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38B-119 BP-2022-1 087 5 STEARNS CT COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 38B-1 19-001 CITY OF NORTHAMPTON Permit: Exterior Res PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit# BP-2022-1087 PERMISSION IS HEREBY GRANTED TO: Project# ROOF Contractor: License: Est.Cost: 3000 FLORENCE ROOFING 071 107 Const.Class: Exp.Date:04/24/2023 Use Group: Owner: P CULHANE TERRENCE C &JULIE Lot Size (sq.ft.) Zoning: URB Applicant: FLORENCE ROOFING Applicant Address Phone: Insurance: 405 RYAN RD WC2-31S-374455-041 FLORENCE, MA 01062 ISSUED ON:09/01/2022 TO PERFORM THE FOLLO WING 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: 5913, Fees Paid: $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner RECEIV@ = -- SEP - 1 2022 he Commonwealth of Massachusetts Boa d of$uilding Regulations and Standards FORMUNICIPALITY ._ ,PT OP BUILDING INSPE IONS chuS.etts State Building Code, 780 CMR USE NoRTHAws-ToN MA 01 6 -13�-g dmg-Pert -- pplication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: SAP" .�-•/Og 7 Date Applied: vikJ, .' 5 I;7 9"l'Z02Z Building Official(Print Name) Signature Data SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Nu bers 7 Stearns Ave. 3�Q / I 1.1 a Is this an accepted street?yes X no Map Number✓ Par I Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) , Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private 0 Zone: _ Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Terry Culhane Northampton,MA.01062 Name(Print) City,State,ZIP 7 Stearns Ave. 413-575-9699 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Remove existing EPDM roof and install new TPO roofing. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire OC> $ Suppression) Total All Fees: $ -iQ, Check NogSola Check Amount: Cash Amount: 6.Total Project Cost: $3,000.00 t'Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-071107 04/24/2023 C.Philip Andrikidis License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 405 Rytan Rd. No.and Street Type Description Florence,MA.01062 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-262-8007 florenceroofing@gmail.com I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 01573 8/26/22 C.Philip Andrikidis/d/b/a Florence Roofing HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 405 Ryan Rd. florenceroofing©gmail.com No.and Street Email address Florence,MA.01062 City/Town,State,ZIP Telephone SECTION 6: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 0 No 0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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(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 con/tad in t�/i& pplication is true and accurate to the best of my knowledge and understanding. C.Philip Andrikidis 08/31/22 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,fmished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton � tH�MP18 „, .7 d, .� Massachusetts ' dIv * :t DEPARTMENT OF BUILDING INSPECTIONS . ' 212 Main Street • Municipal Building Northampton, MA 01060 st%yy -0 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: 08/31/22 ..,..�:'�". .. The Commonwealth of Massachusetts bl4-*. . -w. . „ Department of Industrial Accidents k1 Congress Street.Suite I DD "t :`►tosir .. Boston, MAD211 -?017 y { ws'w nrass.gov/dia Upikers'Compensation Insurance:tffnlarit:Buihlers.TContractoratElectricians1Plunthcrs. TO BE FILED‘4 II II 1 ltl:PEN41t'TING At'I1110RI'I 5. Applicant Information Please Print 1.e2ibls Nate a Bluntness thydriltat in Tian .tf: C. Philip Andrikidis/d/b/a Florence Roofing Address: 405 Ryan Rd. City:State.Zip: Florence, MA. 01062 Phone n: 413-262-8007 Arc coo to er,rpton re!t heck the appropriate hot: Type of ptttytlret(required): l. t am a cnt,l,yer with 5 employes-%[full and an part-time)' 7. J New construct.+ :.a AM a xdu:prop/sew(a1 patnscralrip and tame no ennsk,y'ccs working ka nit:in K. U Rcmode1in ;iny capacity.[No workers'comp.uuuraner required] t r—, 9. D Demolition Ii ara a barns M Mt dkaenr,ail.tarts any xlt °•N.r w.FMA:IN eear>r?.:rnurance requited-I;. l0 j Building addi r n 4.0 t am a h rnaCctwnet and Kiti be biting oantru1ura to conduct ail work on my property, I wilt ensure that aI1 contractors nutlet have Markets'compensation insurance or an sole i 1.j Electrical repai or additions proprietors with no ccrrpk yen_ 12.a Plumbing reps' or additions t I am a retie at contractor and I hose hired the sr art rcte rs breed c n the atiasdicd sheet ' 13_D repairs e Citisol so-ensue,-tom tsss.anal s ues l and hose winker."comp.nouca ire:- 60 Vl c area evaporation and its ntfwrn has e.setnsed then right of raemsptwns pet MC&C. I3'�O�Ct '•,'1 1 tt_',ttt41.and we bate no utrt+ierycri..1\o*taken"carnets.insurance required 1 'Mn appficant that chocks box Ai roust also taH oast the section balm slowing their*M.o.'cos patnation policy mforrn lion. +tkimonnnen w ta>stnt'mii this atir Ln a indicating dies arc doitrn all wick and Jaen tine crut.idc contractor.rant sahnaa a mew affatan it ant :raring mark .Co cti ciadent cheek daps box slant att;u:lard are•A.t•s-,.,•n stat•*t dross msc tks:araa»c..t the sails.:ocatinewesand+fete*newer in eiei ter entStirs thane etnplooyees. tf the rests-coatraettaas tune e-aatik sa .slice ilia•i catnad4 then Auck.ers,'.vent,.relish.muumh a_ I am an employer that is presiding worLers'compensation insurance for my employees. Bellies.is the policy am/job site information. insurance('ositpciny Name: Liberty Mutual Fire Insurance Company Policy#or Self=ins.Lk.#: WC2-31S-374455-052 Expiration Date: 01/25/23 Job Site Address: 7 Streans Ave. CitylStatcZip: Northampton, MA. 01060 Attach a copy of the corkers'compensation policy declaration page(showing the policy number and expiration dallie). Failure to secure eoscrage as required under MGL c. 152,§25A is a criminal siotation punishable by a dine up to SI.S(X).(X) and or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to S 250.(X)a day against the s iolator_A copy of this statement may bc forwarded to the Once of Ins cstigalions of the DIA for insurance coserauc scritication. /do hereby certifr titre - and penalties of prrjarry that the information's pravivied above is true and eat Signature: Date: 08/31/22 Phone 413-262-8007 Official use only. Do not write in this area.to be completed by city or town trial ('its or Toon: Permit/License# ' Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/ oon Clerk 4.Electrical inspector S.Plira h1IB 6.Other Contact Person: Phone#: