24D-136 (8) 176 KING ST-FLORENCE SAVINGS BP-2019-1134
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:24D- 136 CITY OF NORTHAMPTON
Wt .000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: ROOF BUILDING PERMIT
Permit BP-2019-1134
Project# JS-2019-001844
Est. Cost:$32200.00
Fee:$224.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group C PHILIP ANDRIKIDIS 071107
Lot Size(sa ft.): Owner: KING ENTERPRISES LLC
Zoning: HB(100)/ Applicant. C PHILIP ANDRIKIDIS
AT: 176 KING ST - FLORENCE SAVINGS
ApplicantAddress: Phone: Insurance:
405 RYAN RD (413) 585-9171
FLORENCEMA01062 ISSUED ON.4/16/2019 0:00:00
TO PERFORM THE FOLLOWING WORK STRIP & SHINGLE 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:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: OBJ; 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 Oecuoancv sieat
FeeTvpe: Date Paid: Amount:
Building 4/16/2019 0:00:00 $224.00
2)2 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
('�) �
Verstml.7 Commercial Building Permit May 15,2000
City of Northa pto
I ECEIV ofP DepaMlenttwaonly
Building Dep I men Permit -
212 Main St et APR 1 2 Avmlftft
Room 10 2�i el AvabblYty.
Northampton, M 01 0 Two SirugMal Prom _
phone 413-587-1240 F x 44rkgyA RZ r,Imsae
-LLLLiom.nnnm r
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING p 4
SECTION I -SITE INFORMATION B
1.1 Property Address: This section to be completed by office Map .;pr14) Lot I-e(j Unit
J Y Zone Overlay District
- - Elm SL District CB District
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDRGENT
2.1 Owner of Record:
5-rh
Name(Pnnt) / Current Mailing Address.
Signature Telephone
2.2 Authorized Auent:
Name(Print) Current Mailing Address
S — /f 7/
Signature Telephone
SECTION -ESTIMATED CON TRU OSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by pe"it applicant
1. Building Z' (a)Building Permit Fee
2. Electrical -- - - - (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) y/ajJ
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
y-1z- zol9
Building Commissioner/Inspector of Buildings Date
Version L7 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 ❑ Demolition Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs Roofing Change of Use❑ Other❑
Brief Description '..Enter a brief description here.
Of Proposed Work: u.--j 5
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly11A-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 8 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(so
I 1.
2nd _ ..... __.. 2�d
V 3p
0 4-
Total Area(so Total Proposed New Construction(sf)
Total Height(ft)
Total Height If
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Vmionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
this column to be fillod in by
Building Depaament
Lot Size
Frontage
Setbacks Front
Side L: R: L:' R:
Rear
Building Height
Bldg.Square Footage %
Open Space Footage %
(Lot area minus bldg&peva _
Parking)
H of Parking Spaces
Fill:
(volume&Loeaeon
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DON'T KNOW O YES O
IF YES: enter Book Page. and/or Document N.
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 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:
F. Will the construction activity disturb(Gearing,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.
Vemionl.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 118(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 Data
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
Name Area of Responsibility
Address Registration Number
Signature Telephone Expire cit Data
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
Versionl.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
SECTION 11 .OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 -CS u'-tL7 as Owner of the subject property
n ^ I
hereby authorize r )"`�I� /Tf'v"'rt�`�� J to
act on my behalf, in all Waaers relative to work authorized by this building permit application.
Skjoffyrs /y
ure of/Owner Date
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 pena8iea of perjury.
I V—I ✓�r.cht�td cS
Print Name
Signature of Owner nt ate
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
.rte ..
Name of License Holder: l"""'�I�' �" '"�"`�r"� G7/to 7
license Number
tzd
Mai E pimtion Date
signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(e))
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
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: [76 1(`,�g
The debris will be transported by:
The debris will be received by:
Building permit number:
Name of Permit Applicant 'n ��� ✓
Date Signatu `of Applicant
\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston, MA 02114-2017
www.massgov/dia
WRixvkeri'Cornpensxation Insurance Affidavit:Builders/Contractors/Electricians/Plumbera.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information PI-1,
� Please Print Leeibiv
Name (Business/Orgmintion/individual): 1' w-I /A^'NM �j/ ✓
I —
Address: i-/ "� 1�v a-, 7�d
City/State/Zip: o< viWone
Are you an employer?Check the appropriate box: Type of project(required):
LQ l am a cmploycr with employees(hill and/or part-time)' 7. ❑New construction
IMT an a sole pmpncmror partnership and have no employees working torment g ❑Remodeling
/—any mpaaty.[No workers'comp.insurance rcqui ed]
9.3.❑I am a homrow ar doing all work myself.(No workers'comp.insurance rcquirtd1.]` El Demolition
4.❑I am a hommwg con tractors to conduct all work on property.ner and will he hiring Iwill 0❑Building addition
ensure that all contractors either have workers'compensation insuance or am sole 11.[]Electrical repairs or additions
proprietors with m employees. 12.❑Plumbing repairs or additions
S❑l am a general contractor and l have hired the sub.connacmrs lueed on the cliched sheet 13Li0of repairs
These subcontaviors have employees and have won m'comp.insu enec.t a.--+
h❑We area corporation and its officers have exercised their ngbt of exemption per MGL c. 14. Other
152,§1(4),and we have no cWhayecs.[No worketa'comp_insumncc rryui d.]
'Any applicants mat checks box al must also fill out the section below,showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and men hire outside contractors must submit a new affidavit iodicatiog such.
tl omaxuaxx that check this box must attached an additional sheet showing the name of me subcontractors and sate whether or not those entities have
employees. Ifthe sub-connectors have employees,they must provide their workers'comp.policy number.
lam an employer that is providing workers'compemation insurance for my employees Below is the polity andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 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,§25A 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. JJJpppeeesss
I do hereby certify under th art ' oftanywy that the information provided above is true and correct
Sia ture� // Date
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.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
C.PHILIP ANDRIKIDIS DBA
405 RYAN ROAD, FLORENCE, MA 01062
INSURED BY KING &CUSHMAN 413-SM-5610
HIC 9150673
CSL#171107
C:= MSL#11282
I request that you grant a modification to waive the requirement for control construction for
the project at 176 King St. 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