HomeMy WebLinkAboutBuilding Permit #074-13 - 204 COVENTRY LANE 7/30/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: Date Received
Date Issued:
IMPORTANT:A licant must complete all items on this page
0 Lly'-et) l•4e. �o�t� >47d()�-
LOCATION �
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Print
PROPERTY OWNER 'Th 0 m Gu �/7 9 Ae` Unit#
Print
MAP NO:�Q PARCEL: 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 )ff One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
)[Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
(® Sep C1t ���iWell '` x �)Fl o`dplavil ( iWetlendss 0 WatersheclTD strl t }
wers. f
DESCRIPTION OF WORK TO BE PERFORMED:
J7'rlp anle 1-06f aK
(Identification .Please Type or Print Clearly)
OWNER: Name: Yb 6DUJ /?9 Phone:- 9�(� �u�_ 7011
Address: ll e UH:x nJd
CONTRACTOR Name: U f? Phone: 97 {D �3 301-0
i Address: R JL)hn S , Lit JA Mra ��l'Yl t - AA dl S`ff
Supervisor's Construction License: ���� Exp. Date:
a
r
Home Improvement License: / y '�,�(�5 Exp. Date:
I
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.'$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ /d �(�. °v FEE:
Check No.: / 7 e9s, Receipt No.: �2
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
..... .. :.. ... .
;Cinn�fi irc of L1`ncint%(linmai." .
.. _ .. • .. = Clei ria+lira rif.nriri+r"".=;:C+:.:-.".
Location_'2 7 1 Y Ge;1t,w ^161v(--
/ No. Date i
0 7y- ,3
+= TOWN OF NORTH ANDOVER
110,11 46-: Lome-
. � Certificate of Occupancy $
Building/Frame Permit Fee(
Foundation Permit Fee
Other Permit Fee
.,
TOTAL � d
Check#./
SGS
F
25556 Building Inspector
[k
E
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
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
4 �
Planning Board Decision: Comments
R
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 min.$100-$1000 fine
NOTES and DATA-- For department use
I
I
I
Notified for pickup - Date
E �
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
❑ 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 p sed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
{ ❑ Two Sets of Building Plans One To Be Re
i ( turned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
40TE: 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
Doe: Doc-Building permit Revised 2008mi
NORTH
.own of
o _ y �
No. o Y
h ver, Mass, a
COCHIC..l W.C.. y1•
�d p�RAT E D
S U
BOARD OF HEALTH
LD PERMIT T Food/Kitchen
Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT .......... f—
O� r�� to Foundation
has permission to erect .......................... buildings on .....................
.................... ..M.!...... ..Ald lVc!..
Rough
ria e'
tobe occupied as ................................................................................................................................... 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION TARTS Rough
....'. Service
.................. � rse.-.............................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove- Fina'
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. �� ;Z15
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 Haverhill 978-37(-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
' ( ' ter..........-"�.
s Name...�1.D. ls?n5 ......... 1..1<l. .... `..:....................................T phone#... 5 .S..L�n 11 ,
Job Address..�`�'• ... .................City... �G' ../...F.A .. .i! :� ...............State...4A.........
[ specifications:
.............................................................................:................................./................................................................................................
-Strip existing shinglesc 0 apply new drip edge to all edges. /1;11 T
......................................................................................................................................................................................................................
y/Cpply_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.
...................`................................................................................... ....................
Apply felt pa e e layment. /_Iestall ridge vent to , 1r5�
.SJ.yj4.. 4 .'.C:.ct... ( .�............ .. �......
�eroof usSng u ..vim. v < 4 pit s [ g s1 t�Ywarranty.
shin les with a ear
......................................................................................................................................................................................................................
,Counterflash chimney. —New vent pipe flashing. 4-1:.egal disposal of all debris.
I
.....................................................J................................... . ......................... ................ .
Area(s)to be worked on:
......... ......................... ... 1h� .. ..ff. A„�i......ti� .1n, r. �.... .....J...'. .1 ..�{a.• .. .I
l�L I
..........�.
�.. •:..5. 7. ...j�G' /.tYl.t .lr �. •��`,��Gs.rfJ..('. ' �ic .... . .. 1.1.i l..
1 .Y• - �
..... - . �• ........ ... .. ..........
Ro board replacement if necessary /sheet or foot.
.....................................................................................................................................................................................................................
Two Year Workmanship Warranty(Not Transferable) IVT'anufacturer's Warranty as speci ed by manyf���r
The cetor agreest perform the work an�JfuQSish the materials specified above for the SU of S...... .�0...........................�
)Oayable.....!/-.................on....5 a .. ..............
Payable.........-' ...............on............. ................�2.I alance payable on completion o
Owner or Owners are not responsible for Property Damage or Liability w a 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 panics.The undersigned warrants)that be 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 at
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 (segotice of cancellation).
IN WITNESS WHEREOF,the parties have hereunto signed their/...... ' .1 ........day of.. �f ..............20.4 ....
Accepted: ^
Signed.... ................... .......................... Owner
ate," Signed............................................................................ Owner
.... .................I.........`:`�
David astricone,President
Town of North Andover Nokrk
F
It D
3? s� ti �e
Building Department o
27 Charles Street
North Andover, Massachusetts 01845
(978) 688-954S Fax (978) 688-9542
A°R�rt° �PMy,�S
IS
SAC HOt
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 c11, s150ap
The debris/will be disposed of in/at:
r�
Facility location
Signature o 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,
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations .
a 600 Washington Street
Boston, MA 02111
�,� sY•�, www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information CPlease Print Legibly
Name (Business/Organ izationadividual): CA S"T11/ C 6 N E P00.0-N &
Address: U T rb N STRa.T 3A
City/State/Zip: N6, Ah b oy 6K MA 6 MS Phone #: 9 q $ - W '3 Q 0
Are you an employer? Check the appropriate box: Type of project (required):
I.[1 I am a employer with �! 4. ❑ I am a general contractor and I
b. New construction
employees (full and/or part-time).* have hired the sub-contractors
2.El 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. ❑ Weare a corporation and its
required.]
officers have exercised their ME] 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 UtZkoof repairs
insurance required.] t employees. [No workers' 13.0 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 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
'nformation.
.nsurance Company Name: Vk A('Z rl S
r
?olicy#or Self-ins. Lic. #: C 0 a 319171.3 Expiration Date: 9•
lob Site Address: City/State/Zip: N 0. L&,- N v l U yf
Xttach a copy of the workers' compensation poll y 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
ine 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
A up to $250.00 a day against the violator.--Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA.for ins.u6nee coverag.�.verification.
!do hereby certify under the pains andpenalties ofpetjury that the information provided above is true and correct
3i afore: C � Date:
?hone#: 9 7 F W- q a o
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2.Building Department 3. CityrFown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
ACORHCERTIFICATE OF LIABILITY INS D/9/2YDDIYYYTI
INSURANCE g/g/2011
THIS CERTIFICATE 16 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder Is an—ADDITIONAL INSURED, the pollcy(les)must be endorsed. If$UBROGATION IS WAIVED,subject to
the terms and conditions of the policy,cartaln Policies may require an endorsement. A statement on this certlflcate does not confer rights to the
certificate holder in lieu of such andorseman i.
PRODUCER CONTACT
[Aub"RIt1w:
AME:__
willows Inauranca Agcy HONE 978 475 3414 PAz
51 Cochichewik Dr RutER ._.......-- _.
North Andover MA 01845 _
NSRERISJ AFFORDING COVERAGE
INsu�D IU
INsuRm A ktaiden Specialty Ins Co _
DAVID CASTRICONE ROOFING & BIDING INC --
INeURER C
200 Sutton St .Suits 226 INeURlRp:
NORTH ANDOVER MA 01845 INMFA6
INSURER F:
COVERAGES CERTIFICATE NUMBER:CL119906255 REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS_ SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
�L Uep _
LTR liTYPE OF INSURANCE POLY NrA UC1 EFF POLICY
GENERAL UUIUTY Amy= --- LAR$ - ––
EACH OCCURRENCE S 100_0_000
X COMMERCIAL GENERAL LIABILITY -50000
•M
A I.__ CLAIMSADE I X I OCCUR Un00031600 9/06/2011 /6/2012 M EXP
E. ( y one en egrymon)
MD EXP An
e _....—...... 1000
PERSONAL 6 AOV INJURY t 1000000
GENERAL AGGREGATE S 200000_0
GEKLA GGREGATE LIMIT APPLIES PER PRODUCTS•CDMP/OP AGG f 10000.0.0
p0� PRO LOG
_.. .. .. .. ._ .S
AUTOMOBILE UAswry
COMBINED SINGLE LIMIT S
ANT AUTO (Ei>K,'Pdenl)
ALL OWNED AUTOS BODILY INJURY{Per person) S
SCHEDULED AUTOS BODILY INJURY(Per eeta0ent) f
HIRED ALTOS PROPERTY DAMAGE
(Per Kdoert) f.
I_ NON.QWNEDAVTOS
S
UMBRELLA OCCUR $
"MISS LIAa EACH OCCURRENCE s
culMs a,tADE -
DEDUCTIBLE AGGREGATE S
RETENTION S —_ S
WORMER$COMPEN6ATION S
kW EMPLOYERS'LIABILrTY WC STATIJ• ff 0--71{,
ANY MROPRIETOWPAg7NER/EXECUTIVE
YIN 7"Y_LIMITS .._L.CR
OFFICERMEm 6ERNN)E%CIUDED7 a NIA E.L.EACH ACCDENT S
(Meneetery IP NM)
tt 'd0i^b°wrier E.L.DISEASE•EA EMP
DESCRIPTION OF OP EMPLOYE i
ERATI NS
0 below — -- � ......_..—_
E.L.DISEASE•POLICY UMR
:
DESCRIPTION OF OPERA7101161 LOCATIONS 1 VEHICLE$ (AheCh ACORD let,Addillonel Remerwe SeHeeuh,N meM
epees is ngWraey
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 WITM THE POLICY PROVISIONS.
Castriaone Roofing
200 3utton'street suite 226 AUT"CW"UPRURNTATIVE
N Andover, MA 01845 2
"�
ACORD 25(2009109) 4
INS025(2o010M) The ACORD name and logo are registered marks of 0 ORDORD CORPORATION. All rights reserved.
ACOR . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY)
9/23/2011
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(Sy, AUTHORIZED
rnn rr.r UT�TI\Ir/fin M-1 IA - P\T1 Ir nrnTlr ll'.•Tr 11/\1 nrn
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. It 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 -651- � N
233 West Central Street E-MAIL
Natick MA 01760 AD RES
INSURERS AFFORDING COVERAGE NAIC N
D'
NSUREIRA:Commerce Tnpurance Company 34754
INSURED 31969 INSURER B:
David Castricone Roofing & Siding Inc INSURER C:
200 Sutton Street #226 INSURER D:
North Andover MA 01845
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:2141633407 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 CONDITIONSOF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN
REppDI(�UICIC(EYDE FiBY PAIID' CLAIMS,
IN P901W,
GENERAL LIABUTY
EACH OCCURRENCE I—.$
COMMERCIAL GENERAL LIABILITY PREMISES a rrerro. $
CLAIMS-MADE 7 OCCUR MED EXP(Any one erson) $ _
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GENt AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG $
POLICY PRO-jFCT F7 LOC $
A AUTOMOBILE LIABILITY BCNGCV /1/2011 /1/2012 E.)MBIIa @cc era 1000000
ANY AUTO BODILY INJURY(Per persoh) $20000
ALL OWNEDSCHEDULED
AUTOS X AUTOS BODILY INJURY(Peraccdent) $40000
X HIREOAUTOS X AUTOS NON-OWNED PROPERTY DAMAGE $
Peracc1Jenl
UMBRELLA UAB $
OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAMIS MADE AGGREGATE $
DED RETENTION$ $
B WORKERS COMPENSATION C003999723 /23/2011 9/23/2012 X WCS ATU• O -
AND EMPLOYERS'LIABILITY YIN
ANY PROPRIETOR/PARTNEWEXECLMVE E.L.EACH ACCIDENT $100000
OFFICER/MEMBEREXCLUDED? NIA
(Mandatory in NH)
It)res,describe under E.L.DISEASE-EA EMPLOYE $100000
DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $500000
ITi
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more apace Is required)
CERTIFICATE HOLDER CANCELLATION
Castricone Roofing & Siding SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
g g THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Suite 226 ACCORDANCE WITH THE POLICY PROVISIONS.
200 Sutton Street
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE
01988.2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
g �I t.�.�achu�ctt� Ucllartntcnt ul Pul[lic .lafcn
Bu;trtl of Builtlin', Kr,ul,uiun.� an11 titanrlarll
--- Construction Supervisor Specialty License
License: CS SL 99358
Restricted to: RF,WS
DAVID CASTRICONE
31 COURT STREET #
NORTH ANDOVER, MA 01845 ,rs
Expiration: 12/16/2013
. t inini,.i,nr
Tr!;: 7924
SCA 1 C; 20M-05/11
.. Office of Consumer Affairs&Busidess Regulation
hOMEIMPROVEMENT CONTRACTOR
l - _, egistration: 104569
Type:
KA.expiration: 7/14/2014
Private Corporation
DAVID CASTRICONE ROOFING, SIDING&
David Castricone
200 SUTTON ST SUITE 226
NORTH ANDOVER, MA 01845
Undersecretary '