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HomeMy WebLinkAboutBuilding Permit #863-15 - 261 WAVERLY ROAD 4/30/2015Permit NO: `!' Date Issued: , 117` LOCATION—C-Y((1/ I PROPERTY OWNER_ MAP NO: INS x PARCE BUILDING PERMIT TOWN OF NORTH ANDOVER ° t APPLICATION FOR PLAN EXAMINATION- � i y Date Received ANT: must complete all items on this Print / ZONING DISTRICT: Historic District yes Machine Shop Villaqe ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑ Addition . ❑ Two or more family ❑ Industrial `❑ Wration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition \❑ Other Septic ❑ Well ❑ Floodplain ❑ Wetlands Watershed District Water/Sewer OWNER: Name: Address: _ CONTRACTOR Name:A Address: �//, b6 Supervisor's Construction Li( Home Improvement License: Identifi�cation Please Type or Print Clearly) 1 Phone: 97? Phone: Exp. Date: Exp. Date: , 1-j ARCHITECT/ENGINEER Phone: Address: Reg. No. ` FEE SCHEDULE: BULDING PERMITT,$$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Di Check No.: Receipt No.: ' NOTE: Persons con ra with unregistered contractors do not have access t he guaranty fund 0 f Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Sody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature_ Reviewed on Signature Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com ' conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Usgood Street iLocated at 124 Main Streets Fire Departmentsignaf ru e% tem .o Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. a Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I tb and Lied I A — wor deDartment use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 M. 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 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 4, 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 2012 IECC Energy code 4, Engineering Affidavits for Engineered products TOTE: 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 Doe: Building Permit Revised 2014 Location a/. Noh�,3 �— Date Chec� # 2- 12- 3 28711 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector E 0: r L Q ui S p a m s Y o o E ate. Q ar n W to Z Z 0 m o o LL o d v U LL O W N ZU. za m c CJ d °°� o LL O OW. Vf Z J V W J W o u oC 0 u Lu to Z H a o Z W a ui 0 W LL L CO O z 0) �,nLL n al Yj O ( WN O � O ^ C L 1�1 � Q d � Q * c o r S� c �� as m V 7' O P� O40CL Cc E o- �=cn' d U L �' p•- o� > c CL i V : _ o d - c r LA c o� Q (D o CD = O Q N - N F- O w cD 2 m N LUN .r -0— O O � to C O Ln y .Q O L 'E V Z. V O W i v O ._ i H • v (1) OCL •a �, �, Hm m m o F- y- Q 0 V > 2 z m CD z W x uj r_ G W 0- z `Iw .N t W O O O z CL cnO ' CD CM ^^`` a a WQ w •E m m CD a� CD — O CD v O O � O � CL O i v J .CL O .CD V N m r_ Q �.;.��+�`1�.RC,9tl, 1J.1?L� S ROO A7I�iC Sr r.���i'fTSIFRG rEI71ION, INC 96 Arlington A . Dracut, MA 0 11 26 Al Greene - Est sma 1-978-453-4242 Off ce 1-978-888-1700 Cel Dwight Feen 261 Waverly N. Andover, 1-978-314-9( dwight.feen Scope of Work: Remove all layer of with heavy duty i arps Install 6' GAF 1h eath all rakes at all roof to Install GAF Shin dem Install 8" .025 g ige 1 Install GAF Pro Install GAF Timl erlir Install new Cora ent' Install new stack Dipe Install new lead ashi Replace approx. 5 exi closely as possible. Thoroughly clear. and $2.50 Per Lineal Foot Entire job inelu es ( coverage from OAF, MVV 1'?I.OPOSI✓ for the sum of. Five Thousand PAYNIMM, TO All material is.gua to specifications si extra costs will be All agreements ca. necessary msuran( This proposal may t Acceptance of Prop, Payment wil b] \. e as CONTRA Location:.261 04/25/15 rly d. Andover, MA ngled roofmg own to wood deck on entire house roofs, protect g stripping is be ng done. i watch ice/watei shield; underlayment acro all eaves, in all valleys, X11 locations. FAl coverage on all lower sloped back dormer roe felt paper un erlayment on remaining exposed roof deck surfs es, avy duty al i ium drip edge on entire roof perimeters. rter strips across all eaves and up all rakes.) HD Lifetime Architectural shingles with Iimbertex hip/ridge cz ps 400 ridge vent Dn all main ridges. )ot on existing plumbing pipe. 1 on existing br ck chimney. ng vinyl siding panels that are cracked or damaged with new white Magnet grounds and remove all job related debris from property on a K&a Cost to ref lace any damaged plank boird decking (if neede ). ,F Systems Ph s Warranty. First 50 yrs.1Is non -prorated, fu 1 Ia ;ainst any mai erial defect cause, and is transferrable one tim e. to furnish AS FOLIAMUS: and labor complete in accordance with Five Dollars be as specified. fill work to be completed in a sub! tantial workman like ma per standard pradi . Any alteration or deviation from above specifications only upon written orders, and will become an extra charge over and above d ipon strikes, accid nts or delays beyond our controls Owne to ca fire, ton orkers are fully covered by workers compensation Georgoulis thorized Signature II withdrawn by i is if not accepted within b days. al- The above pric es, specifications are satisfactory, and are hereby accepted itlined above. Signature I Da Y ands and house body chimney, and T up siding to match as basis and at jobs completion. rid material D�. pa,d • 6,2600.00 cK# 2Aa to do the work as specified. The followkng ids part of this I contract: All home improvement contra tors must be registered with the Common,, e lth of Massachusetts. Contractor egi tration #11.78 0 and Construction Supervisor License #058498. Inquires about registration should be made to Director, Home Improvement Contractor)I Re gist ration, One Ashburton Place, Roo 13 1, Boston, 02108 (617) 727-8598. Better Business 1Bu ea , Inc. Georgoulis Construction, Int. member ID 35522. Contact the Beter Business Bureau j (508) 652-4 888 or at member ervices c ,bosbbb.org. General All outside wort. areas will be left rake clean. Roofing may result in dust or debris falling into the attic. This contrt do . -s 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, whe her incidental or accidental, that may occur to any A/C, electrical or plumbing equipment that is in talled or located in a plLe that interferes Twit m th roofing or re-roofmg process witin . ormal standar s & practices of a typical and reasonable rooor re -roofing installation. i Payments j The maxim urn, c own payment or advanced deposit allowed by Massacbu'setis IE w is limited to whichever is larger: ( ) One third of the total contractor (B) the entire cost of any special order materials. Final payment is requ red within 15 days of the invoice dat or a late fee charge ' i th amount of five (5) percent of I he said payment sl all be assessed for every 30 -day period for sad p yment outstanding. If non-payment becomes a legal matter, the Homeowne i will be responsible for a 1 legal fees incurred by both parties. Al' Credit Card Sales over $1,000.00 are Subject to a 2.0% Co venience Fee. The owr meeting building beyond The owne damage, o contract. I charge to work cont document the comp) ,s the schedul ng date is approximate.1 The contractor agree to es, but are not responsible for delays caused by weather! Su pl s. asbestos ab tement, hidden damages or conditions, accid nt is aware that the Aork may contain hidde sub tandard cons action practices, that r this case, Georgoi ilis Construction, Inc. to or ginal contract price. In the event the iue to protect the r sidence from the elerr henecessity of the additional work. The < tion of the project. damage, defects, or c ry require additional 11 contact the owner wner can not be cont nts, (rain, snow, ect.) mer understands that Warranty I i The contra tor, Georgoulis Construction, Inc. agrees to correct any wor contract or workmanship that is defective within TEN (10) years from t: the project at N CHARGE t the homeowner. The Homeowner agrees Constructi n, Ii ic. specifying he nature of any workmanship defect, im provided f r ordinary wear and tear, fading, abuse, neglect or casualty, concrete o cau king. No war anty is provided for materials not directly Constructi n, Ii ic. or for used re -installed materials, (including skylight Construction I ) or work do e by others. This warranty excluded cons I Contract cc Dtance Upon acc tan e of the auth rized parties at Georgoulis Construction,) described ereifi will constit a the entire agreement between Georgoul how good faith in rs, subcontractors, acts of God or anything tions such as decay, insect not included in this igree on an additional 1, and it is crucial that :ographs will be taken to additional work will delay s to conform to the ntial completion date of Georgoulis ,. No warranty is cracking/shrinking of by Georgoulis :alled by Georgoulis and incidental damages. contract and all work ruction. Inc. and the The Commonwealth of Massachusetts Department of Industrial Accidents d I Congress Street, Suite 100 Wr Boston, MA 02114-2017 ,ye www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Georgoulis Construction, Inc. Address: 96 Arlington Av City/State/Zip: Dracut, MA Are you an employer? Check the appropriate box: Phone #:9784534242 1. E✓ I am a employer with 10 employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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 proprietors with no employees. 5.rl I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 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. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.0 Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13.❑Roof repairs 14. ❑ 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Admiral Insurance Compan Policy # or Self -ins. Lic. #: WC009774283 Expiration Date: 9/25/15 Job Site Address: 261 Waverly Road City/State/Zip: 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. o I do hereby certify ut fer thefailf and penal#s of perjury that the information provided above is true and correct. 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 #: r 30 15 02:34p Office 19784589997 �1 ACORN` CERTI ICATE OF LIABILITY INSURANCE I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE Al BELOW. THIS CERTIFICATE OF INSUR,kNCE DOES NOT CONSTITUTE A CONTRACT BETWEEPI THE ISSUING REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(Iles) must be endorsed. If SUBROGATION IS WP the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certf Icate does not col certificate holder in Ileu of such endorsernent(s) =ROD'JC=R Phone: (9781263-3500 Fax: (97E) 263-1438 CONTA� Gallant Insurance Agency, Inc. GALLANT INSURANCE AGENCY, INC. PHONE 199 GREAT ROAD I P O BOX 975 IN, Aic.Fxl' 978 2633500 ACTON MA 01720 o Ess• r-- 00.7E (MMR7UM'YY) 04/30!2015 CATE HOLDER. THIS D BY THE POLICIES -R(S), AUTHORIZED bject to to the 263-1438 PRODU.ER 36702 INSURER(S) AFFORDING COVERAGE NAIC4 INSURED GEORGOULIS CONSTRUCTION INC. NSURERa :Admiral Insurance Company CIO SCOTT GEORGOULIS INSURER B : Chartis Insurance Company 96 ARLINGTON AVENUE INSURERC DRACUT MA 01826 INSUP.ERO: INSUP.ERE INSURER F COVERAGES CFRTI ICATF NIIMRFR• ddQAn I or-wmirw nul cc THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHEINSU ED NAMED ABOVE FOS THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT I/VJIi RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SLBJECI TO ALLTHE TERMS, INSR I LTR TYPE OF INSURANCE AD IN L SUBR R WVD; POLICYNUMBER POLYEFF POLICY EN I MMIOICD.YYYY NMIDD P IJ MITS A GENERAL LIABILITY � CA000020975-0 03/05/15 03/05/16 – EACH OCcuRRE CE S 1,000,000 DAMAGE TO REN PREMISES -a o u' nce S 100,000 X COMMERCIAL GENERAL LIA31LiTY i NED.EXP (Any o ieperso) S 5,000 CLAIMS -MADE I XI OCCUR PERSONAL BAD 14JLR Y S 1,000,400 GENERAL AGGR GATE 19 2,000,000 _ PRODUCTS -CO P/OP GG S 2,000,000 GEN'LAGGREGATELIMITAPPL�IESPER: I POLICY 0 JPE � AUTOMOBILE LIABILITY , COMBINEDSING ELIVI (Ea accident/ AVYAUTO —. BODILY INJURY ;Per per n) 3 A -L OWNED .AUTOS - eracci en:). S - SCHEDULEDAUTOSTY DA GEHIRED AUTOS rEBIODILYIVJURY ••en:) I S NON -OWNED AUTOS .- UMBRELLA LIASI OCCUR EACi OCCURRE 4CE AGGREGATE EXCESS LIAR CLAIMS -MADE DEDLCTIBLE b _ RETENTION S B WORKERS COMPENSATION AND EMPLOYERS' LIA91LnY .r I N ANY PRO PRIETOR(PARTN ER'EXECUTNE OFFICERIMEMEER EXCLUDED? I� N1 WC009774283 _ - 09/25/14 0912511 5 X I "' STATIM OTH ' TONY L-1WS E.L. EACH ACCID NT 100,000 S - – E.L. DISEASE -EA NI=LO EE S 100,000 (Mandetory la NN) It yes, i —ibe under DESCRIPTION OF OPERATIONS b— E.L. DISEAS= PO ICY LN IT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLE (Attach ACORD 101, Addltlonal Remark Schedule, if more space is required) I.tRI Ir ILAIt NUl_Utht I GANIiI ION SHOULD ANY OF THE ABOVE: DESCRIBED POLI IES B E CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE T EREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ) AUTHDRIZED REPR EENTATr/E Attention: j he�saI—Wvardrga4h / ACORD 25 (2009109) I © 1988-2009 ACORD CORPOTIO All rights reserve( The ACORD name and logo afe registered marks of ACOR 0/ (P-v&44aCx1,ff1j1eff0, Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT, MA 01826 SCA 1 0 2OM-05/11 ��77!' �ti777?71t177!!1!'.t7f�fi1 t�n'i�7(YJJtCJzrlS�� - ffice of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR egistration: 117870 Type: xpiration: 121127201.6 Private Corporatior. GEORGOULIS CONSTRUCI-ION, !INC. SCOTT GEORGOULIS 96 ARLINGTON AVE �� a DRACUT, MA 01826 Undersecretary Registration: 117870 Type: Private Corporation Expiration: 12/12/2016 Tr# 260054 Update Address and return card. Mark reason for change. F] Address ❑ Renewal ❑ Employment ❑ Lost Card, License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 12116 AWA4r*k -� ISEII01.0-6955849 1JCSanDteo Ext ne sion American 93 INTERNATIONAL SAFEE TY EDUCATION IN571TUTE(l5El) S'"'��"�coancr�'l r4Th�s1� aii•d certlfre " SCOTT ISM!, LT ' IS has completed a'102Houe'bS5HA Hazar ,:R6 ognition Training fo�the 6nstr uctiori Industry. v�` ' 08/23/2013 Director: Scott MacKay Trainer: Taylor Sikes Grad. Date: Not valid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS -058498 I `o; ``` -1 7T' SCOTT C GEORGdULIS ` '�; 96 ARLINGTON DRACUT MA 0126 Expiration Commissioner 10/21/2015