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Home My WebLink AboutBuilding Permit #489 - 120 SALEM STREET 12/19/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: A Date Received Date Issued: A IMPORTANT:Applicant must complete all items on this page LOCATION E' ' 1 t s• Print � PROPERTY OWNER '�::) A S Unit# Print MAP NO:✓ PARCEL: _1 ZONING DISTRICT: Historic District yes no Machine Shop Village y s no 100 year-old structure s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building kone family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ts.i`l"' Septic" ®Well ❑FFlood lainl ` tWetlandsr �` ' ' ,[7UVa e sheciDistrict DESCRIPTION OF WORK TO BE PERFORMED: V (Identification Please T pe or Print Clearly) OWNER: Name: 4�> i ��t Phone: 77(?- ave o Poc>( Address: �Sq l e/✓1 (sT s CONTRACTOR Name: &CcO a L% GD,,) 6T , Z� Phone: 97d";' %5,3-y9y Address: Supervisor's Construction License: (Y�1 ��' Exp. Date: 10- 91-13 Home Improvement License: ,�''��''70 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ A FEE: $ �1 �Q _ Check No.: 11060 Receipt No.: A (Q NOTE: Persons contracting with unregistered contractors do not have access tot guaranty fund N, �S�anature.of AdentlQwner;_ Signature of_contractor ; = 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application ❑ Certified 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) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require.sign off from Fire Department prior to issuance of Bldg Permit New ConstructionSin le and Two Family) � g Y) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit 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: Doc.Building Permit Revised 2008mi i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/Massage/Body Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ IPrivate(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS c� Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments Water & Sewer Connoction/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 1 Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department use - r Ll Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Location T No. Date MaRT� TOWN OF NORTH ANDOVER AL 3? •. p M 9 i i Certificate of Occupancy $ CMUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24896 v Building Inspector NH ORTI 0 0 over 0 No. Apt .� L A K E o , dover, Mass., 11.• ta• � t COC MIC KE WICK A0;?ATE D APS` ,CO U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT........Mt.......wa-f...........................101... .. .. ............................................�........_ Foundation has permission to erect..::...... buildings on .......1 ;onstruction .............. ...... Rough to be occupied as............ a Chimney ... . provided that the person acce ting this permit shall in every respec nform to the terms of the applon file in Final this office; and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough - Final PERMff EXPIRES IN 6 MONTHS _ ELECTRICAL INSPECTOR UNLESS CONSTRUCTIIF&T S Rough ....................... .............. ......................... ....... Service B LDING INSPE Final Occupancy Permit Required to OcLupy Building GAS INSPECTOR I Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To BeDone FIRE.DEPARTMENT; Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det.. GEORGOULIS ROOFING & CONSTRUCTION, INC. 36 Arlingxon Ave" DmM lA 01826 Al Greene.-Estimator 1-97&45-;4242 owe 1-978- -IMCCn &eorgroulisl4ldao(, qtq q C. Or 12110111 125 Sal=SL N.AmlDw,MA 1-97&208-M86 t- - -OAS mginsburg@g4gilbertandrenton wm: .yob on:125 Sam St.N Andover-Ate. Scope of Worts: Remove all layers of roofing down to wood deck on all shingled roofs of the house:bray and garege_ Ins :all 6'Of CO Wicer shield on all roofers,M- n2d&im�at all valleys,around sky and up makes at aIl roof to wall locafiom Ir II CTMShiaglernate felt paper 0M remwmg 04med roof dem 8"-025 gee heady duty black alminuin drip edge on entire roof perunete r& stall GAI+Tunbedm HD L&hme Archaachn al shingles with gnbertm cis oa roof lrnstsll new stack pipe boots on pl>mtbingpipes_ Irnstali new lead flashing&mwd boli;existing chmmey_ Irstall tneenr Caravan -40F1 ride pment an mm rids" Install mw fidl vented catatintnoas alnnmmm soffit veal on all eaves of house, andbadk adddwn- Remove aff job related oris from Prqmty on a€may basts and at jobs completim 52-50 Per Lined Ey&a Cost to reptwe array damaged plank board decking(if needed)_ S7 00 Per Lined FOM F.x1ra const to re pbee any dam Bial,ram or sbadow trine hoards(if needed). Emirs job includes CYAF Sym Plus Warmly. FRV-%Yrs-Is fitll labor and material gage from GAF- fielaly R is recommended thin all tie misting skylights be replaced with the mf My skylight over l0 yrs old should be replaced because the fladmg,Seals tend to break dD%-A,bvem,and leak. The total t4O cost to replace all(2)eustmg skylights with new-%-T would be 51,830-04 vd ich is separate from •--- dw roofing price below NNTE PROPOSE hence to funaish metrial and labor complete in acwrdanna a with above sgex ificatims, fon-the sum of Eleven ThousandThousandT&ree Hundred Twenty Pie Dollars S1IX5.00 101u PAYMLN1 fU HE MADE AS I-OLLOWS: x325.00 PAID IN ABL'ANCE,FORMMM PAID IN FULL MLBEN JOB IS CAoc- WPIZTUY FEUSHEDACC®RIiIAIG TO TIiP ABOWK I Iii MWPOSAL AU ial a Lobe as speed.AO oto be i®a > Men a �� to spmfimihons suboultodper std Pic_Any Aaatm ori fraee abo unvhMg er a cusps wdt be executed only app VkTftn ondes,and wM beams an I chop oewand above the esuwste" oonbMem%M -mss beyond ow ou,&&OWM tin—'fireL W=&and other MMMMMY -€ur IWO& s ase MY covaudby Audxdwd Sigoattue This