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Home My WebLink AboutBuilding Permit # 8/5/2015 oOnrH BUILDING ITg4�a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received anew aawma Date Issued: �� s IIVLP®I2TANT: A licant must complete all items on this page r ✓ r / /r / / rr .r � r r / / ✓, ,r„<,r r r./ / / /iiia ::: / / / 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 1-1 New Building [] One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alt ration No, of units: ❑ Commercial C epair, replacement C:] Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �.( /fir „, ,�i, r i. r / r a r aN� / ,-� I ,ri � ❑ Wr$It 11 (� Dlrtrlc� , (97 L C Identification Please Type or Print Clearly) OWNER: Name ' l Phone Address: t // � /, ,, / r. / / /vr r /r %, r, a/ /i r,/,/ /,// li..r/rrr.,, crrai�r ., ,” r �✓ r„i / ,/ /r, / r /. r1// ./. /l l�. ,. , ,/ r 1 rf, 1, .., r ✓ / /r//i /r, /r r /r.,r r / ,/ r r,” / � ✓� / / // r / r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:EULDING PER/MIT;$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST SED ON$925.00 PER S.F. Total Project Cost- l. FEE: $ Check No.: I lz& Receipt No.: NOTE: Persons contracting ith u egister contractors do not have access to th gu ran.ty fu d a signature of ,gentil n„,. `” a gn to e of`c nk acfar FORTH Town of "� s_� Andover ® O% yy �, h ver, ass, 2A15 T O LAKE 1 COC MICNQWICK AoRATED PPA��`3 � U BOARD OF HEALTH Food/Kitchen PERMT LD Septic System THIS CERTIFIES THAT :. Nk ............... . ....... BUILDING INSPECTOR .... . ..... ....... . Foundation has permission to erect .......................... buildings on .3..3............ . 5�M.4 Rough 4 tobe occupied as .... . .. r............ ...c40 ..................................................................... Chimney provided that the person acceptil�g 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 16 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough -.. ............................ Service ........... ....... . .. ...... Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. 96 Arlington Ave. Dracut,MA 01826 AllGmeeiiiu Es,41rtrniiruir 1-978-4534242 Office 1-978-888-1700 Cell wmrgcru l4I(' k[,cQ it ( IAt..,.(, Matt Gosselin 05105115 33 Harold St. N. Andover,MA 1-781-315-2355 mat th w. o eli111(�t�1,alitaii. orn: 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' ice/water shield underlayment across all eaves,in all valleys,around chimney,and T up all rakes Aavi? U Ml 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 BD 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. 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 any material defect cause,and is transferrable one time. WE PROPOSE hereby to furnish material and labor complete in accordance With above specifications, for the sum af: nett1245. C.02 . Six Thousand Six Hundred Forty Five Dollars $6,645.00 PAYMENTTO 11r MADE AS FOLLOWS: $2.245.00 PAID IN ADVANCE TOWARD MATERIAL COSTS $4,400.00 PAID IN FULL WHEN .10B 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 C o(®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. All agreements contingent upon strikes,accidents or delays beyond our control.Owner cavy tire,tomado and other necessary insurance.Our workers are filly covered by workers compensation insura Georgoulis Authorized Signature This prop seA maybe withdrawn by us if not accepted within.0 days Aceeptai of f Proposal- I c above prices,specifications are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment wf I b made n I lb above. ,' I Sign ur lk ignature Date of acceptance t c'f The Commonwealth of Massachusetts -- Department of Industrial Accidents 1 Congress Street,Suite 100 FF � 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 Legibly 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): 1.0 I am a employer with 10 employees(fidl and/or part-time).* 7. ❑New construction 2.®I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] 4. ❑Demolition 3.®I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]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 I I.®Electrical repairs or additions proprietors with no employees. 12,F]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. 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. 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 etrtploJier 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:9/25115 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. I do hereby certify u1ner the ains and penalties of perjury that the information provided above is true and correct. Signature: Date: AAW-J _- Phone#: f 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#: DATE (MMIDDNYYY) A "RLY CERTIFICATE OF LIABILITY INSURANCE 04/30/2015 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 NCOONNTACT Gallant Insurance Agency,Inc. GALLANT INSURANCE AGENCY,INC, HCONEEz : 978 263-3500 F No: (978)263-1438 199 GREAT ROAD/P 0 BOX 975 E-MAIL ADDRESS: ACTON MA 01720 PRODUCER 36702 CUSTOMER ID: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA Admiral Insurance Company GEORGOULIS CONSTRUCTION INC. C/O SCOTT GEORGOULIS INSURER 13 :Chards Insurance Company 96 ARLINGTON AVENUE INSURER DRACUT MA 01826 INSURER D: 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 LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER NIDD MMIDD LIMITS A GENERAL LIABILITY CA000020975-01 03/05/15 03/05/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 EM SES Ea occu encs CLAIMS-MADE X I OCCUR MED.EXP(Any one person) g 5,000 PERSONAL&ADV INJURY $ 1,000,500 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICYPRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Peraccident) NON-OWNED AUTOS $ $ UMBRELLA LIAR _ OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE DEDUCTIBLE RETENTION $ TH $ B WORKERS COMPENSATION WC009774283 09/25/14 09/25/15 X TORYLIMITS OR AND EMPLOYERS' LIABILITY YIN E.L.EACH ACCIDENT 100,000 ANY PROPRIETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 100,000 Ifyes,describe under E DESCRIPTION OF OPERATIONS below .L.DISEASE-POLICY LIMIT $ 500,000 LE DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additlonal 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: eresa '—Farrah ACORD 25(2009/09) ©1988.2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD � 10'Melylielo fft!1Cy��c�.v�'f� 0/ if Office of Consumer Affairs and Business Regulation rr , 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. scat as 2oM or nt ( Address C-1 Renewal Employment ( Lost Card Office of Consumer Affairs&Business Regulation License or registration valid for individul use only k1f, ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: egistration: 117870 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/12/2016 Private Corporatior. 10 Park Plaza-Suite 5170 Boston,MA J2116 GEORGOULIS CONSTRUCTION,INC. 4WAr*41 SCOTT GEORGOULIS 96 ARLINGTON AVE ;�� y DRACUT,MA 01826 Undersecretary y Not valid without signature - � Massachusefs -Department and Public afety �_...... ..�.- f Patblic S I ? 101 �T� 55849 Board of BuildingRegulations Standards A#tt@�r' Con%truction�Super�i4or UCSanUxeo Extension Sofety[aunri► License: CS-0584981 l INTERNATIONAL SAFETY EDUCATION INSTITUTE(ISEQ I , I This card certifies that: SSCOTT C GEORGbiILT, SCOTT GEORGOULIS 96 ARLINGTON AVE w DRACUT MA 01$26 has completed a 10-Hour OSHA Hazard Recognition Training r d for the Constructionandustry. 08/23/2013 Expiration —" 10!2112015 `---�� Commiissioner Director:Scott MacKay Trainec�5r,Taylor Sikes Grad.Date: