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23A-146 (14) BP-2022-0699 130 PINE ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 23A-146-001 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-2022-0699 PERMISSIONISHEREBYGRANTED TO: Project# ROOF Contractor: License: Est. Cost: 13000 FLORENCE ROOFING 071107 Const.Class: Exp.Date:04/24/2023 Use Group: Owner: FLORENCE CONGREGATIONAL CHURCH Lot Size (sq.ft.) Zoning: URB Applicant: FLORENCE ROOFING Applicant Address Phone: Insurance: 405 RYAN RD WC2-31 S-374455-041 FLORENCE, MA 01062 ISSUED ON:06/13/2022 TO PERFORM THE FOLLOWING WORK: STRIP AND RE-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: 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 • � . Fees Paid: S1WOO 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner The Commonwealth of Massac se JtIN 1 3 Office of Public Safety and Inspectio s 2022 Massachusetts State Building Code(780 C ') Building Permit Application for any Building other than a • e-ofl• • Dwelling (This Section For Official Use On ) Mir' iNs�ECfi 0 Building Permit Number: /_k_____! Date Applied: Building Official: -... SECTION 1:LOCATION 130 Pine St Florence MA 01062 Florence Congregational Church No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2: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 lel . Repair 0 . Alteration 0 Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy ❑ Other 0 Specify:_ Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No lel Is an Independent Structural Engineering Peer Review required? Yes ❑ No la Brief Description of Proposed Work: see attached Proposal SECTION 3: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) 0 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 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 I B: Business 0 E: Educational 0 F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5❑ I: Institutional 1-1❑ 1-2❑ 1-3 0 1-4 0 M Mercantile 0 R Residential R-10 R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 I Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCIION TYPE(Check as applicable) IAO IBO HAD II80 MA IIIB0 IVO VAO VD SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) r ' ' Debris Removal: Water Supply: Flood Zone Information Sewage Disposal: TrenchPerrot Public 0 Check if outside Flood Zone D Indicate municipal❑ A trench will not be Licensed Disposal Site 0 required 0 or trench or specify: Private.❑ or identify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation Not Applicable 0 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes 0 or No❑ Yes 0 No Cl 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: SECTION': PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Florence Congregational Church 130 Pine St. Florence, MA. 01062 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No: (cell) e-mail address If applicable,the property owner hereby authorizes: Name Street Address City/Town State Zip to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O. Otherwise provide construction control form,.(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the profession[coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Florence Roofing Company Name C. Philip Andrikidis 01573 Home Improvement Lic. Name of Person Responsible for Construction License No. and Type if Applicable 405 Ryan Rd. Northampton MA 01062 Street Address City/Town State Zip 413 262,8007 _ - - florenceroofing@gmail.com Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§25C(6)) A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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. Is a signed Affidavit submitted with this application? Yes di No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municj - r)_$ . 3.Plumbing r $ 4.Mechanical (HVAC) $ Note:Minimum fee= ! ..(QtSiLtact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $13,000.00 (contact municipality)and write check number here ____. SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 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/d/b/a Florence Roofing �� Sole Proprietor 413 262 8007 5/27/22 Please print and sign name Title Telephone No. Date 405 Ryan Rd. Florence MA 01062 fiorenceroofing@gmaii.corn Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: lo'! ZdZ2 Name Date City of Northampton v�'!4 �,�� r'!,`. qo sib, : Massachusetts 4" • '`� t !. 2. w � . DEPARTMENT OF BUILDING INSPECTIONS y ` s , 212 Main Street • Municipal Building �j }Dt # --'° Northampton; MA 01060 fi`'y x" 1~\ i 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 Location of Facility: The debris will be transported by: Name of Hauler: Florence Roofing � ) Signature of Applicant: Date: 5/27/22 The Contarunwealth of alassachasetts Department of IndustrialAccidents 1 Congress Strew Suite 10(1 Boston, :4f4 02114-2017 • w1►tw.mass.go►/din 11 ue kcr'' ( oii i'ation insurance Aftidas it:Builders,/Coutractur++E:kctrieiaus(Plutnhera. 1t1111:FU.l:D%%11U nu.PLRstrrt1'tiC:Af t lltll(111. Applicant Information Please Print l.ezibls Nato 1liusuw. <s:..:,,rauian individual C. Philip Andrikidis/d/b/a Florence Roofing Addre s' 405 Ryan Rd. Florence, MA. 01062 , 413-262-8007 C its State Zip: piton = .1re yun ten evisinkr.ocr't hacG the r pprupri.a .float: Type of project(required) 1.2i l ant a ostploycc oath 5 trsvpl :e/,I ftatt:u d or part—train.'" ? 3Nt:Ck construction _.D I>s a 14.4t TLA.,+".10:,)rx9 pACrA e..3•Nr#.ar+1 h.r.e ux.'tlarlewrcrt w.:cAmV g+arMAW as 8_ 3 11 errio&ltng yaw:ylaawrty r\.� totitcra':..trip.rm.uracl.a' rca tara7.l �---� 9. '_I Demolition I ant a huntct,w nt r damF ail work my24:16.[NO notion.':4301p.In%uranc.ngturcxi.t' f(f 0 Building addition 4.t—r�I am a lxn teou ow:and will b.luring contractor to contkla all work en my propa ty. I will amurt:that 418.ut1tratkar%.Wine iota.wu vzs•:au :a+usu+ml trlsWr tnta as amr aide ILO Electrical repairs:or addition .7rr,M,t n, «a.s1^4,iotia`:. 12, l Plumbing,repairs or additions 5 1.ur/a goterat contractor wail ha%c inrcd the ark-ca,r/ttaaWta Itatnti en t ur attached>acrt. 13.',.r0Rextf repairs 11i:;Sub-:w:t:a:tar.haw ctttluuyecs anti ha w:xtoken,'etxtgtr.Irnaera,s. .' 14.[()thee Roofing 11.0%l ear.a corinuatlaxl anal tr)a tlr era haw:caaua.td then right eleAemi teen per M L - ] +I xt.anal w.t ll a' n.,cry-u}mac:..[No'a.,634.0.':a'crup./4141 atlas 4r1/141.201.1 'Any a,'apiti.:W.t Our:ltutics bet=i rnu.a n1.,.,,Lill anal th•No:e n below showing nicer µ e, rs :,.sirens.Alan rota.:}no.fLv. suns. `Ftc m'eNtv.•ti 14ho soh nut turf 3lt-t[kitrr Inda'aturg 111 .am-drop:nit work and Then hire otttsuic c tITra:tora mod aubnii a not attidxt trtnila'a*tg aw h f ontr-sluts that choecto.this but mum.attadrood rut awLlaweul dwct !,:a.tr:t!.,.a. la .0+..elt:aa,':..a•:d-'_.tc t r ,_::�.. !t.,..:r.t`.a:a.!aowc crnployccft. It the sub-contractors hate enirloVat't.they muse pw,i.l.;;,i s ,t. ,..•.. .. r:r ;.. ;: ::.,:•i!• : I am an employer tlerrt is proviihng w,,rAers'Compensation insurance tor My employees_ Below ei the."whey et'net job Niee. information. insurance Company Naine: Liberty Mutual Fire insurance Company Policy>?or Self-ins.Lic.#: WC2-31S-374455-052 Expiration Date: 1/25/23 Job Site Address: 130 Pne St Cats: State Lt : Fiorence,MA.01062 Attach a copy or the workers'compensation policy declaration page(showing the policy number and expiration date). I atitue to secure coverage is required under MCA.c. 152. *25A is a criminal violation punishable by a tine up to Si,500.00 dud or one-year itnprisotuncnt.as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a dry acorns,the s tollatca:..A ci_r ul t xs Nutioniboir inns be finwarified to!dam Ot;irr:+e of Invoititzittsncti of the Dv.km:;insurance VOA er'age verification. I do hereby certify antler the pains and penalties of perjury that the infuremetion provided above is true and correct. Sil;n.tttme: Date._ 5/27/22 Phone»: 413-262-8007 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit,'Liceasc tr issuing Authority(circle one,: I.Board of Health 2. Building Department 3.C'itc/l-os n Clerk S. Electrical Inspector 5. wnhin; Inspector 6.Other Contact Person: Phone 4: • Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 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 applicable No. Item Submitted Incomplete Not Required l Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) I( 10 Surveyed Site Plan(Utilities,Wetland,etc.) 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 . Architectural Access Review(521 CMR) 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information C.Philip AndnMdlsl an/a Florence Roofing 413 262 -8007 florenceroofing@gmail.com 1 CS-Q71107 Name(Registrant) Telephone No. e-mail address Registration Number 405 Ryan Rd. Florence MA 01062 l!— 4/24/23 Street Address City/Town State Zip Discipline Expiration Date - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date - - Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. FLORENCEROOFINWMA.COM C.PHILIP ANDRIKIDIS R 405 RYAN ROAD, FLORENCE, MA 01062 RAW INSURED BY KING &CUSHMAN 413-584-5610 HIC #150673 .— CSL#171107 • W8 5—9 a MSL#11282 S`.`/9 r's,. 413-262-8007 January 8,2022 Estimate for: Florence Congregational Church Job Location: 130 Pine St.Florence,MA 01062 Description: - Remove steel stairs and railing from roof in rear South West corner of building. Stairs and railing to be cut and welded as needed to fit properly with new insulation height. - Strip entire flat roof in rear South West corner of building of(1)EPDM roof system and (1)built up tar and gravel roof down to sheathing.660 sq.ft.+/- - Remove fascia and soffit metal where sagging and repair @$85.00 per man hour.Cost of material plus 10% - Remove existing gutter and reinstall. - Rotted or broken roof deck to be replaced at$5.50 per sq.ft. - install wood blocking equal to height of new insulation. - Mechanically attach(2)layers of 2.6"polyiso insulation to entire roof to achieve an R- value of R-30 per building code.660 sq.ft.+/- - Mechanically attach '/z"fiberboard over existing roof on rear stairwell. - Fully adhere white or gray Firestone UltraPly .060 TPO 660 sq.ft.+/-flat roof and stairwell roof. - Small pitched door way roof in rear to be shingled to match as close to existing pitched roofs as possible. - Brake form 24gauge Kynar finish edge metal to all roof edges.Color to be determined - All TPO related flashings and terminations installed per manufacturers specifications. - Area cleaned and all roof related debris removed to landfill or proper recycling facility by Florence Roofing. - All permits to be applied for by Florence Roofing ACGRIJ CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDD/YYYY) 05/27/2022 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 policy(Ies)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 COONNTACT Susan Fleury CIC CISR CPIA King&Cushman Inc. PHONE (413)584-5610 FAX (413)584-9322 (A/C,No,Extl: I lA/C,No): ) P.O.Box 447 sfleu kin cushman.com ADDRESS: ry® g 176 King Street INSURERS)AFFORDING COVERAGE NAIC Il Northampton MA 01061 INSURERA: Hudson Specialty Ins Co INSURED INSURER B: National Union Fire Ins Co C Philip Andrikidis,DBA:Florence Roofing INSURER C: 405 Ryan Rd. INSURER D INSURER E: Florence MA 01062 INSURER F: COVERAGES CERTIFICATE NUMBER: CL2252704808 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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 BEEN REDUCED BY PAID CLAIMS TLTR TYPE OF INSURANCE ADDL SUER --POLICYF POLICY EXP INSD wvo POLICY NUMBER _ IMM/DDTYYYY) jMM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Es occurrence) $ MED EXP(Any one person) $ 5,000 A HBD100015188 02/13/2022 02/13/2023 PERSONAL&AINJURY $ 1,000,000 DV GEN'LAGOREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JJEECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER. $ AUTOMOBILE LABILITY ' COMBINED SINGLE LIMIT $ (Ea eccitiont) ANY AUTO BODILY INJURY(Per person) $ — OWNED — SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OVvNED PROPERTY DAMAGE $ AUTOS ONLY ,AUTOS ONLY (Peraocldem) $ X UMBRELLA LIAB OCCUR 5,000,000 EACH OCCURRENCE $ B EXCESS LIAB CLAIMS-MADE BE021372491 09/06/2021 09/06/2022 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION il PER ' OTH- AND EMPLOYERS'LIABILITY Y I N I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Job#1- Florence Congregational Church 130 Pine St Florence,MA.01062, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. 212 Main St AUTHORIZED REPRESENTATIVE Northampton MA 01060 1 L�1�� IL IL-1 ,�_,LJKi ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD CONSTRUCTION CONTROL WAIVER From: Florence Roofing 405 Ryan Rd. Florence, MA. 01062 To: Jonathan Flagg Building Commissioner City of Northampton 212 Main Street Northampton, MA 01060 The Massachusetts Building Code, section 107.1 allows for an exclusion from requirements for construction control in certain situations. In accordance with code section 104.10, I request that you grant a modification to waive the requirement for construction control of the project at Florence Congregational Church 130 Pine St Florence, MA. 01062 because the work is of a 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 Andrikidis