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HomeMy WebLinkAboutBuilding Permit #1016-15 - 6 PETERSON ROAD 6/8/2015 NORTBUILDING'PERMIT g.eOH � t r h-+t' •,M1 6 TOWN OF NORTH ANDOVER o .,� -.•w:.; APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �pp��wl'co/•lAt�,��J Date Issued: � • • �SSgcHus�� IMPORTANT:Applicant must complete all items on this page ::-5'_'��- r, •`��l%.t••+, +•••.cy;,r. <� '��.r.::�;;-:-+�'rys••• t` ,�*+: rr;.�. _ _z.'�:w,s- c«!..^.�•z,�• - _ .rr��x `` L' .�- �., Tc�iu�,. _._ •} :',..�..-a'�-*re,c s.��,t r'_t'iA `�+•r�.- -?,.. 2.-0�F:.x•.Xf�+ , ... Y�T+• - - r t% c"s :7�'_ s•. Re„• }aa' �:' -�•,"• 7 .P vv ;� ;:1• ry,: a 1'1i �4t�.. _pT," �'.' _'r,;;_,^ ���: :3 .__+L•, •x' .y x 7 u ;.. ..'���i7 =�Y '�_�i.7�^:;;+�+'-a�.r� s��j�� t��,•�tk',w��r--'•"k.' - : '���� r'�'n-+c.c"s�'�'R`? z:''J,r-�.E?95: r e`.�,' ":=' 'ca. ��. _ F�'�.iR '�{_� s�• r, ,x5 r�.,_�q r�,,�y��.• i. _ 7'_ _ ,%<_ .: _ 6t`�C�''..e-•u"�s_'irs,'!?P .-'�-��f�°y:`.'• ,rl��-x-. e��;�'`t+'t}'"'.,�° ' s'`?r' �_i+f�F�-'..r� '!rAyn�.','��_ ``'`f'�L 'Iru�.`�:"'_ �..:�'r 'rr`�. "a. :.�i.-.�'_"�;'�,�..'v� ,•.--�. ,y.;�,�-.x. �„U'i�^-��n� �,��:6 _�_�-y�' "� a b T�n:� ni;�+.s•-��-^aJM.•.._c'Jc•' :J t � �'c�,�7L+;.�. a•i �p�F���• �rttl� .!��-y'sp�c-,;:. '�„-'},Y l' .r .- _ i' - �-�' �fig�,,a' c �o�. -'�.,...�•Y?J., _ '.r _..; -=�'t"'�,+�f W"r ,;}d•,..+�• ��!L-��.fk r _ a�C` _ '�cr�a: _ •'a_"�.:.•_,•fie'- t: t;•'sic. �„`+"';:' -n'r_T�' %• •�. ,�, - -;,��`&,��.;5?r'•-�•uti' - ee^:"- _.r-rc�•- .�_" _ °�;t..� _�_,e .a:. �� ,r'i21anCv:.�",G�srf. 'v�+ad�i'�''v- 4*'2•"rC�ik .cis~ =v .r ••ic+,� ,-�'S"'.`s ,�'-'•' -�;;1_` ', P::milf��-�- n,•.y�_ ����c•�.�.�`'"'`�°�-���;,:�, $'?'x+° � ��+ -.�.':.�ry�A :;;�5'ti' _"'t;ry ewe ..xti•"- � ?, 'SH 7`�`�n - aC:,•=: ---G• ���d-'0�"a�r3+.-t�"�''yy',-•-,�.-.�_ -;'����j,"_ L.. !N �'�T'X.p-!.� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ✓One family Addition Two or more•family Industrial Alteration No. of units: Commercial ✓Repair, replacement Assessory Bldg Others: Demolition Other •9;t. "',,,,,(Tj'y Al f .CN"af:erx"�-�c:•_v};31r�'-Y� j a �.._:i•.''a!bx�.`°k�•e'�ci•.l'4."p. ' t"'d•r�+. .G� �-?:r:,.s,:p-mt-.t.L:�._'.-.re. fix• - ®a"q�r T tL +---.f_z.i�_. �".., a'r3 7�-•s• - � �}�—^sg DESCRIPTION OF WORK TO BE PREFORMED., 42 I-P VW Identification PIease Type or Print Clearly) OWNER: Name:�-'�ft j1 i exel T" n u y- Phone: Address: 7 T�; 0 1141A ' �®�`{� AVL)vpev d I ' i_ �'p�r<� �k:,'�°v..��.ZS�.t`-_. _``Z�ir.'A ^ z ,�"'''�.:'r r. - f'Y`S�" ''�. •'�Ye`��-ed•t.�`ti:'- `",re "YN '_ i ,!�'E•.:e P - ������: S.i5 t� "`�`rt; '�� .p i�.. 1 rs' Sy-��. Lu�JZ��" �.`45�a�_.. !F^V...r�_ �.•��.,..' y� •'�� i, r V�- n "'Rays t 4. �" •r- -{r -cti'a�-'-�.'. "7d='�"� ,uv -',:� <n- Y��¢�{v a•%1,ab �- y".. _ • � t eS�. � y.'�� - , t_ fr l: •1 P.:�y �.- 'I .� - '" r �Ka'•y �•I IrY p-- wrux,�,•� 'r-a�n.- z,. -nr .r - > �� .:E �+ t � ',��,� tt G'a" �Z ��� x f 'k� �..•' tt'Sr,�� ��jr�••4, �� ^ ,r '.3'�".p ? 9ll ® ,��"�''^•.��7r�a��f���t�v) •'�'�� _���.- •4 ,�� •��}� � �`�r � : - �� qtr .'":�..��'; - �•�-'�'` .b� �,,. ., _ y:: > ui:.� ,.� :. '' ��'"s`' `''� .e� 'fir-'_�.�y�-_''•�_LL •-�ze.e• �- •+3+ _ _.. "'-''�IEa*• rk�- !• •; o'r's".•.s c � �'' �M:.ii5r"-.,c. -qr. .7T i'xnYr<Y" rZiy`• �• .� ',.u.. 'a{,2r'x^"w. ^^a`=, -Y� �h� •.r' ,._ ;� -1-2.,n '�--Kn l .. •c:, �' •T' �.3G:,:q- .R:^^^�1 ME "g�c"tS..,•'il� �DA�f3•� . ..fig �- � •• ARCHITECT/ENGINEER Phone:�D Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:-$ (o Ofes'0D FEE: $ —I a•� Check No.: !�"I ZI Receipt No.: NOTE: Persons contracting with unregistered contfactor s do not have access to the guar antyfund ' �ire fi ,s •.e �J- - :;:� _ �+ �,��.P ._. ti- - a,.dcr,..._.: � _.w _. - - -•�x7�t�`.'1i1��.7��=.er�'�.�'J�Td�'r'a. _'.. ��� atr.r�`y: _� r'. 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 i ❑ Building (Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.L.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 j 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 --New Construction (Single and Two Family) ❑ Building Permit Application 'Cel Liflea Proposed Plot Plan.. L3 Photo of H.I.C. And C.S.L. Licenses ❑ Worker's 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 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 boc:Building Permit Revised 2008 I - • Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody 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 OONSEF&ATI'ON. Reviewed on Signature i�OM 1viENT,S HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition,No: Zoning Decision/receipt submitted yes Planning'Board becision: Comments. Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signafiire: _ Located 384 Osgood Street ,'��f '-Jy' .,1.:.�'. [ f"t:.. �C.r ±�:-•. '3,-"..vy4.P=�..`:.r-r,".'-.n.:i '.'fin a~i4 p��.� :•'dam_ "=r. �c 3ki:^,.-��• �--r-` a7";.,-�,.,t.y.�:�:,;„�'S�N:•':_ e��i��'l �aly����1'^�.�f -^:4. ;p�>- _3�:.^• d.,`+V":"+ ,e!:�rs�. ,.y.:'��Kf _f.s a.� � 'D,[�-r�; �s�er�� ifie..ti-.-s_�..e�.�...���.s=-- ,, '"`_ U��..-r•..:.�:=�_..�;_'_Y:�__.�. :,.w s'xri:E,•st.^ _ ala�. _ �.1;. .��..-.,fi:;. .,�y;.�Y�::::._. -na'fl• ,7.'�,:,-.:5.�`,ti. _-�:,.:. _ �Tr ,{:�.: 3re�e- _'Y.•:.--:.:• ^[-Zc -7c., _ �'( tel.": - - -.11+.-.:_=4=s p't1:': - �_;��••_.Sa-..,_':.'•::'�.:. �i'L T���='(�:i�.'.:Fia+`_s�"'s. '?1A4{-uT•:!v-ti:--,X.�-. .:�?i.< _Ss•'-_+•.1-i.=. _ - �.tf='+-l+ilix _ _—�'-e.�,f-r'" - �:t':.e• "�-,^ _ -_ _^,n:r'::vL"'e: /�1_uv.-;,._-J. .::.moi'. _r it _ - {'S:_.. r_wvy.:, f- .�.}-:r: :✓::Cit _ trF �rl�:'GIl :.Eeu:.:�. :t:•3�. £Til - .•:`Yy -L:R.';6•:.f;:+`" :SSL+":. _ -�.r� .w.-'='Gr.;t"-'s•"sem• _ ..r... .a ��::'_-.,F:_:.' - •-. a..-...a.l .._�:: .>>a.:_a.�•'_tr"_.. ._._. _ _ __ -�:l' �� `rey .,y^..c•.T.h4a`F�---._7•r,.r•..-:-✓.'T-: - .1'T..7 .4.1-.. ...=�1�:- •:{a MA - - _ _ _ -.-.� _ _y• diY. A5 :k 11�a1/1' 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 NOTES and DATA—(For department use) ❑ Notified for pickup - Date i Doc.Building Permit Revised)2010 Location No. `W +� Date i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $.. Building/Frame Permit Fee $A�—"'�' - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ . Check# � Building nsoctor NORTH own of :� ndover h ver, Mass, �i..l� 9 2ais, T O LANE COC NIC Nl WIC K � 41,9 AOr#A �Pa��S S U BOARD OF HEALTH -ER T L D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .... ...... ...... . ..• ......••••• has permission to erect ............ buildings on ........���5 , ...... `............. Foundation p .... ......... g Rough to be occupied as ............ ......... ...... ...;1).& Chimney provided that the person accepting his permit shall in every respect conform to the terms of the application Final on lile 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 Rough 1 - Service ................... ..... ..................................................... Final xi 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, PRES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING &REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRA6TOR REGISTRATION NUMBER 104569 231R SUTTON STREET UNIT 3A, NO.ANDOVER, MA 01845 1n 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 famish 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....../.-.LOCA..... �!t hS./.` ..A./`........................ T hone#....�f.73.. d�.J..:.:...V... .•k"l State..Address.......5...... ... . a..................City..... s •yQ ......:..... ..... Specifications: ................................... ........... ftri existingshin les. . P.P 1 ne.w....drip ....e..d..bg..e.to .e..d....e.s.. ...... ............................................. .....................................................W.. ...f.~.<.�...v...........�..�. .................................................................................. /Apply_feet ice and water shield membrane to bottom edges of house.3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ..... rplyyfcat pac• n erlayment. j'Inst 11 ridge vent to '�rp,. 1•C.a.... ....................................................... . - v keroof using shingles with a _year warranty. PC .............................................1-1............................................................................... ...................................................................................... "Counterflash chimney. Vew vent pipe flashing. #Eegal disposal of all debris. .................................. .................... .........................ai.��....... ........................ .................................................................................... Area(s)to be worked­** orked on: J ...i••Y�j. L AreI.... .<'.zY.................................................................... ................................................................................................................. ..................................................................... ........................................................................ X ... ..... ................... A)Cos ~ 8 SZJ •-- ."�C� GO. Roof board replacement if necessary @ 445 /sheet or — /foot. .......:...............................................................................:.................... .......:.............................. .......... ..... ............ Five Year Workmanship Warranty(Not TransferabIle) Manufacturer's Warranty as specifi b, nufacturer The contractor es toperform the work and famish the materialspecified above.for the SUM $...... .� ........... Payable...:.../. on.....�.... .... Payable....... ..0 ..........on......r�...I.i!`. .. 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 ofabove woik,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.Property may be subject to mechanic's lien if unpaid.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 ofrecord in his(thein) names(s).Them are no representations,guaranties or warranties,except such as maybe herein incorporated,if any,not any agreements collateral• crcto,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 WI parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to the Office of Consumer Affairs and Business Regulations,Tel.(617)973-8700. 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 exc e o the Guaranty Fund provisions of MGL c.142A. Approximate startingdate ofwork. ;1.1.. Completion date......................................................... Receipt of a copy of this contact is hereby acknowledged, d 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 This contract may be cancelled,without penalty or obligation,within three business days of the below-referenced date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc,,231R Sutton St.,No.Andover,MA 01845. IN WITNESS V✓HEREOF,the parties have hereunto signed their names this...1D.1.1!11.day of..�ryw-2...,20../-5.. Accepted: Signed..J:U`....`..4 ........... Owner Signed .......... Owner L Lg;e�_ David Castricone,Presidentt The Commonwealth of Massachusetts -- - = Department of Industrial Accidents Office of.Investigations I. . _- r 600 Washin ton ,Street Bosto«, 11IA 02111 r= ' wfviv.rnass.goP/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information (� ( Please Print Legibly Name (Business/orgataization/Individual): D A\1 1 D C 1�J i 1',1 wNt R (s o(6 F t Is � J i D ( N C., I N L Address: c 3j R Su IT O N S'i RE(r 7 UN 1 i 3A City/State/Zip: No. A NDove_tZ MA 6 1 W Phone #t: q ? i 0 3 & Y,.)U Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 4. F-1I am a general contractor and I . employees (full and/or part-time). have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g_ ❑ Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. 311surance.1 P required.] 5. We are a corporation and its 10.0 Electrical repairs or additions ❑ 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 I Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[_J Other_ comp. insurance required.] 'Any applicant that checks box#i 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 afridavit indicating such. Contractors that check this box must attached an additional sheet shop-ing the name of the sub-contractors and state v�bether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. 'I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: II n o GRAN Fl N rT F SiA T c ! N J l) CAN C l; co Policy # or Self-ins.Lic. #: W U O 39 &9 q 43 Expiration Date: Job Site Address: L Ce'1"CIIkA N1 City/State/Zip:U a - 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 51,500.00 and/or one-year imprisonment; as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 1250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the airs and penalties of perjury that the information provided above is true and correct. Signature: '�--' C Date: Phone Official use only. Do not write in this area, to be completed by city or town offzciaL 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#: ACO® DATE(MMlDOIWYV) CERTIFICATE OF LIABILITY INSURANCE 9,10/2014 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 poiicy(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 PHONE (800)333-7234 a No: 233 West Central St noD'L .sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western. World Insurance Co INSURED - INSURERS Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DSA: INSURER C 43ranite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERMaster 14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN 5LTR I ADDL TYPE OF INSURANCE INSR WVQ U POLICY NUMBER MWDDY� POLICY M DDIYEYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 AM A–C ET NT 50,000 _ iI COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE ❑X OCCUR RPP1388404 /6/2014 /6/2015 MED EXP(Any one person) S 1,000 PERSONAL b-ADV INJURY $ 1,000,000 �I GENERAL AGGREGATE $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X (POLICY I�Pirr.TRO- IOC S AUTOM081LE UABIUTY COMBINED SINGLE LIMIT r� Ea accident S 11000,000 B I ANY AUTO BODILY INJURY(Per person) S II—,I ALL OWNED X SCHEDULED CNGCV /1/2014 8/1/2015 I AUTOS AUTOS BODILY INJURY(Per accident) S X '.;I,aEO AUTOS X AUTO-0WNED PROPERTY DAMAGE f—t Per accident $ 5 IUMBREU .LLA AB OCCUR EACH OCCURRENCE $ EXCESS L1AH CLAIMS-MADE I AGGREGATE $ - DED 1 1 RETENTIONS C IWORKERS COMPENSATION WC STATU- DTH- S AND EMPLOYERS'LJABILFTY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFCERAAEMSEREXCLUDED? NIA E.L.EACH ACCIDENT $ 100,000 (Mandatory in NH) WC003989723 /23/2014 /23/2015 II yes,oesaioe under E.L.DISEASE•EA EMPLOYEE S 100,000 9ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 I DESCRIPTION Of OPERATIONS/LOCATIONS/VEHICLES (Attoch ACORD 101,Additional Remarks Schedule,A more space is required) Roc_ing S siding contractor I CERTIFICATE HOLDER CANCELLATION astricone fofing 8t Siding SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Unit 3A ACCORDANCE 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. INS025nn:vx m Tlan Ar nQr)nnmo�n i Innn oro ronialerori mgrYe of Ar llgn Massachusetts - Department of Public Safety Board of Building Regulations and 9 Standards Conctructiun Sulirrc icor Spcci:tltc License: CSSL-099358 DAVID T CASTRICONE. .._. 31 COURT STREET NORTH ANDOVER nk,1018 5 , Cxp!ration Commissioner 12/16/2015 el� IC 0§11-01", Office of Consumer Affairs& Business Regulation fj t ,OOME IMPROVEMENT CONTRACTOR f registration: 104569 . x iration: 7/14/2016 Type: -' p Private Corporatic DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary Town of North Andover NnkTH q O`41�X0 6 �tio O BUIL I❑ � - L d Department a went o , m A 27 Charles Street Nosh Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 698-9542 t ' 'TlO cs�CNU51i` DEBRIS DISPOSAL FORM ;n accordance with the provisions of MGL c 40 s 54, and a condition of OUI!d ng permit 9 the debris resulting from the wort- s1t211 be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1 s150a. The debris ,vi i l be disposed of in .at: Facility location Signature of Applicant Date NOTA A dcmolitiol permit from the Town of NO Andov Project tluough t?ie Office of the Building Inspector. 2r must be obtained for this