proposal maybe withdrawn by us if acc t wkhinn 30 days- Acceptance ofProposal-Timabove p fiiMamsafisfiU*MY a9d me hMVbY acccPtcd. you areaullmdzeadtodothevW&as Pat w.benwd--asouLb=dabum e S S Date ofWQep aDM f.e 1 j it The following is part of this contract: Contractor Registration All home improvement contractors must be registered with the Commonwealth of Massachusetts. Contractor Registration#117870 and Construction Supervisor License#058498. Inquires about registration should be made to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston, MA 02108(617)727-8598. Better Business Bureau, Inc. Georgoulis Construction, Inc. member ID# 35522. Contact the Better Business Bureau (508)652-4888 or at memberservices(pbosbbb.org. General All outside work areas will be left rake clean. Roofmg may result in dust or debris falling into the attic. This contract does not include clean up or protection of the contents in the attic. In the event a satellite dish should have to be removed to complete project, Georgoulis Construction, Inc. will not be responsible for repositioning after re-installation, should it be necessary. Payments The maximum down payment or advanced deposit allowed by Massachusetts law is limited to whichever is larger: (A)One third of the total contract or(B)the entire cost of any special order materials. Final payment is not required until the date of completion of the project. Payment must be made within seven days from completion date. All Credit Card Sales over$1,000.00 are Subject to a 2.0% Convenience Fee. Work Schedule The owner agrees the scheduling date is approximate. The contractor agrees to show good faith in meeting deadlines but are not responsible for delays caused by weather. Suppliers, subcontractors, building officials. asbestos abatement, hidden damages or conditions, accidents, acts of God or anything beyond our control. Change Orders The owner is aware that the work may contain hidden damage, defects, or conditions such as decay, insect damage, or substandard construction practices,that may require additional work not included in this contract. In this case, Georgoulis Construction, Inc. will contact the owner and agree on an additional charge to the original contract price. In the event the owner can not be contacted, and it is crucial that work continue to protect the residence from the elements, (rain, snow, ect.)photographs will be taken to document the necessity of the additional work. The owner understands that any additional work will delay the completion of the project. Warranty The contractor, Georgoulis Construction, Inc. agrees to correct any work that fails to conform with the contract or workmanship that is defective with in TEN(10)years from the substantial completion date of the project at NO CHARGE to the homeowner. The homeowner agrees to notify Georgoulis Construction, Inc. specifying the nature of any workmanship defect, immediately. No warranty is provided for ordinary wear and tear, fading, abuse,neglect or casualty, or minor cracking/shrinking of concrete or caulking. No warranty is provided for materials not directly supplied by Georgoulis Construction, Inc. or for used, re-installed materials, (including skylights not installed by Georgoulis Construction Inc)or work done by others. This warranty excluded consequential and incidental damages. Contract Acce to Upon acceptance of the authorized parties at Georgoulis Construction, Inc. this contract and all work described herein will constitute the entire agreement between Georgoulis Construction, Inc. and the Homeowner. -Cowonowaleaa 0/ A" Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ,;;.-N' Home Improvement Co�` trdctor Registration Registration: 117870 Type: Private Corporation Z � Expiration: 12/12/2012 Tr# 206063 GEORGOULIS CONSTRUCTION,.IN _ : SCOTT GEORGOULIS ,A 96 ARLINGTON AVE DRACUT, MA 01826 f� �4 AZ - til✓ ��`� t gyp Update Address and return card.Mark reason for change. Address F-1RenewalF] Employment E] Lost Card DPS-CA1 0 SOM-04/04-G701216 Office of Consumes r Affairs e &Bifsines` h' o License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:, 7870 Type: Office of Consumer Affairs and Business Regulation Expiration: '1`2/1212012 Private Corporation 10 Park Plaza-Suite 5170 - Boston,MA 02116 G GOULIS CONSTRUCTION INC. - SCOTT GE0RG0U08 96 ARLINGTON AVE,' DRACUT,MA 01826 Undersecretary Not vali without sig are $_,= ' 'Massachusetts- Department of Public Safet, Board of Buildin!- Re!-ulations and Standards Construction Supervisor License License: CS 58498 SCOTT C GEORGOULIS ,, 96 ARLINGTON AVE DRACUT, MA 01826 . Expiration: 10/21/2013 ('onunissiimer Tr#: 4384 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers .Applicant Information Please Print Legibly Name(Business/Organization/Individual): eI L4 5 Address: �('l City/State/Zip: &G 44A, p i 0 0hone#: T7 ?--1- re you an employer?Check the appropriate box: Type of project(required): [210 �I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 E]New construction I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for mein any capacity. workers' comp.insurance. 9• ❑Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its required.] .officers have exercised their 10 ❑Electrical repairs or additions 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 have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.0 Other *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. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �1 n f; Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their ,self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia