31B-285 100 KING ST BP-2017-0697
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:31B-285 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-2017-0697
Project# JS-2017-001149
Est.Cost: S 18500.00
Fee: 5126.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: C PHILIP ANDRIKIDIS 071107
Lot Size(sq.ft.): Owner: BRANDT ROBERT&JOAN SWERDLOW-BRANDT
Zoning: GB(100)/ Applicant: C PHILIP ANDRIKIDIS
AT: 100 KING ST
Applicant Address: Phone: Insurance:
52 MAIN ST (413) 585-9171
F L O R E N C E M A01062 ISSUED ON:11/21/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF TAMKO HERITAGE
SHINGLES - 50YR
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: 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:
FeeTvpe: Date Paid: Amount:
Building 11/21/20160:00:00 5126.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
18 - r5
____ Version!.?Commercial Buildin&Permit May 15,2000
Department use only
'I City of Northampton Status of Permit
rstIl 1 Building Department Curb Cut/Driveway Permit -
I' *A 17 i 212 Main Street Sewer/Septic Availability
�- _ ___J Room 100 Wamnwell Availability c rthampton, MA 01060 Two Sets of Structural Piens
' - - --OF-One 413-587-1240 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 16e - /1 -0 q 7
1.1 Property Address: This section to be completed by office
foo k,�A S} Map Lot Unit
J Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
T 4
Name(Pont) I\ Current Meiling Address:
%4C. : ,� ul � �4 S�� c}—
Signature ��� Telephone
2.2 Authorized Agent: �,t 1
C•1%",t,p 4vcJ.,^11t_.eL3 (IDS R-yg.-- T -et
Name(Print) Current Mailing Address:
'Pt anep�w.c<
Signature Telephone S w -girt/
SECTION 3-ESTIMATED CONSTRUCTION COSTS -20c/^ goo 1
Item • Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building i 8, WO. vo (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 /,ir
�/ 9 /,�
6. Total=(1 +2+3+4+5) Check Number JJU r7 (f/
This Section For Official Use Only
Building Permit Number Date
// Issued
Signature: � 5 �J/V
(
///o J
Building • •• Sion: ' .oath of in s Date
Versiunl.7 Commercial 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 0 Demolition 0 Repairs 0 Additions ❑ Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing/. Change of Use Other 0
Brief Description Enter a brief description here.
Of Proposed Work: P - " SLt,,It - lam Ko /llri ky. 6171n23-efS- " yr.
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 0 A-3 ❑ 1A 0
A-4 0 A-5 ❑ 1B I ❑
B Business ❑ 2A ❑
E Educational 0 2B I ❑
F Factory 0 F-1 0 F-2 0 2C ❑
H High Hazard 0 3A 0
I Institutional ❑ I-1 ❑ 1-2 0 1-3 0 313 ❑
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 ❑ R-3 0 5A 0
S Storage 0 S-1 ❑ S-2 0 _ 5B I ❑
U Utility ❑ Specify:
M Mixed Use 0 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
is
20 2
3'° 3.e
4th 4�
Total Area(sf) Total Proposed New Construction(sf)
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❑
Version 1.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg.Square Footage
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT 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
0 , 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 0 NO O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre oris 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.
•
Versionl.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:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
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 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 Cl
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version l.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I. �"�`N ✓ 1� `C-A �-� ,as Owner of the subject property
hereby authorize to
act 61t my behalf,in all matters relative to work authorized by this building permit application.
'\lik cc\S P cvre V 1 ,\@ k 1 b
Signatire of Owner Date
I, C a,k,p Aril.te.kc,dlS ,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 perjury.
C .?1,rt,p Arno cnic4 .1
Print Name
It/IY/i
Signature of Owner/Agent ate
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor:u ^ Not Applicable CI
Name of License HolderC 'r„•t, 0 {'y.-d t(r tic, LP O I I o'7
License Number
(-(Or al
c.r.. D. A yji ../y /r 7
Address Expiratio Date!
/0"-- . C$r- c1 -1/
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 application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 22 No 0
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: ( oo LC,
The debris will be transported by: Pc o—tN.t Poo
The debris will be received by: V all-e..7 (t._c_`1 c (,
Building permit number:
Name of Permit Applicant C PLIA f bA .e t Ic d
(1 /1.,/
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Deprrttnent of Industrial Accielehts
Office of Investigations
_.- _.... - _ c=ongress Street,Suite 100
Boston, t-stbti 02114-.2017
ww wat£ass.gov/dia
tNorkers° Compensation insurance Affidavit: Builders/Contractors/Eiectiicians/Pit:srbers
Applicant information Please Print Legibly
Name tBtainessiOreanizationllndividual}: -
Address:
City/StateiZi
Are you an employer? Cheek the appropriate box: ' tine Of Project (required):
i.] I am a employer with 4. 0 I am a general contractor and 1
- employees(full ardor part-time):'
have hired the sub-contractor 6. Q New construction
r 2.(0. I am a sole proprietor or partner-
These
on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have I S. Q Demolition
working For me in any capacity. employees and have workers
o workers' comp. insurance
comp. insurance.: 9. ❑ Building addition
required] 3. We are a corporation and its ID.3 Electrical repairs or additions
;. I am a homeowner doing all worn- officers have exercised their 11.0 Plumbing repairs or additions
o workers corn N
myself. . Main of exemption per iv MOL
Y iv P i s3.',.t. Roo:repairs
insurance required.] ` C. i d-� a I1 > and we have no
employees. No workers' G.,_Other_,,,,,_
comp. insurance required.]
`toy applicant that clicks box?I must also rill out the section helm[shoe ins their worker=compensation polies information.
Romemeners mho submit Ods affidavit indica/lea t tis aredolnaall work and rata hirenudde comate rs must submit a nem affidavit indicmtnz aeh.
-Contractors that cheek this hop must attached an additional sheet showi0$[he name of the sub-contractors and slate%ti mber or no[those entities have
employees. If the still.contractor have employee-they must provide their workers'comp,policy number.
Z cur:on employer that is providing workers'compensation insurance for n9 employees. Below is the policy and job site
infoieiMaon.
Insurance Company Name:_,_,,._
Policy ft or Self-ins. Lia = _. Expiration Date:
Job Site Address! CitviSrateiZip:
Attach a cony of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of 11GL c. 132 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 S250.00 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.
.`do leered} ceffh stifles the paissd29}jienalties of perjury that the ittforniallon provided ft/'j,}�weiistru and correct.
oignawre .,� m„ ._...na 2, 11/' /i&
Phone.: �.
Official use only. Do rat n'rite in this urea,to be completed by city or town official.
City or Town: Permit/License a
issuing Authority(circle one): !�
1 I.Board of health 2. Building Department 3. City/Town Clerk 4. Electrical inspector 5.Plumbing inspector
o,OP net
Contact Person: _ Phone
HILIP
ROOFING
AN ANDRIKIDISLOREC DMA
405 RYAN ROAD,FLORENCE, MA 01062
INSURED BY KING&CUSHMAN 413-584-5610
HIC #150673
CSL#171107
MSL#11282
I request that you grant a modification to waive the requirement for control construction for
the project at 100 King Street 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