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32A-183 (18)
73 BRIDGE ST BP-2019-1308 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mao.Block: 32A- 183 CITY OF NORTHAMPTON Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2019-1308 Proiect# JS-2019-002115 Est Cost $17000.00 Fee: 5119.00 PERMISSION IS HEREBY GRANTED TO: Oonst.Class: Contractor: License: Use Group: C. PHILIP ANDRIKIDIS 071107 Lot Size(sa.ft.Y Owner: COOT IDCF VILLAGE CONDOS Zoning URC(100)/ Agp(icant: C PHILIP ANDRIKIDIS AT. 73 BRIDGE ST App[icantAddress: Phone: Insurance: 405 RYAN RD (413) 585-9171 SOLE PROPRIETOR FLORENCEMA01062 ISSUED ON:5/21/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SH INGLE 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: Prwemay Final: Final: Final: Rough Frame: Gas: Fire Fire Department Fireplace/Chimney: Rough: Oil: 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 sienature• FeeTvpe: Datg Paid: Amognt: Building 5/21/20190:00:00 $119.00 213 Main Street, Phone(4I3)589-1240,Fax:(413)587.1272 Louis Hasbrouck-Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 Deparlit"..use onty City of Northampton Status of " Building Department Curb Cullpffiessay Permit 212 Main Street Sewer/3epScAvedabddy 'G" Room 100 WaterMlell Availabi I Northampton, MA 01060 TM Sob ofStructurel phone 413-587-1240 Fax 413-587-1272 PIOVS49 Plano Other Speufy APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION g� _ t 9� /3 U 1.1 Property Address: Th�i�sl section to be completed by office Map �. T rLed 193 Unit Zone Overlay District - - - - -- -- - — --- Etm St District CS District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Recor : z, e VA66y- /�loses a l t Name(Pr n0 Current Mmhn Atltl ss Signature Telephone 2.2 Authorized Agent: 7". 2r� Name(Pont) t Current Mailing Address 5 S'Sr -7/ Signature Telephone SECTION 3-ESTIMATED CONST CTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed bpermit applicant_ 1. Building ',.. 1-7 L p.moi (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection {C 6. Total=(1 +2+3+4+5) / 7 Check Number This Section For Official Use Only Building it Nyprger Date Issued Signature: 5. 21-201? gulping Commissioner/Inspector of Buildings Date G716"eA � e Versionl.7 Commercial Building Permit May 15,2000 SECTION M CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs Additions [:I Accessory Building E] Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing9 Change of Use❑ Other.❑ Brief Description Enter a brief description here. pp Of Proposed Work: [ 'Ua SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: ..._.__.... _.._.. M Mixed Use ❑ Specify S Special Use ❑ 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 780 CMR 34) SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(so ........ 1' ......... 2nd ....... 2�a .. 3'° 3b .. 411, 4m ... .. Total Area(so Total Proposed New Construction(so Total Height ht) Total Height R 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood.Zone Information: 7.3 Sewage Disposal Syatem: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system[] Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column m be fi11N in by Building DVartmmt Lot Size _. _._......_ ....._.____... Frontage ......._ ..._.....__.__ Setbacks Front Side L R ..._. L _. R ..__ Rear Building Heigh[ Bldg.Square Footage """ Open Space Footage .._ _ -- (Lot ereaminusbldg inalo-io #ofParking Spaces volume At Locatiunl A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O 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 O IF YES, describe size, type and location: E. Wit the construction activity disturb(clearing, grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. f Versionl.7 Commercial Building Permit May 15,2000 SECTION B.PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 760 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: ..._...._.._ _... .._._._. Not Applicable ❑ Name(Registrant): - Registration Number Address Expiration Data Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Data Name Area of Responsibility Address Registration Number Signature Telephone Expiration Data Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Constmction Address Signature Telephone 0 Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 710.77) Independent Structural Engineering Structural Peer Review Required Yes No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING I, - i/, _.� E -� ........_ �11Y./A� UI/ ✓y�J� as Owner of the subject property hereby authorize � 0 �Gy /L to act on my behalf- al r ive to work authorized by this building permit application _. 5-11-71 Signature of a �r ate son- 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 under the pains and penalties of penury,_____ Print Name ....__... .. __._. Signature of 0 ent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor. \ Not Applicable ❑ Narna of l-oenea Holder - �r `�!`'� ja'�'�^k '(-7!> License Number �f�K 12y, z Lf/�yl= Address .�/J Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,$25C(S)) 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 O No O 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: SI- The debris will be transported by: t E The debris will be received by: UO 0 Building permit number: Name of Permit Applicant "3 Date Signature of Permit Applicant The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass.gov/dia VAI others'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeild Name(Business/OrganizmioNlndividuap: C Pk , ( is e,A, Address: olt' l— City/State/Zip: `/1,ot ewc.Q Phone#: Sy-r?,-71 Am yon an employers check the appropriate box: Type of project(required): I.E]lama employer with employees(full andon'smorms)." 7. ❑New construction 2P[...sole proprietor or parmeres,and em employees working formem $, ❑ Remodeling any.,ciry.[No workers'comp.m required.] 9. ❑Demolition J.❑I em a homeowner doing all work myself.[No workers'comp-insurance requimd.]' 4. l.m a homeowner and will he huVn . g w imsers m conduct all work on my property. 1 will 10 Building addition ❑ chissure mat all eonerwaim caborhave workers'wmpensmioa insurance mare sole IL❑Electrical repairs or additions proprietors with no ctnp i,ac, 12.❑Plumbing repairs or additions 5❑I am a gmmal connector and I have hand the sub-contractors listed on the atmchcd sheet )3.❑Roof repairs These sub-contracrnrs have employees and have workers'comp.insum.e. 6.❑We are a corpomtioo and its officers have exercised their night of exemption per MGL c. 14.❑Other 152,$1(5),and we Mve no employees.Mo workers'comp.fro mance required-1 'Any applicant that checks box#1 must also fill out the section below showing their workers'eompensadon policy int rmmon. Hommwnen who submit this affidavit indicating they are tieing all weak and then hire outside commoners must submit a new affidavit indicting such. :Cistrom ors mat check do box most snacked an additional shill showing the time of me sub-conar caul=it state whether or not those entities have employees. If the sub-commacters have employees,they must provide their workerscomp.policy mmnMr. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lia#: Expiration Date: 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 MGL c. 152, 425A 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. 1 do hereby certify under the pains aannd p—ena�lties of perjury that the information provided above is true and correct Cion tum Date' tr 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.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 of the 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 of the 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 ofpub]ic work until acceptable evidence of compliance with the insurance requirements ofthis 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 sub-contractors)morels), addresses)and phone numbers)along with their certificate(s)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 he 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 pennwlicense number which will be used as a reference number. In addition,an applicant that most submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."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, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia From: C To: Louis Hasbrouck Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, 1 request that you grant a modification to waive the requirement for construction control of the project at -73 SL, because the work is of a minor nature,will not affect structural elements, health,accessibility, life or fire safety,and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully,