18D-039 (11) 388 KING ST BP-2018-1252
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18D-039 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOF BUILDING PERMIT
Permit# BP-2018-1252
Protect# JS-2018-002228
Est.Cost:$22000.00
Fee,$154.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: C PHILIP ANDRIKIDIS 071107
Lot Size(sp.ft.): 31581.00 Owner. MCLAUGHUN BRIAN I
Zoning,HBU 00)/WP(80)/ Applicant. C PHILIP ANDRIKIDIS
AT: 388 KING ST
Applicant Address: Phone: Insurance:
405 RYAN RD (413) 585-9171
FLORENCEMA01062 ISSUED ON.512512018 0:00:00
TO PERFORM THE FOLLOWING WORKSTRIP & 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: 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:
FeeTvoe: Date Paid: Amount:
Building 5/25/20180:00:00 $154.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Versionl.7 Commercial Building Permit May 15,2222_
Department we orgy
RECEIVr=U City of Northampton Status'ofPemet
Building Department Curt QalDdrewey,Pat"
212 Main Street SawemSepm Aveilebllily
MAY 2 3 2018 1 Room 100 waterlwexAwaetilny
Northampton, MA 01060 Twp Sep orstrwtnel Flemm
DEPToP nuanr•�u k 4;L3-5q7-1240 Fax 413-567-1272 Plowsite Pore
NORIIIA*I��'; . o _ � Dow Specty
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING ,Q
SECTION 1 -SITE INFORMATN)N b is —I->5a
1.1 PropertyAddress: ` ffi
This section to be completed by oce
Map ( bD Lot CT"!)
"9 Unit
9 Zone Overlay District
Elm SL District CB dstrid
SECTION 2-PROPERTY OWNERSHIPIAUTHORIZEDAGEtyT
2.1 Owner of Record:
He elP,, Current Mailing Adams:
C-
ra � Telephone
2.2'Auth t: ..... .
RsA
Name(Print) Current Mailing Mdress:
rbs--91'7r
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 22,Opp (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee ,{�
4. Mechanical(HVAC) Ff 16Y
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number .27 rl
This Section For Official Use Only
Building Permit Number Date
Issued
natu
Bu' mmissio er/Inso Buildin s
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35�
CUBIC FEET OF,ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition[I Repairs Additions ❑ Accessory Building
Exterfor AiteraUon ❑ Extsting Ground Sign❑ New Signs❑ Roo Change of Use❑ Other❑
Brief Description '.Enter a{{brief description here.(�
Of Proposed Work: s'h'r� e,'j re,J- w/ '('fjC� MQYK�,✓.y�(�
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP jCheck as applicable) Ej�CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A �❑
A4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ TI ❑ F-2 ❑ 2C ❑
H Hi h Hazartl ❑ 3A ❑
1 Institutional ❑ I-1 ❑ I-2 ❑ 1 3 ❑ 3B
M Mercantile ❑
4 ❑
R Residential ❑ R•1 ❑ R-2 ❑ R-3 ❑ "5A ❑
S Storage ❑ S-t ❑ 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 Hazam Index 780 CMR 34):
SECTION 8 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Fiber(sf)
1° is
2 d 2nd
3'd 3.
4- 4d,
Total Area(sf) Total Proposed New Construction(AS
Total Height(In
Total Height ft
7.Water Supply(M.G.L.c.40,§54)„ 7.1 Flood Zone information: 7.3 Sewage Disposed System:
Public 0 Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Vetsionl.7 Commercial Building Permit May 15,2000
8. NORTHAMPTON ZONTNG
Existing Proposed Required by Zoning
This column m bu filled m by
Building nepanmmt
Lot Size
Frontage
Setbacks Front
Side L: R: U R:
Rear
Building Height
Bldg, Square Footage %
Open Space Footage %
(Lot arca minus bldg&gavel
mkui
#of Parking Spaces
Fill:
volume&Wweion)
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 DONT KNOW O 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 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:
