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HomeMy WebLinkAboutBuilding Permit #347 - 14 EDMANDS ROAD 10/21/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �Y Date Received Date Issued: �2J, L1 i ORTANT:Applicant must complete all items on this page LOCATION Rn&A AA 11 Print PROPERTY OWNER l o i m l a i nq unit# Print MAP NO: 62-0PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9 One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other t�xSeptic ®�W.ell ; `OlFloodplaint y;TaterShedDistricf a_,��Water/SewerFi DESCRIPTION OF WORK TO BE PERFORMED: ` 3+rIa� ori d re-�roo� r�-�-irr� hQy�e (Identification Please Type or Print Clearly) OWNER: Name:-tAorrnan Phone: x267 4 9 o Address: and RO&8 v u . D l�Iv_ � dam Nlf} 1 gs rn s n CONTRACTOR Name: s An Lo/,P— 0Q -: Phone: q7 &(A3+3 y J o Address: Zoo S o�- rn Sk . A eNC(uvef. )yA O I i y S i Supervisor's Construction License: �' 3S Exp. Date: a (o -010 i Home Improvement License: f o`4 S(o5 Exp. Date: ARCHITECT/ENGINEER Phone: i I Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ CIL FEE: $ Check No.: c� `' Receipt No.: QL NOTE: Persons contracting with unregistered contractors do not have access to th ar and �S- . i:a•n..a. ture Cf {ant/ lR o .7.-_.... oae Location 7 � i''Iyya No. Date , NORTH TOWN OF NORTH ANDOVER 60 to r OL N � to 9 Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ suMusE 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check r-t rt Building Inspector 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 i INTERDEPARTMENTAL SIGN OFF - U FORM 1 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature 1 I' COMMENTS HEALTH Reviewed on Signature COMMENTS 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 CaOMMENTS .f 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 ® Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi -�:-GIirn-+..rri-iii. •mow.'.! - C,o...�i�..;,,v 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 ❑ Copy of Contract ❑ 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 ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ 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 VOTE: 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 rust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi 1.V 1Y11V Ll:i1 V L v NORTH TO" of ? Andover .. . O �_ .�,:.1.. t No. 4x .,w ti..,,. dover, Vass., Q a — LAKE COCHICHEWICK V B AD�ATFD 17 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System • BUILDING INSPECTOR THISCERTIFIES THAT.............. .......a. .. . . ............ . .hS...................................,....................................... Foundation has permission to erect........................................ buildings on......................... ........ t �. . .....Kms• Rough • ...�� to be occupied as................... T......... .. i!!�..�R chimney ... . . . . . . . . . . .. . .. . . ................ provided that the person accepting th permit shall in every respect confo to the terms of the application on file in Final 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 MTIS ELECTRICAL INSPECTOR UNLESS C®NSTR L C d I S .i I S Rough - ...................... ..................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE.DEPARTMENI' Until Inspected and Approved by the Building Inspector. IBurner Street No. SEE REVERSE SIDE Smoke Det. DAVID CASTRICONE CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS',- HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 ) 200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In HaverhiA 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 premise below described: i Owner's Name........ .G?!'.tx tra 1.... . .. Lt4�.i?..fir ....Tel hone#..�d.(..�':.;4.b..>f?..". LJ�.. Job Address....-.).—....E. ..l,n,,�s ......./fit?.......................city...1.yQ....11'11. ..Zl.l` , .............State........... Specifications: ............................................:................................................................ff........................................................... >�trip existing shingles. -/Apply new drip edge to all edges. .8/'&y;t &I,S)1 VCU ...................................................................................................................................................................................................................... Apply 6 feet ice and water shield membrane to bottom edges of house. 3 feet ice and wter shield membrane in valleys and bottom edges of any unheated areas of house. ..................................................................................................... �jU... ..l... .411`1 (fe'lt pa r underlayment. -Install ridge vent to /Reroof in ` shingles with a �year warranty. .............. ............................................................•....................................................--•...........--............................. -Counterflash chimney. ✓I`lew vent pipe flashing. .�egal disposal of all debris. .................................................1. y..................................................(21 ............... ......Areas. to be worked on• �(� a�ti.../.. ,... . .. :4�� ?• ............ .. 1!I. v'.w' 1.. Ya. .8I lel ....................................................... ............�X.�fti~ ...e:,�....hta l .. ......,1j t.G 1 .....t..... ................................................... .................................................................. .............. Roof board replacement if necessary /sheet •5�/foot. ...................................................................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specified by man f turer The contractor agrees to perform the work and furnish the materials specified above for the SUM of$....�.. �... ............. Payable.............................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).'here 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 Improvement 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 patties are contained herein. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Owner has three business days to cancel this contract and incur no penalty (see notice of cancellation). IN WITNESS WHEREOF,the parties have hereunto signed their names this.......fes........day of......CI.L. .......2011... Accepted: Signed.......::.21 ..r' ' ' ................... ..... Owner CSigned............................................................................. Owner ....................... .... .... ...... � David Castric. .o.ne,Pre.sidentest............. �'7 C J �. �(,,{ / `/a <� C"l A_N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street w_� Boston, MA 02111 . 4i 5-�� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): .DAV 1 I CAy91C oNr 1900 F i N!s- ' SI b/t\t(r INC. Address: 2() C) g%J ;ro o STRr `r So ,rc 2 L(0 City/State/Zip: N o. Am Do i e oc_ fJ A d 11419 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with @ 4. ❑ I am a general contractor and I 6. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑ 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 i officers have exercised their 10.❑ Electrical repairs or additions required.] o 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no II)d II) Roof repairs insurance required.]t employees. [No workers' 13.❑ Other 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. XContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information. 1 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 A (LTi S Policy#or Self-ins. Lie.#: C( �d�g �9'7Expiration Date: Job Site Address: Iq EdPYl/(n as R06-d City/State/Zip: N AA rci, N 611�f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 fonn 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 certify under tithe pains and penalties of perjury that the information provided above is true and correct.' Signature: ' `/ r 6-� Date• Phone#: q ri I U 3 J 4 070 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 Nnkr �0 �eo ,6'�4,o. 0 Building Department o 27 Charles Street A North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 .E �sSACHU5*- I DEBRIS DISPOSAL FORM i 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 c11, s150a. 