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HomeMy WebLinkAboutBuilding Permit # 4/30/2015 %AORT#1 BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO:�-'Vl,,- Date Received Date Issued: gcwu IMPOWfANT: Applicant must complete all items on this page TYPE OF IMPROVEMENT PROPOSED USE ResidentialNon- Residential El New Building ne family El Addition F-1 Two or more family Li Industrial Y 6ration N-o. of units: El Commercial \Aepair, replacement 11 Assessory Bldg 11 Others: 1.1 Demolition Li Other e Identification Please Type or Print Clearly) OWNER: Name: Phone: 7? Address: ��� , //��, ��%/ , ��, , . �/� Ar� , ,�/{,� � ���r�l ��//'�/��� � ,/fir, % ,���, / , 1 , / / / / �/ / / / / ,epi/�f/,�,,„f � �„% �/��,���;� ��,�, �%,, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F. Total Project Cost: $ J FEE: $ Check No.: Receipt No.: f”) 1, )2i.- ”) �� 4 NOTE: C,- Persons con with unregistered contractors do not have access t guaranty fund 4, jg "qna ture"', 114 tkORTH _t own of Anctover ® 4 .i A lb Mass ® t_PkKa °I 1 COC KICMQWtCK �•9 A0;SATE® PX Cl S � BOARD OF HEALTH Food/Kitchen P1ER =M= 1T I U LD Septic System THIS CERTIFIES THAT ......... ®. . ...........+e-'V ........................................................ BUILDING INSPECTOR .............. ..... .... has permission to erect buildings on ... ,/"�!� Foundation ......... ................ (,� ........... ........ .................................... Rough tobe occupied as ....................... ....... .................................................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and 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 I 6 MONTHS ELECTRICAL INSPECTOR . UNLESSI T RTS Rough Service ............ ..... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough ` ,Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. y 'J,r) 'N e� C 96 Arlington MJ e. Dracut,MA 01 26 1-978-453-4242 Off ce 1-978-888-1700 Cel CON19R,A1,4TT Dwight Feene3 04/25/15 261 Waverly Rd. N. Andover,TVA 1-978-314-9681 d.\vight.feenev@eJ)tc.com J b Location:261 Wavrly U.N.Andover,MA Scope of Worlv Remove all layer:3 of s ingled roofing own to wood deck on entir house roofs,protect mg I he ounds and house body with heavy duty larps as stripping is be ng done. Install 6'GAF)X eathe rwatch ice/wate shield,underlayment acros all eaves,in all valleys,aromid chimney,and Yup all rakes at all roof to v tall locations. F I coverage on all lower sl ped back dormer roof I Install GAF Shin glemate felt paper un erlayment on remaining erased roof deck surfaces. Install 8".025 9 ge It-1avy duty aliujmi um drip edge on entire rootperimeters, Install GAF Pro S tart s arter strips acro,�s all eaves and tip all rakes, Install GAF Tim berlin.,HD Lifetime Architectural shingles with Timbertex hip/ridge ps c n roof Install new Coravent N-400 ridge vent on all main ridges. Install new stack pipe I ioot on existing lumbing pipe. Install new lead f lashir g on existing brick chimney. Replace approx. ')exmis 'ng vinyl siding panels that are cracked or damaged with new wl ite mys siding to match as closely as possib.e. I Thoroughly Clear L and magnet grounds and remove all job related debris from property on a Jail y basis and at jobs completion. $2.50 Per Lineal Foot Exfta Cost to relace any damaged plank bo ird decking(if neede i). Entire job indu les GAF Systems Ph is Warranty. First 50 yrs.Is non-prorated,fu l I labor,ind material coverage from GAF, gainst any material defect cause,and is transferrable one tin le. �'"WPOSE iereby to furnish ma-erial and labor complete i accordance with at ove spt cifications, for the sum of &J - 1,2006,00 cvgt 2;ia Five Thousand Nine Hundred Forty Five Dollars $5,945.0) i'A'tivl)?NTTO P"I",�v]ADI VS 14)l $2,000.00 PAUD,INADVANCE TOWARD MATERIAL COSTS.$3,945.00 PID IN FULL WHEN JOB ISCOMP LE MY EINISHED ACCORDING TO THE ABOVE LISTED V.IOPOSAL. All material is guara iteed t o be as specified.All work to be completed in a substantial workman like ma mer acco,ding to specifications sub nifted per standard practi=.Any alteration or deviation from above specifications Invo ving extra costs will bee ecuted only upon written orders,and will become an extra charge over and above d e es imati% 4A 'I All agreements con[agent apon strikes,accid nts or delays beyond our control}0 fire,to ado aid her CP Owne t 04 ry necessary insurance Our v orkers are fully covered by workers compensation g 01 Georgoulis Authorized Signature I This proposal m y be withdrawn by is if not accepted within �days ,ccq)k,'u wo of 1`ropoal-The above pries,specifications are satisfactory',and are hereby accepted. Yo,i are authorized to do the work as specified. Payment wil U mai le as o tlined above. Signature Signature Da-e o:'ac eptance W 1 L,5 The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 - www.mass.gov/dia UV a Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Georgoulis Construction, Inc. Address:96 Arlington Av City/State/Zip:Dracut, MA Phone 4:9784534242 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with 10 employees(full and/or part-time).* 7. []New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.n I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 F1 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. 1.2.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 1.4.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] IL *Any applicant that checks box#I 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 provi(lirtg 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. Ido hereby certify un er the air and penal 's of peijuty that the information provided above is true and correct. Signature: Date: Phone#: �d�y 7 -----T Z— 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#: KIM,r 30 15 02:34p Office 19784589997 p.1 m® ,4►coRo° CERTIFICATE OF LIf WILITY INSURANCE DATE 04!300!2f2(Mml0/YYYY) 015 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 INSUR,%NCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU ER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(jes) must be endorsed. If SUBROGATION IS WAIVED, Subject to the terms and conditions of the policy,certa n policies may require an endorsement. A statement on this certificate does not con fer rights to the Certificate holder in lieu of such endorsoment(s) =ROD•JCBR Phone:(978)263-3500 Fax:(978)263-1438 CONTNA EAS Gallant Insurance Agency,Inc. GALLANT INSURANCE AGENCY,INC. 199 GREAT ROAD 1 P O BOX 975 ac�Ni.17 978 263.3500 v� 01. (97B)263-1438 ACTON MA 01720 ADDRESS• PRODUCER 36702 ¢UBTOfAEft IIX _ — _ _ _ INSURER(S) AIFORDING COVERAG NAIC4 INSURFD OULIS Admiral Insurance Company CIO SCOTT GEORGOULIS _ O CONSTRUCTION INC. INSURER s INSURER A :Chartis InsuranceCompany C 96 ARLINGTON AVENUE INSURERc DRACUT MA 01826 INSUPERD: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 44380 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAYIE BEEN ISSUED TO THE INSURED NAMED ABOVE FOF THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIT RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SLBJECI TO ALLTHE TERMS, 7 INSR TYPE OF INSURANCE AO L EUBR_ POLIG'/EFF POLICY P LI M19ITS LTR _ al R V&Di POLICY NUMBER rnrvDDrvrrr 41. A GENERAL LIAB1LnY CA000020975-0 i 03/05/15 03105116 EACHOCCURRE CE S 1,000,000 X COMMERCIAL GENERAL�LIA31LIYY i PRA MSE TO ENES TE-.ncs S 100,000 CLAIMS-MADE I X1 OCCUR ABED.EXP(Any o ie persD) ° s 5,000 PERSONAL&AD 114JLR Y S 1,000,000 GENERAL AGGR GATE 9 2,000,000 '.. GEN'LAGGREGATE LIMIT APPLIES PER: I PRODUCTS-COAP/OP AGG $ 2,000,000 I Pzko- POLIGY i I IFCT I ;LOC AUTOMOBILE LIABILITY COMBINED SING E LINT (Ea accident] ANY AUTO — BODILYINJURYPer per ) A-L OWNED.AUTOS -- i BODILY INJURY' era=i en:). SCHEDULED AUTOS PROPERTY DAPAWE HIRED AUTOS (Per accioen:) S NON-OWNED AUTOS 5 UMBRELLA LIAR OCCUR T EAG-I OCCURRE 4CE ..__ EXCESS LIAR CLAIMS-MADE i AGGREGATE DEDUCTIBLE ( 5 RETENTION S _ s /!C STATU­ B WORKERS COMPENSATION WC009774283 09/25/14 09125/1 X I TORY LIIAITS AND ERIPLOYEAS' LIABILRY Y111 ANY PROPRIETORIPARTNER'BXECUTNE E.L.EACH ACCID NT $ 100,000 OFFICERIMEMBER EXCLUDED? FAN7 (Mandatory in NHI E.L.DISEASE-EA M-LO EE 5 100,000 If yes.desaibe under '.. DESCRIPnOV OFOFERATIOUS beom E.L.DISEASE-PO ICY Lit IT S 500,000 DESCRIPTION OF 0PERATIO NS/LOCATIONSi VEHICLE (Attach ACO RD 101,Add It]onal Remark;Sch edcre,if more space is requ!red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHEABOVE DESCRIBED POLMIESBE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE T EREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPR<SENTATPX _ Attention- �p j her sa arra / ACORD 25(2009/09) ©1988-2009 ACORD CORPORkTION, Alf rights reserved. The ACORD name and logo ate registered marks of ACOR 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.Marie reason for change. SCA 1 0 2OM-05/11 ( ] Address l Renewal Employment ( Lost Card r'%/rn`f�'�nr�rtcwc�u>allf r�i-'�tdrlJrn�ulrlfS ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. lf.found return to: m gistration: 117870 Type: Office of Consumer Affairs and Business Regulation `- xpiration: 12/12/2016 Private Corporatior. 10 Park Plaza-Suite 51.70 Boston,MA J2116 GEORGOULIS CONSTRUCTION,INC. 1 SCOTT GEORGOULIS 96 ARLINGTON AVERT DRACUT,MA 01826 Undersecretary Not valid without signature Massachusetts -Department of Public Safety ISE1,101 95 d Board of Building Regulations and Standards J' 1JCSanl?tego)Extension America >>� SafegCound Construction S1lpetn isor License: CS-058498 ;G U INTERNATIONAL SAFETY EDUCATION INSTITUTE(ISEI) TdO 1 1 f ti q l This card certlfie`s than SCOTT C GEOROULAN �r y SCOTT GEORGOULIS 96 ARLINGTON AVE' DRACUT MA 01,826 v has completed a 10-Hour OSHA Hazard,Recognition Training forthe Construction.Industry. ration 08/23/2013 Expira 08/23/2018 10/21/2015radon Director:Scott MacKay Trainer:Taylor Sikes Grad.Date: Commissioner