Loading...
23A-080 (9) 31 MAIN ST-COOPERS BP-2019-0741 GIs 4: COMMONWEALTH OF MASSACHUSETTS Map:Block:23A-080 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2019-0741 Project# JS-2019-001222 Est.Cost $18000.00 Fee: $126.00 PERMISSION IS HEREBY GRANTED TO: Const. Class; Contractor: License: Use Group, C PHILIP ANDRIKIDIS 071107 Lot Size(sm.ft.); 21300.84 Owner: COOPER EDWARD R&RONALD E E R&R COOPER PARTNERSHIP Zoning:GB(100 Applicant. C PHILIP ANDRIKIDIS AT. 31 MAIN ST - COOPERS ApplicantAddress: Phone: Insurance: 405 RYAN RD (413) 585-9171 FLORENCEMA01062 ISSUED ON:3/4/2019 0.00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: 001: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 3/4/2019 0:00:00 $126.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �n,;aanv la � A-FIQ&-of v 1-- r) Version .7 Commercial Buil a Permit May 15,2000 City of Northampton DEC 2 6 )018 2 Bu Iding Department Fainsit T 12 Main Street JI N1 I I DIN. Room 100 Ava4aGTity y, "I' "'A lio,,O orthampton, MA 01060 of Strucitag phoneTM- 37-1240 Fax413-587-1272 iiik,� ' 7N, APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION I-SITE INFORMATION t'— t '7-11 1.1 Property Address: This section to be completed byoffice sil, Map 2')h Lot 0 F0 Und Zone Overlay District Elen ft Dishicit C13 1)s e SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Ower of Record, ——----- ... JI Name(Print) cumert Mailing Address Signature tm Telephone 2.2 elephord2.2 Authorized Anent, Avid,, Name(Prim) Cunene M.fling Address Signature Tell SECTION 3-ESTIMATED CONSTRUCTION COST I Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1 Building (a)Building Permit Fee 2, Electrical (b)Estimated Total Cost of Constructor,from(6) 1 Plumbing Building Permit Fee 4 Mechanical(HVAC) 5 Fire Protection 666 & Total=(1 -2+3+4-5) Check Number This Section For Official Use Only Building Pend Number Date Issued Sign 2- ?s Building CommVidanerfirepector of Buildings Data Version L7 Cornmemial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolltlon❑ Repairs❑ Additions ❑ Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Uss❑ Other❑ p Enter a brief description here. Sl+,� h LPDA rb�('- Brief Description �� ✓ ���� Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly11A-1 ElA-2 ElA-3111A El A4 ❑ A-5 ❑ IS ❑ 8 Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3g ri M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A El S Storage El ElS-2 El58 ❑ U Utility ❑ Speciry'. M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF FROSTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: __. _ _. Proposed Use Group Existing Hazard Index 780 CMR 34) Proposed Hazard Index 780 CMR 34) SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so 2n° : .___ .... 2nd .... ... _..... 30 .._._ 3. ..,. ... Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height It 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood.Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone' Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be fllnd in by Building lhpartment Lot Size -------- Frontage Setbacks Front Side L - R: . L R ....._ _ Rear Building Height Bldg.Square Footage - % Open Space Footage _ -. % -- - (Lot area minus bldg&pav 1 din #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DON'T KNOW © YES O IF YES, date Issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO © DONT KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: E. WII theconstruction activity disturb(clearing, grading,excavation, or filling)over t acre or is it part of a common plan thatwill disturb over 1 acre? YES Q NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versiou1.7 Commemial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 110(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant) Registration Number Atltlress Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name.. Area of Responsibility Atltlress Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name Responsible In Charge of Construction Address Signature Telephone r Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize C t^-�` Q 1^^C" 10(15, to act on my behalf, mail matters relative to work authorized by this building permit application_. Signa�re cl D�wnei Date �`` t}r•enr`ILxg�.4� _. ..__.now- as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed untler the ap ins and s of perjury. Print Name Signature_!Ow 1[; nt to SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. JyAt� `` 11 Not Applicable D Name of License Holder " �`(`�✓ 1"`�TL`.Y ILr1� S -- 07110 -1 License Number q Address p Expiraaon Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this applicaton. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes No City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: The debris will be transported by: The debris will be received by: VO- 1 n V TL-eC-vd9z Building permit number: Name of Permit Applicant V "(i n -d✓11 ,cA J 14-z/6L Date Signature of Permit Applicant The Commonwealth of Massachusetts Department oflndustrialAccidents ] Congress Street, Suite 100 Boston,MA 0I114-2017 snww.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name: Address: r'(c�> R-7 ll�_. N City/State/Zip: , M"(OUZPhone#: `'(13 S 5' t Are you an employer?Check the appropriate box: Business Type(required): I.❑ I am a employer with employees(full and/ 5. ❑Retail �.r or part-time)." 6. E]Restaurant/Bar/Eating Establishment ZaYyy I am a sole proprietor or partnership and have no 7, E]Office and/or Sales(inch real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8. ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per C. 152,§1(4),and we have 10.❑ Manufacturing no employees. [No workers'comp.insurance required]' I L❑ Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers'comp. insurance req.] 12M Other C;--o 'Any applicant that checks bux#1 must also fill oin the section below showing their workers'compensation policy infomu "Ifthe wryomn officers have exempted themselves,but the corporation has other employees,a workera'compensation policy o required and such an organvation should check tax#1. I am an employer thatis providing workers'compensation insurance for my employees Below is the policy information. Insurance Company Name: insurer's Address- City/State/zip: Policy#or Self-ins.Lic.# Expiration Date: 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$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 cerdfy,under thepa ini aadyehdl' sof perjury that the information provided above is one and correct. Simulate, 17 ,..... Date Phone#: 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.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.masa.gowan Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more ofthe foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant ofthe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's time,address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permitllicense number which will be used as a reference number.In addition,an applicant that must submit multiple permitAicense applications in any given year, need only submit one affidavit indicating current policy information(ifnecessary). A copy ofthe affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 ry w.mass.gcv/dia From Revised 02-23-15 C.PHILIP ANDRIKIDIS DBA 405 RYAN ROAD, FLORENCE,MA 01062 INSURED BY KING&CUSHMAN 413584-5610 HIC #150673 CSL#171107 MSL#11282 1 request that you grant a modification to waive the requirement for control construction for the project at 31 Main St. Florence because the work is of minor nature,and will not affect health, accessibility, life , fire safety,and is impractical in that the cost of control construction is considerable when compared to the cost of proposed work. Thank you for your consideration. Respectfully, C. Philip Andrikidis Florence Roofing 405 Ryan Road Florence MA 01062