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HomeMy WebLinkAboutBuilding Permit # 8/17/2016 %AO R T b"4 ----� BUILDING PERMIT ,� �zs~ffi.a.'': .'•aN Q TOWN OF NORTH ANDOVER ,c � APPLICATION FOR PLAN EXAMINATION Permit NO: ! Date Received ATIV Date Issued: �a�t "I CH I PORTANT: A licant must conn alete all items on this page / / .,. /i / rl�iii, er l ;,, /�/r ,r, ��/� � r///„r / a/-ri// / �,-G 1 /�r r/ J /ir „,r; ✓ /„ r r r °j �i/�i/�r„//�/////rr//N�/.i/,;/r/,.,/,r,”//�,.�//r,/ii/;//,�/ir,/��r/rro,/rr//„,/,,/:orr,r//ir/r�r/�,rr�//,,rr//e/ri„rlr irii/.,rrrS/o,I/.rr�Urril��r/�!,�/,�./�/�,r r//✓,/,,r r G�GIl/���r,,,.//./,//r/0 1 ,// �R1,/,;/;/i;i/,ri///r .r /t/r rr r, 3 (���,i/i�r///,, /,/.rr /t� ,fl// //,/%.. r "r /,r! /r! /, ,i rrr/.,,� .,r,/.a, / / r, :,,., ✓„ �. >/, .../ rr/. // r,,, „., rrr. /r,/�;„„- .., s „/ "✓ ./ i./ r ..r: / i � /,r„ r , /, r, „ ✓� r// I r�/i ,. , ra l ,,,.� r rrr,-/ G } //�r, r ,/ /,,,, � ,., /. rr ,i�„/r rr/, / -,. ,.r., r,. ,.,..1 r � + (�,�,.7r(, //,,,,✓ /rr r, Q ., Dltr�tr / ri / �� :� r ,,,,,,,r, ✓rrr � r � ��, / / r /i”"� ,r/ rrr /. ✓i: r a,,r r r r /r ,,... /. .,, / r ,r ,,,, y,,$S ,rp0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential t New Building D One family Addition two or more family 1 I dustrial eration No. of units: Commercial Repair, replacement :1 Assessory Bldg ❑ Others: 0 Demolition Other r ri nir�/ n/ �rirra 1/r/l//,/w/%l/,/ 1///� Y(J / „ OI /� ,1/, , r /✓/ /// a�i /�r,ru/ ,r, r” /,/„G /.. r w Identification Please Type or Print Clearly) OWN R: Name: A - Phon ° )/& . , . .,.. �. ,a Ad ss: r r rrr, r r / O r r ,, r r �/r l ��/,,,f%��r r /,r„r,„� / / ,, �w /,����/�/,r /� / is �, ✓ir / ✓, r / r / / r r r r// r / - r i,r lug / / / r r r / /r� ✓ r /i r r / / / it / / ////rr / G��� c i� I/o/� r� 1 r/� �////i��//�///��i�////liiG�/,. „ ,,., ✓,.....,r r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL,ESTIMATED COST BASED ON$125.00 PSR S.F. Total Project Cost: $ - FEE: $ Check No. `° F mm Receipt No. 1 La 3 NOTE: Persons contracting wit nre ist i contractors do not have access to e gu ranty fiend f ' 'CC1traCSignatureo - OtOr Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Pniblic Sewer ❑ Tanniu�assage/Body Art ❑ Swkuning pools ❑ Well ❑ Tobacco Sales ❑ Poad packaging/Sales ❑ Private(septic tank etc. ❑ Pennanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING a DEVELOPMENT Reviewed On—&I& Signature COMMENTS 5'M WQ3� A- 0"AA+ CONSERVATION[ Reviewed on Si-qnature COMMENTS HEALTH Reviewed ori Sictnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow)a Engineer: ,Signature: Located 384 Osgood Street I~IkE= DEPARTMENT Tern Dum stet, on site es:. . rso s i € p p 7 X > fr t s Located at 124 Mom Sti eetA r e,De. artmer t si na ureld r p r r �` COMMENTS :T Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL.- Movement of Motor location, mast or service drop requires approlval of Electrical Inspector Yes - �No BANGER ZONE LITERRTUREe 'des No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department use) U Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 ®RT Town of n 0 �Y No. �o ��K� h `' ver, Mass, L �D CQ� Kl MACK y1. e trep 5 U BOARD OF WEALTH Food/Kitchen PER T Septic System TM15 CERTIFIES THAT ............. J j C....... ... ... ..... .., , BUILDING INSPECTOR ' I.. � Foundation has permission to erect .......................... buildings on ,... ,.►. . ..� .... Q Rough tohe occupied as ..... .1...... ... . ... .....- 1111p.................................................................... Chimney provided that the person accepting this ermit 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 LESS CONST CTI® Rough Service Fina BUILDI INS CTOR GAS INSPECTOR Occupancy Permit Required to Occupy By Rough Display in a Conspicuous Place on the Premises -- Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CEORGOULIS ROOFING & CONSTRUCTION,INC. i 96 ArtLVmn Ayt. 1r� ,ZvU '01826 Al Greene—Director of Field Operations 1-978453-424.2 Office t-9 848's-1700 Cell �e �auEia 14 l�ao!�cirizt CONTRACT Village Green East.Condo Assoc. 07/27/16 do Property Management of Andover P.O. Sox 488 Andover,MA 1-975-583-410I Undao@pmandover.com h3bati i ;Village Green Fast Condo Assoc.N.Andover,MA Scope of Work: (Roof Replacements) Rcimve all layers of roofing down to plywood deck on entire shingled roofs of all buildings,as specified in bid Specs., Molly tarping the work areas to fully protect the house bodies,decks,and landscaping.Re-nail plywood decking as needed. Rem,oye existing siding€roan all sides of cheek wail locations to accept new ice/water shield and aluminum step flashing. Dave existing 1 x 3 shadow board from All cave lines,run ice/water shield onto fascia board 3",re-install I x 3 trim board. f, ll Grace Select ice/water shield underlayment 9'across all roof eaves,4%'in all valleys,3'up rakes at alt roof'to wall locations,around all roof protrusions,And curring up onto all face and sidewalls a minimum of 2'. Install new 6" sip over the newly installed drip edge for proper and added water tightness. Ir tall new.019"aluminum step flashing al all roof to wall locations in conjunction with ice/water shield,Install new roll Ihshing at all horizontal face walls in conjunction with ice/water shield. frail GAF heck Armor synthetic underlayment over remaining exposed root deck surfaces. loll 8".025 gauge heavy duty brown aluminum drip edge on entire roof perimeters. Infill GAF Pro Start starter strips across all caves and up all rakes. Lill GAF Timberline HD Lifetime Architectural shingles with Timbertex Hip/Ridge caps on roof,cutting ridge as nccmary to ensure there is a 1 ''/s"opening on each side of ridge pole and extending the entire length of ridge, Install new heavy duty stack pipe boots on all plumbing pipes, lLall GAF Snow Country ridgevent on all main ridges. fail new pre-pritned cedar clapboards and/or cedar shakes an all roof to wall areas where removed to properly flash and f. Painting or staining to be done by others and is not included in this contract. itall new.032 gauge aluminum rain diverters to replace any rain diverters currently it)place. Insull new lead flashing on all existing brick chimneys,properly mortar lead scam,seal all others seams for water tightness. aughly clean and magnet grounds,and remove all job related debris from property on a daily basis and at jobs impletion. Georgoulis Roofing,Inc,will comply with all OSTIA,MA,and federal safety work practices.As a GAF Master Flute Certified enactor we will comply with GAF's product specification and installation guidelines, SSt3.00 Per Sheet Extra Cost to replace any rotted or damaged plywood decking(if needed). 57.50 Per lineal Foot Extra Cost to replace any rotted or damaged fascia,rake or shadow trim boards(if needed). -Geargaulis Roofing,like.is a GAIN'Master Elite Certified Contractor job includes GAif!'s Systems Plus Warranty. First 40 Yrs.Is non-prorated,full labor and material.coverage GAF,against any material defect or installation cause, at no MI e. WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, fiW the sum of, 'n.rft Hundred Thirty Thousand Eight Hundred Thirty Dollars $330,830,00 The Cornnionwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www niass.govAlia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Busitress/Organizatiori/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.[D I am a employer with 10 employees(fill and/or part-time).* 7. ❑New construction 2.©I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'corp.'insurance required.] 9. r_1 DemolitionIF]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'cornpcnsatiorn insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 1 Roof repairs "'hese sub-contractors have employees and have workers'comp.insurance., I__I I—I p J-1 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. tContractors that check this box most attached an additional sheet showing the name of the sub-contractors and state whether cruet those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I alit an etraployer that is providing workers'compensation insurance for my eiraployees. Below is the policy all d joh site information. Insurance Company Name.Admiral Insurance Company Policy#or Self-ins. Lic.#:WC009774283 Expiration Date:9/25/16 Job Site Address:Village Green East Condo 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 S'L'OP WORD ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certifyAkwmfl=�_' er the airsof pea jury that the information provided above is true and correct. Si,,nature: Date: Phone#: Official use only. Do not write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: c`Q CERTIFICATE OF LIABILITY INSURANCE [�!E (MMMDNYYY) 3/11/2076 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(las) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Phone: (978)263.3500 Fax: (978)263-143B CONTACT Gallant Insurance Agency,Inc. NAME: GALLANT INSURANCE AGENCY,INC. PHONE (97$)2$3.3500 FAX {978)263-1438 199 GREAT ROAD 1 P 0 BOX 975 E-INA€L E�1 ACTON MA 01720 PRODUCER _ PRODUCER 36702 CUSTOMER ID' INSURERS)AFFORDING COVERAGE MAIC# INSURED IN... James River Insurance Company GEORGOULIS CONSTRUCTION INC. INSURER B Chartis Insurance Company Y CIO SCOTT GEORGOULIS 96 ARLINGTON AVENUE INSURERC DRACUT MA 01826 INSURERD: 1NSURERE 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, INSR TYPE OF INSURANCE AOD'L SUBR POLICY NUMBER POLICY EFF POLICDY EAP LIMITS LTR €NSR fYYffl WVD A GENERAL LIABILITY 000706700 03105116 03/05147 EACH OCCURRENCE S 9,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TD RENTED $ 100,000 P EMISES a ccur CLAIMS-MAOI I-XI OCCUR MED.EXP(Anyone person) $ 5,000 PERSONAL&AOV INJURY $ 1,000,000 GENERAL AGGREGATE ; 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGO $ 2,000,000 POLICY PRO-JEnr LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accldenl) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Par accident) $ SCHEDULEDAUTOS PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-OWNEO AUTOS $ S UMBRELLA LIAR OCCUR �.. EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ j RETENTION S $ g WORKERS COMPENSATION WC009774283 09126115 09/26116 X �" STi rcB DTH i AND EMPLOYERS' LIABILITY - YIN ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 900,000 OPPICERIMEMBER EXCLUDED? � NIA (Mandalery In NH) E.L.DISEASE-FA EMPLOYEE $ 100,000 DESCRIPTION NuMer DON OF OPERATIONS Galrx E.L,DISEASE-POLICY LIMIT $ 500,000 F I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Aftach ACORD 401,AddlGonal 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, AUTHORIZED REPRESENTATIVE Attention: Q ` eresa rrah ACORD 25(20 9 09) 0 1988-2009 A55RD CORF5 RATIO I rights reserved. The ACORD name and logo are registered marks of ACORD /> Office of Consumer A.ffatirs and Business Regulation R+ 10 Park Plaza- Suite 5170 Boston, Massachusetts 42116 Home Improvement Contractor Registration Registration: 117870 Type: Private Corporation Expiration: 12/12/2016 Tr# 260054 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Mark reason fpr change, 1 Address Renewal Employment [ Lost Card SGA 1 O.', POM-05111 r//rr`itpnr yrr1nru{rrll�c f r`tr r.;;orlre�sr!/i Mee of Consumer Affairs&Business Regulation License or registration valid for individul use only £'r ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ Type: Office of Consumer Affairs and Business Reputation gistration: 117870 yp 10 Park Plaza-Suite 51.70 y, ;� lvxpiration: 12112(2016 Private Gorporatior. Boston,t11A 2116 mtys., GEORGOULIS CONS71RUc°TI JN,INC. 8 SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT,MA 01826 Underseeretury Not valid without signature Massachusetts Department of Public Safety Board of Budding Regulations and Standards 1811-'11010-6955949 License: CS-05849$ CSaTiDieQfo Extension AMM dca Construction supervisor %1 INTERNATIONAL sArETy6uc;i 1cNIN571TLTEUSFI) A SCOTT G GEORG.OULIS;°.. This card certifies that: 96 ARLINGTON AVEN+'t II SCOTT"GEORCOULTS owacuT MA o1 zs has compteted a 10-Hour OSHA Hazard Recognition Training for the Construction Industry. " 08/23/2013 ,,,� CA,, Expiration; 1012112017 I Dlrnctar:Scott MacKay Trainer:Toylor5ikes Grad.Date: Commissioner I I