29-495 (8) BP- 022-1562
405 RYAN RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
29-495-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2022-1562 PERMISSION IS HEREBY GRANTED TO:
Project# SIDING/WINDOWS Contractor: License:
Est. Cost: 21000 FLORENCE ROOFING 071107
Const.Class: Exp.Date: 04/24/2023
Use Group: Owner: ANDRIKIDIS C PHILIP& SHELAGH M PAYANT
Lot Size (sq.ft.)
Zoning: WSP Applicant: FLORENCE ROOFING
Applicant Address Phone: Insurance:
405 RYAN RD (413)585-9171 SOLE PROPRIETOR
FLORENCE, MA 01062
ISSUED ON: 12/05/2022
TO PERFORM THE FOLLOWING WORK:
SIDING AND WINDOWS
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: )9 . Tj.
Fees Paid: $147.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
ThJ Commonwealth of Massachusetts
, N O V 2 3 2l r:aard f Bu,lding Regulations and Standards FOR
Massac usettis State Building Code, 780 CMR MUNICIPAL
_ USE
t,F >pl4ag-AFA ivatioii To Construct,Repair,Renovate Or Demolish a Revised Mar 2 11
^'^r1TFiA ""nN %AA 05060 One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: /2,,!—?.).— I AsCL 7i + Date Applied:
Kt<Vi� 5� //a /1-0 20za
Building Official(Print Name) Signature Date
SECTION I: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
405 Ryan Rd.
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 ❑
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
C./Philip Andrikidis Florence,MA.01062
Name(Print) City,State,ZIP
405 Ryan Rd. 413-262-8007 cpandrikidis@comcast.net
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building B Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg. ❑ Number of Units Other 0 Specify:
Brief Description of Proposed Work2:Installing new siding and windows. l)-csci'o2 a.5)
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $21,000.00 1. Building Permit Fee: $ Indicate how fee is determined:
O Standard City/Town Application Fee
2.Electrical $ ❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fee :,$Q
LCU �/
Check No.r Check Amoun% ``\ Cash Amount:
6.Total Project Cost: $21 ,000.00 0 Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-071107 1/25/23
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
413 262-8007 SF Solid Fuel Burning Appliances
florenceroofing@gmail.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 01573 8/26/23
C.Philip Andrikidis 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 413-262-8007
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 a No .❑
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 112322
Print Owner's or Authorized Agent's Name(Electronic Signature) 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. 142A.Other important information on the HIC Program can be found at
www....ass.zov/oa Information on the Construction Supervisor License can be found at w s+w..nass.govddps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,fmished 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 _ _
?%r.� �'ti,:' ,.,, ..� SSG,
iMassachusetts �w - 'ems.
,,y DEPARTMENT OF BUILDING INSPECTIONS .S.4
/�r
212 Main Street • Municipal Building "�ti
'�� Northampton, MA 01060 rstW 1,:�i1�
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
234 Easthampton Rd.Northampton,MA.01060
Location of Facility:
The debris will be transported by:
Name of Hauler: Amherst Trucking,Inc.
4 /
Signature of Applicant: Date: 11/23/22
The Cononon tvc'ult/t of Massachusetts
Department of lndustrial Accidents
1 Congress Street:Smite 100
Boston.MA 02114-2017
trnvsci a. .govid
))lieker''('a►tnpensa ilea Insurance Affidasit:Builders/CentraetemTElertritrian.fPtumbrrt.
!t)BE FILED 4'11 ii 1111:PERM!i'I LNG.fit"11101tI i\.
Applicant Information Plea.c Print I.ca_ibh
7\ame th- ,lino'On.thinrrcittctitltntitoititto! C. Philip Andrikidis/ d/b/a Florence Roofing
Ads: 405 Ryan Rd.
Gity/State Zip: Florence, MA. 01062 Phone413-262-8007
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I am an employer that is providing warAers'compensation insurance far my employees. Below is the polity end job site
information.
tasurateecompany Nate. liberty Mutu lfiire Insurance Cogip3ny___._.______.
Policy#or Self-ins.Lie.n WC2-31 S-374455-052 Expiration Date: 1/25/23'
Job Site Address: 405 Ryan Rd. city state Zile_ Florence, M 01062
Attach a ceps of the workers`cotnpensation policy declaration page(showing the policy nuutbei•.end expi. liondate)i.
Failure to secure cos rage as required under MGL c. 151§25A is a criminal's t.,i ttion punishable by a fine pup ter S $(K).00
and''or one-year imprisonment.as%%ell as civil penalties in the foram of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement my be fora anted to the Mice a of lna estigations of the D1A for insurance
coverage verification.
dew hereby Bert under thepainsatsutpensalti ,afperjury�stintdikeiwfbrnmw provistr+d'abo aia'Arunarialcurr c:r.
`s Signature: > Date: 11/23/22
Phone 4: 413-262-8007
Official use oult. Do not write in Mis area;to he completed'hy cite ter town ofciaL
(ity or Town: Pernsitiikense d
Issuing Authority(circle one):
1.Board of health I.Building 1)epartntent 3.('ity Town Clerk 4.Electrical Inspector {. Plumbing In'pectar
6.Other __-�---
Contact Person: Phone rt: