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HomeMy WebLinkAboutBuilding Permit # 11/17/2015 OORTH BUILDING PERMIT F NORTHANDOVER . a..........�9a 0 � TOWN APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received / .. CFeU��6 Date Issued: I PO TANT Applicant must complete all items on this page 011, r , r / / f / r l / I / 1 r / r r 1 / / r TYPE OF IMPROVEMENT PROPOSED USE Reside ' I Non® Residential ] New Building C ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg 11 Others: ❑ Demolition ❑ Other ✓.r/-.,.,r �/i.,r viii., r,%, r e c;,,. ,,.,, ri/r , ,, ., // „. „////%/r /,I� ii r � r/ , i„ r //,i,: ,, ///%�6,..%/.../�.. // / /✓ ,,; �i 1 fir, ,rr r � Identification Please'Type or Print Clearly) OWNER: Name: Phone: Address: / r / / s ,,/,�//%.,,///tri ✓, i, ,1 r„r r/ � / f/ l / � /, / / %�>/� ////�r / / / / r I r rr r III l . r r rli /f / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. d„ /` - Total Project Cost: $ FEE: $ ,J li Check No.: IeO,`'5 ®Receipt No.: ,,, <5.5 Y NOTE: .Persons contracting with unregistered contractors do not have access t the guaranty fiend Signafur c►f P+ a caner iOature bcon, radtra AM ® T lictov er -�dt y�. h vertu ass, O LAKE / COC MIC KE WICK ORATED AVVN �5 S U BOARD OF HEALTH Food/Kitchen PERM- IT T LD Septic System THIS CERTIFIES THAT ........ 27-.l.!.��yy:�............................................................. BUILDING INSPECTOR Foundation has permission to erect ........ buildings on ....�.5..7 � ....��... .................. ..... ....................... Rough tobe occupied as .................;72...�.! ... .... . .. . ...7....................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT E I ONT S ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Q`.� ............................... 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 Approvedby the Building Inspector. Burner Street No. Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL, FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location 4f Facility) Signature of Pe i Applicant Date 2� l e t- hin lv i5S ac ale4 (-,ee- GEORGOULAIS R00FINC3 & CON SIMI,)CT_110N, INC 96 Arlington Ave. Dracut,MA 01826 1�l Greene x eeste.-Estis—mora 1-978453-4242 Office 1-978-888-1700 Cell �� f tqo (t conj CONTRACT Barbara Tomkins 10/06/1.5 157 Lancaster Rd. N.Andover,MA 1-978-821-5233 bjt.t]1]]tcit S{C?aoi.con1 Job Location:157 Lancaster Rd.N.Andover,MA Scope of Work: Remove all layers of roofing down to wood deck on entire house,all additions,and garage roofs,protecting the grounds and house body with heavy duty tarps as stripping is being done. Install 6'Grace Select ice/water shield underlayment on all roof eaves, in all valleys,3'up rakes at roof to wall locations,and around all protrusions. Install GAF Shinglemate felt underlayment over remaining exposed root deck. Install 8",025 gauge heavy duty aluminum drip edge on entire roof perimeters. ' Install GAF Pro Start starter strips across all eaves and up all�rakes. Install GAF Timberline HD Lifetime Architectural shingles with Timbertex Hip/Ridge caps on roof. Install new stack pipe boots on existing plumbing pipes. Install new Coravent V-600e ridgev4nt on all main ridges. Inspect and seal all lead flashing on,both existing brick chimneys. Thoroughly clean and magnet grounds and remove all job related debris from property on a daily basis and at jobs completion. Georgoulis Roofing,Inc.will obtain the required building permit,and the cost is included. $55.00 Per Sheet Extra Cost to replace any damaged plywood decking(if needed). Entire job includes GAF Systems Plus Warranty. First 50 Yrs.Is non-prorated,full labor and material coverage from GAF,and the warranty is transferrable one time. WE PROPOSE,hereby to furnish material and labor complete in accordance with above specifications, for the sum of. bet.Va.d • 1330.0® Ck 9.3414 Twenty One Thousand Three Hundred Thirty Dollars $21,330.00 PAYME114T TO BE MA11E h,';FOLLOWS: $7,330.0 0 PAID IN ADVANCE TOWARD MATERIAL COSTS.$14 000.00 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 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.- a-----�'� All agreements contingent upon strikes,accidents or delays beyond our control.Ownero carry fi ,tornado and other . necessary insurance.Our workers are fully covered by workers compensation insur t� Georgoulis Authorized Signature This proposal may be withdrawn by us if not accepted within 0 days. A c€;.eptanc orf Proposal-The above prices,specifications are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Z/, Signature SignatureDate of acceptance A /� DATE (MMID01YYYY) Ac® ? ' CERTIFICATE OF LIABILITY INSURANCE 11/05/2015 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(ies) 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). CONTACT Gallant Insurance Agency,Inc. PRODUCER Phone: (978)263-3500 Fax: (978)263-1438 NAME: GALLANT INSURANCE AGENCY,INC. PHONE (978)263-1438 ac N-Exl: 978 263-3500 A cFAXNo 199 GREAT ROAD/P O BOX 975 E-MAIL ADDRESS: ACTON MA 01720 PRODUCER 36702 CUSTOMER ID: INSURER(S) AFFORDING COVERAGE NAIC fi INSURED INSURERA Admiral Insurance Com an GEORGOULIS CONSTRUCTION INC. INSURERS :Chartis Insurance Company C/O SCOTT GEORGOULIS INSURER 96 ARLINGTON AVENUE —INSURER D: DRACUT MA 01826 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 47220 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, ADD'L SUBR POLICY EFF POLICY EXP LIMITS ]NSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MWDDIYYYY MM/DD 1,000,000 T GENERAL LIABILITY CA000020975-01 03105/15 03/05116 EACH OCCURRENCE $ DAMAGE TO RENTED $ 100,000 X COMMERCIAL GENERAL LIABILITY P EMISES Ea occur-ce 5 MED.EXP(Any one person) $ ,000 CLAIMS-MADE I X]OCCUR 1,000,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: '.. PRO- LOC POLICY COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ '.. SCHEDULED AUTOS PROPERTY DAMAGE $ (Per accident) HIREDAUTOS $ '.. NON-OWNED AUTOS $ EACH OCCURRENCE UMBRELLA LIAR OCCUR AGGREGATE '.. EXCESS LIAR CLAIMS-MADE '.. $ DEDUCTIBLE $ '.. RETENTION $ WC STAN- OTH B WORKERS COMPENSATION WC009774283 09/25/15 09125116 X TORYLIMITS 100,000 AND EMPLOYERS' LIABILITY YIN E.L.EACH ACCIDENT ANY PROPRIETORIPARTNERIEXECUTNE I� OFFICER)MEMBER EXCLUDED? NIA E.L.DISEASE-EA EMPLOYEE 100,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Attention: heresa arra ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department ofIndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/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): I.E]I am a employer with 10 employees(full and/or part-time).* 7. []New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. EJ Remodeling any capacity.[No workers'comp,insurance required.] 9. EJ Demolition 3.01 am a homeowner doing all work myself[No workers'comp.insurance required.]t IOE]Building addition 4.[:]l 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. 12. Plumbing repairs or additions 5.[:]1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6.[:]We are a corporation and its officers have exercised their right of exemption per MOL c. 14.[:]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required,] L *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. fContractors 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 employers tleat is providing workers'compertsatiort iitsararace fof•my employees. Below is the policy and job site information. Insurance Company Name:Admiral Insurance Company Policy#or Self-ins.Lie.#:WC009774283 Expiration Date:9/25/16 Job Site Address:157 Lancaster Road 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., mrd peva e I do hereby certify;urier tali Z' ,at4, sofperjuryt at the information provided above is true and correct. Signature: '0 Date: V Phone#: 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 Pei-son: Phone#: M aW lo it a!C,'1°'Ale, 11,9/cAaJ.; ,r 71j ef��4d b Office of Consumer Affairs and Business Regulation y 10 Park?laza- 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. r, i Address : Renewal Employment ( ' Lost Card SCA 120M-05111 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only i`j UM ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration• 117870 Type: Office of Consumer Affairs and Business Regulation x xpiration: 12/12f2016 Private Corporatior. 10 Park Plaza-Suite 5170 Boston,MA 2116 GEORGOULIS CONSTRUCTION,INC. 9 SCOTT GEORGOULIS 96 ARLINGTON AVE , -- DRACUT,MA 01826 -� Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards Iw E'l10i0-69558 9 License: CS-058498 -�*UICSanDiegol Extension �t�f�l�'C�x� Construction Supervisor ii J rr of w INTERNATIONALSAFEI"YEDUCATION INSTITUTEUSER q1 unil SCOTT C GEORGOULIS`.. ° This card certifies that: 96 ARLINGTON AVEN SCOTT GEORGOULZS DRACUT MA 01828 has completed a 10-Hour OSHA Hazard Recognition Training for the Construction Industry. Director:Scott MacKa TralnerTa torsikes Grad. Expiration: 08/2 rt."/1� MacKay y d.Date: Commissioner 10!21!2017