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Building Permit #1015-15 - 50 CHESTNUT STREET 6/8/2015
BUILDING-PERMIT �µ°oT;��tic TOWN OF NORTH ANDOVER - 6 APPLICATION FOR PLAN EXAMINATIONaw + _ Permit NO: Date Received Date Issued: I SSACHUS' WWI IMPORTANT:Applicant must complete all items on this page - T �_�.._. s, I. .,.._�. .F..r __ ._. ..�_...._ ...._._-,rt-....-.,..:;-.r.•� ____ >. .,..,.:..�.. ,>-r<.r'-_i•.>>4- _ fir. _- ... .._,� 4_._:_.. iL- _.e_�.e.:....1 .,:.e•�..:.r n;.-s,n=- ,,,:1:..3...,.1_ - - :'t A .��-�.sl ...,r1 .. ..tee-'. >7:. 1. -•tix .Z� - ..-F.v.Grc•�., - f_�. n.�.c,• _ _�a., mea_•' - - I�. „�,-..- - ,'1 h; - _ •`fir _ :.^�,, `3: .3•. _ _ _ _a=te �x -4t r, STs' - ,rte•-,: ..y-.•�-_. - .Cf+max. �.. _ .(< - - -3�_t-'^.-..:�rY>'�a•,•--tv:.Y�r,�jt .tib' �} X� - Ttt: •��._����4,. vt _-a��;- r�•.o_,�f..+�.�:c rs ti� h '-0 •'�••S 154 _ _ _- _ ���.Y_n�� _ _ _ -_ .� r ��,'S��C�1' 1. __ _ __ _ •Y ::.a±i.. ,�'yja•N:: •._v, _ h'�y. =r-a°,.-.��;•,^-__..-�F.��: _..�.....>. .--.,, ,.._..,. ,_:,w ter._ .,,_.�, ,-�.... - - -' - .:;�:." - _,S'}. - - .,_F:K•.' y4� �i:'`r.3„n"•d'.-'i`��r �rU'liw �iL_....>t' - __1l^,.A.� .°G=P.,-,'cc•t:-^ i.-. r_:�Yn�"s's-'--`-�Y�•�r.'�x,i3`ai7...t_: �4'•�'e y, .j, - .,r :I'ra =i '_-E7. .yam'`.Y.�._- ^il' r::,:•'i;-q-�:._,`n. .,,f._.. ,.1...�::r5`-�n,. �.°4,t.. ..:m�K'&'+r.•;.._-�_{_- _ :.[!..._i5z,.'��is` _- ':k .�4�-.,-a':: - �.:,._ e..t� t�:y� - tG-,_ - ixi?:y•= �='Y'_,....sk�_�-�r..,7�� __�Y:'�1s 'r" ('. --' - - __ �,�._ 't�:. / '�, r.,F,t_,!`�¢ _ -_ .:*��`K J a.ia=1• =c�j{,,t'L.',,'�7e�:.+t' ''r:�,yeaL-j-�-•,: ,��^`vLL�. �_' = s;.'ik' ,;r• .,.v,:-fir cTh:._., �'����`f-'� .s;•.;- ..-rs`�°I:h.�:s�.,.,r_ .w-r.�•= ��. _rvl JJ�� __ [IT - f {T-: - tiA- 1��-7...�'--'P• 'r- -{.p. ..��,4 .•;,kr_ ,.F;•:4�Yt•� �7�. __ ..l�a' (. :';vrl--, _ F��.I*��=:f' ..:f.e.. .�'»:+'=•x� _�78._... .,:.- ;� ''}} -nv'a't�Yh�f4;::••'c•£, - - - .�'_—rY-' - - - :.sne.- u]"- ti:lgti.,r• 2'r :{., 1.;�:, �~�'<^:'Lti.: - ..y,=�"U1•.�..� ..2Cr�ti �'el-llF -7i;^,-r�n .i�;,'[.�t1t`,.J•�' .f?ri__v _ll 'i4'.,."_�:'r 'eTVF:cs .;tG. 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'.':,_ ir-- .g-•i. -•.ac .--,t�.r�"c',.f�:nr 'a,. ,E, .E -,•:n. ;:m_ 41t:>w ::;a..rr.� a4` .r:a:��>m:��� •3.. ����,,..r+-->�•.'r. - �-ti:•ih+ ' - - ✓��r�. _.a}•,F- ra,�_'�.kr_ .�!7+'.:�t,.,, z�� c- - ..un, r;mid, a'�,'. rnx-,'-+;:i�'''_�:r.�', t.�sRs*ti'�rr .{...�v •�I�` '.-r`_°:�- - 'r^r. ,rte• qtr v,.t_sYs._ '�_ ➢•"r,: �--:j=:=eL= �r ty`�Y�w-,-.-t�.�1s,3„�_spn,_�^,e•n}�,_a rr e;�is"�-2,:-:^a'-,r�•T''er��'".r,7i,.,;{ter-Y-'."_,''�'t•;#;h:j�� T•','�.''-i''._--s _Oa^,=4i:,_ n;'�c,irRs', - :yt'...f,�s _ y'_..,!"s'9=" ,=,. k -j�_ �--�;it kt5:�icr^-.=:,� =',.4j.�•�r.�r,*. zi,7.r��{n 3 r_: w- .�, 7 ',i'• r r{. - �x r 7,_ ,r•��r ?;•gin�'.v,,, .,..�.rr�:o.. �s_���s.5+.`: .:m .c� .,:�t,� �g.zia�' _�;:��•;,.a,.rrt.."<1:����711�'�"�T�r:• •:�����"e;,��'vs3,s,_ ;`I�i , 3.. Qrr�:�.-��I:r�_:_,�__:,.4::,..r<..,:•'• ar,�•=.�_.,...._r.,z_�'.r........ ......�....Ic.!-71' �-._ ._?-�_ _ -.,.l.c. _ _ - _ - _ =�: �f+ , TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building -10ne family Addition Two or more•family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other e_�"_�i•aJ'ir+':%GrY e.ur-:-vvc..y.,.._i:i-"�:r._-- __,-:.._,r _ _ .vs,<"'�-;' L'_" -'S.) _ "�H,�,�'•• _ _N'..•'1 LIN- DESCRIPTION 3 ='� '.:��;OF WORK TO BE PREFORMED. a.nA ( \/I'() sLVI 46 0-1t S k I fki &re6�--J Identification Please Type or Print CI.early) OWNER: Name: uct al A Phone: 91f Address: AY-464,-' MA of Fl-( 'e'%.?we�,- .�.-.�.=,:+.'aa:F.s��-`FG-s:��r''a..•r.-_,%�.r�5-'�.,..xr:,3:_;-ur-r:.,:�+l.�rltl:'=r,a..�`.snr�r�s'_4�a'".�'�.a"„.e,.,.'.__-.,,..t"",__r+r,-"-'c:,°::n.,_:x.r k-C,..-i•.....xr.M�yJ;�,r-sn�e"�^�t.'i y.S^Tr.a-u''_.'-`---_. .-i''4v_�..-'+a - Location No. Date . - TOWN OF NORTH ANDOVER y• Certificate of Occupancy $ Building/Frame Permit Fee $,'2Zr Foundation Permit Fee $ �^ Other Permit Fee $ rc TOTAL $ Check# ' 26Ci Building Inspector J Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL— S ISPOSAL ` 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 DATEAPPROVED. PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on _ Signature C(D%MiV1EN l S. HEALTH Reviewed on Signature ' COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes I Planning Board Decision: Comments -Conservation Decision: Comments Water& Sewer Conn ection/Sig nature&Date Driveway Permit DPW Town Engineer: Signatiire: 4. Located 84 Os ood Street i — . - :; trilo—': 2.3 :..:. := -.t�� S.te �17 t .'j',1, y _ Ocat �af=s. - __ _ _ n.�tre - - - - - __ -div."�T�l;•'-:.,7�-::":-_: +'i ii:�i?�`--.�t-`� 'F. - .r>•-�_i; - - - cc3-moi.=-^-=- - - - - =i::�;�n _ t,-r: _ — a - — 7T,e' - n _ .a /.clate�_..• _ _ _ r...t .-'.._:-.u::': "-.::"i•--':-is--..] ... -_•`-.n,..... _/ -...4= _ -.i7�•`s'��"',�'+� - �:3 - ';•'fes-��:�'T•�I^!'-v��- }T _ _ L 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 ofElectricalIns Inspector Yes No . DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.s10o-$1000 fine NOTES and DATA—(For department use) i ❑ Notified for pickup - Date i 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses i ❑ 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 o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ iviass 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 ._..t:-New Construction (Single and Two Family) ❑ Building Permit Application ❑ Ceriified 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 Doc:Building Permit Revised 2008 1 � NORTIF� own of s E ndover O - I 0 I WMENNOW No. T h ver, Mass C o K6 > COCNICKl WICK ��AERATED I'P�,`�5 S V BOARD OF HEALTH Food/Kitchen . PERMIT L D Septic System THIS CERTIFIES THAT a.. BUILDING INSPECTOR has permission to erect4w I % Foundation .......................... buildings on ... . ........................ ,., Rough L tobe occupied as ............... . ..... ........... ................................... ......... ................................... Chimney provided that the person accepting this permit shall in every respect conform to thl-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 MONT ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST 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. 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 Haverhill 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 Pelow described: Owner's Name.....tir... .11 ................... . tJn... TieCLl hone 0..: V.,fktL..1�...1.............SSot.a..t.e........M ............Job Address..... ...... .:4r1City.. ....... f S eci rcations: .............��...-.. .................................:................... .. ........^.......................p....r ... ............... ......... +Areas to be covered: �I..... .� :.�..� .... ,: .... .. us. ..�....................................................................... ✓Apply vinyl sidings Type: J?G:..............���'..!ll., { ...QJA.9.� ........ "' C .. ...� �t .e....... over fascia boards and rake boards. ,/install vinyl soffit - solid perforated ................................................................................ .... /COV r wood casings. and windows.Ci)o�ht eplace any gable vents and dryer vents with vinyl. ........................................................... f... . �i s�......................../.......................................................................................................................................... (Apply underlayment. Type:T 111— .......L.....Y Q.L(.S. p�'...'.....v�! ...tiS Q lt.�yi f .e r,.. .. ........ .. . ing siding stripped gaover ✓Legal dis osal opsit debris �� r/S.l � '�2 ars( /`� Yt l ...................................... ..........`.....................D� ......... ..�.t............... r r ........ . ............. Rotted wood replaced /sheet .. �,D o��_ !foot. v..rc-y e, o n/" .....F' k. .1 . �...G.`�''r.�i ..�?� >~j.;lu �......s F..................... ...... r��s . 1.��.�Z:1.......`�e 5 X ` O.x1. S•o .•> .11 ! ..•J•...1r.1 i.1 f .ci.i ....Qyt.1..!?i'L.0(1..�5 t .C,.. . .... Q. .........../..la. ......... 'l.� ...04T..y?. �..../1. .'.s ' ... L,./..(✓lZ.k�...................... .P...(.-.i:.�Y.t��.. ... .A.C��: ..�J.9.�... 5�..�i...�..��,27.�.,..`.� .. .. .�,. I•P�5 One Year Workmanship Warranty(Not Transl cable) Manufactu A is Wanty as spec' ed byma acurer The for agefs to perform the work and ish thepaterials specified above for the SU of$........ Y. .... .....on..EaFnage .- ' cy/�...... Payable( Q.t2e7.......on.... .. .O.XI Balance payable on completion of job or(Tuners are not responsible for Property or Liability whr 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 wails,crumbling plaster,exposed nails,dust in attic or other living spaces).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 that remains unpaid,immediately due and payable. It is agreed that,if permitted bylaw,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 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 undersigwd wWant( s) that be is(they are)the owners(s)of the above mentioned premises and that legal title themo stands of record in his(their)nathes(s).There are no representations, guaranties or warranties,except such a may be herein incorporated,if any,nor any agreements collateral hetero,nor is the contract dependent upon of 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. Ail Home Improvement Contractors shol be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Conuractor 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 f cancellation). / IN WITNESS WHEREOF,the parties have hereunto signed their names this.(\� day of.../....kGEI. . ...,20..f1 Accepted: r I, Signed. k�a.... ... .. ....... .... Owner < Signed............................................................................. Owner .. ............ David Castricone,President The Commonwealth of Massachusetts - - - Department of Industrial Accidents _ Office of.Investigations 15 600 Washington Street ,, F Boston, jILI 02111 w)viv.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( Please Print LejZibly Name (Bu.siness/Or�aaization7ndividual): D/��{ 1D C`\�`R 1 C�Vt 'RUcr-( ix is " J i D I N C� 1W L Address: X2,31 SUIT-0 N S T RE C 7 UN 1 i 3A City/State/Gip:_No, A NDOyt tr, �)A U ( k 4J Phone #:_q ?.� -� 3 �vZU Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 7. Remodelng2.❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub-contractors have g_ ❑ Demolition working for me in any capacity. employees and have workers' com insurance. 9. [_1 Building addition [No workers' comp. insurance P required.] 5. 0 We are a corporation audits 10.0 Electrical repairs or additions P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑ 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 arorkers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a nevi,affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state Vether or not:hose entices have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. Ian: an ejtiplo}er that is rovidtn rt orkers com ensation insurance or m em Zo ees. Below is the oli.c an " P o P .f Y P Y d ob site P Y 1 information. Insurance Company Name: o � 12f1N tri SiA 7c � t`IJU �fiNCl; Co _ Policy #or Self-ins. Lic. #: W C() O :39 &9 q oU Expiration Date: Job Site Address: S e Ci /State/Zi b C��' S� ty p &�6vev M�-o Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required quued 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certifyunder the pains and penalties of perjury that the information provided above is true and correct. Si�mature: -R-J Date: Phone 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#: i CERTIFICATE OF LIABILITY INSURANCE DATE 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 pollcy(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 CONTACT SUSan Donnell NAME: Eastern Insurance Group LLC IAIr PHONEErtl. (800)333-7234 (A/C No: 233 West Central St E-MAILDRE .sdonnell@easterninsurance.com A INSURER(S)AFFORDING COVERAGE NAIL k Natick MA 01760 INSURER A:Western World Insurance Cc INSURED INSURERS Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DHA: INSURERCGranite State Insurance Co. Sutton Street Unit 3A 231 Rear SLt INSURER D: INSURER E: North Andover MA 01845 INSURERF: COVERAGES CERTIFICATE NUMBERMaster 14-15 REVISION NUMBER: T;.(IS 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. I�R I TYPE OF INSURANCE ADDL SUER POUCY NUMBER POLICY EFF POLICY LIMITS GENERAL UABfLr Y EACH OCCURRENCE S 1,000,000 -5A`–MZ9 TO RENTED X I COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S 50,000 A CLAIMS-MADE 7 OCCUR NPP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 lel PERSONAL d ADV INJURY $ 1,000,000 HI GENERAL AGGREGATE $ 2,000,000 L2.E1'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X I POI-ICY I�PRC- LOC S AUTOM091LE LIABIUTY COMBINED SINGLE LIMIT Ea accident S 1,000,000 AM!AUTO BODILY INJURY(Per person) S .LL OWNED X SCHEDULED BCNGCV /1/2014 8/1/2015 �i AUrl OS AUTOS BODILY INJURY(Per accident) S NON-OWNED X I HIRED AUTOS X AUTOS PROPERTY DAMAGE S r— Per accident I UMBR`.Lia LUAB OCCUR EACH OCCURRENCE S I E.XCESS UAB I CLAIMS-MADE AGGREGATE S I Dc0 I I RETENTIONS S C I WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LLABILITY Y/N ':,NY PR OPRIE7OR/PARTNER/EXECUTIVE OF=IC=RUEMSER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT S 100 000 If yes,Oe SC'iJe vrlde4 (Mandatory in NH) 0003989723 /23/2014 /23/2015 E.L.DISEASE-EA EMPLOYE S 100,000 �UESC7IFTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I OESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,A more space is required) Roo_ing & siding contractor I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CastriconeRoofing & Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3ATlACCORDANCE WITH THE POLICY PROVISIONS. 231 R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 John Koegel/MET ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. IUS025nn:m5,n, Th.A((1Qr7 efmm��nrl tr nn�ro roniaFnrori marLo of&rno l Massachusetts - Department of Public Safety Board of Building Regulations and Standards � C„nstructi,m SuixrrN icnr Shrri;1lt\ License: CSSL-099358 ' DAVID T CASTRttONE. 31 COURT STREET NORTH ANDOVER M&01$'5 A� CXpiratlOn ommissioner 12/16/2015 XWO __ .'III/,i.i ;�• Office of Consumer Affairs& Business Regulation 1 ,F}'OME IMPROVEMENT CONTRACTOR 1R WE egistratio n: 104569 rc Type: pi pi ration: 7/14/2016 Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary i Town of North Andover � Nt�RT O 6 c�1��o 4�0 Building Department o7., 27 Charles Street Nonh Andover, Massachusetts O 1 S45 (978) 688-9545 Fax (978) 688-9542 yc01o, SHCHU5E DEBRIS DISPOSAL FORM ;n accordance with *ale provisions of MGL c 40 s 54, and a condition of Bui!d;ttg Permit n the debris resulting from the wort: sliall be disposed OF in a properly licensed solid waste disposal facility as defined by MOL cl 1 sl50a. The debris will be disposed of in .at Facility location- ^ Signature of Applicant Date '40T` A demol,tiol; perrrut from the Town of No Andover must be obtainedfor this Project tlueugh the Office of the Building Inspector.