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HomeMy WebLinkAboutBuilding Permit #Exception - 33 HAROLD STREET 5/1/2018 H BUILDING PERMIT 014 �10%AO DRT,ll TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 4 " �9SSACHUS���� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic E Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: 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: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ., Sianat �r of on :i ` } Plans Subrni'ed Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well El Tobacco Sales 11 Food Packaging/Sales El Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS II Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 4 I Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Y Located 384 Osgood Street FIRE DEPA,�RT�MENT TernDu psteronisiteA �- _ m I�Locatedlat:r124iCIUlai et - �YeS` ..0 n�Stre_ _ r Fire�Department si ` k . gnaturefd"ate z - COMMENTS: ,_ - 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 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 Ll Notified for pickup Call Email I Date Time Contact Name Doc.Building Pennit 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 4, Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. An / Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: 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 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 4 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 i Location No. l ► —4c)I(, Date • TOWN OF NORTH ANDOVER • ; e Certificate of Occupancy $ ' Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $�._ TOTAL $ Check# 2 Building Inspector NORTH Town of Andover O To No. soh ver, Mass,041c"I.Wic" `lies RgTED � �y 1 U BOARD OF HEALTH PERMF m T LD Food/Kitchen ` p Septic System THIS CERTIFIES THAT ...............:... �d,5s Y BUILDING INSPECTOR ....... .. ... ... . .. ..... ....... ...... ...... has permission to erect ` .............. Foundation ................:......... buildings on .3� ............. .fto�. Rough to be occupied as .... . .. . .. ..... ..................................................... ................. Chimney provided that the person accepti this permit shall in every respect conform to the terms of the a.pplication on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 ............................ i BUILDING INSPECTOR Final ' GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough ! Display in a Conspicuous Place on the Premises — Do Not Remove Final No i Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. I Smoke Det. GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut,MA 01926 Al Greene-Estimator 1-978-4534242 Office 1-978-888-1700 Cell weorgoutis l4l&ol.com CONTRACT Matt Gosselin 05/05/15 .33 Harold St. N.Andover,MA 1-781-315-2355 matthew.gosselinl @gmail.com Job Location:33 Harold St.N.Andover,MA Scope of Work: Remove all layers of shingled roofing down to wood deck on entire house and porch roofs,protecting the grounds and house body with heavy duty tarps as stripping is being done. Install 6' A Of AM W ice/water shield underlayment across all eaves,in all valleys,around chimney,and 3'up all rakes ioo `S6 I locations. Full coverage on all lower sloped front porch roofs. Install GAF Shinglemate felt paper 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. j Install new lead flashing on existing brick chimney. Thoroughly clean and magnet grounds and remove all job related debris from property on a daily basis and at jobs completion. $2.50 Per Lineal Foot Extra Cost to replace any damaged plank board decking(if needed). Entire job includes GAF Systems Plus Warranty. First 50 yrs.Is non-prorated,full labor and material coverage from GAF,against an material defect taus and is transferrable n i re8 � Y e, crab e o e time. WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum of. De�. Pa:d• � �AK5.oG C1tV1��G Six Thousand Six Hundred Forty Five Dollars $6,645.00 PAYMENT'ro 131'.MADE A8 170LLOWS: 2 245.00 PAID AD ANCE TOWARD MATERIAL COSTS.$4 400.00 PAID IN FULL WHEN $ , IN V T , JOB IS COMPLETELY FINISHED AQQQRDING TO THE ABOVE LISTED PROPOSAL All material is guaranteed to be as specified.All work to be completed in a substantial workman like manner according Colo r' 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. Alla agreements contingent upon strikes accidents or dela b �►wPCo4.� g 8 p delays beyond our control.Owner cavy tire,tornado and other C necessary insurance.Our workers are fully covered by workers compensation insura Georgoulis Authorized Signature This props maybe withdrawn by us if riot accepted within.0 days Accepts e� f Proposal- a above prices,specifications are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment wi 1 made �putli ahove. r � Sig Si store Date of tant acce e P 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 ctbosbbb.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. Pa, ents 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. Warranty 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. The Commonwealth of Massachusetts z Department of Industrial Accidents a 1 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 Leeibly 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.❑✓ I am a employer with 1 employees(full and/or part-time).* 7. ❑New construction 2.F1 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 31-11 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q 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.EJ 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.t p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑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. f 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 Company Policy#or Self-ins.Lic.#:WC009774283 Expiration Date:9/25/15 Job Site Address:33 Harold Street 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 un er the a. and penalties of perjury that the information provided above is true and correct. Si nature: Date: Phone#: �/7 `����.�� 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#: ACORD` CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 0413012015 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). PRODUCER Phone: (978)263-3500 Fax: (978)263-1438 CONTACT Gallant Insurance Agency,Inc. GALLANT INSURANCE AGENCY,INC. PHONE d: 978 263-3500 FAX (978)263-1438 199 GREAT ROAD/P O BOX 975 E-MAIL A C No ACTON MA 01720 AD CRODUMERUsT. ERI 36702 INSURER(S)AFFORDING COVERAGE NAIC p INSURED INSURER :Admiral Insurance Company GEORGOULIS CONSTRUCTION INC. INSURERS :Chartis Insurance Company C/O SCOTT GEORGOULIS 96 ARLINGTON AVENUE INSURER C DRACUT MA 01826 INSURERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 44380 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 ADD'L SUBR POLICY EFF POLICY EXP TR TYPE OF INSURANCE INSR WVD POLICY NUMBER LIMITS NIDD MMIDDIYYYY A GENERAL LlAeam CA000020975.01 03/05115 03/05/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES o rence $ 100,000 CLAIMS-MADE I�OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV 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 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 LIAR OCCUR EACH OCCURRENCE EXCESS LIA6 CLAIMS-MADE AGGREGATE DEDUCTIBLE RETENTION $ $ B WORKERSCOMPENSATION WC009774283 09/25/14 09/25/15 X TORYTLIMITS OTR ANDEMPLOYERS'PLOYERS' LIABILITYYIN ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT 100,000 OFFICERIMEMBER EXCLUDED? 0 N I A (Mandatory In 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 Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: &S_� eresa /arah ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _ �_ C.��YGfi �t�/j'�?!1'1'1iC.��I�Ll1f'Q%��l'li Q • �^�����CLG1?/�i<ZE%trl.',1 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: 12/12/2016 Tr# 260054 GEORGOULIS CONSTRUCTION, INC. SCOTT GEORGOULIS -- 96 ARLINGTON AVE - DRACUT, MA 01826 ---- — — - - - Update Address and return card.Mark reason for change. SCA 1 0 2OM-05/11 C (—] Address (i] Renewal �j Employment [—i Lost Card ri-'Tn unnrmnn�anrrt't�o r'•�i<r;3�ir�usrtll ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration 117870 Type: Office of Consumer Affairs and Business Regulation xpiration: 1211212016 Private Corporatior. 10 Park Plaza-Suite 5170 Boston,MA 12116 GEORGOULIS CONSTRUCTION,INC. 1 SCOTT GEORGOULIS 96 ARLINGTON AVE DRACUT,MA 01826 Undersecretary Not valid without signature u 1�t Massachusetts -Department of Public Safety 1SEI1010-6955849 Board of Building Regulations and Standards Construction Supen icor UCSanDiego I Extension America► CLicense: CS-058498 +� iNrEAnAnoNA1 SAFETY EDUCATION INSTITUTE(tsEI) S, �ONnci This card certifiesthat: � SCOTT C GEORGbULI$" SCOTT GEORGOULIS 96 ARLINGTON AVE• -' DRACUT MA 0826 has completed a 10-Hour OSHA Hazard Recognition Training for�the Construction,Intlustry. y . 08/23/2013 Expiration Commissioner 10/21/2015 Director:Scott MacKay Trainer:Taylor Sikes Grad.Date: