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23B-047 (33) BP-2022-0591 80 LOCUST ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23B-047-001 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-2022-0591 PERMISSIONIS HEREBY GRANTED TO: Project# ROOF REPAIR Contractor: License: Est. Cost: 30000 FLORENCE ROOFING 071107 Const.Class: Exp.Date:04/24/2023 Use Group: Owner: NORTHAMPTON CITY OF SMITH SCHOOL Lot Size (sq.ft.) Zoning: URB/WP Applicant: FLORENCE ROOFING Applicant Address Phone: Insurance: 405 RYAN RD WC2-31S-374455-041 FLORENCE, MA 01062 ISSUED ON:05/25/2022 TO PERFORM THE FOLLOWING WORK: ROOF REPAIR FROM WIND DAMAGE 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: , I , d' '1 ♦ Fees Paid: $ 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Office of the Buildinc Commissioner RF:CHI;T. _ :_.. .. The Commonwealth of Massachusetts Office of Public Safety and Inspections ��V 22 5 Massachusetts State Building Code(780 CMR) 20 Building Permit Application for any Building other than a One-or Two-Family Dwellin (This Section For Official Use Only) r o r nun_rnn,�!N PFrnnNg �KZIHA>,1(,?nN.MA01060 Building Permit N umber. 22•►5-9Date Applied: .____-- Burldmg Offociab ' SECTION 1:LOCATION . 80 Locust St Northampton 01080 Smith Vocational and Areal High School No.and Street C TToow no 4 7 Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION Z:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building la Repair 0 Alteration 0 Addition 0 Demolition ❑ (Please fill out and submit Appendix 2) Change of Use ❑ Change of Occupancy 0 Other 0 Specify:400409 Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0 Is an independent Structural Engineering Peer Review required? Yes 0 No B Brief Description of Proposed Work: Section of roof blew off Building D and we are replacing that section with TPO roofing. SECTION 3c COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): _ Proposed Use Group(s): _ .. _ SECTION 4 BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) Total Area(sq.ft)and Total Height(ft) SECTION 5c USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2 0 Nightclub ❑ A-3 ❑ A-4 0 A-5❑ B: Business 0 I F Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 14-3 ❑ H-4❑ H-5❑ I: Institutional 1-1 0 1-2❑ 1-3❑ 1-4❑ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4❑ S: Storage S-1 0 S-2 0 U: Utility❑ Special Use❑and please describe below: Special Use Description SECTION&CONSTRUCI7ON TYPE(Check as applicable) IA 0 IBO HA 0 BB IBA MB0 IV 0 VA VBO SECTION 7:SITE INFORMATION(refer to 780 CMR 1053 for details on each item) Trench Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal- Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal 0 A trench will not be required 0 or trench or specify Private❑ or indentify Zone: _ or on site system 0 permit is enclosed❑ Railroad right-of-way. Hazards to Air Navigation ,T T .t n ! :r.,r.._s i< _n•,- _ :___Not Applicable.❑ Is Structure within airport approach area? is their review completed? or Consent to Build enclosed 0 Yes❑ or No Cl Yes 0 No 0 SECTION&CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Does the building contain an Sprinkler System?: Special Stipulations: Design Occupant Load per Floor and Assembly space: _ C P-d / rf p/o) ec7L � i - • - The Commonwealth of.tlassachuhetis • • - • Department of Industrial Accidents •-v.• L 1 Congress Street,Suite 100 'itir7 • • Boston. .S1.4 02114-2017 . . www.ntass.goriilla . i1I ker.'( prii%IitIOn 111%11r111er.tfridin Builders:1'entraeturs.F.Irctririans..Plumbers. It)HI I-it VD\'‘I l tl lift 11.B5111 I IN(..-‘t I 110R1 It. %polkas( Inf4argual1on Please Print Letibis Nam::t ): 1 mttt C. Philip Andrikidis/d/b/a Florence Roofing Addrc„. 405 Ryan Rd. • Stateiij Florence, MA. 01062 Phone 413-262-8007 i.tvitsphs,.,1:( !tic 441pruinfati; 'fpr of project(required). 33 ,:t1!1•..: 5 - .3 DinnitiltIon •%.•!/‘ Na• I 3 ihnidiN: I I.:1•6: AI • 41. cr.-' I Z rer zit.or i:••:•1•14..;":. :.I I :1.1.;k1I.,. • n e t; vratrs....; A 1•1. •• •• ; "10614:1 11,.l!, $1 61.4 44: !IA t:A 0.6 !2iitt ••••:?.11...:: Nt'•ei.• 'VI. • •;IC. • . ••ti.!IN; L., X...S.• • •a-!•it:1;01,arftilt ...nk •. . 0.1111,1. •••:at‘11'1,1! am an emplas-er that is providing worLers•sompensation insurance for my employees. Bt.boo. t+th.. pr41,.1.-and iLb'ire infirrmatian. Insutanss.(omp:Itt). Liberty Mutual Fire•Insurance Company ,v: S;if-ittN. VVC2-315-374455-052 E-xpiLltiter:1):::e. 1/25/23 -•• • - • 80 Locust St ,,r.• Northampton, MA. .tttach a cam of the ss orkers compensation putic declaration page(shooing the policy number and expiration dale). I ailw it 4::41.4s'as iimittiVti undo M(.41- :CA is it cruuutai N:oidt kkk uputaisit,gh: t*%. fittc up to,s1.5tx.)1K! and trap:Isortnu:nt. v,cif t:tti 111 LIM: tttittl r4 STOP WORK ORDER,Ind iinc of up tt,S250.00 ,2a.k •2 A;.•• !Pt., ‘..ONSfjI I Si,hereby(verify wider the Mink awl penalties vi/ptriurty that the ralorottatton provided above is true HMI correct. Sivutoss 5/23/22 413-262-8007 IOfficial use only. Do nut'trite in MA area.to he completed hy do.or'Mien Official. (§r loon: rcrfilit:I.ICIrD4w Authorit (circle oner I.Board of health 2. Building Department 3. Toon Clcrk 4. I:frctric Inspecteir 5. PluinhirIa ifiNlector 6.Other _ Contact Person: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL.) •--i CS-071107 4i24123 C.Philip Andrikidis/d/bia Florence Roofing License Number Expiration Date Name of(SL Holder 405 Ryan Rd. List.C'SI Type tsee below, U 1 No,and Street -— Type Description Florence MA.01062 t= 1 ntestrirred(E3uildings up to 35,(100 cu.ft.) 1 - R Restricted l&2 Family Dwelling City.Town_State,ZIP �1 : Wtasonry t RC • Rooting Covering i WS Window and Siding i SF : Solid Fuel Burning Appliances , ofin 413.262-8007 florencern - gCgmatrcom ��� I Insulaticm Tele hone i) Demolition - p Email uldtrss _ _..___ i 5.2 Registered Home Improvement Contractor(WIC► C.Philip Andrikidis 01573 Si26123 - -__ ___.__... _._�__.. IIIC um Registration Number Expiration Date I II( Company Name or ITIC Registrant Name 405 Ryan Rd ' florenceroofm mal.com 9@9 No and Street Florence,MA.0 062 413-262.8007 Email address City.'Town. State. ZIP I elephone 1 SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.I.. 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 oldie building permit. Signed Affidavit Attached? Yes CO No.sass. ....0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I ' . 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 i 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 • contain this ion is true and accurate to the best of my knowledge and understanding. C.Philip Andrikidis ,51.2q,l as Print Owner's or Authorized Agent'.Name(Electronic Signature) Date NOTES: I. An Owner who obtains a building permit to do h►sher own work.or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(I IiC► Program). will not have access to the arbitration program or guaranty fund under 'y1.(J.1...c. l42A. Other important information on the HIC Program can be found at www.rnass. uwoca Information on the Construction Supervisor License can be found at �wyy m,, s,,gov:'dtti 2, When substantial work is planned, provide the intprmation helm. Total floor area(sq. f1.1__.__...__.. (including gm age, finished basenrentattics,,decks or porch) Gross living area(sq. fl.) _ Habitable room count Number of fireplaces Number of bedtroams Number of bathrooms Number of half baths Type of heating system _ `twnb�t of decks po+relic, Type of cooling system__ ...._. _ Enclosed _ - Open , 3. "Total Project Square Footage" may be substituted for Total Project t ost City of Northampton Massachusetts / . , DEPARTMENT OF BUILDING INSPECTIONS • • / 22 Mt Street • Munl.cl.pai Eluz.Idng Wortt,.*2mpt,:>r MA 0106:' CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOULON AND RENOVATiON PROJEC:Si 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: '1/a'esy Location of Facility: The debris will be transported by: Name of Hauler: Amherst Trucking Inc Date: 5/23/22 Signature of Applicant Appendix 1 Construction Documents are required for structures that must comply with 780 CMMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where a litabit' _ _._...__. Fes__- - ; tit). Item Submitted incompicte T_ Not ktjwre ci i I , n hitr aural Foundation -- 3 Struitu ra{ __._. , 4 Fire Suppression . Fire.Alarm(pas require r au>r tb HVAC F ectri al s 1 Plumhuig(include local t onnt -iuins o teas(Natural,Propane.\+es.iical or other) lt3 "fur,eyed Site Plan 1,I_.tonn s.Wetland,et i 11 Spee'ific,attons 12 Structural Peer Re•v ie 13 Structural Tests h Inspections Program 14 Firs;Protection Narrative Report _.. :> , Existing}'iui14mg Su ryes]iriiestigauort ` to 1 Energy Conservation Report i 7 Architectural AL-,ess Review"(521 C MR') 18 Workers Compensation Insurance; } i t 1G `:aZartou5 Material Mlitrgatio�r. Documentation _- t .,mac-r i 1. 21 , Other(Specify) I 22 ()the>r (Sr .rtt") ._ 'Areas nt.Desism or Construction tot which plans are not complete ai Ott firth_'e+t aj+plk'anxon submittal must hl' Lientltit:i herein ttori.u,identified must not tic commenced until tn.),a^^!r._atitn,.ha'h ; t a s^at�.t`'d and tilt'rro'<.& eonstrix-tion document amendment has t<rn af+tfrerrt d In the , authority having wrr iiictu n Registered Professional Contact Information ' r"atr,i,ncr voes cites Fk +t asr Roan; a•,. 2�; +- fiote ifiroofe*if]tgicrna1S con 1 t✓S-07 1 07 _ -_ ___ ; Registration Number Name(Registrant) iekrhotie\a.. e-mail address •• U 405 Ryan Rd Florence MA 0'0 ... 4,)24/23 tbsciptme Expiration 'Irate • Sheet address City 11own `_Mateo Zip t , Name(Registrant) I elephon& No. e-mail address Registration Number __ ._. _ -_.__ ___ __.__ __. .._._.. �. Discophile Expiration Date Street Address City/Town State !ir �__ __" _ ....._.___ _ ......—_... _ __ ...