HomeMy WebLinkAboutBuilding Permit #695 - 565 TURNPIKE STREET 5/2/2006NOR7N 1
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Permit NO: J
Date Issued: —06
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
DateReceived:
IMPORTANT: Applicant must complete all items on this page
LOCATION �E7 J 74 fZ c/ --r
Print
PROPERTY OWNER �� of e�
Print
MAP NO.: PARC L: ZONING DISTRICT:
Tt1nT ♦ 1�Tn iTQV "Ll nrrn nr1U!'' H1QTn1D1C n1.QTR1VT vvc% n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non -Residential
01 New Building
0 One family
L Addition
11 Two or more family
❑ Industrial
Iteration
No. of units:
I] Repair, replacement
1 Assessory Bldg
Alcommercial
Demolition
Moving (relocation)
❑ Other
❑ Others:
0 Foundation only
DESCRIP't IUN UP W UK -r It) tib rx- 1-t-)M1vtr.0
,i,574// 4eitl f- 1 d er roe
Identification Please Type or Print Clearly)
OWNER: Name: ( Phone: tl
`
Address: P f Cq jo ox- 7 `Zl 1 ��.4 e
CONTRACTOR Name: - � Gr/2 / f C Phone:-
Address: q6 ail aIle-
Supervisor's Construction License: ���� Exp. Date:
Home Improvement License: ��� ® Exp. Date. -/0 'Id - 01(
ARCHITECT/ENGINEER Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDAG PERMIT. $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED O,v !115 Q0 PER S.F...
Total Project Cost S 3 4 10 0 x 10.00=FEE:$- MIZ. OC/
Check No.: 0] (W114 (n6)4-) Receipt No.: �S
PaVc i of 4
V
TYPE OF SEWARGE DISPOSAL
_
Tan ning'Massage/Body Art LJ
--
Swimming Pools I-
Public Sewer !
_
Tobacco Sales
Food Packaging/Sales
Well iJ
_
Permanent Dumpster on Site
Private (septic tank, etc.
Electric Meter location to
project
NOTE: Persons contracting with unregistered contractors do not have access to the guars ty firnd
Signature of Agent/Owner Signature of Contractor
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St mped Plans ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING -&-DEVELOPMENT ❑ ❑
❑ Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
CONSERVATION
COMMENTS
HEALTH -
COMMENTS
DATE REJECTED
❑
DATE APPROVED
11
DATE REJECTED DATE APPROVED
t
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: _ Comments
Conservation Decision: Comments
Water & Sewer connection signature & date
'Temp Dumpster on site yes --no— Fire Department signature. date
Building Permit Approved and Issued by:
Paige 2 of 4
Building Setback (t})
DIMENSION
Front Yard Side Yard Rear Yard
Required Provided Required
Provides Required
Provided-
rovided
DIMENSION
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
NOTES and DATA — (For department use)
Page 3 oi' 4
Doc [Nsi,EcriONAL SERVICES DLPAH'I'MLN :BPF0RM0i
'rrrted .1%1(" Jan. `ruo
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
Addition Or Decks
❑ Building Permit Application
❑ 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)
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
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: INSPECTIONAL SERVICES DEPARTMENT:DPFORN105
Location
No. 69S Date %;
MORTIy TOWN OF NORTH ANDOVER
0
41
4L I Certificate of Occupancy $
IT ACHUS Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $ 13 CID
TOTAL 15 001
Check# 1;071 z 637,PP
w+ f'y1 65
19168
Building Inspector
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COD
GEORGOULIS ROOFING & CONSTRUCTION
96 ARLINGTON AVE
INC,
DRAC.UT MA 01826
Ma.(978)453-4242
Nh.(603)-898-5857
Toll free(800)-340-ROOF
PROPOSAL
PROPERTY MANAGEMENT OF ANDOVER,INC
ATTN; JIM TOSCANO
04/21/06
JOB LOCATION;
P.O. BOX 448
CHESTNUT GREEN
ANDOVER, MA 01810
565 TURNPIKE ROAD
978-683-4101 FAX# 978-686-4664
ANDOVER, MA
INSTALL NEW RUBBER ROOF OVER EXISTING UPPER FLAT ROOF ONLY.
REMOVE EXISTING CAP METAL ON UPPER FLAT ROOF PERIMETERS AND CUT FIVE 5'
ON EXIST1NG11�IEMBRANE ROOF. ( ) ON CENTER OPENINGS
MECHANICALLY FASTEN 1/2"
RECOVERY BOARD OVER EXISTING FLAT ROOF
STALL GENFLEX .060 FULLY ADHERED EPDM RUBBER ROOFING OVER RECOVERY BOARD, UP ON TO
PARAPET WALLS AND TERMINATE AT ELEVATOR SHAFT. WITH GENFLEX FASTENERS.
INSTALL GENFLEX 3" SEAM TAPE ON ALL SEAMS.
INSTALL NEW COPPER SLEEVES IN ALL ROOF DRAINS.
INSTALL GENFLEX UNCURED EPDM FLASHING ON PLUMBING PIPES, ROOF HATCH, SCUPPERS,
AND OTHER PROJECTIONS.
INSTALL NEW LEAD FLASHING ROOF DRAINS
INSTALL ALUMINUM L -STOCK EDGE4AND NEW CAP METAL ON FLAT R
ALUMINUM WAS REMOVED. ROOF
PERIME'T'ER WHER
INSTALL GENFLEX 5- COVER TAPE OVER ALUMINUM L -STOCK. E OLD
REMOVE ALL RELATED DEBRIS FROM PROPERTY.
TEN (10) YEAR WARRANTY ON WORKMANSHIP.
TEN (10)°MANUFACTURERS WARRANTY ON MEMBRANE.
CONTRACTOR TO OBTAIN BUILDING PERMIT.
WE PROPOSE hereby to furnish material and labor- complete in
for the sum of. accordance with above specifications,
THIRTY EIGHT THOUSAND ONE HUNDRED DOLLARS
PAYMENT TO BE MADE AS FOLLOWS;
$38,100.00
All material is guaranteed to be as specified All work to be
10 specifications submitted per standard MI'lic-. An rPiebod as ubstantial worimran like manner according
extra cwsts will be executed on Y alteration or
IY upon written orders, and will becomede an extra above SlIeCifications involving
All agreements contingent upon strikes, accidents or delays beyond our control. Owner icer and above the estimate.
Cur
necessary insurance. Our workers are fully covered by workers , gado and other
LISCENSE f OSS49S HOME IMPROVEMENT CONTkeis comp REOI� �NTACTOR SUPER
ON#11
Authorized Signature
This proposal may be withdrawn by us if not accepted within 30 days.
Acceptance Proposal- The above
You are auth to the sped are satisfactory and are hereby accepted_
will be made as outlined above.
;ignattire
igna nr�3ate of acre ce
FROM
(MOM)APR 24 2006 14:18/ST.14:16/No.6836136636 P 2
ACOA . CERTIFICATE OF LIABILITY INSURANCE
°4:12 200
PRo°ucm (918)459-2101 Ext-
Daigle Company, Albert A.
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
313 W I lard Street
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
'TYPE OF II'MRANCIE
Dracut, IAA 01828-5099
POLICY EFFECTIVE
INSURERS AFFORDING COVERAGE NAIC #
INSURED Georgou I i s Const ruct i on Inc.
INSURER A: L loyds London
INSURER a: kw ie9n Name Assurance
96 Ar I i ngton Ave.
INSURER C:
Dracut, MA 01826
INSURER D:
EACH OCCURRENCE $ 1,000,000-00
INSURERE;
nnvraer_cc
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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS-
INSR
WRN
'TYPE OF II'MRANCIE
POLICYNUMBER
POLICY EFFECTIVE
POLICY EXPIRATIONLTR
DATE MWDDfYYI
LIMEYS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000-00
X COMMERCIAL GENERAL LIABILITY
LGL059893
02/15/2006
02/15/2007
PREMISESEwa =pence $
CLAIMS MADE ® OCCUR
MED XP (Any one P—M) b 6,000,00
E
A
---�-_-_�-
PERSONAL& ADV INJURY $ 1,000,000.00
GENERAL AGGREGATE $ 1,000,000.00
GEN .L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - WNIPIOP AGG $ 1,000,000.00
POLICY PRO- LOC
AUTOMOBILE
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) S
BODILY INJURY
(Per Petaon) $
ALL OWNED AUTOS
SCHEOULEO AUTOS
BODILYINJVRY
(Per accdent) $
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE S
(Per e—kle t)
GARAGE LIABILITY _
AUTO ONLY - EA ACCIDENT S
OTHER THAN EA ACC S
ANY AUTO
AUTO ONLY. AGG S
EXCESSNMBRELLA LIABILITY
EACHOCCURRENCE $
OCCUR u CLAIMS MADE
AGGREGATE $
S
S
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC STATU•OTH-
TORV t I
B
rRfFXEMPLOYERS' LIABILITYW
ANY ECUTIVE
WIC782_68-24
09/25/2005
09/25/2006
EL.EACH ACCIDENT $ 100 000.00
E.LDISEASE -EAEMPLOYEE S 100,0W.00
E
OFFICEMEMBERXXXC UDEW.
H yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT I S 500,0N.00
OTHER
DESCRIPTION OF OPERATIONS T LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISKNNS
I
CERTIFICATE HOLDER CANCELLATION
Property Management of Andover, Inc. SHOULD ANY OF Tiff ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Chestnut Green DATE THSXEOF, TIRE ISSUINCI INSURER {YELL ENDEAVOR TO MAIL 10 DAYS WRITTEN
555,565, & 575 Turnpike Rd. NOTM.F TO THE CERTIFICATE HOLDER NAMFD TO THE LEFT, BUT FAILURE TO DO 80 SHALL
Andover MA 01810 IMPOSE NO OBLIGATION OR LLA OFA KIND UPOWOVINSURER, ITS AGENTS OR
ACORD 25 (2001108)
CORPORATION 1988
�% .�om,no.zuira/l/ a�,/ aaciivaelld
_ Board of Building Regulations and Standards
y - HOME IMPROVEMENT CONTRACTOR
Regrstraban .:117870-_-y - �_.-
Ex131ra10n 12/12/2006
` Type Private Corporation
FV
GEORGOULIS CONSTRUGTION,;INC.- -- '— •;�
.SCOTT GEORGOULIS4
96 ARLINGTON AVE '•:
DRACUT. MA 01826
--L — Administrator
✓�e �oorrmza�ru�ea�: o���Cr6aa'T.%iu6elTb +
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 058498 i
Birthdate: 10/21/1966 I.
Expires:, 10%21/2007 Tr. no: 5948.0 i
Restricted: 00.
SCOTT C GEORGOULIS
96 ARLINGTON AVE
DRACUT, MA 01826 Commissioner
0