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Home My WebLink AboutBuilding Permit # 10/4/2016 VkOR*" BU .ILDING PERMIT 4U 0 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EAMIN A I Permit NO: Date ReceitNl/ TO U Date Issued: IMPORTANT: Ap licant mist cornplete all items on this rr ,,,,. 'fir ;,�,'., /a� r l ,- '' - r. l- ,r ,, ,. ';:". / / r /�/ e// /„J/ /. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 11--;-0�ne family Addition Two or more family ❑ Industrial No. of units: I Commercial .......... � eration L"kepair, replacement Assessory Bldg L-1 Others: Demolition Other v // s10/1 Identification Please Type or Print Clearly) Phone: OWNER: Name: 7 Address: /5 r //, / , / it ,i �/ ARCH ITECT/ENGI NEER Phone: Address: I Reg. No. FEE SCHEDULE:BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: Check No.: L11- -LI`43 Receipt No.:_-, �° . NOTE: Persons contracting wi unregistered contractors do not have access to the guaranty.fund Signature of Agent/Owner f ' t%oRTII '4 Town of 6 ndover 0 1 No, AIL �o . LAK, h ver, Mass, 4� Aq. eoc"Ic"awltK 4' �.9 a�R tF o S V BOARD OF HEALTH PER DFood/Kitchen Septic System THIS CERTIFIES THAT ..... ........ v , S BUILDING INSPECTOR has permission to erect ....... buildings on � Foundation s .. Rough to be occupied as .......... , . .. ... .. .�i�.�f................................................................ chimney provided that the person accepting t s 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 MONTHS Fina! PERMIT EXPIRES I 6 MOTS ELECTRICAL INSPECTOR UNLESS CONSTRUC N START Rough t Service ... .l�1... ..� ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occ ipaUI Permit Required to Occupy Building 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 pet. GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut,MA 01826 Al Greene-Director of Field Operations 1.978-453-4242 Office 1-978-888-1700 Cell eor o M4101aol.com CONTRACT Mike Foraste 07/09/16 990 Forest St. N. Andover,MA 1-617-504--7853 mcforaste@gmafl.Co11'!. .lob Location:990 Forest St.N.Andover,MA Scope of Work; Remove all laycrs.of shingled roofing down to wood deck on entire house,bay window,and garage roofs,protecting the grounds,landscaping and house body with heavy duty turps as stripping is being done, Install GAF Storm Guard ice/water shield underlayment 6' across all eaves,around chimney,around all protrusions, T up all takes at all roof to wall locations,and full coverage on bay window 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 HD Lifetime Architectural shingles with Timbertex hip/ridge caps on roof. Install GAF Snow Country ridge vent on all train ridges. Install new stack pipe boots on exiting plumbing pipes. Install new bathroom box vents to replace existing vents. Install new rain diverter above front entry-to replace existing rain diverter. Install new lead flashing on existing brick 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 PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum of { Le Eight`Thousand Eight Hundred Thirty Five Dollars $8,835.00 bet i P-k4 , 83 .00 a ll W 1'AYM1:N'['7'013G MADE AS t-C)LLOWS: '. ` �$ IG $2,835.00 PAID IN ADVANCE TOWARD MATERIAL COSTS.$6,000.00 BALANCE PAID IN FULL WHEN.JOB IS COMPLETELY FINISHED ACCORDING TO THE ABOVE LISTED PROPOSAL. AR 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 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.Ownerto arry fire,tornado and other t necessary insurance.Our workers are fully covered by workers compensation insuranc Georgoulis Authorized Signature This proposal may be withdrawn by us if not accepted within0 days. Acceptance of Proposal--n€e above prices,specifications are satisfactory and are hereby acceptedYQa are authorized to do the work as specified. `_. Payment will be made as outlined above. c �i As agreed to-with Al Gree€ `on S ptem er 15.2016 email,the price will include the shed as wel, Si nature v�+� Si nahue Date of acceptance q LG f�(p 1; g P The Commonwealth of Massachusetts Department of Industrial Accidents I Congr-ess Street,Suite 100 Boston, MA 02114-2017 WWW.Mass.kovIdia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Apulicant Information Please Print Legibl 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.E]I am a employer with 10 employees(full and/or part-time).* 7. El New construction 2.n I am a sole proprietor or partnership and have no employees working for rrie in 8, E]Remodeling any capacity,[No workers'comp.insurance required.] 9. n Demolition 3.[31 am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 n Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on illy property. I will ensure that all contractors either have workers'compensation insurance or are sole ILE]Electrical repairs or additions proprietors with no employees. 12.r]Plumbing repairs or additions 5.0 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 Raaf repairs 'these sub-contractors have employees and have workers'comp.insurance.1 6.F-1 We are a corporation and its officers have exercised their right of exemption per MGL 0. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required] IL *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation Policy information. t llomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for ittv eniplqvees. Below is the policy acrd job site information. Insurance Company Name:Admiral Insurance Company Policy#or Self-ins.Lie.#:-W-CO-0-9,7-74283 Expiration Date:9/25/17 Job Site Address:990 Forest Street 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatip, I do h erehy certif ender re iris rind pe dtiev oJ'peijuiy that the information provided above is true and correct, I Si nature: Date: Phone#:9784534242 Official use only. Do not write in this area,to he completed hp city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk A.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Pei-son: Phone#: 3 I 7ATE ,,1M1W1DDNYYY) CERTIFICATE OF LIABILITY INSURANCE1190/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the cortlficate.holder in lieu of such endorsement(s). PRODUCER Phone: (978)283-3500 Fax: (978)263-1438 NO€N'ACT Gallant Insurance Agency,Inc. GALLANT INSURANCE AGENCY,INC. PHONE FAX 199 GREAT ROAD 1 P 0 BOX 975 Arc Na ExM 978 263-3500 Ac Ne: {978)263-9438 E-MAIL ACTON MA 01720 o Ess: _ INSURER($)AFFORDING COVERAGE MAIC it INSURERA :James River Insurance Company GEORGOULIS CONSTRUCTION INC. �INSORER8 :Granit State Insurance Company CIO SCOTT GIORGOULIS INSURERC 96 ARLINGTON AVENUE INSURER D: DRACUT MA 01826 INSURERE INSURER F COVERAGES CERTIFICATE NUMBER: 52085 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRNSR TYPE OF INSURANCE Ws0 y yp POLICY NUMBER POLICY EFF POLICY EXP LIMITS MMIOD MbI%R _ _ A X COMMERCIAL GENERAL LIABILITY 000706700 03105/16 03/05/17 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADEOCCUR DAMAGE TO RENTED _ 100 000 PREMISES(Ea occurenco) MED.EXP(Anyone person)_ $$ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- _J_ POLICY D JECT LOC PRODUCTS-COMP/CP AGG $ 2,000,000 OTHER: mm $ AUTOMOBILE LIABILITY COMBINED SINGLE OMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDAUTOS AUTOS BODILY INJURY(Per accident) $ — HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS €per accldent) $� $ UMBRELLA LIAB OCCUR _ EACH OCCURRENCE $ �_ EXCESS UAB CLAIMS-MADE AGGREGATE $ DEC) I RETENTION$ $ B WORKERS COMPENSATION WC009774283 09/25/16 09/25/17 X 5 ATVTE__ ERH AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNEWEXECUTIVE YIN E,L.EACH ACCIDENT $ �... 100,000 OPFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ (Mandatory In NH) N f A 100,000 If yes,describe under -- DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Add€tional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of N.Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: Theresa M. Farrah ACORD 25(2014101) ©1988-2094 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD R rtrxe o Office of Consumer Affairs and Business Regulation !' 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 117870 Type: Private Corporation Expiration: 1 211 2/20 1 6 Tr# 260054 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Marls reason for change. I Address ' Renewal z Employment j ' Lost Card SCA 1 4455 2OM-05/11 ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only MI .- ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 117870 Type: Office of Consumer Affairs and Business Regulation b xpiration: 12/12/2016 Private Corporatior. 10 Park Plaza-Suite 5170 Boston,MA 2116 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE � ,y DRACUT,MA 01826 Underseeretary Not valid without signature Massachusetts Department of Public Safety . ` Board of Building Regulations and Standards I.cSE1I.0I0-6958,49 ._ License: CS-058498 1JC an j p� Extension sipn Ap1fg�er c Construction Supervisor INTERNATIONALSAFMEDVCAT10NINSFITUTE(ISEl) '2"'2=�� SCOTT C GEORGOULIS,:,,,,, This card certifies that: 96 ARLINGTON AVEt4i SCOTT GEORGOULZS DRACUT MA 0182s has completed a 10-Noor OSHA hazard Recognition Training forthe Construction Industry. .OK— 0$123/201 �.�n �.� = expiration: Di 10/2112417 Director:Scott MacKay Trainer:Taylor5ikes Grad.Date: Commissioner