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HomeMy WebLinkAboutBuilding Permit #605-2016 - 157 LANCASTER ROAD 11/17/2015 "ORTFI 9 L BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - �/ Permit NO. � Date Received •� �m ..,�• ^ SACHt1`��i�� Date Issued: / 7 I PO TANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reside l Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition _ ❑_Other 1 Septic : i Well Floodplain ❑Wetlands f.7 Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: !1 Phone: Address: - CONTRACTOR Name: n� _ -Phone: 2 Address: zw �J Supervisor's Construction Lic se: ,D�., Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: 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: $ S� i Check No.: 4. fl) 45r- Receipt No.:"%l'e'l I NOTE: Persons contracting with unregistered contractors do not have access t the guaranty fund ignature of A enUOwner Signature of contracto �'C' :a Plans Submitted ❑�- Plans Waived.❑ Certified Plot Plan S'A tamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swing Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS f• CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature COMMENTS >` Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 0 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: ;f RE',DEPA.R�TMENT TempD:umpster onsiteesy LL - 384 Osgood LocatedF . _- . �n Street .I 4Locateddat 124Main,SteetE - -�- m- - y FireDepartment srgnature/dates ! I�C®MMENTf&_. I Dimension Number of Stories: Totals square feet of floor area based o q n Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast 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) I ❑ Notified for pickup Call Email F Date Time Contact Name Doc.Building Permit Revised 2014 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/Cross Section/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 VOTE: 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 o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 Clerics 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:Building Permit Revised 2014 NORTH own o t E ndover No. , 0161 -1K Y -IF � h ver, Mass, / ;�SL A"Kil COCNIC00WICK BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System ` THIS CERTIFIES THAT ...............-�(.Q: 1��....��:Z.l.!.:/.`r�.�:............................................................. BUILDING INSPECTOR / Foundation has permission to erect buildings on ....I.5..7... 1. t�f :. . .......................... ....................... Rough to be occupied as .................�...�.!��..... ....��.r.. . q .z ...r....................................................... Chimney provided that the person accepting this 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. NORTh Town of E \Andover 0 0 ver, Mass, � o cocN�c„ew�cw �1. S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..............-�t.?." .�'IT�c....��'1..1.!y.:�.................. ........................................... BUILDING INSPECTOR . buildings / Foundation has permission to erect ......................... g ....�.5.7... 1. t�f �°....��... ....................... Rough to be occupied as .................Z72 ... /7('.. .Z�7...�....................................................... Chimney provided that the person accepting this 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service 141.1 .�................................. 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. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: (Location 4f Facility) Signature of Pe Applicant Date r hAS lv ,SS urs GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Allington Ave. Dracut,MA 01826 n M Greene-Estimator C U V 1 1-978-4534242 Office 1-978-888-1700 Celt aeomoulisl4laaol.com C-- .. CON'T'RACT „Barbara Tomkins 10/06/1.5 157LancasterRd. N.Andover,MA 1-978-821-5233 UjtomkinS@ 1Qy,aljl.c0n1 Job Location:157 Lancaster Rd:N.Andover,MA Scope of Work: Remove all layers of'roofing down'to wood deck on entiire house,all additions,'and garage roofs,protecting the grounds and house body with heavy duty tarps as stripping is being done. Install 6'.Grace Select ice/water shield underlayment on all roof eaves, in all valleys,3'up rakes at roof to wall locations,and.around all protrusions Install`GAF Shinglemate felt underlayment over remaining exposed roof:deck Install 8".025 gauge heavy duty:aluminum drip edge on entire roof perimeters. Install GAF Pro Start starter strips across all eaves and up•alhrakes. Install GAF Timberline HD Lifetime Architectural shingles with Timbertex.Hip/Ridge caps on roof. Install new stack pipe boots on existing plumbing pipes. Install new Coravent V-600e ridgevant on all main ridges Inspect and seal all lea l flashimgom both existing brick chimneys. ; Thoroughly clean and magnet grotfnds 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;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-prorated,full labor and material coverage from GAF,and the warranty is transferrable one time. WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum'of. Pp:� • '1330.00 c140,3414 Twenty One Thousand.Three Hundred Thirty Dollars $21,330.00 PAYMENT TO BE MADE AS FOLLOWS: $7,330.00 PAID IN ADVANCE TOWARD lYIATERIAL COSTS 514,000.00 PAID IN FULL WHEN JOB IS COMPLETELY FINISHED ACCORDING TO THE ABOVE LISTED PROPOSAL. All material is guaranteed to be.as specified.Ail 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.Owner o carry f ,tornado and other . y necessary insurance.Our workers are fully covered by.workers.compensation insur Georgoulis Authorized Signature This proposal may be withdrawn by us if not accepted within 4days. Acceptance of Proposal-The above prices,specifications are'satisfaetory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Signature Signature Date'of acceptance. 0 �3 — J 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 IN 35522. Contact the Better Business Bureau (508)652-4888 or at memberservices@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 cbmara. . .'�+'• '+,�J'n •. n7 ;kx 5•A.�.o- d fix ' �'�^ ..t� ii Fr M. �q 4. cr __ _ ._.;- >>.itt 'uf';b, czrw•..a.. n the project at NO Cii.A=ii '_ Construction,Inc,specff)-!z. -� `_ _- =�- - __ c ly.N11 o warranty is provided for ordinary wear and tom; : = :ti: ` ;or minor cracking/shrinking of concrete or caulking.No warranty is VmNi ed f= &m4v supplied by Georgoulis Construction,Inc.or for used,re=installed 41s not installed by Georgoulis Construction Inc)or work done by others.This-wmm,a&A. M 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. =DATEIDOIYWY)ACC>RO° CERTIFICATE OF LIABILITY INSURANCE2015 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 certificate holder In lieu of such endorsement(s). CONTACT Gallant Insurance Agency,Inc. PRODUCER phone: (978)263-3500 Fax: (978)263-1438 NAME: GALLANT INSURANCE AGENCY,INC. PHONE (978)263-1438 ac No Exi: (978)263-3500 ac No 199 GREAT ROAD I P 0 BOX 975 E-MAIL . ADD SS' ACTON MA 01720 PRODUCER 36702 US ER ID: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A :Admiral Insurance Company_ GEORGOULIS CONSTRUCTION INC. INSURER ;Chartis Insurance Company C/O SCOTT GEORGOULIS INSURER 96 ARLINGTON AVENUE INSURER D: DRACUT MA 01826 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 47220 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, ADD'L SUBR POLICY EFF POLICY EXP LIMITS INSR POLICY NUMBER MMID NYYY MMIDD LTR TYPE OF INSURANCE INSR wvD 1,000,000 A GENERAL LIABILITY CA000020975-01 03105115 03105116 EACH OCCURRENCE $ DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY ISES a occ rs MED.EXP(Any one person) $ 5,000 CLAIMS-MADE I ^ IOCCUR PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- LOC $ POLICY COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ Per accident HIRED AUTOS $ NON-OWNED AUTOS $ EACH OCCURRENCE UMBRELLA LIAB OCCUR AGGREGATE EXCESS LIAB CLAIMS-MADE DEDUCTIBLE $ RETENTION $ WC STATU- 0TH B WORKERS COMPENSATION WC009774283 09125/15 09125116 X TORYLIMITS 100'000 AND EMPLOYERS' LIABILITY YIN E.L.EACH ACCIDENT ANY OFFICER)M MIBERwEXCLUD D?ECUTNE -EA EMPLOYEE 100,00 17 N I A E.L.DISEASE (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 107,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 North Andover ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: i� ' eresa /arA,rah ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD J The Commonwealth of Massachusetts z Department of Industrial Accidents a I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lezibly 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): 1.0 I am a employer with 10 employees(full and/or part-time).* 7. ❑New construction 2.M I am a sole proprietor or partnership and have no employees working for me in 8. F1 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.n I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my 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. Plumbing repairs or additions 5.❑I am 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. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'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. $Contractors 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. -lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Admiral Insurance Company Policy#or Self-ins.Lic.#:WC009774283 Expiration Date:9/25/16 Job Site Address: Lancaster Road 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 verification., Ido hereby certify u er th a'` and peva es of perjury that the information provided above is true and correct. a Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: n��1.� ��f,1�ll.��yt�1�1�11�E?f�'1 i�fl.• f1 -,�i��l�':S�l f.�'FC.'fL7.11E'�.�• 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: 12112!2016 Tr# 260054 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 Update Address and return card.Mark reason for change. ( � Address ; Renewal Employment j Lost Card SCA1 +G 20M-05111 ____._ _.� _-�`%���:a»tnear:ur�rrlt���f�''Z�fr�;a�✓:UJrlls "- Mce of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: istration: 117870 Type: Office of Consumer Affairs and Business Regulation piration: 9211212016 Private Corporatlor. 10 Park Plaza-Suite 5170 Boston,NIA J2116 GEORGOULIS CONSTRUCTION,INC. 1 SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT,MA 01826 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards 1SEI1010-6955849 License: CS-058498 S7 UC SaxiDiego, Extension Construction Supervisor INnRNATIONALSAFETYEDUCAnONINMTUTE(ISEq ^ �' t�� y ��• SCOTT C GEORG.OULW:. a This card certifies that: 96 ARLINGTON AyEN' DRACUT MA 01826 SCOTT GEORGOULIS has completed a 10-Hour OSHXHazard Recognition Training for the Construction Industry. 08/23/2013Expiration: ' L 1012112017 ; Commissioner Director:Scott MacKay Trainer:Taylor Sikes Grad.Date: r Location No. �r� .2�f� Date // / 71/f • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ i Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check# � /l .a 2968 1 _` Building Inspector