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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