25A-184 (16) 76 INDUSTRIAL DR BP-2016-1537
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 25A-184 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:ROOF BUILDING PERMIT
Permit# BP-2016-1537
Project# JS-2016-002618
Est. Cost: 520000.00
Fee:$100.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: C PHILIP ANDRIKIDIS 071107
Lot Size(sq. ft.): 65340.00 Owner: BASILE FRANK)
Zoning:(1493V Applicant: C PHILIP ANDRIKIDIS
AT: 76 INDUSTRIAL DR
Applicant Address: Phone: Insurance:
405 RYAN RD (413)585-9171
FLORENCEMA01 O62 ISSUED ON:6/2712016 0:00:00
TO PERFORM THE FOLLOWING WORK:Strip roof and install mechanically fastened TPO
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 4 Foundation;
Driveway Final:
Final: Final:
Rough Frame:
Gas: 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 signature: FeeType;
Date Paid: Amount:
Building 6/27/2016 0:00:00 5100.00
212 Main Street, Phone(413)587-1240, Fax: (413)5874272
Louis Hasbrouck-Building Commissioner
Versionl.7 Commercial BuildingPermit May IS,2000
a
Department use only
railimin
City of Northampton Status of Permit:2 i
Building Department Curb CubOriveway Permit
212 Main Street Sewer/3eptic Avaflabllity
Room 100 WaterWell Availability ,-°- - - Northampton, MA 01060 Two Sets of Structural Plans
phone 413-5874240 Fax 413-587.1272 Plot/Site Plans
Other Specify
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
1.1 Property Address: This section to be completed by office
T, I-vLA,4}y� \ Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Sea"l Riess,\t 3- (al. N,ll 1'4A,
Name(Print) Current Matting Address:
{{�"��,
4v, - yocg
_ I
Signature Telephone
2.2 Authorized Agent:
C 2tissTryi tQ,rs:rt Itsd.5 'lay 2.t.., 12-a
Name(Print) Current Maling Address:
r 244 -48Aa1
Signature 11 _ Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building ZOO (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) . 1/on
5.Fire Protection {
6. Total:(1 +2+3+4+5) 2_ea000 Check Number 316/45"
L
This Section For Official Use Only
Building Permit Number Date
Issued
Slgnat f% �y�j/� -
/
di __ 6 ,z-/e
Buil. g Commissionedlnspeolor of Buildings 1 Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs ❑ Demolition Repairs 0 Additions 0 Accessory Building
Exterior Alteration ❑ Existing Ground Sign❑ New Signs 0 Roofingg Change of Use❑ Other 0
Brier Description Enter a brief description here.
Of Proposed Work: •c4k ,` # -c- b.r+.wC
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) ] CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 0 A-3 0 1A 0
A-4 0 A-5 0 16 0
B Business ❑ 2A 0
E Educational 0 _ 26 0
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard 0 3A ❑
I Institutional 0 1-1 ❑ 1-2 0 14 ❑ 38 0
M Mercantile 0 4 ❑
R Residential 0 R-1 ❑ R-2 0 R-3 0 5A 0
S Storage 0 .... S-1 0 S-2 0 56 ❑
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(st)
1a a
2nd god
37
4in 4m
Total Area(sQ Total Proposed New Construction(sQ
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system
Versions 7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES•FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
_ i-- Not Applicable 0
Name(Registrantp.
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
_ —...._... _..._. I
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area pt 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
Version!.?Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes Q No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
RI.1-e�1 ! ,as Owner of the subject property
hereby authorize C• Pkke A.e + r at-c), to
act on my behalf,in all matters relative to work authorized by this building permit application.
Signature of Owner11 Date
I, attic, Y+ �r✓ s'.tCtc)..1 . 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 penal of penury.
Print Name .. .
C. 1QLnl.P Amlot-U' S 41146
r
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor:�,''� Not
Applicable 0
Name of License Holder: C-yell+(" 4..64-'k..ats .._ (/21/17.......
License Number
Li-sr le .... gzA O??fol
Address Expiration Date
..pp
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(5))
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 Yesso) No 0 ,,,
• The Commonwealth of Massachusetts
==rr� Department of Industrial Accidents
az Office of Investigations
�Z' , lv .
41 I Congress Street, Suite 100
1: 14.1.t= Boston,MA 02114-2017
.-a—t www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (l3usiness/OrganizatiomJndividuat): C'9%.-.A e Ae.ckr,11,4:5
Address: t(o 5" 2 «„ Q a
City/State/Zip: P("-erve Cibbt Phone#: Cts--"t t 1 r
Are you an employer? Check the appropriate box: a Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
,r-ay employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.9 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
I_ ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity.
employees and have workers'
[No wkers' comp. insurance comp. insurance.: 9. ❑ Building addition
required.] 5- 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I,❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.*.'Roof repairs
insurance required.) ' c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.] _
*Any applicant that checks box 41 must also till out the section below showing their workers'compensation policy information.
t Homeowners 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 mime of the soh-contractors and state whether or not those entities have
employees it the sub-contractors have employees.,theymust 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,
Insurance Company Name: _
Policy#or Self-ins. Lie.#: _ 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to 51,500.00 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 he forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct
[Signature: Date:
Phone#: 513.-.11-11
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#:
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: 7t, trd„et,- (
The debris will be transported by: r'(o. <.,,-,2_ •-7
The debris will be received by: Wt_7 fl-ac ,cit 3
Building permit number:
Name of Permit Applicant C •P.1,,o Arckr,
Date Signature of Permit Applicant
HILIP
ROOFING
FI AN ROA ,ANDRIKIDISLOREC DBA
405 RYAN ROAD,FLORENCE, MA 01062
INSURED BY KING&CUSHMAN 4135845610
HIC #150673
•
CSL#171107
MSL#11282
1 request that you grant a modification to waive the requirement for control construction for
the project at 76 Industrial Drive Northampton 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