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HomeMy WebLinkAboutBuilding Permit #176-14 - 0 WINTER STREET 8/26/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 2�,k Date Issued: A!A14M0_RT.AANT:Applicant must complete all items on this page 'LOCATIO.NI._ /I_Jr = I!7'y��2t' Pnnt PR®PERTYrOWNER c �G',51r/2�• = T_ I rm Pnnt 100�YearOldsStructure� yes; nod: MAP�N® d PARCEL ZONING DISxTRICJ }Hlstof$ Api tact f yet nog _- - Machine Shop}Village� ye , n_oj TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ElNew Building XOne family ❑Addition ❑Two or more family ❑ Industrial ; ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other WatershedTDlstrict ❑ Septic .❑rWell zFlood0$_0 ❑Vlletlands 0 1 DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) l f I I OWNER: Name: Phone: Address: TRACTOR' ='Name -_ Q /1 1 7n L,J _P-hone Supervlsor's�CorstructonP Licen_s._e 9`c � Expo Date HOrne�lm rovementLlcense I a 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. Total Project Cost: $ pJ FEE: $ Check No.: ' Receipt No.: ��� NOTE: Persons contracting with unregistered contractors do not have access to the gu\ap'Jranty fund Agen /Owg . . r. . , t Sgnature;of contractor _. s A . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 1 TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBodyArt ❑ 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature i i COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes- .- 4 Planning Board Decision: Comments i Conservation Decision: Comments Water & Sewer Connection/Si ncnaature& Date Driveway Permit DPW Towo ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes. no Located at 124.Main"Street Fire Departiberit'-signature/date COMMENTS 4 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 droprequires 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 I ® Notified for pickup - Date Doc.Building Permit Revised 2010 I - I - Building Department The folowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits L Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract u Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a Mass check Energy Compliance Report (If Applicable) a 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) o Building Permit Application Li Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i, 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 app.al 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: Doc.Bui!ding permit Revised 2012 1 .fL. Location No. 7(o Date • - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ Building/Frame Permit Fee $ /9y•0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s Check# 2-- Ul 26 77 Building Inspector e NORTH Town of ndover No. hLAKO , ver, Mass, V►3 Z �3 .Q COC"I C OC"IC Nl W IC. 1' S V BOARD OF HEALTH 4 Food/Kitchen PE.. R ILD Septic System THIS CERTIFIES THAT ..... 1VG�....... = a BUILDING INSPECTOR ..... ...... h.45................... .. .............. . Foundation has permission to erect .......................... buildings on .............. 1�!. '.... ..................... R� Rough tobe occupied as .......... . ...`. ........... ..... t.............................................................................. 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough {rte' ►............................. Service .................... ......... ... . . . u���:�r� 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 Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE DAVID CASTRICONE CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 013 0 @-0 SUTTON STREET, ;NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314 Uwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: r............................C...i.ty....... .�.Y.0 0. .s..........Te oneOwner's Name...... L b # .................... Job Address... I.V;. . �r..�:....... ...... .4State3..•.•• 'F!..•.f..:.•.E..• Specifications: :.....................................................................................: �.(�1y i�Strip existing shingles.�JJ ✓Apply new drip edge to all edges. " . .................:..................................................................................................................r................................................................................ t-Apply Lfeet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. /Apply elt p er nderlayment. 'In 11 rid a vent to xisL g - , L . t -z . .....:........................... ................................ I/Heroof sing : -! shingles with i year warranty. ........................ ....:...............................:...............i'd-i..............................................................1.... ........ .. ,�ounterflash chimney.......... ew vent pipe(lashing. Legal disposal of all debris. r r r &iYt--T1,.......y. ........... ...J..:............................... O � ... . Area(s)to be worked on: f 1 ' 1. ( �....................... .......................................... . . ...�-'' .... . � T.?.(. ......j.... B ILit►1 G .../•-IGC'1.....J'. ppx �►•.••'�: .�1 1� k /� 1`�.. ........... IF Crj'E' lL "s � ... h` t ..ii�G6�1•• P.ii.il .... U-14.e_.... , �s: n Roof board replacement if necessary /sheet Ar Amde .............................................................................................................................................................. ....................... .......... Two Year Workmanship Warranty(Not Transferable) N anufacturer's Warranty ass ' ted by manufacturer The contractor agrges to perform the work aqdis the materials specified above for the S of$. '161�..Yylo.......•••• Payabl . .V.62,42.Q.......on ............... Payable.............................on.................................. Balance payable on completion of job Owner or owners are not responsible for Property Damage or Liability while job is in operation. Contractor is not responsible for any damage to the interior of property,including pre-existing conditions(i.e.water stains,crumbling plaster,exposed nails)or conditions resulting from application of materials specified above(i.e.objects coming loose from walls,crumbling plaster,exposed nails,dust in attic or other living spaces).Items in attic may need to be covered by homeowner.All materials are property of contractor. Any dumpster placed by contractor is for his use only.Upon completion of above work,all undersigned agree to execute and deliver to contractor,their joint note in accordance with his(their)above obligation as requested by contractor. Upon refusal to do so,contractor may at its option declare the entire contract price or so much as then remains unpaid,immediately due and payable. It is agreed that,if permitted by law,contractor shall be paid by the owner(s)all reasonable costs,attorney fees and expenses,in addition to the amount due and unpaid,that shall be incurred in enforcing the terms and conditions of the contract and/or any lien in connection herewith.It is further agreed that this contract may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)that he is(they are) the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their)names(s).There are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Horne Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 t • Tel:617-727-8599 Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction- related permit or deals with unregistered-contractors i xe uded from the Guaranty Fund provisions of MGL c.142A. Approximate starting dateofwork.el vr� 44^:...... Completion date.4 2>sRvlt:Kt�ui •• J....< '"''/'IP/{DB�t�. Receipt of a copy of this contact is herebylacknbwledged,and it is further acknowledged by the undersigned that the forego'ifig provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be binding upon the parties and that all of the agreements and understandings of said parties are conta' ed herein. l�+:Atc� DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES r��r': Wood Owner has three business days to cancel this contract and incur no penalty (see notice of cancellatio ). IN WITNESS WHEREOF,the parties have hereunto signed their this.: ........�.....day of..;.t....` •••.••,20• `3' Accepted: Signed..... ................ ... . ................................ Owner Signed............................................................................. Owner ................................................................... David Cas tricone,President The Commonwealth of Massachusetts Department ofIndustritrlAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual)L tJ tD l RS72t?it �L ll00 F N(k if Sa tA.�Gr /A) . I Address: s u T roz S7tuE T S a l T-L JA City/State/Zip: No. AN be ton. HA 0 hYf Phone#: 9 7[ •(o U •J Vol 0 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with_1 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9 E]Building addition [No workers'comp.insurance 5. El We are a corporation and its required.] officers have exercised their 1011 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.EJ Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12,;K Roof repairs insurance required.]t employees.[No workers' 1311 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they ai•e 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name:. C.� #o1 jeT/S Policy#or Self-ins.Lic.#: �i��w�/�' 4041 FJ MI J Expiration Dater 9�j�� -a�,�01J Job Site Address.—//S t 1l) JAcfi _ City/State/Zip: /Yd,.t/► Jrl. /'� �I� �� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under the pains and penalties ofperjury that the information provided above is true and correct. Sia-nature: C Date: Phone 4: 7fV Ga 420 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#: AC"R[7 CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD!YYYY) 9/24/2012 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). PRODUCER NAME: Select Dept ext 66807 Eastern Insurance Group LLC -Main PHO —r arc NE No FAX cuc No0.508-653 8089 __- 233 ','fest Central Street E-MAIL Natick MA 01760 ADDRESS:S k erninsanc om INSURER(S)AFFORDING COVERAGE NAIC 4 INSURER A: coerce & Industry 119410 INSURED 3i969 INSURER B: David Castrcone Roofing &Siding Inc INSURER C: _ 231 Rear Sutton Street,. Unit 3A INSURER D Norm Andover MA 01845 INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: 1S38501247 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. NOTLVITHSTANDING 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 I TYPE OF INSURANCE AD UBRI I POLICY EFS POLICY EXP I LIMITS LTR INSR WVD POLICY NUMBER I'MM/DD;'YYY• MMIDDYYYY GENERAL LIABILITY _ EACH OCCURRENCE $ j CYJt:1n.IERCIAL GEI%IEP.-.L LIABILITY DAMAGE PREMISES A oIITEi aice _ CLAIh1S MADE L�OCCUR MED EXP(Any,ne per Eon) S PERSONAL R ADV INJURY 1$ GENERAL AGGREGATE S GEN'L AGGREGATE-1f.rT APPLIES PEP. I PRODUCTS-COMP-< AGG R")LIC:Y I I PRO I 1 LOC I �S I AUTCMCBILE LIABILITY W101:31NIED SINGLE LIMIT L Ea accidein 'ANY AUTO I i &OILY INJURY(Per person) $ ALL O'1>'NED SCHEDULED I I =.OTOS i AUTOS I I BODILY INJURY(Peraccbent) $ —�NON O--VNED I PROPERTY DAMAGE - HIREDA.UTOS I IAUTOS I (Pel acckienn $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAR I— CI-MMS MADE I I AGGREGATE $ .I DED I i RETENTIONS $ A WORKERS COMPENSATION W0003989723 //23!2012 �9l23/2013 IX NiC STATU- OTH. AND EMPLOYERS'LIABILITY t7 IT I c YEN 4tJ1'PROPRItTDRtFARTiIE R�'EkECUTIVE I I ❑ E.L.EACH ACCIDENT §100,000 I OFFICERr:AE M6ER EXCLUDED? N r 4 ; (Mandatory in NH) i 1 E.L.DISEASE EA EMPLOYEEI$100,000 If Yes,d6scilbe urdri I DESCRIPTION OF OPERATk7NS below E L DISEASE POLICY LM,1 T §500,000 I I I I i DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101,Addllional 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 David Castricone Roofing 8 Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. 231 Rear Sutton Street, Unit 3A North Andover MA 01845 AUTHORIZED REPRESENTATIVE A c ®1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010;05) The ACORD name and logo are registered marks of ACORD EASTERN INSURANCE A�D® CERTIFICATE OF LIABILITY INSURANCE DATE(M ' PRODUCER 978 211 6368 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willows Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE. DOES NOT AMEND, EXTEND OR 51 Cochichowick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I North Andover MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER WORLD INSURANCE CO ._ - - .. .. DAVID CASTRICONE ROOFING 6 SIDING INC S IINSURERB: CASTRICONE ROOFING & SIDING INC i INSURER C, 231 Sutton St €I3A INSURER D. NORTH ANDOVER MA 01645 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTAN DING 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. INSR ADDU I POLICY NUMBER POT ICT EFFECTIVE POUCY EXPIQInrr IRATION L�tl LTR )MURg, MF OF INSURANCE CM DATE 11111111 GENERAL UABILITY EACH OCCURRENCE _ S 1000000 i ATO RENTED 3 SDDDD COMMERCIAL GENERAL LIABILITY PREMISES(Ea xCUffBRQ61......... —'- A CLAIMS MADE X i OCCUR�PP1332898 9/6/2012 9/6/2013 MEDEXP(Anyoneporson) S__- 1000 -...- PERSONAL dADV INJURY $ 100000 ! GENERAL AGGREGATE I$, .,_.. 2000000 GEN'L AGGREGATE LIMIT APPLIES PER:I PRODUCTS-COMP/OP ACG S2000000 -----_---__-- POLICY _ PRQ I COC AUTOMOBILE LIABILrTY ! E(EQ. MBINED SINGLE LIMB I ANY AUTO eccidonq $ __ I ALL ON,'NED AUTOS BODILY INJURY $ $OHEOULED AUTOS HIRED AUTO$ ' 8OI)LY INJURY (Per accident) S I NON-OWNED AUTOS I .—._._. . ._.... PROPERTY DAMAGE i - (Per acdconl) GARAOE UABIUTY j j AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER T14AN EA ACC AUTO ONLY' AGG F EXCESS I UMBRELLA LIABILITY ! EACH OCCURRENCE OCCUR I--_ CLAIMS MADE - AGGREGATE DEDL!CT15LE RETENTION S 5 WORKERS COMPENSATION WC STATU- ER OTH- AND EMPLOYER 5'LIABILITY TORY UMLT..$YIN _ - ANY PROPRIETOR/PARTNER/F-XECUTIYE rE. l EACH ACCIDENT 3 'OFFICERMEMBER EXCLUDEDi - "•"' - - !(MBfWatOry In NH) .L.DISEASE-EA EMPLOYE SPECIAL PROVISIONS 0e10w L DISEASE-POLICY LIMY S OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED EFFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Castricone Roofing & Siding NOTICE TO THE CERTFICATE MOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 90 SHALL Unit 3A IMPOSE NO OOLIGAT10N OR LIABILITY OF ANY KIND UPON THE INSURER,ITS A01 IS OR 231 R Sutton Street REPRESENTATIVES. 17 1 AUTHORIZED REPRE ATl North Andover, MA 01845 ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS0251a009011.01 The ACORD name and logo are registered mark9 of ACORA INN;1c'huSc[ Dc llal'tntcnf ul PUldii, 1:1fct f Buai'd of Building Kc,u l:rtiun. ;incl Sh1111I1111I Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 cam_ Expiration: 12/16/2013 I ( iuuui�sincr Tr>; 7924 SCA i L:• 20M-05/11 ;;k� Office of Consumer Affairs&Busirdess Reulat on yA40ME IMPROVEMENT CONTRACTOR j1tegistration: 104569 Type: is =expiration: 7/14/2014 Private Corporation DAVID CASTRICONE ROOFING, SIDING& David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Undersecretary' Town of North Andover o� Building Department o - 27 Charles Street North Andover, Massachusetts 01845 s --a f " (978) 688-9545 Fax (978) 688-9542 OR1TlO FPµ`y�� SSACNIJs�� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 9 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, 81 50a'. The debris will be disposed of in /at: Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector,