29-432 (5) BP-2022-1337
11 ELLINGTON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-432-001 CITY OF NORTHAMPTON
Permit: Exterior Res
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1337 PERMISSION IS HEREBY GRANTED TO:
Project# ROOF Contractor: License:
Est. Cost: 8100 FLORENCE ROOFING 071 107
Const.Class: Exp.Date: 04/24/2023
Use Group: Owner: BUSHEY JOAN M
Lot Size (sq.ft.)
Zoning: WSP Applicant: FLORENCE ROOFING
Applicant Address Phone: Insurance:
405 RYAN RD WC2-31 S-374455-041
FLORENCE, MA 01062
ISSUED ON: 10/17/2022
TO PERFORM THE FOLLOWING WORK:
STRIP AND RE-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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: T.)15/
• V • >9 •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
The Commonwealth of Massachusetts '' - -
���f�,, ti ._ R
W Board of Building Regulations and Stand -_ _!_i!,;, NI IPALITY
Massachusetts State Building Code, 780 MR SE
Building Permit Application To Construct, Repair,Reno, ateGe1bein7li evise Mar 2011
One-or Two-Family Dwelling ( CUU
This Section For Official fJse ---�}
Buildin Permit Number: }3. 7 07i-bo,,,,,,r;'M-A nE5 oNs
i �33 Date Applied: . ^'
---.... '�N.►,AA n�^tip
la3 ays) / '/ -t) r7-
Building Official(Print Name) Signature Date
i
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
11 Ellington Dr Florence,MA.01062 a� 1.
1.1 a Is this an accepted street?yes x 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.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone?
_ Municipal 0 On site disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP' 1
1
2.1 Owner'of Record:
Joan Bushey Florence,MA.01062
Name(Print) City, State,ZIP
11 Ellington Dr.
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:Roofing
Brief Description of Proposed Work2: Strip the shingles and apply ice and water barrier,and apply new shingles.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only I
(Labor and Materials) I
1. Building $8,100.00 1. Building Permit Fee: $ Indicate how fee is determined:
2. Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Total All Fees: $ Ap
Check No.A'1 heck Amount: lQash Amount:
6.Total Project Cost: $8,100.00 ❑ Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-071107 04/24/2023
C.Philip Andrikidis/d/b/a Florence Roofing License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
405 Ryan Rd.
No.and Street Type Description
Florence,MA.01062 U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
4135859171 florenceroofing@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
01573 8/26/23
C.Philip Andrikidis/d/b/a Florence Roofing HIC Registration Number Expiration'Date
HIC Company Name or HIC Registrant Name
405 Ryan Rd. florenceroofing@gmail.com
No.and Street Email address
Florence,MA.01062 413-585-9171
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 0 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
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'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.
C.Philip Andrikidis 10/17/22
Print Owner's or Authorized Agent's Name(Ele onic Signature) Date
NOTES:
I. 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. 142A.Other important information on the HIC Program can be fou id at
T.-3.vw. a: _zcr.`.,c.Information on the Construction Supervisor License can be found at rii. ass. .ivk pr
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (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"
City of Northampton
s° ..,..si
Massachusetts - ?e,,
'�. 4 is DEPARTMENT OF BUILDING INSPECTIONS �' R
212 Main Street I Municipal Building
Northampton, MA 01060
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in: Valley Recycling
Location of Facility: 234 Easthampton Rd.Northampton,MA.01060
The debris will be transported by:
Name of Hauler: Florence Roofing
Signature of Applicant: Date: 10/17/22
The Commonwealth of Massachusetts
Deportment of Industrial Accidents
� _ I Congress Street.Suite 100
Boston.MA 02114-2917
t4'tf utsnas.s.gat'din
t.r leers'('anrprnsation Insurance A idasit:BuiMer JContnictortJEkctrkiansiPlumbers.
to HE FILED WITH THE PERM l I!NG At'TH(HNT%'.
Applicant Information Please Print 1.41:ibh
tt[t tl3atsat�.r.,()rtmrlratuut Hrd,tudtual;k C. Philip Andrikidis/d/b/a Florence Roofing
Address: 405 Ryan Rd.
City State:'Zip:__Florence, MA.01062 Phone#: 413-585-9171
1.re.or an rmrptu' C'traralatiaarapprapeiatoWa,, 1'ipeerPreit <'
'1 am a employer ugh 4 etri Suyo 11'411 m3 as rcrt-utrn Y.• 7. J Neu construct
i ANY a WIC-PtOpriCSat ea p".m:Nlam are hrn.e um employ raa v..aai srei •r -ea.:a 11 r. ^( Remodeling
Itri``�'
.—e:sin•capxrt}.(No Noriera'camp.m..urtncc tzqu�rut.l •J
'9'. p)4utuattsaxt.
a.71.agree a twaaaxw.rier wtueaa i•all.arnr4 Leif- Aa*w. ate.'erg•afl1.1aa»ec PciiiteirCd. '
130 kttlll
op t ant a to rnmNatet and v.ail Me truing auarrx4urw.tr,4m:taxr all%a rk i+a ms pnapa riy t%tit
JI abase tint a!!eirmacton.calm ett.r moMeta'e.a+. .stout IM/61626.CC.r ac-.,.nip I I 0 Electrical repairs or additions
prtitesevair.with CAP.:sq t ya'a.N.
i 2.0 Plumbing repairs or additions
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t Ilene a h-eura setrie,lame coriMb_v.n.are.taar t warier:az1r47.nr men.e Ih.�A""r nee a torpcxatauo and M.a flu.have rwetere t dray rageseumrp aaa p et aariL e_ � -�Ofi.-rRt�ofin9
t52.tti;it.and Ne'.7lat a rw eitydine\f.(:sa weaken ate!miar awe rerrtrrerll r
• Jppla ant ttlu1 ctsxk,,box at mw.t al.0 fill tit the se tin below Jam snag their wu.ka73.'eOinpli►S4atr pul.y irformolwn_
txvawt e9us wits"saPr:ni;dim arta:L..rr irate: ing diet arc Ju..,E all add arairttmaa,hate outside omenacrars mast submit a arm akticbr r it • ierptaxti.
4:use ialo w,thaw duck dm.box lime:aeta.:taai!:am,.t.k w�rt;staraet%e.ter.the name.al` ;to ih.o s arresars.ma!mite*hdher armee dame,., . Haan r
.yett+l„yw a Li thue a l,- ammict2e,ha.e istuia rim a le 51!a m WVISiboCre ria rs{aa
/am an emplus cr that is providing"centers'compensation insarancc for ml.employees_ Below is the policy and jolt site
information.
InNuraruce company'Vartstc:_ Liberty Mutual Fire Insurance Company
Policy#or Sett-ins.Lie.Is: WC2-31S-374455-052 Expiration Date: 1/25i23
11 Ellington Dr Florence, MA.01062
Job Site Address: Cily State Zip:
Atmttb a copy oldie workers'compensation polies declaration page(showing the policy number end expiration date*
Failure to secwe cns cragc as required under MC.L c. 151 25A is a criminal violation rtion punishable isltaablr by a line up to S 1.500.00
and or one-year imprisonment.as ttcll as cit it penalties in the form ofa STOP WORK ORDER and a fine of up to S250.00 a
(:a) against the trotator.A copy of tins statement may be foruartded to the Office of intestigalttonsof t c DIA for insurance
co%crag teri.ticatiun.
!do hereby credit.under the pains.and penalties of perjury that the infarsnauon pnsui lkd above is true wirrl correct
Date: 10/17/22
Phone".
413-585-9171
Official use only. Der not write in this area.,to be completed by city ornow*of="it:iaL
City or Town: Permit/License 0
Issuing Authority(circle one):
I.Board of Health 2.liuildinrti l)ep.trtment 3.City/Timm Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
( (intact Person: Phone*: