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HomeMy WebLinkAboutBuilding Permit #447-13 - 109 FOREST STREET 12/5/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: '11(7 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION' 109 Fzrck i S" r-i--c f- Print PROPERTY OWNER SW C-Y Anon Unit# Print MAP N0: PARCEL: Z ZONING DISTRICT: Historic District yeo Machine Shop Village ye-(no 100 year-old structure yo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Se c ad'hi po Wetl'and's El Watershed District DESCRIPTION OF WORK TO BE PERFORMED: I an ces k I aq L MOF (Identification Please Type or Print Clearly) OWNER: Nae: Sc.o YY1 c r h rkc)n Phone: 1)r6 lO 7 7y L Name: Address: 'nulr k `Pmc�Ove/ (YEA 0 r c(s CONTRACTOR Name: Cad hjLO(1P Rob h nS ' SI t I i c Phone: Address: S:- c�-)u , JA 06r4i- Ar)&& I(1'lAOJEl ; 4 Supervisor's Construction License: 993S6 Exp. Date: 1;�- 1 (D _d 013 Home Improvement License: [D4 E19 Exp. Date: 17 I q -o�bl V ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ w 0 0 00 FEE: $ Check No.: ) Oy � Receipt No.: O / NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I"o-;;•iP+R-Fr=M�iis � "w;r;i ru '� .'N:.":sr< _'*_4t-%, }a�'h s'�4�R!!^ :1 :-,rx..,c.-•:..a;,4-,Y.,v.:"r.`4 - - .e9 fx:. nf,n ntrnr'.tnra i Location I aq +W/ &e e� No. � Date • TOWN OF NORTH ANDOVER Q,- h, -h Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ j c� Other Permit Fee T TOTAL $ i A j Check# —An)- 26011 — 26011 Building Inspector p Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ 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 DATEAPPROVED VED ` PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r + Zoning, Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 m1n.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C.-And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition or Decks ❑ Building Permit Application -uCertified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 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 I Doc: Doc.Building Permit Revised 2008mi I NORTll Town of t E : sAndover No. dow 15 4 _ 401er Mass �. 'OIL - h v__ , COCMIC 2 Nl WIC K V - - - - - - - - - - ATED �P�`',�•cy - s U BOARD OF HEALTH PERMIT L-D Food/Kitchen Septic System S.. 0 . A � , Ni-low . OA .... BUILDING INSPECTOR THIS CERTIFIES THAT .............. b ...+. .......... .:........... Foundation has permission to erect ... ..... .. ............... building n .... ... .... .... ...�........••••• Rough tobe occupied as ......:.. ........'... ....... ... ....... . ............................................................ Chimney provided that the person accepting i.s 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 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 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 1;l A "&SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhUI 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: t�l�K tv Iv u N 9 31.J(U �2`1271 Owner's Name.............qq.<-1 .::r.:1�.......................1.......................................n..�.........../.�.Telephone#................................................. JobAIddress.........q. ...1. Fc,P, Si Sj(ZtET..............City.....!.1 ..:...t1. 4�`r?L:`! :� ...... State....UA.......... ................. ................ ......... Specifications: .......................................... ......................................... p ....................... .... ...... ................ Strip existing shingles.' i4(Apply new drip edge to all edges. (r,4j.Z Apply, feet 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. /APP'Y................I.........I................... .. .. .. ..........................................................................,...................................... felt paper underlayment Install ridge vent to 1'0 P D F ..........:............................ . ......... ..................................... V Reroof using Cf�JILti� '- .� CG2iCi shingles with aD year warranty. ........ ... ..... ... .................. ........................................................................................................ Counter.tl.ash. ..chimney... .....✓ New vent pipe flashing.y; Legal disposal of all debris. ................................................. ......................... .. '............................................................... ................ ................ ........... ............................ Area(s)to be worked on: .............................................1?IGrC....�'''11 Z ......................................................................................................................................... ...................................................................................................................................................................................................................... .I............................................................................................................................... 7 . ..5 . ........... ...................................... Roof board replacement if necessary @ 6�63/sheet or `i/foot. ...................................................................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Wanufacturer's Warranty as specified by an acturer The contractor agrees to perform the work 4�n?d furnish the materials specified above for the SUM of$..... U..°�.............. Payable........ ...............oni-.................. Payable.....................' ....on................................. 1,45alance payable on completion of job Owner or Owners are not responsible for Property Damage or Liability whilejob 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 teams 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,Home InVrovement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108 Tel:617-727-8598 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 is excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work................................................ Completion date......................................................... Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing 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 contained her@in. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES16 Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). r :ltl��..day of... 4(� :L, IN WITNESS WHEREOF,the parties have hereunto signed their names this... . . Accepted: St .. .. .. .......................................... Owner Signed t g l� k. 11 ... � ............. Owner David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations . 600 Washington Street Boston, MA 02111 ° n. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/Individual): C6 ,51,11 CONE PO O F/ Nit' � 51.b/146 Address: 23) R 5u ?' tb N ST(Z&—T- 3A City/State/Zip: . O• Anbovek MA 6MS Phone #: 9q $ - 6 0 Are you an employer? Check the appropriate box: Type of project (required): th 4. ❑ I am a general contractor and I 1.® I am a em to er w] �! 6. New construction P Y ❑ employees (full and/or part-time).* have hired the sub-contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet F1 Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.1Roof repairs insurance required.] t employees. [No workers' ] 13.0 Other comp. insurance required.] . eq ] `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 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 their workers'comp.policy information. 'am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site nformatiom nsurance Company Name: A(Ms S ?olicy#or Self-ins. Lic. #: C D Q 3 q g 9 oZ3 Expiration Date: • a3 -j fob Site Address: log T�Ure_A- SbT-d City/State/Zip: �IA 01 K attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a zne up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a SWOP WORK ORDER and a fine )f up to $250.00 a day against the violator.--Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverag�.verification. do hereby certify under the pains and penalties ofpetjury that the information provided abov is true and correct. 3io afore: 01 J . C Date: ?hone#: 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#: Town of North Andover oY SORT n Q Building Department o ` 27 Charles Street A North Andover, Massachusetts 01845 (978 688-9545 - ,r,w., +` ) Fax (978) 688 9542 SACHU5� I DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c,l 1, sl 50a. The debris will be disposed of in /at: Facility location i Signature of Applicant nt Date NOTE; A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector. I I I I I ACERTIFICATE OF LIABILITYOA/11/DDIYY2 INSURANCE 9/11/2012 PRODUCER 978 273 6368 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Willows. Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 51 Cochichewick Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I North Andover MA 01845 INSURERS AFFORDING COVERAGE ' NAIC# - .. -.-------- ----- INSURED INSURER A.WESTERN WORLD INSURANCE CO DAVID CASTRICONE ROOFING & SIDING INC & _ - '. INSURER B: CASTRICONE ROOFING S SIDING INC - __ . INSURER C: 231 Sutton St #3A _._._....._._._.__ .. ..... . . INSURER D. NORTH ANDOVER MA 01845 _._. __. ..__..__.........._. INSURER E: COVERAGES 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,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. (NSR IADD'l! LTR N RDiPE FIN N POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE MMIDD DATE MM/DD LIMITS GENERAL LIABILITY --" EACH OCCURRENCE $ 1000000 ! COMMERCIAL GENERAL LIABILITY DAMAGE 0 RENTED — ----- PREMISES_ occure ._ _ 50000 nce $_i OCCUR12 9/6/2013 I MED EXP(An son $ I I- --------y one one a err ) 10 00. PERSONAL 8 ADV INJURY $ 1000000 GENERALAGGREGATE i$ 2000000 _._. j GEN'L AGGREGATE LIMIT APPLIES PER:i -2 - PRO- PRODUCTS-COMP/OP AGG _$.._._ 2000000 ; POLICY:' LOC AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT $ — ANY AUTO (Ea accident) ALL OWNED AUTOS I - -- 1 BODILY INJURY I I SCHEDULED AUTOS (Per person) HIRED,AUTOS ; BODILY INJURY i $ NON-OWNED AUTOS i (Per accident) PROPERTY DAMAGE $ I i (Per accident) GARAGE LIABILITY j AUTO ONLY-EA ACCIDENT $ _ I ANY AUTO -._...__..—._._. ...__.__..... __ - ' EA ACC $ I OTHER THAN _...._.._.a__ AUTO ONLY EXCESS I UMBRELLA LIABILITY AGG i$ IEACH OCCURRENCE i -------: ---- ._....,__.._.-..OCCUR L— j CLAIMS MADE I � � -- - - (AGGREGATE g DEDUCTIBLE _._ --------- i $ I RETENTION $ WORKERS COMPENSATION �$—_ I T C STATU- DTH- ,AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN —— --- OFFICER/MEMBER ECCLUDED? ❑i E.L.EACH ACCIDENT $ (Mandatory in NH) I If yes,describe under E.L.DISEASE-EA EMPLOYE $ SPECIAL PROVISIONS below -— — ---------- ._.. ,.OTHER ; • E.L.DISEASE-POLICY LIMIT i $ I ' j i I i � I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVIi SIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Castricone Roofing & Siding DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Unit 3A NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 231 R Sutton Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR North Andover, MA 01845 REPRESENTATIVES. AUTHORIZED REPRES ATI „a ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(20o901).01 The ACORD name and logo are registered marks of ACORD AC RO CERTIFICATE OF LIABILITY I DATE(MM/DD!YYYY) INSURANCE 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). PRODUCERNT CT NAME: Select Dept ext 66807 Eastern Insurance Group LLC-Main PHONE 1 7 00 we No: 653 -509 233 West Central Street EMAIL Natick MA 01760 ADDRESS: t n om INSURERS AFFORDING COVERAGE NAIC s i INSURER A:Cornmerce & Industry 19410 I INSURED 31969 INSURER 8: David Castricone Roofing &Siding Inc INSURER C: 231 Rear Sutton Street, Unit 3A North Andover'MA 01845 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 1538501247 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE " POLICY EFF POLICY EXP LTR INSP wVD POLICY NUMBER fMMIDDIYYYYI IMMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 4 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F—I OCCUR tv1ED EXP(Any one erson) $ PERSONAL R ADV INJURY $ GIf— ENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ PRO POLICY LOC $ AUTOMOBILE LIABILITY Ea II'NlerA ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) I N014-OWNED PROPERTY DAMAGE I HIREDAUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WC003989723 /23/2012 /23/2013 X I WCSTATU- OTH AND EMPLOYERS'LIABILITY YIN TO IM I ER ANY P,ROPRIETORIPARTNER/EXECUTIVE OFFICER/MEN48ER EXCLUDED? N/A E.L.EACH ACCIDENT $100,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $100,000 II ves,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS;LOCATIONS I VEHICLES ("Hach ACORD tot,Additional Remarks Schedule,it 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&Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. 231 Rear Sutton Street,Unit 3A North Andover MA 01845 AUTHORIZED REPRESEgN�TATIVE ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD '` itilassachusct[s- Dcltartnlcnt of Public SafctN } Board of Buildin!g Rc.r�ulations and Standard Construction Supervisor Specialty License License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 c Expiration: 12/16/2013 ('uumiisxiunrr TO: 7924 SCA 1 0 20M-05/11 v r niiaruoircoeu�C�r�E�!'�. uuu�/rrde/.Y' Office of Consumer Affairs B Busidess Regulation I;. _DOME IMPROVEMENT CONTRACTOR registration: 104569 Type: �—;expiration: 7/14/2014 � Private Corporatic n DAVI6CASTRICONE ROOFING, SIDING 8 David avid Castricone 231 R SUTTON ST SUITE 3A _ NORTH ANDOVER, MA 01845 � '— — Undersecretary G'