E. 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.
Vereiont.7 Commercial Building Permit May t5,2000
SECTION 9•PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUtLOM W ANSUBJECT TOO STRUCTURES
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 118(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not APplimble ❑
Name(Regisbant): ""—'
Registration Number
Address � —'
Expiration Date
SignaWre Telephone
9.2 Registered Professional Engineer(s):
Area of Responsibility
Address Registration Number
Signature
Telephone ep Expaallon Date
Name
Aron of Responsibdiry
Atltlress �... Ragisl-fioa Number ....... .-
Si ure_... teleWmre EWraemr Date ^..
Name Area of R¢sponsibdhy —
Address Registration Number
Signature ^Tele one
ph Expiration Dale
Noma Area of Responsibility
Addmss - -
Registration Number
Sgneture W
101900M -'
p Expiration Dale
9.9 General Contractor
Not Appiir bfe ❑
Company Name:
Responsible In Charge of Conatmsdon
Address
Telaphpne
Version L7 Commemial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 C111111110.11)
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, ��-'Xl� k c^1 Y IX"I�� ,,.f,1 k 1� as Owner of the subject property
i
reby authorize 1 1^ \10 ' " " vL M ok'r- to
act on y a ,I a relative to work authorized by this building permit application.
of er (� Data
C , L�,il I-Yu�o( �S ,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.
Print Name
c ?h ntp A �� �a 5/�/ ,
Sgneture of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor. / 1 Not Applicable [3Name of License Holder:. C(17"1"•1t l •( yok"L k A, 0-7 1l Dy
License Number
�{�z y�r9
Address Expimti
L,(v5- R-Jw '�Lel P(orc.,.Ct ' '-(t�'S� y.� t
Signatu Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted vath this application.Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 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: p,
The debris will be transported by:
The debris will be received by: V-Utw 9-e-y C 1
Building permit number:
Name of Permit Applicant C •��,1, l� "�� J�"CL
Date Signature of Permit Applicant
\ The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/E[ectricians/Plumbers.
TO BE FILED WITH THE PERMITTMG AUTHORITY.
Applicant Infor a 'on I Please Print Legibly
Name (th siness/Organixatim✓mdiwduap: C
Address:
City/State/Zip: Phone#: ��r' 0// -7
Are you m employer+Check the approprode boa: Type of project(required):
I.[]l...ployor with employees poll mdlier part-fime) 7, ❑New construction
2.rVarn a sole proprietor in parmership and have no employees working fmmein g. C]Remodeling
any capacity.[Ne workers comp.inswance required.]
3.❑l ama homeowner doingall work myself.[No workers'comp.insirsommiired.l' 1 Demolition
4,[—]l am a homeowner and will he hiringtractors to conduct all want on m n I will ]0❑Building addition
can ymml y.
um that au covhunms either have wonm%comhema[ion inaummc or are sole 11.❑Electrical repairs or additions
proprio na withno employees.
12.C]Plumbing repairs or additions
5 1 am a general contractor and I have hired the subcontractors listed on the attached sheet.
Theo odcontrumrs have cmployms and have worker%,scro nsurancei t3. oof repairs
6.❑We sm a corporation and as officers have exereued Meir right of exenrytion per MGL c. ❑Other
152,gt(4),and we have an eorployces.[No workers'comp.insurance required.]
.Any applicant that cheeks box NI must also fill oat the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and thrn hire outside contractors must submit a new atPdevit indcming such.
ICmtranors that check this box must attached an additional sheet showing On rune of dar s ibcin traerms and sec¢whemer or not those entifics have
employees. Ifthe sub-conhacwrs have employees,they must provide Ilreir wooers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the pofiry andjob site
information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: 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 farm 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 in the Office of Investigations of the DIA for insurance
coverage verification.
do hereby cerfi/fy under the pains and es jperjury that the information provided above is true and correct
Si,mdme' ` ( 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/fown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#: