Loading...
HomeMy WebLinkAboutBuilding Permit #345 - 198 DALE STREET 10/21/2011 L Of NORTH'01-110 06 BUILDING PERMIT 10 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 0 Permit NO: Date Received &S CHU Date Issued: `� J / - IMPORTANT:Ap2licant must complete all items on this page p 4 t wt 'PR 01WNE �s **ST OR101, MAP 001;U, A", Z Ntw 0ST"Wrl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 'One family 0 Addition El Two or more family El Industrial El Alteration No. of units: El Commercial ,Z Repair, replacement [I Assessory Bldg [I Others: 0 Demolition El Other "Edflopdpial -N, W11,11" W WOW DESCRIPTION OF WORK TO BE PREFORMED: A Identification Please Type or Print Clearly) Phone: ?2161t13S-'1 OWNER: Name: b"te.1 Address: U SPP-Ce4 Nvy-k Anddvev "A Ji ATAe AA1V V MI. U OAT o 10 50�11 txp batiz �4- j Qat ARCHITECT/ENGINEER Phone: Address: Reg. No.. FEE SCHEDULE:BOLDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ — Check No.: Receipt No.: b14 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SIanature of Ad!*/0*6 Location No. Date NORTH TOWN OF NORTH ANDOVER Oitt. a :•,�O � s i 9 Certificate of Occupancy $ ..�:_. : s<.cMustt� Building/Frame Permit Fee $ a � Foundation Permit Fee $ Other Permit Fee $ r TOTAL L $ k Check # Building Inspector 24765 r 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 DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS II Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit Located at 384 Osgood Street FIRk iEPR "MEIT Tete but""o onsite gest . t.cted at tZ4 Maim Street Firs Department� natulretdate T ^ IYfcwNi 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 2007 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 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 TofNORTIy 0 0 No. 3 /.P- -�t o , dover, Mass., AI up I I 4 0 L LAKE COC, MEwICK V AD4ATED PPS\ �S BOARD OF HEALTH Food/Kitchen PERM .IT _T D Septic System 4 BUILDING INSPECTOR THIS CERTIFIES THAT......... �aw. .......... ►. ' � 1�/ ....................................................... Foundation Q haspermission to erect........................................ buildings on ....... •••1• ...vk(c...... .fit............................ Rough t0 be OCCUpled as...........lacceptinphis Chimney provided that the person permit shall in every respect conf 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 qoo PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS LESS CONSTR V CT, 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 BeDone FIREE"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 200 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 pre ' es below des//crib f: Owner's Name.... 4ia .....Z Y..1.eS j a.?1 .................................................Tel one#..�.c2.. .'..... .. ....... Job Address........I.9.L1......��. .L....1,...1..Y..c.........................City....1�12�,..�.la. .fit.lf.4'.->................Stat e....N4........ Specifications: .. ................................... ...................................................I.................... ... ................................................................................ trip existing shingles.(/)� .Apply new drip edge to all edges WI,/ e f� ...................................................................................................................................................................................................................... ,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. ....................................................................................... ..,.. .................................................... ..$.................................. 'Arpply felt paper n erlayment. --fnstall ridge vent to . ............... ..................... ... `... ..................................................................................................... ✓Reroof using , ` shingles with a L50 year warranty. ...................................................................................................................................................................................................................... Counterflash chimney. 4Nfqw�vent pipe flashing. Legal disposal of all debris. ................................................ ..........r.3.. .... ................................ .. .............................. .............................................................. Area(s)to be worked on: l/) ............................... TY......... � ef.....1.�1... e. .. ..... .... ........ .............. .. ...... ...................................................... ...........0 ....tv..... ..�5.�,.a .. ......" .�. .�t1. . ....... . 'l .......f .a...... • .t ............................................ 8, ...................... ixl/ r� .................................................... Roof board replacement if necessary @ 40 /sheet orV`�,/foot. ....................................................................................................................................................................... ...................................... Two Year Workmanship Warranty(Not Transferable) NIknufacturer's Warranty as speciC y manufacture The contractor agrees to perform the work Arid ish the materials specified above for the SU of$....I,I���Ji......... Payable...�a2 c...................on:S..a..................... 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 preexisting 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 anis 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 terns and conditions of the contract and/or any lien in connection herewith.It is further agreed that this contract maybe 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)namcs(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 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 parties 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 notic f cancellati IN WITNESS WHEREOF,the parties have hereunto signed their names this.n. day of. I_,2 0.. Accepted: � Signed 1 : ................ Owaer:1............ . 404 .................Signed -INA..� L Owner David Castricone,President n The Commonwealth of Massachusetts Department of Industrial Accidents LV Office of Investigations k9i 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelribly Name(Business/Organization/Individual): 4STS;/C to IvF RUO F i/V tr - S'lb/ti(-r %L Address: �,2 G L� jSu7nti PT S(-'1T& Z2-(- City/State/Zip: No, A/VboV6 K . kA U/ eclf Phone#: 97f (e3 2 Are you an employer? Check the appropriate bog: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I employees(full and/or pait-time). * have hired the sub-contractors 6. E]New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. p Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11. Plumbing airs or additions 3.El I am a homeowner doing all work g re p myself. [No workers' comp. right of exemption per MGL 12'1St Roof repairs insurance required.]t c. 152, §1(4),and we have no 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. ;Contractors 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 employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:�[� Policy#or Self-ins. Lic.#: MIO L9 9 2 01.3 Expiration Date: Job Site Address: ��( �C�L�%�7��.t City/State/Zip: / out° 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 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 certify under thepains and penalties of perjury that the information provided above is true and correct. Sign e: J_..._/ �J C Date: Phone#• 97F 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 NOkrN F ^. Building Department o 27 Charles Street '' J0 North Andover, Massachusetts 01845 nV. ' (978) 688-9545 Fax (978) 688-9542 °� 'ISS/ICHU`�E'� 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,11, s150a.. The debris/will be disposed of in/at: G-. Z' �' . , 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, �illd 01fice of cullsulnel Affairs Its illess l4gulatioll Construction Supervisor SpecialsLicenseLicense ",,.HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Registration: 1104569 Type: RestricIE!d lu: RF•WS Expiration: 7114/2012 Ptivale Cofporatio DAVID CASTRICONE DA SD CASTRICONF, ROOFING, SIDING& 31 COURT STREET David Casincone NORTH ANDOVER, MA 01845 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 ExPl(Ahow 1116/2011 I'm 99358 i ACQCERTIFICATE OF LIABILITY INSURANCEFg/23/20WDDIYYYY)D 1 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 NAME: Eastern Insurance Group LLC - Main PHONE - -7 AACNc. B-653-8 233 West Central Street E-MAIL Natick MA 01760 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 8 IftURERA:CoI1VnerCe Insurance Company 34754 INSURED 31969 -. INSURER B: David Castricone Roofing & Siding Inc INSURER C: 200 Sutton Street #226 INSURER D: North Andover MA 01895 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1270599931 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 I S POUCYNUMBER MM/DDIYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ '4COMMERCIAL GENERAL LIABILITY PREMISES Ea occunenoe $ CLAIMS-MADE OCCUR -ME D EXP(Any one son) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY BCNGCV /1/2011 /1/2012 EaaoC1dert 1000000 ANY AUTO BODILY INJURY(Per person) $20000 ALLOWNED SCHEDULED BODRY INJURY AUTOS X AUTOS (Peraccdenl) $90000 X HIREDAUTOS X NON-0WNED PROPEATYDAMAGE AUTOS Peracddem $ $ UMBRELLA UAB OCCUR EACHOCCURRENCE $ EXCESS LIABHCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC003989723 9/23/201 AND EMPLOYERS'LIABILITY 1 9/23/2012 X WC STATU- OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT OFFICERdtEMBER EXCLUDED? N/A $100000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $100000 II yes,descrlbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LMR $500000 DESCRIPTION OF OPERATIONS,'LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Castricone Roofing & Siding, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Sutton Street, Suite 226 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD AIS CERTIFICATE OF LIABILITY INSURANCE °A'�` "°°"' ' 9/9/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. PHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES " BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the cortl8cate holder Is an ADDITIONAL INSURED,the pollcy(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 doss not confer rights to the certificate holder in lieu of such endorsemen a. PRODUCER CONTACT NAME: _ _ _ Willows Insurance Agcy PHONE 978 47_5 3414 �x, 51 Cochichewik Dr EMAIL PRODUCER - curromEm in s. r. North Andover MA 03845 _ INSURER(S)AFFORDING COVERAGE _ NAIC r INSURED imouRER A widen Specialty Ina Co DAVID CASTRICONE ROOFING & SIDING INC 200 Sutton St Suite 226 _.._ NORTH ANDOVER MA 01845IMMER6; "' INSURER F: COVERAGES CERTIFICATE NUMBER-CL119906255 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. MSR, —_.. __.�...__ DtfUBp _._. _ LTR TYPE Of INSURANCE POLICY NUMBER PmUCYEFF MwooNmi ExP ---• •U MITI •__.—_. GENERAL LIABILITY -AM WVD EACH OCCURRENCE _ S _ 1000000 X COMMERCIAL GENER�AL LIABILITY -DMGFZ TO RENTED PREMII.S_4.$-L y meunanae� I S 50000 A cLaets MADE I X I OCCUR 00031600 9/06/2011 /6/2012 MED EXP(Any Ane Breen f 1000 _ ?6P-WNAL A ADV_INJURY a 1000000 FOENERAL AGGREGATE S 200000_0 G£N1 AGGREGATE LIMIT APPLIES PER DUCT3-COMPIOP AGG S 1000000 _.. ... __ .. .. ._.S .. .. .. POLICY RG' Loc AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ib accident) S ALL OWNED AUTOS BODILY INJURY IF*Pereon) S - SCHEDULED AUTOS BODILY INJURY(Per xeideM) b HIRED AUTOS PROPERTY DA—MAG E f (Per eCCldenl) I_ NON-OWNED AUTOS f UMBRELLb A UAB OCCUR EAON OCCURRENCE : PxCaSS LIAB CLAIMS�IADta AGGREGATE a DEDUCTIBLE s RETENTION a — — ---- - WORKERS COMPENSATION a AMD EMPLOYERS'UABIL rV WC STATU- OTµ ANY PROPRIETORiPARTNERIFXECUTiVE YIN• TO.R.Y_LIMIT.B OFFICERMEMBER EXCLUDED7NIA E.L.EACH ACCIDENT f (MmdAlnry In NH) Q N yes,describe under E.L DISEASE.EA EMPLOYEf DESCRIPTION OF OPERATIONS Wpw E.L.rnBEASE-POLICY UK4rrl{.....—..—-- I DESCRUMN OF OPERATIONS I LOCATIONS J VEHICLES (Attach ACORD tot,Addrronu Rerearka Sehedule,N mere Apace M required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Cas tricone Roofing & Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS, Castricone Roofing 200 Sutton Street Suite 226 AUTW0%q=WRESENTAME N Andover, HA 01845 n E AC 25(2009!09) ` ®f968VC ORD CORPORATION. All rights reserved. IN5023(2ooew) The ACORD name and logo are registered marks D