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HomeMy WebLinkAboutBuilding Permit #093-14 - 38 RUSSELL STREET 7/30/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: v Date Received Date Issued: Z �43 IMPORTANT:Applicant must complete all items on this page LOCATIONUSSC,( I Print. PROPERTY OWNER �"�eV�n �`L.Q r Print 100 YearOld Structure yes no MAP NO: PARCEL?D ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition 0 Two or more family 0 Industrial 0 Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��ri p and ► h i nG le. ro U Identification Please Type or Print Clearly) OWNER: Name:���eyPn 1,&urtfr Phone: Address: J k'uSs�l1 �� Orfh �n�Oyel, I`fA U i ���r i CONTRACTOR Name: "Sb/A16- Phone: Address: ,31 R 6677y3 STaE SSU/7-e- X36 14277/ Amboyel" IY/+ DIM- Supervisor's Construction License: q 9 Exp. Date: JA -/6 JOi 3 Home Improvement License: Exp. Date: 7 ��'v7015J 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: $ c 0 6, 00 FEE: $ �o — Check No.: .2-/35 Receipt No.: 24 to 7A, NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor E)2- 1J- C,ZL...,.i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 0 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 t. Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments (Conservation Decision: Comments II Water & Sewer Connection/Signature& Date Driveway Permit ' 'b. DPW Town Engineer: Signature: Located 384 Osgood Street 'FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Departirnerit signatureldate COMMENTS I 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 4 I NOTES and DATA— For department use I ® Notified for pickup - Date Doc.Building Permit Revised 2010 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 U Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work " Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application Li Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) u Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I 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 Doc: Doc.Builling Permit Revised 2012 I r 771 Location No. /-3 l Date • - TOWN OF NORTH ANDOVER • • • Certificate of Occupancy $ Building/Frame Permit Fee $�- - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check#2135- 26672 2/35"n6612 Building Inspector NORTH Town of : Andover O " - 0 No. - ,� o h , ver, Mass, COCNIC"RMIK. y1' �1,95°'4�reo rPa��S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT � �"`Y xa`l`'�t 4 ............................................................................ BUILDING INSPECTOR ............... .............................. has permission to erect buildings on . � �. Foundation .......................... ....... ... .......................................................... Rough to be occupied as ........... �;�. '.. s .. ......................................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service .................. ... . ,....... ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE DAVID CASTRICONE 7,A4 -13 CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 0231 IR AN SUTTON STREET,S 14(r NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Baxford 978-887-6147 In Iloverhiu 978-374-73]4 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: F Owner's Name.........61 i...�..... ................. Q........ATel hone.#l12i=.. 0..!Job Address...III?..... ...... ..................... '............. State..... Specifications: Strip existing shingl —Apply new drip edge to all edges. (,JL,�e, ...................................................................................................................................................................................................................... ,/Apply�_teet ice and water shield membrane to bottom edges of house. 3 feet ice and water shie mem ran in valleys and bottom edges of any unheated areas of house.FIW/ �/.t �� ............................................................................................ IF .................................. ✓Apply felt PaTIF u erlaymenL k4nstall ridge vent to42 rk .., yt tL.................... ...................... ... ....................................................../1....... .�) ........ .... z.,Reroof u rng shingles with a ' year warranty. Y�P� ..................................................................................................................................................................................................................... /Co terfla chimney. 'New vent pipe flashing. legal disposal of all debris. ..s�. ...............................e........ .......................................................................................... ............................................... Area(s)to be worked on: .......... ........ ................................................... ........ ................. ............................................. .. .. ........................... ..... ..... .... . .... .. �. .1� ,► -.... . u�s.. - ........................... .........-9.B.Q................................................................. ....... ......l a.l .t .. .....................-........7.x.4.... ................ ......... U Roof board replacement if necessary @<4 /sheet olV±k/foot. ,) y ....................................................................................................................................................................... ......... ................. Two Year Workmanship Warranty(Not Transferable) Wanufacturer's Warranty as speci ed y°�,,nn}p�facturer The contractor agrees t9 perform the work and is the materials specified above for the S of S.....4..7.�3.......... ... Payable......fti,2,,............::on. f` `.......... 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).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 unregis eyed contractors is excluded from the Guaranty Fund provisions of MGL c.142A. ir Appr6ximate starting date of w rk................................................ 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 cellati n).// IN WITNESS WHEREOF,the parties have he signed their:names this... .....day of.3...AV...........20.Accepted: Signed...... .. .... ................................................. Owner Signed............................................................................. Owner David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly NaMe(Business/Organization/Individual)�3AU ib (2AST 2t c eA)L W 0 F 1146: 9. S.D/Al Cr /4 C. Address: 013/ R S u T Toz Syu E f 'So i n- City/State/Zip: No. AM ao da rt. HA 6. AY r Phone#: 171 •6 1-3 -J Val 0 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with q 4. ❑ I am a general contractor and I ' 6. F1 New construction employees(full and/or part-time).` have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.tR�Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13F1 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 a're 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. I 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� f4 4 1C T/S Policy#or Self-ins.Lic.#:r W0: 003 lid MMU Expiration Date`:� 9 �� •a10�r/i c Job Site Address: b �l)J,�' S� ' City/State/Zip: N0 Pbp `! Ovel A ` O.� 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. Ido hereby certio under thepains andpenaldes ofperjury that the information provided above is true and correct. - Simature: -`/ C Date: Phone#: 5771r, do d 1�2 0 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or,trustee of an individual,partnership,association or other legal entity,employing employees. However the owner-ora dwelling•house hayingnot more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or,repair work on such dwelling house or on the grounds or building appurtenant thereto'shall not because of stich employrrient be deemed to be a'employer." MGL chapter 152,§25C(6)also states'that"every state or local licensing agency shall'vvitht o'ldihe issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department hasprovided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)saiderson is NOT required r 1 i to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigatiolis 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877,MASSA.FB Revised 5-26-05 Fax 4 617^727;7749 www-Mass.gov/dia E:ASTERPl INSURANCE DATE(MWDONYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 9/11/2012 PRODUCER 978 273 6368 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Willows Insurance Agcy HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 51 Cochichowick Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I North Andover MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED 12wBURERAYESIFRN WORLD INSURANCE CO DAVID CASTRICONE ROOFING 6 SIDING INC S 8: CASTRICONE ROOFING 6 SIDING INC INSURER C, 231 Sutton St #3A INSURER D', NORTH ANDOVER MA 01845 INSURER E' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAV PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. INSR ADD'Li I pOUCV NUMBER POT ICT EFFECTIVE POLICY EXPLgATION LRAITS LTR INNRUTIEF OF INSURANCE pENERAI LIABILITY EACH OCCURRENCE — S 1000000 �C'ETO RENTED 3 550000 COMMERCIAL GENERAL LIABILITY PREMISES(Ee occutreRQeJ_...,..___ . A _ CLAIMS MADE ; X i OCCUR pP1332988 9/6/2012 9/6/2013 MED EXP(Any one Dorson) S__ 1000 PERSONAL 6AOVINJURY 3 1000000 ! GENERAL AGGREGATE 15 _., 2000000 GEN'L AGGREGATE LIMIT APPLIES PER. I PRODUCTS-COMP/OP AGG S 2000000 POLICY PR !LOC jr AUTOMOBILE LIABILITYLICE MBINED SINGLE LIMB ANY AUTO emocnl) S —_--.. ----- ALL OWNED AUTOS BODILY INJURY $ $CHEOULED AUTOS (Per p"on) HIRED AUTOS BODILY INJURY S NON-OWNEO AUTOS (Per accidonl) —— • I _. .._..... PROPERTY DAMAGE j (Per accldenl) GARAGE UAPIuTY I_AUTO ONLY-EA ACCIOENT 3 ANY AUTO ! OTHER THAN EA ACC 3 AUTO ONLY AGO F EXCESS I UMBRELLA LIABILITY ! EACH OCCURRENCE -_ OCCUR i— CLAIMS MADE AOl3REGATE -_-_ S ,,,-,• ,_.._ . _ $ .. DEDUCTIBLE —_ S RETENTION $ I 5 WORKERS COMPENSATION WC STATU- DTH- AND EMPLOYERS'UABILITY YIN TORY LIMIT-$, ER ANY PROPRIETOR/PARTNER(F-XECUTIVE El EACH ACCIDENT 3 _ I (MeeseEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ In NM SPECIAL FROVISIONS Dillow I El DISEASE-POLICY LI.M1Y S OTHER DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF 1HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Castricone Roofing OL Siding NOTICE TO THE CERTIFICATE HOLDER NAMED TO 11+E LEFT,BUT FAILURE TO DO 90 SHALL Unit 3A IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AOENTS OR 231 R Sutton Street REPRESENTATIVES. AUTHORIZED REPRE AT], 42 North Andover, MA 01845 ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200901).01 The ACORD name and logo are registered marks of ACORD 4CG�Rt� CERTIFICATE OF LIABILITY INSURANCEDATE(MMlDD!YYYY) 9/24/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: tf 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 NONT AME: Select Dept ext 66807 Eastern Insurance Group LLC - Main PH0 No Ex 508-651-7700 a c No) 508 653 8089 233 West Central Street "MAIL Natick MA 01760 Al)l)REss:selectwQrkerninsurance.com INSURER(S)AFFORDING COVERAGE NAIC 6 INSURER A:CO imerce & Industry 19410 INSURED 31969 INSURER B: David Castricone Roofing &Siding Inc INSURER C. _ 231 Rear Sutton,Street, Unit 3A INSURER D North Andover MA 01845 I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1538501247 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESC91BED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INTp j TYPE OF INSURANCE AD BR pCLICY EFF I POLICY EXP IN R.WVD POUCYNUMBER 'MM,rDO'YYYY I MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ �- C:/7t:1 o-AERCLAI GEPIE RAL LIABILITY NLa. A JJED -- PREMISES Ea oecunenoe S J CLAIMS MADE OCCUR HIED EXP(Any one per eon) $ PERSONAL R ADV INJURY- . i I$ I GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: I I J PRODUCTS COfAP!l-IP AGG 1$ 71LI.Y i PRO �1 LOC AU TO MC'oILE LIABILITY I i Ea 8cxldeltl AP:Y.SUT(7 IBODILY INJURY(Per per sent $ 4,LL O'W'NED j .i SCHEDULED '- __ �.UTOS AUTOS BODILY INJURY(Per acc/dent) $ .177 NON O'-VNED I PPERTY DANIAGE eLkHREDAUTOS 1 I AUTOS Jentl $ $ UMBRELLA LIAS I OCCUR ` I EACH OCCURRENCE $ �- j EXCESS LIAB CLAIt"IS;.1ADE AGGREGATE $ DED 1 'RETENTIONS I $ A WORKS RS COMPENSATION 1VC003989723 ')/23/2012 9/23/2013 X "/C S7ATU- O7H ANDEMPLOYERS'LIABILITY Y.N . I O I ❑ I T-�Yl AN\1 PROPRIETOR%F.RTi'dER/6XECUTIVE I OEFICERBMEMBER EXCLUDED? N-A E L.EACH ACCIDENT $100,000 (Mandatory in NH) E.L.DISEASE EA EMPLOYEE $100,000 II 1'e 5.d65Cr il7B Under DESCRIPTION OF OPE RATC')NS bebw E L DISEASE-POLICY OMIT $500,000 I I I DESCRIPTION OF OPE RATIONS%LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN David Castricone Roofing& Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. 231 Rear Sutton Street,Unit 3A North Andover MA 01845 AUTHORIZED REPRESENTATIVE � q I ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD !NIA,..aClit I f[: - Dc 11c11'tntr11t ul Pultlic (cn } Bo ilI(1 u( Bu1:1 Bill F2c_uliuns anti .�tantlit I IC -"— Construction Supervisor Specialty License License: CS SL 99358 Restricted to. RF,WS DAVID CASTRICONE 31 COURT STREET `} NORTH ANDOVER, MA 01845 Expiration: 12/16/2013 ' ( , iiuni.a„nrr Trr: 7924 SCA 1 C' 20M-05/11 O Office of Consumer Affairs&Busi ess Regulat on :ll own E IMPROVEMENT CONTRACTOR Registration: 104569 Type: (x `l:expiration: 7/14/2014 Private Corporation yc DAVID CASTRICONE ROOFING, SIDING 8, David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 Undersecretary Town of North Andover NORTH 0��1Lr0 E O. i. Building Department o 27 Charles Street A Norrll Andover, Massachusetts 01845 9 z I (978) 688-9545 Fax (978) 688-9542 7 q�R�Teo �Pµy•(h 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 lice,ised solid waste disposal facility as defined by MGL cl 1, sl 50a.. The debris will be disposed of in/at: � Z' l Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of N orth Andover must be obtained for this project tluough the Office of the Building Inspector,