__._._- Registration Number Name(Registrant) Telephone No. e-mail address _ __. _ Discipline Expiration bate street Address City i-rown State Zit+ , Please follow this link for to be used by Registered Design 1'rotessionals CONSTRUCTION CONTROL WAIVER From:' Florence Roofing 405 Ryan Rd. Florence. MA. 01062 To: Jonathan Flagg Building Commissioner City ofNorthampton 212 Main Street Northampton, h8/\O1U80 The Massachusetts Building Code, section 1O7.1 allows for an exclusion from requirements for construction control \n certain situations. |n accordance with code section 1O4'l0, | request that you grant a modification to waive the requirement for construction control of the project at 80 Locust St Northampton, MA. 01060 because the work is of minor nature, will not affect structural elements, health,accessibility, life or fire safety, and will be done in accordance with the prescriptive requirements of the code. Thank you for your consideration. Respectfully, �_ �~ � ~~ ~�~ C. Philip Andrikidi5 „..........eleell ot ACCW I;) CERTIFICATE OF LIABILITY INSURANCE DATE/SIM/DD,YYYY; ‘leeper"-- :,5.'23;202: THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED.the policylies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ... PRODUCER CONTACT Susan Fleury CIC.CISR CPIA NAME: King&Cushman Inc. PHONE (413)584-5610 FAX (413)584-9322 iti4ArLo.'” (AIC,,,,, P.O.Box 44T sfieury©kingcushman.Ctrr ADDRESS 176 King Street INSURERS)AFFORDING COVERAGE 1 NAIC 4 Northampton MA 01061 INSURER A, Hudson Specialty Iris Co INSURED INSURER Safety Insurance Company I 39454 El' C Philip Andrikidis,DBA:Florence Roofing INSURER c Liberty Mutual 405 Ryan Rd. INSURER D INSURER E. 1 Florence MA 01062 •INSURER F COVERAGES CERTIFICATE NUMBER: CL2252304798 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOu' HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PDLIC't PEHIO2) INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEE t,.REDUCED BY PAID CLAIMS, INSR ADDL-SUBNI POLICY EFF POLICY EXP LTR , TYPE OF INSURANCE ,PM AND' POLICY NUMBER .JIMAMEIFYYTY) (MM/DO/Yren LIMITS ,Xl COMMERCIAL GENERAL LIABILITY $ 1,000,000 EACH OCCURRENCE I DAMAGE-10 RI?,; nDe Er 100,000 CLAIMS-MADE 1.• -ei OCCUR I PREMISES IEa occurra , S 5,000 MED EXP cAny one person) $ A ..1 H8D100015188 02/13/2022 02/13/2023 PERsoNAL is ADv iNJuRy s 1.000,300 i 2.000 000 GEWL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ ' 1---'PRO- 2,000,00D POLICY I JECT E LOC ,pc,,,,,,,,,,,,..0FAGG S ......— s OTHER . COMBINED SINGLE OMIT $ 1 000,000 AUTOMOBILE LIABILITY t • (Es Amman)) — ANY AUTO BODILY INJURY(Per.,-erep..a B — ovin4E.c ...e, SCHEDU n= LEL 1700890 01/0912022 01/09/2023 BODILY INJURY(Per deint !1 AUTOS ONLY **'-‘ AUTOS 4 ----Ne HIRED Ne NON-OWNED PROPERTY DAMAGE AUTOS ONLY .... AUTOS ONLY (Per ecciden1) . . PIP-Basic s 8,000 UMBRELLA LIAB OCCUR • EACH OCCURRENCE •,-- .-- EXCESS LIAB CLAIMS-MADE AGGREGATE i$ DED 1 ! RETENTION$ i , S WORKERS COMPENSATION PER I (ER AND EMPLOYERS'LIABILITY Y I N 1 000,000 ,,.. ANY PROPRIETORPARTNERIXECUTIVE OFFICERMEMBER EXCLUDED? E N E L EACH ACCIDENT S ' I A WC2-31S-374455-052 01/25/2022 01/25/2023 ' `-- 1,000.000 (mandatory In HMI El.DISEASE•EA EMPLOYEE $ Byes,deserter unoe EL DiSEASE-POLICY LIMIT r : •DESCRIPTION Of OPERATIONS beep% .• • , s 1,000,008 I DE SCRTTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,111.1 be attaC,e0;I more space s reqw,ec9 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Northampton 212 Main St AUTHORIZED REPRESENTATIVE / .... Northampton MA 01060 ., 'CR*.rtY aiiL I . T 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD