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HomeMy WebLinkAboutBuilding Permit # 12/13/2016 (2) ORTN BUILDING E IT TOWN OF NORTHANDOVER APPLICATION FOR FLAN EXAMINATION Permit NCS: � � Date Received Date Issued: wCHus im ORTANT:Applicant must cum lcte all items on this page rr rr, „r r / r / r 7it/ i r r r ri ri � <r a, ;c <,,,,,✓i/..ri/�. //,,,,,., /%f �"" .,.,;,/ / //. „ r, r/ / "<r r // ,,.i. ,,, ri. ��i// %i ii r�////,/ ,iii . r� / ,,,�� � ,'n .��� r. /r/ ,/„� .ri,,,,, / / ,,.,ri,rr: ar //„ ,r,,,, ,✓J, ”, ,r ///�//rr,, ,/ �./�/%// oi''.. r e / ///ii/,// / /i/'✓r%/iii/ilii///tai r ...,, / ri � / rrr i TYPE OF IMPROVEMENT P'ROP'OSED USE Residential Ikon- Residential E New Building 1 One family I I Addition -1 Two or more family I Ind„pstrial Iteration No. of units: i' commercial � epair, replacement Assessory Bldg I Others: I I Demolition _1 Other YY„i / r; �, /ii tri/ir/,�/i%' ?'//4p -77—/ //i//�. / ii/ / / /, r ,� /// <.. / /i/////i /,,..�/l/ ,,,. /ii // „✓:kk,,, /r �i/j /�r/�r„,�� 1;�rii;�,,, 2� %�//,/,/%%���j za tdentifeation Please Type or.Print Clearly) OWNER: Name: 4,h�::' Po .._ .�_ . Address: ;;rr/ir< r r. "� ..,�, r, , ,,,e ,✓ �,,, r., ;, r �//r r,,.,, div /; � / rr/,. /: „///%/ .. „ar ,� ✓.. o ,.,, /... r / of / / / r ,, //. r /// ✓. r�,r , r </ r / /r / r/ r �. r r ,,.,, ,.,,,.,,,,,, ,,./„ /,r, ./ ,,,,,,-„ i/ ,,. % , ///, ,.,- ri/ r ✓ rrrr ,... / , /: ,ierv. rr ,iii, „,,, r �l/.rr // /i r r, v. ✓,r iii% � / /i� / %/ r.. ,.,ir l „r ,..✓ „ r r.. /, / o", /�� / e.r r ,�,,.. -. fi/rr ..,r, ,r ....,. ✓ ri.. ,;,„ rii /alis. �� -- - �� �w� ARCHITECT/ENGIN honk. - u Address: Reg. No. EEE SCHEDULE:BULDING PERMIT:$9,2.00 PER$9000.00 OF THE TOTAL ESTIMATED COST SA SED ON$92&00 PER S.F. Total Project Cost: gym . FEE: $ hp Check No.: ( � .. "... .�„ Receipt No.: i NOTE: Persons contracting with unreistered contractors dry not have access to tl guarantpfund Signature of gentf ef� � ture of'oof�t�� � �w ................. ................................. .................. .............. .. ..... ........... ..................... ............................... ..... t%ORTP:_ FI Town a over No. h ver, Klass • ;10 TE D JL? BOARD OF HEALTH PE I Food/Kitchen LD Septic System THIS CERTIFIES THAT ab BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ..... ... .......I.m.).. ... . ........ .. ..ti.... goo, r a Rough ...ft ... .......e to be occupied as AS .... .... ..... m...�m-4 & L .... Chimney provided that the pe Ing this permit shall in eviry respect conform to the S of the application i 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 MONkTS ELECTRICAL INSPECTOR UNLESS CONSTRUPjNST TS Rough Service ......................... ...... ......... .......... Final BUILDING INSPECTOR I GAS INSPECTOR Occupancy Permit Required to Qccupv 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 Det. �-eo V.; UJ GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut,MA 01826 At Greene-Director of Field Operations 1-978.453-4242 Office 1-97"88.1700 Coll aeoraouIis 141&gLcAn—i CONTRACT Norman Lee 08/07/16 Re: 946 Osgood St. N.Andover,MA 1-978-375-7744 rilee@ncsne.com Job Location-946 Osgood St.N.Andover,MA Scope of Work (Siding) On back side of restaurant,back half section of driveway side,and back quarter section on street side. Strip all existing vinyl siding, Fur out the area behind condenser unit,replace the rotted soffit area with new pre-primed pine. Install new Tyvek house wrap and 3/8"foam insulation board on entire body of restaurant where stripped. hislall new white,vinyl vented soffit panels on all soffits.Cutting open wood soffit for venting if needed. Wrap all L.'Xistilig flacial,rakc,Shadow alO�,vhldow trim with new white.019 all.1111111um coil stock. Install new Certainteed"Monogram.046",Double 4"clapboard style,vinyl siding on entire specified wall areas,with standard S"vinyl corners,and vinyl light/outlet blocks. 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 wall sheathing(if needed), Entire jobs comes with Georgoulis Roofing,Inc.full 10 Yr.installation warranty,and a lifetime warranty from the manufacturer Certainteed on all materials. WE,PROPOSE hereby to furnish material and labor complete in accordance With above specifications, for the sum of. (0330.00 CV-0 II(A Sixteen Thousand Three Hundred Thirty Dollars $16,330.00 12%116 PAYMENT TO BE MADE AS FOLLOWS: !6 �Q.PA�IDIN��DVAN�F- �1 COSTS. ��ALAN P r L S rLr C TOW T L S��THR'��B D��PROP��OSA Win OR IS CO� F To �A 11%1 G �Nj T�LY F�NS H�C�O All material Is guaranteed to be as specified.All work to be completed in a substantial workman like manner according to qppcificatians,;ubminod pvr Siftwlard pmqioes,AnyolicraUQn or drviiAkm mors,0130--,Pvvif'GR1iQ13S;T1v0)viA1g extra costs Will be executed only upon written orders,and will become an extra charge over and above the estimate. I All agreements contingent upon strikes,accidents or delays beyond our control. "I Owner carry t tornado and oflier �I necessary insurance.Our workers are fully covered by workers compensation insunia, Georgoulis Authorized Signature Thisproposal may be withdrawn by us if not accepted within40 days Acoeptaricu of-Prop -1-rha above mice",specifications me,s465fihctory and tu-C hereby acceptcd, you use jaiAlitirized to do Ov.,work as q1w6fle(L Payment will e in do o ith d abo Date of accept Ilk /rk acceptance Signature ature The Commonwealth of Massachusetts Department of Industrial Accidents A I Congress Street, Suite 100 Boston, MA 02114-2017 1VWfV.n1ass.goi'/(1ia Woriiers,Compensation insurance Affidavit: Buildet-s/Contractoi-s/Electi-iciaiis/Ptijimbet-s. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le0bly Name (BLisitiess/Org-,iniz,,itiotilitidividual):Georgoulis Construction, Inc. Address:96 Arlington Av City/State/Zip: Dracut, MA Phone #:9784534242 Are you all employer?Check the appropriate box: Type of project(required): LE]laura employer with io._,,___cnil)loyees(full and/ot-I)ail-tiiiie).* 7. E]New construction 2.71 ann-it sole proprietor or partnership and have no employees working for me in 8. � Remodeling any capacity.[No workers'comp insurance required.] 9. M Demolition 3.E]I ama homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F-1 Building addition 4,n I ani a homeowner and will be hiring contractors to conduct all work oil try property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.Fl Plumbing repairs or additions 5,M 1 ars a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance., 14.F-1 Other G.©We are a corporation and its officers have exercised their right of exemption per MGL C, 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 not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I tint an employer that is Providing ivorkers'compensation insurance.1br iny employees. Below is the policy andjoh site information. Insurance Company Name:Admiral Insurance Company Policy It or Self-ins,Lie.It:WC009774283 Expiration Date:9/25/17 Job Site Address.946 Osgood Street City/State/Zip:N.Andover MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(late). Failiare to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine tip 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$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatiot 1111, Idohereby certify tMdei ��nsanflpei ties of perjury that the inforinationprovided above is true and correct. �A ' Signature: Date: Phone Official use only. Do not write in this area,to be completed by city or toivll official. City or Town: Perinit/License,#___ Issuing Authority(circle one)' 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector C.Other Contact Pei-son: Phone M ACIOR"' CERTIFICATE OF LIABILITY INSURANCE OATS ;MMIODIYYYY, 09/30/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the polioy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). 's PRODUCER Phone: (978)283-3500 Fax: {978)263-1438 Y €CONTACT Gallant Insurance Agency,Inc. d GALLANT INSURANCE AGENCY,INC. PHONE FAX-- 199 GREAT ROAD 1 P O BOX 975 (ac,rao ExI (978)263-3500 _�L..No): (978}263-1438 € E-MAIL ACTON MA 01720 Afl0RE5S', _ INSURER($)AFFORDING COVERAGE NAIL# INSURERA :James River Insurance Company_ NS1JRtb GEORGOULIS CONSTRUCTION INC. INsuRFR B :Granit State Insurance Company CIO SCOTT GEORGOULIS INSURERG 96 ARLINGTON AVENUE fNSURERO: DRACUT MA 01826 INSURER E 1NSURER 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 GERT$FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR TYPE OF INSURANCE :ADDL Su8R POLICY NUMBER POLICY EFF POLICY EXP LIMITS _LTR _ _- "D WVO-. .....,..,_ __ -..-.._._ LMMI�QF/YYY (MnuDDIVYYY)..._ A X COMMERCIAL GENERAL LIABILITY 000706700 031051'16 03/05/17 EACH OCCURRENCE$ 1,000,000 DAMAGE f6 RENTED '1 l CLAIMS.MADE X I OCCUR PREMISES(Ea accunance) $ 100,000 { MED.EXP(Any one person) $ 5,000 { PERSONAL&ADV INJURY $ 1,000,000 _..1 GEN'L AGGREGATE LIMIT APPLIES PER: j GENERAL AGGREGATE $ 2,000,000 POLICY�J PE LOC i 'PRODUCTS COMP/OP AGG $ 2,000 ODO ,.... .,0 OTHER: j _ _.. 1 $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY � (Ea accident) � $ ANY AUTO I BODILY INJURY(Per person) I $ _ SCHEDULED .....,--- ------.......... ALLOWNE.D BODILY INJURY(Per accident) $ AUTOS AUTOS HIREDAUTOS NON-OWNEDPROPERTY DAMAGE -- --- -- AUTOS Ipereccident} $ -._.-..._ .w....--- ---............ ......-- -- __.... UMBRELLA LIAR OCCUR o EACH OCCURRENCE $ EXCESS LiAB CLAIMS-MADE AGGREGATE $ DED I IRETENT€ON$ B WORKERS COMPENSATION k WC009774283 09/25116 09/25/17 PER ,ETH AND EMPLOYERS' LABILITY X STATUTEER _ ANY PROPRIETORIPARTNERIEXECUTIVE 4Yf N I E.L.EACH ACCIDENT $ - 1 OO,ODO OFFICERIMEMBER EXCLUDED? E NIAE.L.DISEAS&EAEMPLOYEE t $ 1OO,ODO (Mandatory In NH) -- If yes.desOho under I E,L,DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below 3......_ ,, DESCRIPTION OF OPERAT€ONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is requlredi I CERTIFICATE HOLDER CANCELLATION i 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. AU7RORiZED REPRESENTATIVE Attention: Theresa M. Farrah ACORD 25(2014101) O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD w . Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MaOachusetts 02116 Nome Improvement;.; 4ntractor Registration Type: Corporation Registration: 117870 Georgoulis Construction, Inc. �11�� �, w Expiration: 12/11/2018 96 Arlington Ave i Dracut, MA 01826 o t"k i 1 C� Update Address and return card. Mara reason for change. $CA1 4.5 20M-05111 n iArld r�?a� (��l'�i(+1x7/Z7//fYFIIIf"</fl✓1 t�r'�7fCJJld(°/fldJ(^�fS Office of Consumer Affairs&Business Regulation r�fie NOME IMPROVEMENT CONTRACTOR Registration valid for individual us®only Type: Corporation before the expiration date. If found return to: f 'Racfistration EX—Piration Office of Consumer Affairs and Business Regulation .,. ✓ T17870 12/11/2018 10 Park Plaza-Suite 5170 Boston,M 03a16 Georgouiis CobttruetiorlJrc. Scott Georgoulls 96 Arlington Avg Dracut,MA 01826 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards fsl 10 10itt),`w 949 License: CS-058498 /G/j°°�'�e jl erica Construction Supervises � ���—�'�n���a� ( �xten5ion Sa� �4��e. IME'aNAT'IONALSAF6YEDUCATIONIN5TITUTE.tISEI! An", SCOTT"C GEORGO6LIS, , This cart]certifies that: 98 ARLINGTON AVE,M1I SCOTT GEORGOULIS DRACUT MA 01$26 r has completed a 10-Hour OSHA Hazard Recognition Training for CheCpnstr•uction Industry. 08/23/2013 Expiration:lorxirzol7 Commissioner Director:Scott MacKay Trainer:Taylor Sikes Grad.Date: