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Home My WebLink AboutBuilding Permit # 5/18/2016 ..........um,:A. BUILDING PERMIT oI,,��, ;�� TOWN F NORTH ANDOVER � R .,,., � APPLICATION FOR PLAN EXAMINATION Permit NO: �' Date Received Date Issued: / . IMPORTANT: Applicant must complete all items on this page %//!i;%.a..., /,,../. %/ i// riri /„ ,v,,, rr ,3,,,, /,.rr ,;� / //,/, ,,,r i,,;,,, i�,i/%/ .,/ ",//iii / ,///�/i �/ r�/ / r�%//i/� �j!� ��///i„�/!%/,,,!%/%//� ,,,,�, / / /iii�/ �/,;,/ �/j ��„� �,�/%/%%%/,/�j a„%�,//j ;�/� �,,,e jrr� / r /, / �� /„ ,,/ r i,„i; / ,, Iachre �Ira ,V�llg v0s 'n'o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Cl New Building �] O„�ae family I-1 Addition I-wo or more family =01IM"mercial trial ❑Alteration No. of units: _i Repair, replacement I Assessory Bldg __i Others: I I Demolition I Other l �eptNd �I 11lleil I Flodaln ,� Watersh ,d Difrlct jr'y'v e /dew r r YL Identification Please Type or Print Clearly) LI °'� OWNER: Name: �` . �.�� ” � � � �� > Phone ��^' "., Address: „r NrRACTO ,,,,,,,,,; / „"//, /ilii/ // � �i / ,i ��% �^"//r✓i/%/� �� 4 r�, i � / ! r ,�r A ! I�''✓� `> ,H `i', r// /ia, r///// /i %/ i%/'��/%r i/i�i 4i/ / Da// art' rvI er s i/rrr / � ////i/i/iii//� /ilii%✓��/iri/coli // � /„f � ..i e / %/ a,..%;:;; ;,,, ;;; �', � ///, �, // �. ARCHITECT/ENGINEER Phone: Address: Reg. No, FEE SCHEDULE:EULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST EASED ON$925.00 PER S.P. Total Project Cost: $ WO FEE: Check No. ,. 5 L Receipt No. a NOTE: Perso zs contracting with unregistered contractors do not have access to the guaranty.fund Signature of Agent/Owner ripture of contractor u, tjORTH Town ofi ,.11: �2 _ ,L ® ncloverM ® j `. �.. � _ _ ® T �o � L.K� h ver, ass, '5"' /_ �G C% COCHICM@WICK �.�5 RATE® i,4�`�.(5 U BOARD OF HEALTH Food/Kitchen P E K mlvml I IF T LD Septic System � / Co/) C r BUILDING INSPECTORTHIS CERTIFIES THAT ..... .. .. .....................:s EE l //.�f` Foundation has permission to erect .......................... buildings on ........................................... ...... Y ........a.. Rough to be occupied as ..............5 7..... .,/... C..Ivo....................................... . ........................... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T RTS Rough .....•...... Service ................. ..... . . . .... ... �:�......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 7` GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut,MA 01826 Al Greene---Director of Field Operations 1-978-4534242 Office 1-978.888-1700 Cell georgotilisl4l@aol.com CONTRACT Beechwood Properties 05/05/16 Attn:Bud Hart 40-60 Beechwood Dr. N.Andover,MA 1-978-697-6977 pbhwih(c7i�,gmail.eom Job Location:40-60 Beechwood Dr.N.Andover,MA Scope of Work: Remove all layers of shingled roofing down to wood deck on entire second building roofs,protecting the grounds, landscaping,and buildings body with heavy duty tarps as stripping is being done.Re-nail plywood decking as needed. Install GAF StormGuard ice/water shield on entire roof deck surfaces,full coverage. Install 8".025 gauge heavy duty aluminum drip edge on entire roof perimeters. Install GAF ProStart starter strips across all eaves and up all rakes. Install GAF Timberline HD Lifetime Architectural shingles and Timbertex hip/ridge caps on roof. Install new Coravent V-600 ridge vent on all main ridges. Install new stack pipe boots on existing plumbing pipes. Replace all existing bath box vents with new Broan bathroom box vents. Thoroughly clean and magnet grounds and remove all job related debris from property on a daily basis and at jobs completion. $55.00 Per Sheet Extra Cost to replace any rotted or damaged plywood decking(if needed). Entire job includes GAF Systems Plus Warranty. First 40 yrs.Is non-prorated,full labor and material coverage from GAF,against any material or installation defect cause,and is transferrable one time. WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum of. 1)e�. Pa;� %'000.00 CVJ 'A2`b$ Twenty Five Thousand Dollars $25,000.00 PAYMENT TO BE MADE AS FOLLOWS: $8,000.00 PAID IN ADVANCE TOWARD MATERIAL,COSTS.$17,000.00 BALANCE PAID IN FULL WHEN.TOB IS COMPLETELY FINISHED ACCORDING TO THE ABOVE LISTED PROPOSAL. All material is guaranteed to be as specified All work to be completed in a substantial workman like manner according to specifications submitted per standard practices.Any alteration or deviation from above specifications involving C p extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate, All agreements contingent upon strikes,accidents or delays beyond our control.Owner ty carry fire tomado and other necessary insurance.Our workers are fully covered by workers compensation insurane . Georgoulis Authorized Signature This proposal may be withdrawn by us if not accepted withi 30 days. Acceptance of Proposal-The above prices,specifications are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signa `"t^—� Signature Date of acceptan'AX, The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, ,bite 100 Boston,MA 02114®2017 www.mass.gov/dia . .x Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Anplicant Information Please Print Legibly Name (Business/organization/Individual):Georgoulis Construction, Inc. Address:96 Arlington Av City/State/Zip: Dracut, MA phone#:9784534242 Are you an employer?Check the appropriate box: Type of project(required): I.Q I am a employer with 10 employees(full and/or part-time).* 7, E)New construction 2.®I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'camp.insurance required.] 9. ❑Demolition 1 I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 10E]Building addition 4E]I am a homeowner and will be hiring contractors to conduct all work on my property. ]will ensure that all contractors either have workers'compensation insurance or are sole 11.®Electrical repairs or additions proprietors with no employees. 12.®Plumbing repairs or additions 5. 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.® p Raaf repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that is pr^ovidirtg workers'coitipensatiorr insurance far my employees. Below is fire policy and job site information. Insurance Company Name:Admiral Insurance Company Policy#or Self-ins.Lic.#:WC009774283 Expiration Date:9/25/16 Job Site Address:40-60 Beechwood Driv City/State/Zip:N. Andover, MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGI,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 form of a STOP WORI4 ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Z do hereby certify errrd the p ins rnd penaltie of perjury that the information provided above is true and correct. Signature: 11 Date: Phone#: ri' ark': . 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/ own Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 7031111206 AC40RV' CERTIFICAT ®F LIABILITY IN U NC (MMIDD/YYYY 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(les) must 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 Phone: (978)2633500 Fax (978)263-1438 CONTACT Gallant Insurance Agency,Inc. GALLANT INSURANCE AGENCY,INC. HONE FAX 199 GREAT ROAD/P O BOX 975 Arc No Exl: (978)263-3500 as (978)263-1438 E-MAIL ACTON MA 01720 ADDRESS: PRODUCER 36702 CUSTOMERID: INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA James River Insurance Company GEORGOULIS CONSTRUCTION INC. C/O SCOTT GEORGOULIS INSURERS Chartis Insurance Company y 96 ARLINGTON AVENUE INSURER DRACUT MA 01826 INSURER D: INSURER E INSURER COVERAGES CERTIFICATE NUMBER: 48658 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, ONDITIONS QF SUCH P,,,,,,, MITS SHOWN HAVEREENE UCED BY PAI)CLAIMS, INSR TYPE OF INSURANCEADD'L SUER POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MWDDffYM LIMITS A OENERAL LIABILITY 000706700 03/05/16 03/05/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100 000 PREMISES(Es occurence $ , CLAIMS-MADE I X I OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ .a-- L [4OCCUR EACH OCCURRENCE $ EXCESS UA8 CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION WC009774263 09!25/15 09/25/16 J( WC STATU- OT}I AND EMPLOYERS' LIABILITY V/N I S I ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 (ManOFFIdatorERIy in NH) EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 II yes,des«ibe under DESO IPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REPRESENTATIVE Attention: eresa 0, rraa ACORD 25(2009/09) ©198 - 009 A RDCORPORATION. A I rights reserved. The ACORD name and logo are registered marks of ACORD Office Of Consumer Affairs and Business Regulation f 10 Park Plaza- suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 117870 Type: Private Corporation Expiration: 12/1212016 Tr# 260054 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Mark reason for change. t 1 Address Renewal ; Employment Lost Card scar 0 M-05/11 1iceroytrs��:�ata�ulf/r f i �itriSurlaJelZ ffoe of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR gistration: 117870 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/1 /2018 Private Corporatior. 10 Park Plaza-Suite 5170 Boston,MA 2116 GEORGOULIS CONSTRUC'TIQN,INC. 9 SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT,MA 01326 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards r � oISPI'l 10 10-69.55849 License: CS-058498 L1CSanD ego Extension Ami * Construction Supervisor INIERNATIONALSAfETYECIUCA710NIN511T1YrE(ISEI) Safety LblFgl/t This card certifies that: SCOTT Cr,EpRGOt1LIS 96 ARLINGTON AVEN y SCOTT GEORGOULZS DRACUT MA 01526, e has completed a 10-Hour OSHA Hazard Recognition Training for the Construction Industry. "" , . 08/23/2013 ., C/� ^— Expiration: — � 10/2112017 Cliroctor:Scott MacKay Trainer:Taylor Sikes Grad.Date: Commissioner