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 through the Office of the Building Inspector, �la.,.,ailllucfl, llriuutnlrul ul Public �:Ifco .J/�G V[i IIt II L1//C4YXt 141, o//,.. �(.ItJJI{I'/2il J f�l1:U•lJ l)f Iilllltlin.4 J\C-UJill lull, :111(111anlJal•11, � l)IliCl'UtCUl1SUInerAItlllrS&lillli[K55liC•6h11 u1x0 Construction Supervisor Specialt License L Y _ •-,,HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Registration: 104569 Type: Resiricied w: RF,WS Expiration: 71/4/2012 Private Corporatio 1 tklV1 _ DAD CASTRICONF ROOFING, SIDING 8 DAVID CASTRICONE t 31 COURT STREET David Castricone NORTH ANDOVER, MA 01845 �a: 7t 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Ullticrsccrctury Expiration: 1 211 61201 1 ( ;iuuii"i„n[r I'm 99358 • I 09/09/2011 12:07 FAX 978 475 3165 EASTERN INSURANCE 0 002/002 _ I DATE(WWDDlYYM AiCO{R[]� CERTIFICATE OF LIABILITY INSURANCE 9/9/2011 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(193)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 certlfIcate does not confer rights to the certificate holder in lieu of such endorsement a. PRODUCFR PONTAcT NAME: Willows Insurance AgcyONE foo 978 475 3414 Sl Cochichewik Dr ADDA PRvvucECUSTOMER in 0R -- North Andover MA 01845 _• _.-• INSURER(S)AFFORDING COVERAGE .—,WUC N. INSURED INSURERAMiden specialty Ina _CO INSURER_B.". I)AVID - DAVID CASTRICONE ROOFING & SIDING INC INS IRERCi - - — - — IN$URER D 200 Sutton St Suites 226 INSURER E: NORTH ANDOVER MA 01845 _......-. . msuRER F COVERAGES CERTIFICATE NUMBER^CLI19906255 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. LTR• -- TYPE OF DURANCE ---- --- OroT SIIBR pOL14V NUI+I9ER MPOLIC YEFF POLICY DDY�Y --• LIMITS —ALM WVD GENERAL LIABILITY EACH OCCURRENCE _ S 100_0_000 X COMMERCIAL GENERAL LIABILITY PREMI�.^_F,'yS1Ee xcurrenm -$.-_-..-...• .-50000 A _ CLAIMS.MADE n OCCUR 100031600 9/06/2011 /6/2012 MED EXP(Any ane pmon g 1000 PERSONAL b ADV_INJURY 6 1000000 GENERAL AGGREGATE S 200000_0 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlDP AGG $ 1000000 POuCV JECT PRO- LOC S AUTOMOBILE YABILRY COMBINED SINGLE LIMB S (Ea accldanU ANY AUTO BODILY INJURY(For person) S ALL OWNED AUTOS --• - ..--- ......_.....—__. BODILY INJURY(Per ae6dent) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per MCWON $ NON.OWNED AUTOS S $ UMBRELLA LIA6 H OCCUR EACH OCCURRENCE S 11LCM LIAE CLAIMSAAOR AGGREGATE $ DEDUCTIBLE RETENTION S S WORKERS COMPENSATION WCSTATU- *;H- AND EMPLOYERS'LIABILITY YIN, .. T¢.RY LIMrr,,9 ..—L�� ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT # OFFICEMMEMBER EXCLUDED7 NIA •••.-- (Mandstory In NH) E.L.DISEASE•EA EMPLOYEE g If yes dowibe order DESCRIPTION OF OPERATIONS blow E.L.DISEASE-POLICY LIMIT g DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ANach ACORD 101,Additional Remarks Saheduis,N mere epees Is required) CERTIMATtE HOLDER CANCELLATION davidcastriconeroofingaidi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Cas t:ricone Roof itsg & Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. Caetric*ne Roofing 200 Sutton Street Suite 226 "I'*H° D�"REs�rA"vE N Andover, MA 01845 ACORD 25(2009/09) V 0 ISIM2FOWCOO CORPORATION. All rights reserved. IN5025(20MM) The ACORD name and logo are registered marks of ACORD A6Ro CERTIFICATE OF LIABILITY INSURANCEFg/23/2011 DATE(MMIDD/YYYY) 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 CONTACT NAME: Eastern Insurance Group LLC - Main PHONE - _7 ASC No: 508-653-8089 233 west Central Street E-MAIL Natick MA 01760 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S IftURERA:Comrnerce Insurance Company 3�751 INSURED 31969 INSURER B:CHART IS David Castricone Roofing & Siding Inc INSURER C: 200 Sutton Street 4226 INSURER D: North Andover MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1270594431 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. 1� AODLSUBR DY /DY7p TYPEOFINSURANCE t g POLICYNUMBER MM/DYYYY FF POLICY MIYYY LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occunenoe $ CLAIMS-MADE F—I OCCUR MED EXP(Any oneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY BCNGCV /1/2011 /1/2012 Eaaeck IJ1000000 ANY AUTO BODILY INJURY(Per person) $20000 ALLOWNEDSCHEDULED BODILY INJURY AUTOS X AUTOS (Per accident) $90000 X HIREDAU703 X NON-0WNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA UAB OCCUR EACHOCCURRENCE $ EXCESS UAB Ll CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y I N 0003989723 9/23/2011 9/23/2012 X WCSTATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEMIEM13ER EXCLUDED? N iA E.L.EACH ACCIDENT $100000 (Mandatory In NH) E If yer,describe under L.DISEASE-EA EMPLOYE $100000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LMII7 $500000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Addtilonal Remarks Schedule,H more space is required) I CERTIFICATE HOLDER CANCELLATION C� stricone Roofing & Siding, Inc. SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Sutton. S_txeet, Suite 226 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD