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Home My WebLink AboutBuilding Permit #172 - 118 SECOND STREET 9/5/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �sS�cNue°4 �/ Permit NO: �" Date Received: Date Issued: I 0 IMPORTANT: Applicant must complete all items on this page LOCATION — a0 '6e.0 a V r Print PROPERTY OWNER V / I n r � �) Print MAP NO.: 1, PARCEL: �' ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building 0 One family U Addition XTwo or more family 0 Industrial 1, Alteration No. of units: E Repair, replacement ❑ Assessory Bldg 0 Commercial ❑ Demolition 0 Moving(relocation) Other 0 Others: 0 Foundation only DESCRIPTION OF WORK TO BE PREFORMED Fcon4- ao,, J re-Qr roo(--- n, & Identilication Please Type or Print Clearly) OWNER: Name: O C[(/t (� �}'� O F-7�/l Phone: j7L'.Sba-y/3 Address: 31P;n e- PIA`.� l�� o x f �l , G l U l q o'►/ - CONTRACTOR Name: &eO(-A t k-,/14 S C o T =✓IC, Phone: 77f-%y `e 4/Oe:P Address: q9 CZ`li v e- ,9(' ,,, Supervisor's Construction License: l>,6,-g Ile Exp. Date: /O- a/-o 7 Home Improvement License: //C? (??o Exp. Date: /,I - /V-O ARCHITECT/ENGINEER Name: Phone: .address: Reg. No. FEE SCHEDULE:BULDAG PERMIT:,SI0.00 PER$1000.00 OF THE TOT4L ESTIMATED COST BASED ON 5125.00 PER S.F. Total Project Cost I � �Id'Oc�. eJ x10.00=FEES � Check No.: '.3 Receipt No.: Page lof4 TYPE OF SEWARGE DISPOSAL Public Sewer - Tanning./Massage/Body Art _. Swimming Pools ,J _ Well iJ Tobacco Sales Food Packaging/Sales Permanent Dempster on Site Private(septic tank,etc. — Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of Contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF- U FORM DATE REJECTED DATE APPROVED PLANNING &DEVELOPMENT ❑ 1 ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION. ❑ ❑ COMMENTS Lv DATE REJECTED, DATE APPROVED HEALTH ❑ ❑ 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 Temp Dumpster on site yes__no-,�— Fire Department signature,date_ Building Permit :approved and Issued by: Wage,ot4 Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided DIMENSION Number of Stories: Total square feet of Floor area,based on Exterior dimensions. Total land area,sq. ft.: NOTES and DATA—(For department use) Pale 3 uI'd 7c:INSPECTIONAL SER\,ICES DLIIAR'fMLN'1:13PFORM05 (1'caicd I�IC.lan.'(dio Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMEN'rMFOR5105 Page 4 of 4 Location No. Date ' MORTq TOWN OF NORTH ANDOVER Certificate of Occupancy $ • orb+��.. .` a ITSus t� Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ t I Check # 19547 C-4�k Building Inspector NORTH Town o RAndover 0 0% No. W over, 01'. SW 0 Mass., 0 t�- L A /fesCOCHICHEWICK 0RATED BOARD OF HEALTH Food/Kitchen PERMIT .T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... ....avtd......... ............................................................................ Foundation has permission to erect........................................ buildings on.... ....... ...... Rough 6 Chimney to be occupied as........ provided that the person acceptingi is permit---- - shall in every resp onform to the terms of the application on file in Final 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 Ile wvww� PERMIT EXPIRES'IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR 0 S Rough U< MT S-A - BUILDING- -.- Service INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. f�Li-15-20CJ6 i��s� Lowur Jq M Ami _ _.. - • - .- - --- • , Ci i?C)'s<CiE7i 5R0 )i'I NC's a MN'.S,e ;,lC', 96 ARI.INGTOM AVC DRACUT MA 01526 MA(973)-453-4242 Md(603)-89S4657 Toll Free(800)-340-KOOF Pax(978)-458.9997 Ctnail-&rjnc,,ljrr nhon.cont 08/15/06 DAV.ID,MORTON JOB LOCATION; 26 PINE PLAIN ROAD 115-120 SECOND STREET AOXPORD,MA 01921r' tN-ANDOVER,MA A 975-502-6376 W#781-981-3186 wr , o► .l r71't11ii"Ou �� .✓ k��6 Z Remove ROOF WN TO WOOD DUCK ON REAR MAIN ROOF ABOVE VALLEY AND FRONT MAIN ROOF BETWEEN V LF.VS ABOVE FRONT DUCK ONLY.ALL OTHER ROOFS EXCLUDIM. -INSTAL t GAF 10E/WATP.RSHIP,LD UNDERLAYMCNT ON AWVE ROOF EAVES AND VALLEYS. FNSTAI.I. S-LR FELT PAPM OVEREXPOSED BOARDS. INSTALL r HEAVY DUTYA25 ALUMINUM DRIP CUGE.ON ABOVR ROOF PERIML'•TOM. INSTALL OAF'f1MOERLINE 30-YEAR ARMTECTUAL SII1NGLUS ON ABOVE MT;HONED ROOD. INSTALL NEW FLASHING ON PLUMBINC PIPES. INSTALL CORAVUNT RIDGEVENT ON ABOVFRIDGE AND NINE(9)BOX VENTS ON ABOVE ROOM REMOVE ALL DEBRIS FROM PROPERTY. FIVE(S)YEAR WARRANTY ON WORKMANSHIP. 53.00 PER SQUARE FOOT TO REPLACE ANY DAMAGED ROOF BOARDS. $60.00 PER SHEET TO REPLACE ANY DAMAGED PLYWOOD ON ROOF. NOTP.;$5400.00 ABOVE CONTRACT PRICE TO 1NSTALL'r COX PLYWOOD OVER EMS'ti ING ItOOF SOAMR ON ABOVE MENTIONF.A ROOF DECK 11-DETERMINED THAT R06F DECK IS UNSUITABLE.FOR NBW ROCU'. WI: 11,01114 Nl•=ha'eby to[tmtish Matmial and labor-complete In accordance with above•spocJlfet tiom. for the sum of. NINE THOUSAND BIGHT HUNDRED DOLLARS 49800.00 PAYMP.W TO DC MADE AS MUMS; IM M00 PAID IN CULL WHEN M-nTKRIALS ARRIVON SITE.S6000.1M PAID IN PULL WHEN JOR LS COMPLEMELY FIM-Sffg>ACCOROIN(:1Yf TNI:AAM 1 W_ZV PROPOSAL All malarial i%guarsace i to be so s w4cd.All tivali b be aaePhAW in a IoUtaQBd workman Me woun auaading to 4=1remionn sabmivad owstasdard lVMWW;,Al*allostion m dcvixdm rront*ovasftdriaAim bavolving Dari sort%+ill be only am amtrcn ordal.and Will kuarne ter Boa eherge over and abort the awmnc All 4rcc itan c WfiW4t upw strikaa ud&lua or dt b*$brytn�d wr Owner M cant'lim tomedo old adwr aeecu"insutmoo.Our worker+m fully awao0 by worttae — Authorired$i mule This Proposal may be withdrawn by us If rM accepted within 10 dayr.. :111a+:e:l-11oabovePrlra.VtAff426UMWeand wehweby . You WC. to do aw 211"" t wH!be nod vr� Sigr►atwe ;igrtatuee .Data of accePU rcc TOTAL P.02 it 0 i � T1�e �oom►�nw�uuea/,� o�✓G�,aaaaclauaet,<a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:.-1.17870 -- Expiration: 12/12/2006 Type: Private Corporation GEORGOULIS CONSTRUCTION,]NC. .SCOTT GEORGOULiS 96 ARLINGTON AVE DRACUT,MA 01826 Administrator ✓frr �ona�nunr«eall� a�-�t!ii,:3a�uaell6 i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 058498 i Birthdate: 10/21/1966 i Expires: 10/21/2007 Tr.no: 5948.0 - Restricted: 00 SCOTT C GEORGOULIS 96 ARLINGTON AVE G- DRACUT, MA 01826 Commissioner , r i 1 The Commonwealth of Massachusetts Department of Industrial Accidents Ra Office of Investigations - e 600 Washington Street Boston,MA 02111 5�. www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 6e 17C,, Address: City/State/Zip: _ ��Dl Phone #: 4r"" '"� bC� Are you an employer? Check the-appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 6. New construction 1. I am a employer with ❑ eart-time to ees full and/or .* have hired the sub-contractors mP y ( p ) listed on the attached sheet # ? [-j Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. F] Demolition working for me in any capacity. ` workers' comp.insurance. 9. ❑ Building addition o workers' co insurance 5. ❑.We are a corporation and its [No � officers have exercised their 10.❑ Electrical repairs or additions required.] - 3-❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or, additions myself [No workers' comp. c. 152,§1(4), and we t emphave no 12.❑ Roof-repairs employees. [No workers' insurance required.] 13.0 Other 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 must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ant an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: Q — �O Policy#or Self-ins. Lic. #: �.- 49 q Expiration Date: Job Site Address: SeC a, � ✓�� City/State/Zip: /1-Q�t ��✓Q/'i�1e; T Attach a copy of the workers' compensation policy declaration page(showring the policy number and expiration date)... Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 fihe violatoF-Be advised that a copy of this statement may be forwarded to the Office .of Investigations-of the DIA-for insurantyenovei;ig verification. I do hereby.cer tify urtd the pains mrd penalties of perjury that the it formation provided abovve is true and correct Si ature: Date: Phone#. s F l use only. Do riot write in this area,to be completed by city or town officialr Town• Permit/Ucense# g Authority(circle one): rd of Health 2•Building Department 3.City/Town Clerk 4.Electrical Inspector 5-Plumbing Inspector nr FROM (FRO SEP 1 2006 15 :34/ST. 15:33/No. 6836136942 P 2 CERTIFICATE OF LIABILITY INSURANCE °9;/2006 "Y' PRODUCER (978)459-2101 Ext. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Daigle Company, Albert A. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 313 Wi I lard Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW_ Dracut, MA 01826-5099 INSURERS AFFORDING COVERAGE MAIC N INSURED aeorgoulls Construction Inc. INSURER ALIO ds London 96 Ar I i ngton Ave. INSURER B:Aver lean Home Assurance Dracut, MA 01826 INSURER C: INSURER D: INSURER E COVERAGES 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 1S SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS DD• POLICY EFFECTIVE POLICY EXPIRATION LTR E OF INSURANCE POLICY NUMBER LIMITS GENERALLIAMLm EACHOCCURRENCE s 1,000,000.00 MMF TO RENTED X COMMERCIAL GENERAL LIABILITY LOL059893 02/15/2006 02/15/2007 PREMISES a oewrome $ 7CLAIMS MADE �OCCUR MED EXP(Any ono Pwam) $ 5,000.00 { A PERSONAL&ADV INJURY S 1,000,OOO.00 77 GENERAL AGGREGATE s 1,000,000-00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 1,000,000.00 POLICY PEO - LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s ANY AUTO (Ea acadanq ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Pa Peed HIRED AUTOS BODILY INJURY = NON-OWNEDAUTOS (Per PROPERTY DAMAGE s (Per accident) - GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG E EXCESSAUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ i $ DEDUCTIBLE s ]RETENTION $ $ WORKERS COMPENSATION AND WC ST TU' O R EMPLOYERS'LIABILITY ANY PROPRIETORlPARTNERIEXECUTIVE WC782-68-24 09/25/2005 09/25/2006 E.L.EACH ACCIDENT s 100 000.00 B t OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOY s 100,000.00 11 yas AL PROVISIONS below a under IAL PRE.L.DISEASE-POLICY LIMIT ; 500 000.00 SPEGt OTHER i DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS S I CERTIFICATE HOLDER CANCELLATION David Morton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 118-120 Second St. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAzjAw TO DO SO SHALL N. Andover MA 01810 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE 1 REIT,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED�ATl ACORD 25(2001/08) CORPORATION 1988