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Home My WebLink AboutBuilding Permit #730-14 - 1492 GREAT POND ROAD 4/18/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:,—x;0 �� Date Received Date Issued: ORTANT: Applicant must complete all items on this page LOCATION _ Print PROPERTY OWNER.__ Se�r•�� cZcrz{q Print 100 Year Old Structure yesno MAP NO.} 2, PARCEL:�D ZONING DISTRICT: .Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building One family 11 Addition =o or more family 0 Industrial ❑Alteration No. of units: ❑ Commercial )<Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: _Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: Phone: 1 Address: /Q6/ Supervisor's Construction License: 0-52!9f Exp. Date: 16_c/-IS Home Improvement License: //7 a Exp. Date: /c;2 ARCHITECT/ENGINEER Phone: i Address: Reg. No. I FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 9�®�� FEE: $_ Check No.: oZ o2 I Receipt No.:� NOTE: Persons contracting with unregistered contractors do not have accesItth e guaranty fund Signature-of Agent/Owner Signature of contractor Plans Submitted FE Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fol; wing is'a list of he'required.forms to be-filled out for.the appropriate.permit to be obtained. Roofivg. , Siding, Interior Rehabilitation Permits oBuilding 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 o 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 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 ❑ 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 aprr�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Building Permit Revised 2012 - -Dimension-Number of Stories: Total square feet of floor area, based on Exterior dimensions._ _Total land-area; sq. ft.: ELECTRICAL:-Movement of Meter,location, mast or service drop requires approval of I Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-.Chapter 166.Section 21A.nF and G rhin.$10041000:fine f I NOTES and DATA— (For department use I I I ® Notified for pickup - Date E Doc.Building Permit Revised 2010 Plans Submitted ❑ ...' Plans Waived ❑ .` Certified Plot Plan ❑ Stamped Plans ❑ STYPE O:F=sSEWERA -E DiSPOSAL" Public Sewer ❑ Tanning/Massage/Body Art ❑... .Swimming Pools ❑ Well ❑ _Tobacco.Sales ❑ Food Packaging/Sales El -Private,(septic tank,etc:_ ❑...: : Permaneint 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 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 Tools Engineer: Signature: Located 384 Osgood Street FIRE DEPARTIVI;.L`NT - Temp Dump'ster on site yes.:.. no `Located-at 124 Mair Street-- Fire Departure►it sigi�atu'reldate`' COMMENTS ._. Location f`T/� �A n/•csy ��. No. Date . - TOWN OF NORTH ANDOVER • ��1"'1L�U 76-� • • f Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee 5: Other Permit Fee $ TOTAL $ Check Building Inspector NORT1i Town of � tndover O . No. - C, h ver, Mass, .p coc"Ichawicw oi. Te s U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......z Dbr&rft ........................................................ BUILDING INSPECTOR has permission to erect . buildings on .f.10A.........&m.-POA.d.....120dc. Foundation 0 Rough to be occupied as ........S�..nw%............*...... .. ..... ............................•......... Chimney provided that the person accepting this permit shall in every resp!7confor 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final S PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR II UNLESS SS CONSTRUC ARTS Rough Service ......... .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy 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 Det. E I 70r:3/3,,2014 M/DDIYYYY) Amo oR CERTIFICATE OF LIABILITY INSURANCE 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(ies) 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)263-1438 CONTACT Gallant Insurance Agency,Inc. GALLANT INSURANCE AGENCY,INC. CO No Ext: 978 263-3500 AX Ne, (978)263-1438 199 GREAT ROAD/P O BOX 975 E-MAIL ACTON MA 01720 ADDRESS: PRODUCER 36702 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC# INSURED GEORGOULIS CONSTRUCTION INC. INSURERA :Seneca Specialty Ins Co C/O SCOTT GEORGOULIS INSURERS :Chartis Insurance Company 96 ARLINGTON AVENUE INSURER DRACUT MA 01826 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 39143 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 ADD-1_1 SUBR POLICY EFF POLICY EXP LTR INSR wvD POLICY NUMBER MM/DD/YYYY MMIDD LIMITS A GENERAL LIABILITY BAG-1019845 03/05/14 03/05/15 EACH OCCURRENCE $ 1,000,000 X1 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PR MISTS Ea occurence $ CLAIMS-MADE I7 OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL RADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC IFr- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE 1' $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE RETENTION $ ' $ B WORKERS COMPENSATION WC009774283' 09/25113, 09/25/14 X WC STATU- OTH AND EMPLOYERS' LIABILITY Y/N TORY LIMITS FR $ ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT 1 OO,000 / OFFICER/MEMBER EXCLUDED? NIA (Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of N.Andover ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: Ray Gallant, President ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Na'a co I GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut,MA 01826 Al Greene-Estimator 1-978453-4242 Office 1-978-888-1700 Cell HYPERLINK"mailto:georgoulis141@aol.com"georgoulis141 aol.com CONTRACT Jeffrey Doran 03/27/14 1492 Great Pond Rd. N.Andover,MA 1-781-630-1954 HYPERLINK"mailto:Jef-rey.p.doran@lahey.org" Jeffrev_p.doran_,lahey.or Job Location: 1492 Great Pond Rd.N.Andover,MA Scope of Work: Remove all layers of roofing down to wood deck on entire house,and garage roofs,protecting the grounds and house body with heavy duty tarps as stripping is being done. Not