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Home My WebLink AboutBuilding Permit # 6/20/2016 NORTH BUILDING PERMIT 0 ma TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ll -20 lb" Date Received ORATED Date Issued: ®rid geth 'V-SACHUS IMPORTANT:Applicant must complete all items on this page 0 TYPE OF IMPROVEMENT PROPOSED USE Resj'de tial Non- Residential ❑ New Building -, One family Ei Addition Two or more family El Industrial 7!Oteration No. of units: [I Commercial Repair, replacement L–i Assessory Bldg El Others: -i Demolition Other All M 5i Watershed District Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6 FEE: $ 0V Check No.: L Receipt No.: 3 79 NOTE: Persons contracting wit unregistered contractors do not have access to the guaranty fund Signature,of AgentlOuunernature of contractor - I , — Ft4®RTH Town of Andover ", 4: W_A_"h ® LAKE ver, 6$SS, COCMICH$WICK U BOARD OF HEALTH Food/Kitchen PEn... MIT T LD Septic System THIS CERTIFIES THAT .....-... ,,,,,, BUILDING INSPECTOR . Foundation has permission to erect.......................... buildings on .... ...... .. ...... ...... .. ......... .... . . Rough tobe occupied as ........571tAp...... ........... .. ... .... ................................................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST 10Rough Service -.0 " . ......... .. ...... ..... ..... . ........ ........ ...... Final BUILDIN SPEC ®R GAS INSPECTOR ccupancy Permit Required to Occupy By Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be ®one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 96 Arlington Ave. Dracut,MA 01826 Al Greene—Mrfwor of Field aOper;'I iuns 1-978-453-4242 Office 1 978-888-1700 Cell reo� rgoulisl4l Qaol,coin CONTRACT Jim Mullin 05/14/16 6 Lavender Cir. N,Andover,MA 1-978-884-0705 jvvi-nullin@comcast.net Job Location:6 Lavender Cir.N.Andover,MA Scope of Work: Remove all.layers of shingled roofing down to wood deck on entire house,additions,and garage roofs,protecting the landscaping and house body with heavy duty tarps as stripping is being done. Install 6' GAF Weatherwatch ice/water shield underlayment across all eaves,around chimney,around all protrusions, 3'up all rakes at all roof to wall locations,and full coverage on front porch roof Install GAF Deck Armor synthetic felt underlayment on remaining exposed roof deck surfaces. 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 Ultra HD Lifetime Architectural shingles with Timbertex hip/ridge caps on roof. Installi��ridge vent on all main ridges. Install newsp°peNot 6-1 existing plumbing pipes. Inspect and properly seal aII seams and joints of lead flashing on existing chimney. 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 damaged plywood decking(if needed). Entire job includes GAF Systems Plus Warranty. First 50 yrs.Is non-prorated,full labor and material coverage from GAF,against any material or installation defect cause,and is transferrable one time. WE Plt.OPO' E hereby to furnish material and labor complete in accordance with above specifications, for the sum of, btt. 4,11(0%30.00 -rGa30.00 CK Seventeen Thousand Eight Hundred Thirty Dollars $17,830.00 PAYNIPIVI'TO 131:MiADI:AS FOLLOWS: $6,830.00 PAID IN ADVANCE TOWARD MATERIAL COSTS.$11,000.00 BALANCE PAID IN FULL WHEN JOB 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 wotkinan Tike manner accon5mg to specifications submitted per standard practices.Any alteration or deviation from above specifications involving 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 to carry fire,tornado and other necessary insurance.Our workers are fully covered by workers compensation insuran Georgoulis Authorized Signature This proposal be withdrawn by us if not accepted within 30 days. ACCCptan"C' J, rop seal-The above prices,specifications are satisfactory and are hereby accepted. You are authorized to do the work as specified, Payment will ma as utlined above. Signature Signature Date of acceptance 5 ltn 1 64 Auer, T1u.G tlSq� . The Cantnrarzweulth of Massachusetts W. Department of'Industr'ictlAccUents I Congress Street, Suite 100 Boston,MA 021142017 www.nutss.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant 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): 1.0 I am a employer with 10 employees(full and/or part-time). 7, ®New construction 2.®1 am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3, I aa homeowner doing all work myself[No workers'comp.insurance required.]t m 10 ®Building addition 4.®I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole i I.E]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5,C]1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.® p Roof 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#I 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or riot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer•that is providing rvorkers'coinpensatiort insurance for nay employees. Below is the policy and job site information. Insurance Company Narne:Admiral Insurance Company Policy#or Self-ins.Lie.#:WC009774283 Expiration Date:9/25/16 Job Site Address:6 Lavender Circle 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 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 form 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 to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify ttnd ritep 'ns ndpenaltie, 6! perjury that the information provided above is true and correct. Si nature: ® Date: Phone#: Official use only. Do not write in this area,to be completed by city or toren official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE (MMIDDNYYY) ACC)/ CERTIFICATE OF LIABILITY INSURANCE 03/11/2016 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 WANED, 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. NAME: GALLANT INSURANCE AGENCY,INC. 11 E Ed. (876)263-3500 FAXNo, (978 )263.1438 199 GREAT ROAD/P 0 BOX 975 E-MAIL ACTON MA 01720 AD SS• PRODUCER 36702 USTO ER 10: INSURER(S)AFFORDING COVERAGE NAIC N INSURED James River Insurance Company GEORGOULIS CONSTRUCTION INC. INSURER : p Y C/O SCOTT GEORGOULIS INSURER B ; Chartis Insurance Company 96 ARLINGTON AVENUE INSURER DRACUT MA 01826 INSURER D: INSURER E INSURER F 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 P1111 MITS SHOWN HAVE BEEN R UCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADO'L SUBR POLICY EFF POLICY EXP LTR INSR WVO POLICY NUMBER D LIMITS A GENERAL LIABILITY 000706700 03/05/16 03/05/17 EACH OCCURRENCE $ 1,000,000 X1 COMMERCIAL GENERAL LIABILITY DAMAGETORENTED Mca $ 100,000 CLAIMS-MADE I7OCCUR person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'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) g ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ S UMBRELLA uA8 OCCUR EACH OCCURRENCE $ ExcEss Llae CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ i RETENTION $ $ B WORKERS COMPENSATION WC009774283 09/25115 09/25/16 XWC STATI U-S Orr AND EMPLOYERS' LIABILITY YIN Zwr j ANY PROPRIETORlpARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? I� N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,deaWbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS!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 V� rra ACORD 25(2009/09) 1988-2009 ACORD CORPORATION. All rights reserve . The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and, Business Regulation 10 Park Plaza a Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration. Registration: 117870 Type: Private Corporation Expiration: 1211212016 TrIft 260054 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Mark reason for change. 1 Address ' Renewal ' Employment 1 Lost Card SOA 1 45 220M-05111 r`/1reYyrO"I MnrzrM011f>1r r"`f�zR;rrr�r%�efL; lOftice of Consumer Affairs&s Business Regulation License or registration valid for individul use only 1 ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 117870 Type: Office of Consumer Affairs and]Business Regulation x iration: 12!12/2016 Private Corporatior. 10 Park Plaza-Suite 5170 "U p Roston,MA 2116 GEORGOULIS CONSTRUCTION,INC. 1 SCOTT GEORGOULIS 96 ARLINGTON AVE ;,r� �Y _,_._ DRACUT,MA 01826 Undersecretary Not valid without signature ..... ... ... ..... �,__. _ ...__. . . Massachusetts Department of Public Safety Board of Building Regulations and Standards 13111010-6955849 License; CS-058498 L1CSanDiego Extension Sgatree9ca,'ll Construction Supervisor INTERNATIONAL SAFETY EDUCATION INSTITUTE(ISEi) arti This card certifies that: SCOTT C GEORGOULI'S 96 ARLINGTON AVE11 SCOW GEORGOULTS DRACUT MA o1826- has 1826ehas completed a 10-Hour OSHA hazard Recognition Training forthe Construction Industry. / � ....,. 3 08/23/2013 .��. CA---- - ` '" Expiration: 1012112017 Director:Scott MacKay TraineTaylor Sikes Grad.Date: Commissioner