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HomeMy WebLinkAboutBLD-19-000472 ONE & TWO FAMILY ONLY- BUILDING PERMIT ` Town of Yarmouth Building Department or r 1146 Route 28,South Yarmouth,MA 02664-4492 s+�� 508-398-2231 ext. 1261 Fax 508-398-0836 ''...�`I`�E■ Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair,Renovate Or Demolish a. a One-or Two-Family Dwelling . This Section For Official Use Only Building Permit Number/33O' r/ten 97'Z- Date Applied: . . Building Official(Print Name) �Sigbanue,_ ::.,... : :. . Date- . :SECTION 1:SITE INFORMATION •- . 1.1 Property Address: , 1.2 Assessors Map&Parcel Numbers 5 Waltham Or A/esD 7P•rnOdR 76 152 1.la Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided — 1.6 Water Supply:(M.O.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 10 Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ❑ Check ifyes❑ : SECTION 2: PROPERTY OWNERSHIP' - ' 21,Owner'of Record: I� West Yarmouth MA, 02673 h na. in . Mu Name(Print) City,State,ZIP • 5 Waltham Or - qg-y318 No.and Street Telephone Email Address . ' . SECTION 3:DESCRIPTION OF PROPOSED WORK=.(check all that apply) • l, ''. New Construction Cl Existing Building K Owner-Occupied ❑ Repairs(s) O Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg.0 Number of Units_ Other $1 Specify: Bath remodel • Brief Description of Proposed Work2: Remodel Ind ft hathronm. No rhanoes to lak'dtit. C P I V E p New fixtures new tile floor, tile shower walls. Sheetrock will be removed"fr ume walls. e.to 1-C9-e. e(eoo'- OK Lett rn.cer ,r/� '. r :f;,:: r,SECTION.4?ESTIMATED CONSTI}UCTiTO$COSTS:,,;. `. .(_ '•.:.,..:44- _- EstimatedCosts: t - c7-Hc Jti,t, LLf RAImr�lT Item '.Officiallfrse Oily -` -� (Labor and Materials) :k.::"...:'-'.::::::':;t:: : _,. 1.Building $ 14000 :•1:::Buildbig Permit Feer$KO:Indicate how fee is determined: 2.Electrical $ 1000 ❑Standard City/TownApplicatiorl$ee.?:,,,, :.,+-t:.$ .:...i','�,,i:: `' O T ital Project Costt 6 multiplier: z . ii .. 3.Plumbing $ 500(1 2:: OtherFees $ .S ::i' 4.Mechanical (HVAC) $ - 5.Mechanical (Fire $ Suppression) Total All Fees $,. CheckNo:'i..;::.:2 Check Amount -_ .Bala. Cash Amoun " t: - 6.Total Project Cost: $ 20,000 Qpald?nFull: ❑OutstandingnceDie:'• J JJSy 1/47S #/ °6 SECTIONnse(CSL)5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor LiceCS 102290 11/24/18 • • John J. Sambogna License Number ExprationDate Name of CSL Holder U 38 Suffolk Ave List CSL Type(see below) No.and Street Type , Description West Yarmouth, MA 02673 U Unrestricted(Buildings up to 35,000 cu.ft) City/Town, R Restricted 1&2 Family Dwelling wn,S�'ZIP M Masonry RC Roofing Covering WS Window and Siding 774-994-1880 john @jjswoodworking.com SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 173772 John J. Sambogna LLC 11/12/18 HIC Com �t�I or HIC Registrant Name HIC Registration Number Expiration Date 38 Ski olkRave john©jjswoodworking.com NMedSFirilmouth MA, 02673 774-994-1880 Email address . City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§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 p No...........0 • SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN • OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize John Sambogna to act on my behalf,in all matters relative to work authorized by this building permit application. cor stwla M.aAIgk 1 7n-]7lcclgk �li©ha Print Owner's Name(Electronic Si Date • SECTION 7b:O WNER1 OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. John J. Sambogna 1), el", 7/0 Print Owner's or Authorized Agent's Naipe(El omc tgnature) Date _ NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142k Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dns 2. When substantial work is planned, rovide the information below: Total floor area(sq.R) hQ 94/ (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms • Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed - Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" 0 .1.4„? TOWN OF YARMOUTH o�-.. C BUILDING DEPARTMENT �`% y 1146 Route 28,South Yarmouth,MA 02664 N� r$ 508-398-2231 ext. 1261 Fax 508-398-0836 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR,Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 5 Waltham Or.,West Yarmouth Work Address Is to be disposed of at the following location: Yarmouth Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. dr --&..a i Sig 1 .tore Applica A ate Permit No. The Commonwealth of Massachusetts ct Department oflndustrialAccidents • "eM111= 1 Congress Street, Suite 100 • Boston,MA 02119-2017 " 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): John J. Sambogna LLC Address: 38 Suffolk Ave City/State/Zip: West Yarmouth, MA 02673 Phone #: 774-994-1880 Are you an employer?Check the appropriate box: Type of project(required): I.❑I am a employer with 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. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. r 9. ❑Demolition ❑ y [No workers'comp.insurance required.] 4.0 l am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 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 n ❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other Bath remodel 152,§I(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 Homeownen 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. AIM Mutual Ins. Co Insurance Company Name: Policy#or Self-ins.Lie.#VWC-100-6017025-2018A 1/24/414/1 Expiration Date: Job Site Address: 5 Waltham CIr. City/State/Zip: West Yarmouth MA 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify tha• an enalti of perjury that the information provided above is tru and correct Signature: e if/ Date: l 76 Phone#: 774 4-18 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® , Massachusetts Department of Public Safety • Board of Building Regulations and Standards License: CS-102290 C:lt 'r 4r Construction Supervisor ;if P`4 fif If i 3 f JOHN J SAMBOGNA 'J" 38 SUFFOLK AVE }L. — / Wf.!_ EST YARMOUTH MA 02673 .1 I Expiration: Commissioner 11/24/2018 • IAc 1777m m0 nmead o C,,deLccAuie� . Office of Consumer Affairs&Business Regulation • _ _.�} HOME IMPROVEMENT CONTRACTOR before e or the valid for Individual use only , Type: LLC before the expiration date. If found return to: ` - Registration Expiration Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 w ' - - 173772 11/12/2018 Boston,MA 02116 John J Sambogna,Lc. - -= John Sambogna" �o n 4/1/.1,1---- // 38 Suffolk Ave. ^""""5 4/ . 4/1l/77C�T West Yarmouth,MA 02573 Undersecretary ' f Not valid wi ut signature • • m 2 r! Nco Q I a LS.' U C.,1 i1 :\ ! P 52 • I: -.Iroom Covered Porch • 1. doset I:.throom tsar �a Laundry O Nese Tile Flo - Sitting Areap Bedroom Ir /All Vg `-' dost : throw • .r;iiroom �$ \ I -- H ► I� - S .dOset {/ sae 731/r 2nd C•i Bath RemodelExisting and Proposed 2nd Floor Contractor-John J.Sambogna LLC No Changes to Layout Kaiak Residence 38 Suffolk Ave. 5 Wait9am dr. 4A= 1' West Yarmouth, MA 62673 West Yarmouth, MA 62673 774-994-1e80 johnC�j}��nraodworking.00m BFILE COPY TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF 'AS BUILT' COMPLIANCE. 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