to include back addition roof. Install 6'GAF Weatherwatch ice/water shield underlayment across all eaves,and Yup all rakes at all roof to wall locations. , Install GAF Deck Armor 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 new Coravent V-400 ridge vent on all main ridges. Install new stack pipe boot on existing plumbing pipe. Inspect and seal all seams and joints on lead flashings of existing chimneys. Thoroughly clean and magnet grounds and remove all job related debris from property on a daily basis and at jobs completion. Georgoulis Roofing,Inc.will obtain the required building permit from the town and the cost is included. $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-prprated,full labor and material coverage from GAF,against any material defect cause. WE PROPOSE hereby to fin-nish material and labor complete in accordance with above specifications, for the sum of beD. Tc,-'d- -* a(00-oo C ILA q0b 313`1'1 Nine Thousand Six Hundred Dollars $9,600.00 PAYMENT TO BE MADE AS FOLLOWS: $2 600.00 PAID IN ADVANCE FOR MATERIAL COSTS.$7.000.00 PAID IN FULL WHEN JOB IS COMPLETELY-FIMMIED ACCORDING TO THE ABOVE LISTED PROPOSAL-- Acceptance ROPOSAL Acceptance of Proposal-The above prices,specifications are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will b ade as out' e. / Signature Signature Date of acceptan 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(c�r�,bosbbb.org. General All outside work areas will be left rake clean.Roofing 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.In addition,the Roofing contractor will not be liable for any damage,whether incidental or accidental,that may occur to any A/C,electrical or plumbing equipment that is installed or located in a place that interferes with the roofing or re-roofing process within normal standards&practices of a typical and reasonable roofing or re-roofing installation. 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 required within 15-days of the invoice date or a late fee charge in the amount of five(5) percent of the said payment shall be assessed for every 30-day period for said payment outstanding.If non-payment becomes a legal matter,the Homeowner will be responsible for all legal fees incurred by both parties.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. Wgganly The contractor,Georgoulis Construction,Inc.agrees to correct any work that fails to conform to the contract or workmanship that is defective within 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 Acceptance 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. r�. The Conunonwealtli of Massachusetts Departnieiit of Industrial Accidents Office of Investigations 600 Washington Street . i Boston, NIA 02111 jvwiv.mass.bovIdl(l Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly \ame (Business.%Orsanization![nditiduai): �� o i Cc) Address:�� City/State/Zip: 6 Phone #: Are you an employer?Check the appropriate box: 1.2 1 am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. El'New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have no employees These sub-contractors have working for me in any capacity.- employees and have workers' 8. ❑ Demolition No wor [ kers comp. insurance comp, insurance.*. 9• ❑ Building addition 3.E] required.] 5. We are a corporation and its 10.❑ Electrical repairs or additions I am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [\o workers' comp. right of exemption per MGL insurance required.]T C. 152 12•❑ Roof repairs q ] . §1(4),and��e have no p employees. [\o workers 13•0 Other comp. insurance required.] *Any applicant that checks box 11 nntst also till out the section belo\\showing their\\orkers'copensation polio information. Homeowners that t ch submit this must art indicating the\-are doing all.cork and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet shoeing the name of the sub-contractors and state whether or not entplo\ees. If the sub-contractors have employees.they must provide their workers'comp,poliCV number. those entities have I ant an enrplgyer that is provicGng workers'conipertsatiorr insurance for m},employees. Below is the polich andjob site information. Insurance Company\gine: ]L �� Policv#or Self-ins. Lic.#: w c:> 9 7�� Expiration Date: Job Site Address:_l 9-), !�(`e� City/State/Zip:- Attach a copy of the-workers' compensation policy declaration page(showing 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 S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fie Of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of n Investigations of the DIA for insurance coverage verification. tfication. do Irereb► certifyrnrder t/repains purr/penal[/es of perjury that the information pr•ovieted above is true and correct. Signature: Date: 3- 3l—Izl Phone 4: Offrcial use o»h'. Do not write in this area, to be completed br citr or town gffcial. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of licaith 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: =E Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registrabon: 117870 Type: Private Corporation Expiration: 12/12/2014 Tr# 234343 GEORGOULIS CONSTRUCTION, INC SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Mark reason for change. EliAddress Renewal F] Employment - Lost Card- 1 s. 20Aii-05h 1 _ 9 Massachusetts - Department of Public Safety Board of Building Regulations and Sta^dards Construction Super*n-isa)r License CS-058498 SCOTT C GEORGODUS ` 96 ARLINGTON AVE ` DRACUT MA 01826 Comm�ss;oner 10/21/2015 ISEIIOIO-6955849 �tJCSanDiego I Extension American tyCouncfl INTMNAnoNALSAFETY EDUCATION INSTITUTE(ISEq Sgfeene+.�• This card certifies that: SCOTT GEORGOULIS has completed a 10-Hour OSHA Hazard Recognition Training for the Construction Industry. G —- 08/23/2013 r Director:Scott MacKay Trainer Taylor Sikes Grad.Date: