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HomeMy WebLinkAboutBuilding Permit #638-2017 - 946 OSGOOD STREET 12/13/2014k-/ Ai W CI`r BUILDING PERMITo;-, lT�' VIS 3� ,` •6 TOWN OF NORTH ANDOVER ° r ( APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 1 IMPORTANT: Applicant must complete all items on this page LOCATION 9 0 � sT ' t v o PROPERTY OWNER n K �6 n Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesr Machine Shop Villa e yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building :] One family Cl Addition 71 Two or more family u Innd stria) Cl teration No. of units: LU�Commercial Y'Repair, replacement -J Assessory Bldg u Others: Demolition Other —LJ _ Septic L i Well _ Floodplain _ Wetlands _l Watershed District Water/Sewer Identification Please Type or Print OWNER: Name: Address: 7'V 13 A- 7704/ CONTRACTOR Name: Phone: Address: Cv Supervisor's Construction Licens ( ��Exp. Date: -7 Home Improvement License: // 7e76) Exp. Date: /g ARCH ITECT/ENG IN EER Phone:69999m4mr Address: --• No. 0 FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED C(�OST BASED ON $125.00 PER S.F. Total Project Cost: $ U, 6y FEE: $ � I Check No.: ( -3 Receipt No.: t-,),nZ NOTE: Persons contracting with unregistered contractors do not have access to t guarantyfund Signature of Agent�Owner ture of contractor �� Plans Submitted ❑ Plans Waived U Certified Plot Plan ❑ Stamped Plans ❑ TyPB'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body 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 - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Siqnature COMMENTS ^HEALTH "OMMENTS Reviewed on nature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Commen Co Water & Sewer Con nection/Siqnature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Locatea 6M Usgood Street no -imension 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 Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filletl 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 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 o 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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: 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 t Doe: Building Permit Revised 2014 Location Lj No. Date Check# / � �' -3 11 3 70 < TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ �C( (fq Foundation Permit Fee $ Other Permit Fee $- TOTAL $ Building Inspector v C � 0 O CD CDo-0 A CL c• Q �• r- > � 'D 0 O vCD cC o r�� q C - CD CD o CD ou W 3 a CD EL O y• �• C I � v O z CD 0 n o m O CD 0=-% y = <, CD N N c m CD CD n rtCLC1 m D- O O .+ Q. 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O Y11 h =t �CD .-� CO) ' d) O —1 CD CD 2 Lm: a -1 D to CL c cn 0 =r rtCD _ CD=_ 0 < to � rt O0� w o -hCD Cr D CD C Q ooh ccn Q o CL fCD Q -o �CD N rt CD 0 su o � rtNew CD CD rt n<D y v_CD �D 'a O � 3 0: 0 fu 3 0 N p (D K ; N z Z co j 7 N O � S R !p n ro 0 S 5.T R z O � S T N n S �' 7 rn Z) O C 3' T O C Q d O (n m '6 A y �< v T O O \ n T v m m z y -AI O m m n n m 0 C W Z m 0 3 C p Z m 0 3 3 W p O m = CD II Si -60-e11 GEORGOULIS ROOFING & CONSTRUCTION, INC. 96 Arlington Ave. Dracut, NSA 01$26 / A[ Greene - Director of Field Operations I-97&453-42420 ice IA78-888-1700 Cell gegMooulis l4l l.com Norman Lee. Re: 946 Osgood St. N. Andover, MA 1-978-375-7744 n1ee A' ncsne.coin Scope of Work: (Siding) CONTRACT V -'C 08/07/16 Job Location: 946 Osgood St. N. Andover, MA On back side of restaurant, back half section of driveway side, and back quarter section on street side, Strip all existing vinyl siding, leave in place all tile type siding. Fur out the area behind condenser unit, replace the rotted soffit area with new pre -primed pine. install new Tyvek house wrap and 3/8" foam insulation board on entire body of restaurant where stripped. Install new white, vinyl vented soffit panels on all soffits. Cutting open wood soffit for venting if needed. Wrap all existing facial, rake, shado%v arra vri rdow trite with new white .019 aluminum coil stock. Install new Certainteed "Monogram .046", Double 4" clapboard style, vinyl siding on entire specified wall areas, with standard 5" vinyl corners, and vinyl light/outlet blocks. Thoroughly clean and magnet grounds and remove all job related debris from property on a daily basis and at jobs completion. $55.00 Per Sheet Extra Cost to replace any rotted or damaged plywood wall sheathing (if needed). Entire jobs comes with Georgoulis Roofing, Inc. full 10 Yr. installation warranty, and a lifetime warranty from the manufacturer Certainteed on all materials. WE PROPOSE hereby to furnish material and labor complete in accordance with above specifications, for the sum of. D�� . Po; d • "030-0o C K# '11(3 Sixteen Thousand Three Hundred Thirty Dollars $16,330.00 PAYMENT TO BE MADE AS FOLLOWS: $6,330`00 PAID IN ADVANCE TOWARD MATERIAL COSTS. SI0,000.00 BALANCE PAID IN FULL WHEN JOB IS COMPLETELY FINISHED ACCORDING TO THE ABOVE LISTED PROPOSAL. All material is guaranteed to be as specified. All work to be completed in a substantial workman like manner according to Specifications submi ted per sttindard poctiCeS:Any ahcratioa ar devintiort from abov-c spzaific4ous involving extra costs will be executed only upon written orders, and will became an extra charge over and above the estimate. All agreements contingent upon shutes, accidents or delays beyond our control. Ownercarry fire tornado and other necessary insurance. Our workers are fully covered by workers compensation msurangl l� GeMoulis Authorized Signature This proposal may be withdrawn by us if not accepted within0 days. Acceptance ,f W ' tl i -'Phis abnverice$Lature wo f ua6ons are satisfactory and are hereby accepted. You are autriorized to do the work as specified. Payment will a made li d a Signature Date of acceptance ir` fit? 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@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. 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 kw1wDepartment of Industrial Accidents 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 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.F� I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.❑ 1 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.❑ 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. E] Remodeling 9. ❑ Demolition 10E] Building addition 1 L Electrical repairs or additions 12. [] Plumbing repairs or additions 13.❑Roof repairs 14.E] Other *Any applicant that checks box # 1 must also till 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 Company Policy # or Self -ins. Lic. #: WC009774283 Expiration Date: 9/25/17 Job Site Address: 946 Osgood 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. - I do hereby certify der" "s and pe ties of perjury that the information provided above is true and correct Phone #: / 7 7 &L/4/ 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 (MMIDD/YYYY) 09/30/2016 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 GALLANT INSURANCE AGENCY, INC. 199 GREAT ROAD / P O BOX 975 CONTACT Gallant Insurance Agency, Inc. NAME:PHONE FAX rvc. No. Ext1: (978) 263-3500 pC Nel. (978) 263-1438 E-MAIL ACTON MA 01720 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 000706700 INSURER A : James River Insurance Company 03/05/17 INSURED GEORGOULIS CONSTRUCTION INC. INSURERB : Granit State Insurance Company INSURER C/O SCOTT GEORGOULIS 96 ARLINGTON AVENUE INSURER D: DRACUT MA 01826 INSURER E DAMAGE TO RENTED PREMISES Ea o=urence) $ 100,000 INSURER F COVERAGES CERTIFICATE NUMBER: 52085 RFVISIAN NtIMRFR- 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSDADDL WVD POLICY NUMBER POLICY EFF MOLIC POLICY EXP (MMfDDOLICYEYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY 000706700 03/05/16 03/05/17 _ EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES Ea o=urence) $ 100,000 MED. EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO - POLICY ❑ JECT 0 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE JAGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANV PROPRIETOR/PARTNER/EXECUTIVE YINE.L. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) Nip WC009774283 09/25/16 09/25/17 X PR STATUTE ERH EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE -POLICY LIMIT 1 $ 5500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of N. Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention. Theresa M. Farrah ACORD 25 (2014/01) U 1958-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SGA 1 0 2OM-05/11 (gl-W W01,XWt0'1tW16a14 OICAWadlml� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmprovemei.: tractor Registration Georgoulis Construction, Inc. 96 Arlington Ave Dracut, MA 01826 r'�/�� `�c=snzrrnzarr�crll� c�r i'ftzssanfurrl2't Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR 'type: Corporation 4RWstration Expiration - : j 17$70 12/11/2018 GeorgouGs CotSht,etior#;1riC: Scott Georg outis i t 7! 96 Allington Avey Dracut, MA 01828 x� Undersecretary Type: Corporation Registration: 117870 Expiration: 12/11/2018 to Address and return card. Mark reason for change. 71 Azld,p*9 1.1 Ranowal n Elrpinyment ❑ Lost Card Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, M 02ii6�.w Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards ISEIIOIO-6955849 License: CS -058498 !UCSanDiego Construction Supervisor j Extension A Grfca --^Yt,�ill INTERNATIONAL SAFETY EDUCATION INSTITUTE (ISEI) SCOTT C GEORG,OULIS .- 4 This card certifies that: 96 ARLINGTON AVENUE r =� � DRACUT MA 01826it) SCOTT GEORGOULIS ? �` has completed a 10 -Hour OSHA Hazard Recognition Training .� for the Construction Industry. r-JZU�- CA,i' - 08/23/2013 Expiration: Commissioner 10/21/2017 Director: Scott MacKay Tralner:Taylor Sikes Grad. Date: