?1,t/l (�2 r 4 Zoning District Proposed Use
1.3 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.4 Water Supply fM.G.L c.40.S 54) 1.5 Rood.Zone information: Comment=
Public Private Zone: BFE
Section 2 Property Ownership/Authorized Agent
2.1 Owner of Record:
Name(print) Mailing Address:
Signature Telephone Telephone
Email Address:. j
2.2 Authorized Agent:
Name(print) Mailing Address:
Signature Telephone Fax
Email Address:
Section 3 -Construction Services
3.1 Licensed Construction Supervisor. Not Applicable U
License Number
Address
Expiration Date
Signature Telephone Email Address:
4/Ed/a")it/-0
COMMERCIAL ONLY_ B U.13HN PERMIT
APPLICATION REGULATORY APPROVALS NOTICE
Address of Proposed Work: G;ci o st-tafi oi �-e S• 'I A r m Ov4i-N M\ OZ(Ofo
Scope of Proposed Work: t 0(2) n_I,( i 4.(4 c-I- work awl assOciaed
r,
e l UPI p Vyl.l�vil-� r e w atnh'i S yOI o Til+Q+.-PVI_i a d a-Fe
'Meld he saldol• ,
Date: — -I 8 I 2( 2 2
Based on the scope of work described above,the applicant is required to obtain approval sign-
offs from the following departments as checked-of below:
Health Dept —508-398-2231 ext. 1241
Conservation—508-398-2231 ext. 1288
Water Dept.—99 Buck Island Road, 508-771-7921
Old Kings HWY. Hist. Comm. —5.08-398-22631 ext. 1292
Engineering Dept.—508-398-2231 ext. 1250
Fire Dept.—Kevin Huck/Scott.Smith, 96 Old Main Street, SY
Note: Please call Fire Department for an appointment. 508-398-2212
Other
Appropriate plans and/or application shall be provided to each departments checked-off above.
Each of these regulatory authorities has their own n requirements outside the jurisdiction of the
Building Department All applicable approvals shall be obtained prior to submitting a building
permit application to the Building Dept.
Thank you for your cooperation.
Receipt A.cknowledaPment:
10-(A — i S— 7J e j 2 0 2z
Applicant's/Signature Date
Rev.Jan. 2019
3.2 Registered Home Improvement Contractor:
Company Name Not Applicable ❑
Address Registration Number
Expiration Date
Signature Telephone
• Section 4-Workers'Compensation Insurance Affidavit(M,G.L c. 152 S 25C(5) ,
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
Not Applicable 0
Name (Registrant):
i Registration Number
Address
Expiration Date
Signature Telephone
Section 5.2 Fegistered Professional Engineers)
Hams Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Marna Area of.Responsibility
Address R'gistr3tion Murnber
Signature Telephone Expiration Date
Names Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date he
Section 5 f ad/lifV'tca/ Su6(. dog(
(A ti►t, ve M tin I WO r KS, 1,1.4 Not Applicable ❑
Company' Name
tet-wt b-et- RU S e Sous 4 `Nor n4 Afr,- t3 r -&r S •
p-r ^r o6S0anAihL for:.r etnirtinn / D� ��
4�9 . e0.tr.Q u,hsg.I/ P - •
Adore r/il i St /Vw 40I ZIP� eq5 q
signs re '( ��[ 11T�4"1 v _ Telephone
' - Section 6 -Description of Proposed Work(check all applicable)
• New Construction . (tor multiple family only) No.of Bedrooms (for multiple family only) No_of Bathrooms
• • Existing Bldg. .0 Repair(s) Q Alterations
0 Addition la
Accessory Bldg. 0 Type Demolition Other Specify:
Brief Description of Proposed VVoric
M,ethanica► Du ork ai, 1 v nt-
9 •
Section 7-- Use Group and Construction Type
Building Use Group(Check as applicapable) Construction Type
A ASSEMBLY A1 .l!1 A-2 ( A 3 1A
A-4 ❑: .. A`5 El 1S ❑
B BUSINESS 2A
E EDUCATIONAL ❑
F FACTORY ❑ F-t ❑ _ F_a ❑ 2G -,l]
H HIGH HAZARD- . (� 3A
0
I INSTITUTIONAL Q 1-1 Q I a (] 1-3 Q 3g
M MERCHANTILE 4 0
R RESIDENTIAL
S STORAGE Q s-4 S-
❑ 59
U UTIJTY 0
SPECIFY.
It MIXED USE a.
SPECIFY:
S SPECIAL USE CI
SPECIFY:
Complete this.section if existing building undergoing.renovations:additions and/or change In use:
Existing Use Group: Proposed Use Group: . .
Existing Hazard Index 780 CMR 34
_. Proposed Hazard;Index 7B0 CMR 34
Section 8 Building Height and Area
Building Area Existng(if applicable) Proposed
Number of floors orstones
include basement levels
Floor Area.per Floor(st) i9.- I205e1(IsF/24 Lc' ifL7 JF _
Total Area All doors(sf) ) 11 S F
Total Height{fl) 17S- es-
'Section •9'- STRUCTURAL PEER REViEW(780CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes No
\4tFrSECTION 1 Ca OWNER AUTHORIZATION -TO BE COMPLETED WHEN
iir
OWNER'S AGENT OR CONTRAETOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property,
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Date
Signature of Owner
i
ode cst
J4 H 4Sin,k,002$
9�
. . V
/ . k ip ,�,i. $ :. .r� 'f.:. r .
ea
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.
1-0 UNIQUE VETAT,IAORKS, U
An Arden Building Company
489 Narragansett Park Dr. AMBER-ROSE SOUSA
Pawtucket,RI 02861 Senior Project Manager
0:401-365-1573
C:401-266-8954
F:401-728-9180 ® 0 0 Q
asousa@uniquemtl.com www.uniquemtl.com