HomeMy WebLinkAboutBuilding Permit #911-13 - 32 WATER STREET 6/26/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
/
Permit NO: l — 13 Date Received
Date Iss
RTANT: Applicant must complete all items on this
LOCATION'
I
PROPERTY OWNER J o hn � � 140A Print � -cl 6C)rd vn
Print 100 Year Old Structure Aes no
MAP NO: .1 PARCEL: ZONING DISTRICT: Historic District no
l Machine Shop Village no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
-J�cTwo or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
Aepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic. ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
El Water/Sewer
0
OWNER: Name:_Joh
5 Phtw'
Address: 5(&
CONTRACTOR Name:
DESCRIPTION OF WORK TO BE PERFORMED:
Ie.
Identification Please
Calm ).�d
�S C�as3in5
f
'00T1
Ie or Print Clearly)
rlr+hor 60('r0'1 PI
3 q W a?Cr S +yce.l--
\or+4. tor" neer •rM
F310 -
W
Address: o`,3 ( R Suiin S �. Su It 3 A � iof` k AndoW. IYA 01
Supervisor's Construction Licenser Exp. Date: 101
r--
Home Improvement License: O�� L� Exp. Dater 61114 112-01"
ARCHITECT/ENGINEER Phone:
Address:
Reg. No.
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ '59 R) FEE: $
Check No.: Io6) Receipt No.: Q k! -Lb
NOTE: Persons contracting with unregistered contractors do not have access to the guar my fund
Signature of Agent/Owner : Signature of contractor
Plans Submitted 11 Plans Waived 11 Certified Plot Plan ❑ Stamped Plans 0
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/MassageBodyArt ❑ ...
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
PLANNING & DEVELOPMENT ❑
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE APPROVED
El
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Pi*nning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tovv Engineer: Signature:
uocatea M4 usgooa btreei
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
MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine
NOTES and DATA — (For department use
® Notified for pickup - Date
f
Doe.Building Permit Revised 2010
No
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofirp,g, 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
MOTE: 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 apo: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submAted with the building application
Doe: Doc.Builjing Permit Revised 2012
-�52-34-
LocaLion
Dateo 12(p 1 L-3
N o. 64'
Check # Q w
TOWN OF NORTH ANDOVER
Certificate of Occupancy $—
Building/Frame Permit Fee s4e-�—
Foundation Permit Fee $
Other Permit Fee $
TOTAL - $
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DAVID CASTRICONE
6,/Y,8
CASTRICONE ROOFING & SIDING INC.
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
A 3 (t 2W SUTTON STREET, SUITE 226, NO. ANDOVER, MA 01845
In North Andover 978-683-3420 1n Boxford 978-887-6147 In HaverhX 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:
Owner's Name ........ Q..�...........i............................1. t........................1 (.G r G... �1... Telephone ff.... !.) C.Q..✓.
Job Address...........! .ti .......7. 43. t✓r City.......} .....► !.VI C .4?' r State.. ..........
Specifications:
.. ...................................... ........................................................ P........
trip existing shingles. • pply new drip edge to all edges. W k4i_"
..................................
...............................................................................................................
t-�pply...(t7 feet ..ice and wa...te..r..shield....m..embrane........to bo..tto..m ed....ge..s of ..house...... ... 3 feet..ice and water shield membrane
in valleys and bottom edges of any unheated areas of house.
..............
................................................................................. ..................r ... ...............� ..........
Apply felt pa pSunnder ay��t, Install ridge vent to (•-�.(J� � �f_ (� 1�7�L ...�� '7 ���. ......................
I' ......1.^..+ r....J..........f...q.....y......................................................................................................................
Reroof using ��(' �(t�t (PCr< I J(1�t rylr.L%� f'tt' (a }V i- shingles with a —2_ year warranty.
r......................................................................................... .
...................................................................................................................
t/Counterflash chimney. New vent pipe flashing. al disposal of all debris.
......................................................................................................................................................................................................................
Area(s) to be worked on:
.................................................................................. .
..................................................0.................................................
........................... a.Q.J............... .. ....................... ........ -------------------------- ------ --- ---- - - -------------
..............................................................
Roof board replacement if necessary @ e6 /sheet or V /foot.
-
--
-------------_...........
.....................................................................................
.......................................
Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specified by 4 ufact er
The contractor agrees to-peZ or the work and furnish the materials specified above for the SUM of $... �.. VP ................
Payable .........Xle- ........ on ... .XIAN ............
Payable ..................=...... on.............................. 4 lance 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, theirjoint 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, anomey 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 be is (they arc)
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 notice of cancellation).
IN WITNESS WHEREOF, the parties have hereunto signed their names this ......((.�.. day of ........... yihR�., 20.%....
Accepted: 9.�..
Signed............ (:2...:-:........ Owner
Signed .... Owner
David Castricone, President f
DAVID CASTRICONE
CASTRICONE ROOFING & SIDING INC.
ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
, '3 (,,Pflo'SUTTON S'riUE'f, SUITE 226, N0. ANDOVER MA 01845
In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374-7314
I/we 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:
Owner's Name ........ JlT1.!�I+1)11
.......:d . .............L ( ��..t U ......1 '.G ( � �:.��.�1... Telephone N....h. l.: �.�1..4.. �.s��l�.�. � 4j)
Job Address ...... .....si::..i? ... ..�. T....... .Gi,.T..�: { .... `............... Ci `4'. .�.... iIA
Specific•atiom
l>
...........................................`/...........................................................I.........
..................
...............
.......................
.......
.......
..............
VStrip existing shingles. Apply new drip edge to all edges. W ,K.tJ�-r- ti It
......................................................................................................................................................................................................................
I/Apply 6' 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.
,............................................................................................. _
......}....................,........,..................................
I,/Apply left paper under aymen Install ridge vent to IQ @ ,�. �(.►�/'f Ct jC "�'
................. .....y..... 5 - ,--- ti
.............................�_ ....................................................
.........................................................
Reroof using �rf� �lt i��i Q� lZq�(� ryt; / (�f('t j (t �' shingles with a j year warranty.
. �..........................................................................................
.................................................................................................................
uCounterflash chimney. New vent pipe flashing. egal disposal of all debris.
.......................................... ........................................................ .......................... ................................... ........................ I..............................
Area(s) to be worked on:
......................................... .................. ..:....................
.................
:................a................'.................................::�................................. G ...01..................................................
.................................. l: C.(": . �0G'..4?t...............................................
..........................................................................
..............................................................................,,................................................................ .......................................................
Roof board replacement if necessary C& /sheet or �Av foot
...........................................................................................................................................................................................................
Two Year Workmanship Warranty (Not Transferable) Manufacturer's Warranty as specified by of ct er
The contractor agrees to erform the work and furnish the materials specified above for the SUM of $.... �; .. ..............
Payable ......... ...T..P..... on ....:�:i`.Xk`` t':...........
Payable ........................... on............- ................. dance 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 proporty, including pre-existing conditions (i.e. water stains, crumbling plaster, exposed nails) or
conditions resulting from application of materials specified above 0,c. objects coming loose from walls, crumbling plaster, exposed nails, dust in anic 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 mid deliver to contractor, theirjoinl note in accordance with his (their) above obligation as requested by
contractor. Upon refusal to do so, contractor niey 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 -hall bind and apply to their heirs, successors or estates of the parties. The undersigned wanant(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 agrrxment in reference hereto shall he binding only if in writing and signed by all pmiies.
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 I ftrovement 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 tmderstood 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 notice of cancellation).
IN WITNESS WHEREOF, the parties have hereunto signed their names this ...... I...........
day of ..........�>��rr.-:., 20.1.9
Accepted:
Signed............................................................................. Owner
Signed............................................................................. Owner
David Castricone, President `�
Town of North Andover
Building Department
27 Charles Street
North Andover, Massachusetts 01845
(978)688-9545 Fax(978)688-9542
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 sliall be disposed
of in a properly licensed solid waste disposal facility as defined by MGL cl 1, s15 Oa..
The debris will be disposed of in /at-
/' Z' t E
O ,yfn / V /
Facility location
Signature of Applicant
Date
NOTE: A demolition permit from the Town of North Andover must be obtained for this
Project tluough the Office of the Building Inspector,
The Commonwealth of Massachusetts
Department of Industrial Accidents
~A Office of Investigations
li 600 Washington Street
V Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Bus iness/Organization/Individual): CA5TR1LOAt '�NnyY tlk
.Address:_ A 3 1 A Sy�ko,n Sk(re 0 3 A --
City/State/Zip:'Ra Atka vel M A 0 I lq{ Phone #: q? t 6%33U.0
Are you an employer? Check the appropriate box:
1. ®I am a employer with 8
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
5. ❑ We are a corporation and its
[No workers' comp. insurance
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] f
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
I l.❑ Plumbing repairs or additions
125a�Roof repairs
13.❑ Other
*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 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.
Insurance Company Name:_ .S
Policy # or Self -ins. Lic. #: W Coo 39 89 U3 Expiration Date:/ l • A 3 • 020 13
19
Job Site Address: �o/'c_ cJ 7 �i� S e City/State/Zip: / & 1111v f iof. —
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requited 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 the pains andpenalties of perjury that the information provided
above is true and correct.
Signature Cam Date fi '`3
Phone #: 0131 413 .3 q
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 #:
Ucltartntrttt til Pucn
Buai t) of Builtlirl'R tIIutiun. ;Intl tituntlurll
Construction Supervisor Specialty License
License: CS SL 99358
Restricted to: RF,VVS
DAVID CASTRICONE
31 COURT STREET #
Y` S
NORTH ANDOVER, MA 01845
Expiration: 12/16/2013
(uiuni.<inrr
T r>~: 7924
SCA 1 C; 20M-05/11
���e �curnr•ntrrr�u�/� r.-��^r/rir,i.iuC'�ir.irr'/i
Office of Consumer Affairs & Busidess Regulation
„
el" IMPROVEMENT CONTRACTOR
1{ _ registration: 104569
- �_- Type:
ate= expiration: 7/14/2014 Private Corporation
DAVID ASTRICONE ROOFING, SIDING &
David Castricone
200 SUTTON ST SUITE 226
NORTH ANDOVER, MA 01845
Undersecretary
AC" � CERTIFICATE OF LIABILITY INSURANCE g/DA!E J DYYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONT CT
NAME: 7 _
Eastern Insurance Group LLC - Main /C
ANFAX
No Ezi 508 651 7700 alloL508 65 83 O8g
233'vVest Central Street E-MAIL
i�atick MA 01760 ADDRESS:S rninsanc o
INSURER(S) AFFORDING COVERAGE NAIC 6
INSURER A :rOMMerCe19410
INSURED 31969 INSURER B
David Castricone Roofing & Siding Inc INSURER C:
231 Rear Sutton Street, Unit 3A INSURER D:
North Andover MA 01845
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: L53RSn19d7 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 SY 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.
NSR
LTR
I TYPE OF INSURANCE
I
AD
INR
B
WVD
POLICY NUMBER
POLICY EFF POLICY EXP
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LIMITS
GENERAL LIABILITY
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BODILY INJURY (Per person) $
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UMBRELLA LIAB
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A WORKERSCOMPENSATIONWC003989723
AND EMPLOYERS' LIABILITY Y; N
ANY PROPRIETORiPARTPJER'EXECUTIVE
OFFlCERttdEMBER EXCLUDED?
(Mandatory in NH)
u ve.s. dascube uMer
iDES(RIPTIONOFOPERATk>NSbeIow
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9/23/2012
:/23/2013
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IX N/CSTATU OTH.
O IT �
E L. EACH r'.CCIDENT ' $t 00,000
E L. DISEASE - EA EMPLOYEE $100,000
EL DISEASE POLICY Lm+IR $500,000
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I
DESCRIPTION OF OPERATIONS LOCATIONS t VEHICLES (Attach ACORD 101, Addllional Remarks Schedule, !I more space is required)
w" laoo-tU IU Ak UMU UUMrUHA HUN. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
David Castricone Roofing & Siding Inc
231 Rear Sutton Street, Unit 3A
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
North Andover MA 01845
AUTHORIZED REPRESENTATIVE
i
w" laoo-tU IU Ak UMU UUMrUHA HUN. All rights reserved.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
EASTERN IPIS'URANCE
® DAYS (MMIDDNYYY)
ACORD CERTIFICATE OF LIABILITY INSURANCE 9Iii�2o12
PRODUCER 978 273 6368 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Willows Insurance Agcy ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
151 Cochichewick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
North Andover MA 01845
INSURED ....
DAVID CASTRICONE ROOFING 6 SIDING INC 6
CASTRICONE ROOFING & SIDING INC
231 Sutton St #3A
NORTH ANDOVER MA OIB45
INSURERS AFFORDING COVERAGE
NeURER A, WE STERN WORLD INSURANCE CO
I INSURER B; ... ....
INSURER C,
INSURER D.
INSURER E:
NAIC #
LU V CJ(MV CJ
BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
THE POLICIES OF INSURANCE LISTED
TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH
THIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT,
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, U(CLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 90 SHALL
INSR ADD -Z" DATE NUMBER POT ICY EFFEE OF INSURANCECTIVE POLICY lXPIR/iTION
LIMITS
DENERAL LIABILITY
OCCURRENCE — S 1000000
AUTHDRIZHORIZNTA1IVEE. EO REPRE A
TiCGEACH
FTO RENTEDs 50000
COMMERCIAL GENERAL LIABILITY •
PREMISES (Ee xcurrengel.....�..___ .
A CLAIMS MADE :� X j OCCUR �PPI 332898 9/6/2012 1 9/6/2013
MED EXP (Any one person) S 1000
PERSONAL -&, ADV INJURY S 1000000
GENERAL AGGREGATE ) $. _,_., 2000000
PRODUCTS COMP/OP AGG I S
GEN'L AGGREGATE LIMIT APPLES PER: I
- -_._ __2200000
POLICY . PR COC
I
AUTOMOBILE LIABILRY
COMBINEO SINGLE LIMB 3
' I
(Ee accidonq
ANY AUTO
-----
ALL OIAN60 AUTOS
BODILY INJURY $
(Per person)
SCHEDULED AUTOS
.. -. HIRED AUTOS
BODILY INJURY $
(Per accidonl)
NON•OWNE0 AUTOS
PROPERTY DAMAGE S
(Pe, accldenl)
GARAGE UABIUTY
I AUTO ONLY - EA ACCIDENT $
AN'Y AUTOj
OTHER THAN EA ACC S
AUTO ONLY' AGG $
EXCESS f UMBRELLA LIABILITY '
EACH OCCURRENCE S
OCCUR CLAIMS MADE -
AGGREGATE
__ 'S •
OEDU'CT15LE
RETENTION $
5
WORKERS COMPENSATION
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WC STATU- OTH-
I.TORY LItdLT.S. ER
AND
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER'F_XECUTIVE
EACH ACCIDENT
3
OFFIOERMEMBER EXCLUDEDi
"-""
(Manag*ry In NM)
.L._DISEASE - EA EMPLOYE11
�1_`L
m. dee VIDe Jndef-SPECIAL FRO'vIS10NS 0010W
DISEASE - POLICY LIMIT
S
OTHER
DESCRIPTION OF OPERATIONS I LOCATION$ I VEMICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROYISIONS
f FRTIFICATF Hoo r1FR CONCPt I OTION
ACORD 25 (2009101) W 19UV-Z009 AGVKU GUKPUKATIUN. All rgnt5 reservea.
INS025 (2ooson.ol The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOYE DESCRIBED POLICIES BE CANCELLID BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
Castricone Roofing & Siding
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 90 SHALL
Unit 3A
IMPOSE NO OBLIGATION OR UABILfTY OF ANY KIND UPON THP INSURER, ITS AOENT9 OR
231 R Sutton Street
R -
AUTHDRIZHORIZNTA1IVEE. EO REPRE A
North Andover, MA 01845
ACORD 25 (2009101) W 19UV-Z009 AGVKU GUKPUKATIUN. All rgnt5 reservea.
INS025 (2ooson.ol The ACORD name and logo are registered marks of ACORD