HomeMy WebLinkAboutBuilding Permit #638-2017 - 946 OSGOOD STREET 12/13/2014k-/ Ai
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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
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TOWN OF NORTH ANDOVER
Certificate of Occupancy $-
Building/Frame Permit Fee $ �C( (fq
Foundation Permit Fee $
Other Permit Fee $-
TOTAL $
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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: