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HomeMy WebLinkAboutBuilding Permit #597 - 36 ANDOVER STREET 3/13/2007 i tkORTH BUILDING PERMIT O .1 069 TOWN OF NORTH ANDOVER G? �` ( 4, 6 �� APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received �� ORArgo "�qg � SSACHU`�� Date Issued: V U 7 IMPORTANT: Applicant must complete all items on this page LOCATIONS i PROO'ERTY-OVVNEI wWrint F IUAP NO; , PARCEL: ICT ZONING DISTR : R 3 HISTORIC DISTRICT" ye no t TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family KAddition ❑ Two or more family ❑ Industrial I ❑ Alteration No. of units: ❑ Commercial 1 ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Q Septic d Welly g `4d Floodplart E Wetlands ;0 'Watershet istrict Vater/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identi cation Please Type or Print Clearly) OWNER: Name: 1C�J&! D w- 1w1yK,.000 Phone: 1778 6475��� Address: �� �/t/�O(/�/2 7"/2 �% �t/U/�T� /�C�(/�•+2. CONTRACTOR Name:��1��l 14-YY1 }��'t3 = Phone. Address. � t Supervisors Construction Lieese: .�-� / Exp. Date:. C `` I Horne Improvement License . . `- - Exp. Dte: ARCHITECT/ENGINEER d17/�GrG LG Phone:��17� Address: S /!•r/ �� .�/f aA r// g. No. 1 FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ (0 ©�� ' �� FEE: $ i Receipt No.: 900 Check No.: TL NOTE: Persons contracting with unregistered contractors do not have access to"he gu r my fu d Signature of Agent/Owner Signature of contractor 1 Location ZI) U'��-� No. '"a Cly" Date �j' J NORT1y TOWN OF NORTH ANDOVER f ; 9 Certificate of Occupancy $ ♦ s �G; � • F ;�s'••°•'<� Building/Frame Permit Fee $ s�cnust Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20G ��` �� Building Inspector Plans Submitted Plans Waived ❑ Certified Plot Plan Stamped Plans THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED i PLANNING & DEVELOPMENT ❑ ❑ COMMENTS I I TE REJECTED DATE APPROVED CONSERVATION . COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS I TYPE OF SEWERAGE DISPOSAL I Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ f A f1 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Punning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street i FIRE"'-DEPARTMENT'-- Temp Dumpster on site yes no ` Locafed�at 1,24 Mala Sheet Fire t)doartment sirg'natureldaf ° e, IC NTS I I Dimension 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 NOTES and DATA— For department use i ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 I Building Department I The following is a list of the required forms to be filled out for the appropriate permit to be i obtained. I Roofing, Siding, Interior Rehabilitation Permits i ❑ Building pp 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 Addition Or Decks I wilding Permit Application YCertified Surveyed Plot Plan Workers Comp Affidavit photo Copy of H.I.C. And C.S.L. Licenses r>�opy Of Contract ❑ Floor/Crossection/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 New Construction (Single and Two Family) ` I ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses R ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 f k l SPS . ayp. -6moe.. 07 . �180AW of Building Regulations u'2':S aa dards - {, tttl i HOME IMPROVElkNT ONTftq ( q Registration `• 39101 u= ` 1=xpfra- �;�' 8/512007 r f Tyise 6dual - WILLIAM:POGLOR 79 JOHNSON 5T NolkAiUDOVER,MA 01845 ✓tiea3rlmraaru;ea�l�� ✓ ira at�u BOARD OF BUILDING REGU[ATIONS { License: CONSTRUCTION SUPERVISOR l Number: CS 083917 Birthdate.:tl6/2$Z1957 h:. Expires:06/28/2008 Tr.not 28106 Ros.tiil6to.d:l 00.'.` WILLIAM:H POGOR.= 10 LACY ST. NO ANDOVER,"MA 01845' Commissiorfer —�+ I I J WORK CHANGE ORDER FORM Glen&Antonia Macon (36 Andover Street,North Andover,Massachusetts) Change of Work Date: Contract Date: C{ - - 0(� This Work Change Order applies only to those items specifically addressed herein. Nothing in this Change Order shall be construed to change any other term or condition of the Original Contract or other change of work order forms, fimure or past unless specifically stated. All work will be reflected at a time and material-billing level. Stated and explained in the original contract and will be billed weekly or in advance, due to the expeditious nature required by these changes. The following list has been developed to inform the client with regard to the scope and amount of labor, materials and monetary requirements,but should not be construed as all-inclusive list. Customer Initial Date Description of Change(s): 1. Drafting 1.1. Exterior elevations. 1.2. Entire Floor plan 1.3. Submission To Historical-Society 1.4. Submission Building Department and any other appropriate Departments. 1.5. Energy envelope. 2. Survey 2.1. Redraw addition on lot survey 3. Structural Engineering 3.1. Review structural engineering and restamp. 4. Additional Excavation: 4.1. Re-dig footings i 5. Additional Concrete. Customer Initials Co ctor Initials WORK CHANGE ORDER FORM Glen&Antonia Macon (36 Andover Street,North Andover,Massachusetts) Change of Work Date: Contract Date: I Continued from page i of 2 6. Additional Formwork 6.1. Remove existing formwork 6.2. Rebuild and reinstall 7. Additional Materials 7.1. Exterior materials 7.1.1. Sheathing 7.1.2. Ceiling Joists 7.1.3. Additional windows 7.1.4. Roofing materials 7.1.5. Siding&Trim 7.1.6. Floor joists 7.1.7. Sub-floor i 7.2. Interior materials 7.2.1. Flooring 7.2.2. Wails,ceiling 7.2.3. Insulation 7.2.4. Interior trim 8. Labor Expenses 8.1. Rework. 8.2. Extra work. 8.3. Holding Time costs. I 9. HVAC 9.1. Extend heating loop Customer Signature Date Contractor Signature Date OK afl 2 Customer Initials 112n or Initials gCORD. CERTIFICATE OF LIABILITY INSURANCE 77 7DA (MMIDD/YY" 12/2007 PRODUCERTHIS CERTIFICATE IS ISSUEDAS A MATTER OF INFORMATION Circle Business Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 247 Newbury St. ALTER THE COVERAGE.AFFORDED BY THE POLICIES BELOW. Danvers, MA 01923 978-777-7030 INSURERS AFFORDING COVERAGE NAIC# INSURED William Pogor General Contracting INSURER n ESSEX INSURANCE CO Services, LLC INSURER B: Granite State Insurance Co. 10 Lacy St INSURER a Travelers Insurance Co. North Andover, MA 01845 INSURER D: 978-685-2425 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTEDBELOW 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR %E)ErL LTR NSRD TYPE OF INSURANCE POUCY NUMBER POLICY E�� DATE IDYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �( COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocarenw) $ 50,000 CLAIMS MADE 1XIOCCUR MED EXP(Any onepersorl) $ excluded A 3CS2317 8-19-06 8-19-07 PERSONAL&Am INJURY $ 1,000,000 GENERAL AGGREGATE $ 2 000 000 GEITL AGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPIOPAGG $ 1,000,000 POLICY P F]jECT Li LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Ea aaxWd) $ ALLOWWNED AUTOS X SCHEDULED AUTOS (PW P—)INJURY $ 250,000 Q x HIRED AUTOS BA17900886 02/23/06 02/23/07 BODILY INJURY $ 500 000 X NOWOWNED AUTOS (P-acmdent) i PROPERTY DAMAGE (Peracddent) $ 100,000 GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANYAUTO EAACC $ OTHER THAN • AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE C 8734899 01-13-07 01-13-08 E.L.EACH ACCIDENT $ 100,000 B OFMCERfMEhBER EXCLUDED? E.L.DISEASE-EAEMPLOYEE $ Ryes desaibelrWer 100 000 SPECIAL PROVISIONS below E.L.DISEASE POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BYENDORSEMENT/SPECIALPROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION GLEN & ANTONIA MACON DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_DAYS WRITTEN 36 ANDOVER STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL NORTH ANDOVER, MA 01845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD25(2001108) 0ACORD CORPORATION 1988 rvi lsaulltAI Lt JAL&M �UI)1 AC CERTIFICATE OF LIABILITY :0 ATE. PRODUCER (603)898-6320 FAX - INSURANCE oz(603)89a 8269 007 Foy Insurance Group - Salem THIS CERTIFlCATE IS ISSUED Ag A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 130 Main St - Suite 103 HOLDER,THIS CERTIFICATE DOES NOT AMEND EXTENp OR I Salem, NIi 03079 ALTER THE CONERAGE AFFORDED BY THE POLICIES a LOW. Terri Truhn INSURERS AFFORDING COVERAGE NISURBD Kevin GO 1n NAIC 0 PWJRFAj dBA: Godin's Carpentry & Remodeti A* National Grange Mutual 14788 62 Pleasant Street ISUMRe: Liberty Mutual Salem, NH 03079 INSURER IN6URER 0: j CINSURER E ONE 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 yy�RESPECT TO WHICH THIS CERTIFICATE MAY aE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS a'HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,tNSR D TYPE OF wavpAN« POLICY NUMBER E1�IRATION c�ENE 13M ERCIAL WW9434 11/29/2006 11/29/2007 RI c E ms! X COMMERCtAI.OENERALLIASILITY S00 00 CLAIMS MADE C�occuR RE s 500,0 A PEA S 500 00 GENL AGGREGATE LIMITAPPLIES PER ZENERAL AO TE i 1.000.00 POLICY �ECaT Loc ASG : 1.000100C AUTOMOBILE LABILITY ANY AUTO COMBINED SINGLE LIMTf ! (EeaxldenQ ALL OWNED AUTOS SCHEDULEDALITOS BODILY INJURY S HIRED AUTOS (Pm P��t NON-OWNED AUTOS 80DewWRYJ INURY (Per 1 s PROPERTYM DAMAGE ! GARI►G4 LUIBNnY (Per axkg ANY AUTO AUTO ONLY.EAACCIDENT S --EOTHER THAN EAACC S AUTO ONLr AGG S EXCE66NMBREIIA LIABILmr OCCUR F-1 CLAIMS MADE EACH OCCURRENCE ! AGGREGATE ! i OEDUCTIBLE S RETENTIDH E ! WORKERS COMPENSATION AND WC531S36053T016 11/29/2006 31/29/2007 X Y�3TA U• DTII. EMPLAYERS•LA8RM g ANYPROPRIETOWPARTNERfEXECL{TIyE E,L EACHaCC10ENi 3 100 00 OFFlCER/MEtABER EXCLUDED? SPECUIy9CAk PR a vomer E.L.DISEASE-EA PLOYEE ! 100,00 OVISION$below EM � OTHER E.L.DISEASE-POLICY U Mrr ! 500.0001 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RTIFICAT XCAA&C-Em=ATION SHOULD ANY OF THB ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE 7HBRR0F.THE ISSUING TNSUMM WILL ENDEAVOR TO MNL .10 DAYS WRITTEN NOTICE To THE CERTIRCATE HOLDER NAMED TO THE LEFT. William POgOr BUT FAILURE TO MAIL SUCH NOTRCE SMALL IMp"r;NO OBUGATION OR uABILRTY 10 Lacey Street OFANYKINDUPON THE INSURERITSAGEMORRLI, NTAT1yP.,S. N. Andover, MA � A • ACORD 25(2DOUD8) FAX: (978)685-2425 OACORD CORPORATION 188a I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit Please Print Name: Location: CIS_&ZgZ2t /1 X Phone x'78 576 /9 75 0 am a homeowner performing all work myself. �I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. F-1 Company name: Address City: Phone#• Insurance Co. kil POlicy# Company name: Address D G V 6,'1 /vp 12 Ci �/L� �( - Phone#: Insurance Co. 3"'g uii � r,� � Policy Failure to secure coverage as required under Section 25A or MGL 152 can lead to the Imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify un er the pains d naltfes of perjury that the information provided above is twe and correct. Signature Date -311316-7 s Print name ! &6-yrz, Phone#1, 376$75 Official use only do not write in this area to be completed by city or town official' C] Building Dept ❑Check if immediate response is required Building Dept Licensing Board p Selectman's Office Contact person: Phone#: Health Department Other I FORM WORKMAN'S COMPENSATION j . II CERT WD PLOT PLAN PREPARED FOR: GLEN & ANTONIA MACON AT 36 ANDOVER STREET NORTH ANDO1/ER$ MA, NORTH ESSEX REGISTRY OF DEEDS_ BK. 9487 PG. 122 ASSESSOR'S MAP: 59, LOT 24 ZONING: RES 3 SCALE 1=50' DATE. FEBRUARY 15, 2007 NOTE SETBACKS TAKEN TO CORNERBOARD. W EXISTING !� 2 STORY cNo rU AREA= 1.47E ACRES oin u6 w ce r O. 36� 18.2' PROPOSED ' ADDITION 4.8.6• �^ v1 in A 510:8'± P�t}i OF4SS9 cy Als N0. 3577 PREPARED BY �0�ar_LAND BORN ABAGBS & ASS'OCUM,. PROMSIONU LAND SURVEYORS 9 BARTLETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 5441 i NORTH ANDOVER OLDE CENTER HISTORIC DISTRICT COMMISSION Certificate of Appropriateness This Certificate of Appropriateness is issued this Twenty Fifth day of January 2007 to Glen and Antonia Macon for 36 Andover Street in accordancei w th Chapter 40C of the General Laws of the Commonwealth of Massachusetts as amended and the by-laws of the North Andover Olde Center Historic District Commission. This will allow the expanding of the Kitchen on the left side of the home with the plans and d narrative approved at t ' meed g. Geor H. S hru er, F man K t leen Szyska j Robert Stevens Martha Larson Leslie opki s Har zn n Ric and Michael Gramly Joseph Piotte Peter Devlin i NORTH ANDOVER OLD CENTER HISTORIC DISTRICT COMMISSION Application to Obtain Approval for Building Alterations within the Old Center Historic District Date: April 11 , 1988 Owner(s) of building to be altered : Eugene H. and Judith B. Avrett Location of building: 36 Andover Street - Description Description of proposed exterior alterations that would be visible from the street or public area, and that are not specifically excluded in the Bylaw: We are planning to renovate the interior of the back ell of our house to change a garage/storage area into a back living room and to add a second bathroom uptairs . The architect ' s plans for this renovation show two windows to be added on the east side of the back ell that would be visible from the street. The attached plan of the east side shows the existing windows and the two new proposed windows. The two new windows would match the existing ones . No other alterations would be visible from Andover Street (or any other street) or from any public area (e. g. , the playground) . The attached photographs show the present view of the east side from the street, as well as the view of the west side of the house. On the west side , large evergreen shrubs completely block the view of the back ell from the street. We have chosen Claude E. Menders , who was the architect for the recent Brick Store renovation , as the architect for this project. He has a great respect for the preservation of historic buildings. Requested action to be taken by the Commission: Notify the North Andover Building Inspector, or issue a certificate of appropriateness , to the effect that the Commission approves the proposed alteration as stated here , to the extent that the Commission' s approval is required. A decision at the May 9th meeting of the Commission would be appreciated;. a ure(g) of owner(s) : MAY 0 4 1988 I'M ANDOVER WILDING DEPT. 9' 4 1 77 nUn -- -_ UUU _ [_11.11 [_�Un - - ._ Ung - _ L1U❑ [_1111--Ll - -_ - - U UUU -. -- Wih oinl_ o: .. . __. . -.._ be adde -- - -- - - UU I UUU -_ UUU -=- nU[ - new bay _� Wln�ow nr-1r- [ ; nnn n11n - i_U[_� U[ �c _II J �.�_IC:I 1 -� -.il J nl _T _ I-IT] no"� visible - -from -th ❑UC] CIUCI (11111 - __:_ UIJ❑ -= lUUI-1 -- 51reet �1 50UTH WINO, EAST MyArIoN i g "val V"MM I"MI5SMIMi j� t�� ;•� s {`�ti "$:dot /f ,.2�•< �'� }�,.; }�.., VYt� ...r f�a tf fj7t3 x) ''� � �i h y �� IVA � # 't m , flrr 7 'sir`lj�i11 t, § a;` ; �, �� 'a,S<� • UIVI IA f