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Building Permit #182-2016 - 73 FARNUM STREET 8/20/2016
q.lk ; O�t.IORTH BUILDING PERMIT ttt R TOWN OF NORTH ANDOVER o= �ti``' APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received " Da4TED n�A1y�5 - �SSacHus�� Date Issued:. 9/1-P6 I 0RTANT:Applicant must complete all items on this page >�Yr>,..-�:✓,a--,-_ 110- ss2N:._ n.:hr• __ - _ "yam_ _ _ __ _ _ _ _ +-�. -�s+r .. _ ._i• .. f .,.. ., r. .,. Y?. ... ...r::...'.S.r'= �_!-�r.�.. .r•=1:` - _ _ -ice-rte?• ♦„n. '......._::v-�•a, ....;-,.. o :... ... Viz..:-irv.� •..: .� ..... -Ir..._-,., o-:..✓:.. ..✓'_ -�.. - �'�IC':.1i:�u -,`..'.r,='(,. _ :�.. __.... c ..._-•S-'u�.4T.•:..- L _ .. :� .. _ .lr.....�..,?t..if.•l- -•5... - _ - 1_Y,'iL:a=. - :r:-.:1T .f - rf••,�::_-- ^,:ata:- - __ - - 7• - •-[.- ..{y Tc: :4�c�'-' ,_ - `-tet r- =:` . - Nom. - - - - _ !'t�: _.Gtr: - i'�!�"1 _ -cq:'.L+..- ,.rri •:r'_�,a'i:::^.._:�,=�:a..l:...ia. _ p,5•„r���: u CCJ r ter.?.. _ _ _ _ •_.L. - ,lo-.. -...] •!�� -�F�v. 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S,g:,N:�S:„ d�t-�'a[• '1-�..�;'.fz_-[s:-:�r,�vn'�y- _'�, 1�-i..:;{ '-aS_._ - si:Efrr�.f,-�yr� t'Ar�r,..5:. _ ..;J: _t'' _sr• -.-ePRO- -TYPE "':rlti,r'.'�,'•`.-_rt._.�?��L nY�`?r.._� T'r T�-��- _ ,_4-•q--u.+ dL rvr' _ •:�> �_ 3'.�..'t•- .rtK.... Wil:v''.4;r-•= _- �,`.,'`��_'; -nn -.r�.s--:='f ._{,;. -e.�.u.,,l :t?-yu e: _ - ^t lc�.q'•- .:u-`•:•.Zl}':. •rte. ;!�• • a�r�a+fes,. 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 _lam'. - .�,].t'�=.r!• _:.i•- •!•L�.r:::^-.'S;3SY{.- �"=K-`ir"'" - - - -- �r.'-.-�p-m'•'.,a.�r-_i,r.�+i'yr-is�•a-^3•-w,BCS'•.`�•�.l,.�'!.�ti,��'7v`_,�r�i+.r•,y:��4,=a_�Y'}ta'3`~�1T":�r r iir�;���i.3r'h•�„'''r��"�z;^'�zi7.-.�•-,�rt_ti.Tr_Kc-;,f('`t��.•:-u�a-r����y,�.xf•3.,ryi,��' �R,.-�i�.2'-.;�Ea''%-35��'ti`�-V 9o-r_�-�c_..g.�.�o a�.z-t;�.M�.p,^.Sk.h-F.c.E.�aC�>s"-m�-: -r��I•..'£.-,-���i=",i�y+v"`4-ze�'.�,:,C-:tEz,.,?.ra.4',^�:��,7�'Y,�"^ar''.���+-.µ'l1,�L.7;T1�`�':vs .dN-] �r�=i5r�yy."E-'F1Yt'�:r`.L;.--.=_=��--"...�^.fpn"r�Jr'.ga,j}c�v�',7'�ic�?J}�F'r.�'""r�"",z��..-r-�;.~,a•.-n�;"-xri�6�"�^,ry�c�Y�.�610< ��•-.'���'��- .1-1 O; .ss=r,- � ,:�t..e?• w;a.;.frs.-. v -ra�,x.-_:....-_... _.._.,•!.-... ___.:�:.:2_._.��.L'i�•i..�_�5+.ga_:-:�•i>r-,r���:>z=.?f_ _aY_.. 7.e rw�',= .r�' �;.:&.=4c�.:�.M,i _ '�-`^'a,�.a�iJ• �•>±,:-_ r=im�"� _ !'--�� 1_,FI DESCRIPTION OF WORK TO BE PREFORMED., S�f 0 M M_SW 6c,G voo Identification Please Type or Print CI.early) OWNER: Name 1. �� Phone: l ay O Address: 6* r6.AOM I`� � ( A 1 E`f.- _ ..k',''..1ii':' ...i'.�ti'.• mll__ r�-; r--_-' _.�a• =F=y _"' -.mo ,.a �c>•.�..,� :>�r br--.�.." j^ r ,J"�i, '• '^x'So �tt^F ."'-nr`" `@].t'4 m t,U•'''y.,"'•�-,'.'..'�aSFv. 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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: $' � �� (�� FEE: $ l Check No.: / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location No. 1 Date 10 "J ON TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee s s t Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# f r Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans Pti 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r - -Planning Board Decision: Comments f - ' -Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DP • W Town Engineer: Signature: Located 84 Os ood Street FIC �]y� ]�J� :.�. ..r.��u;`•-• .:4�5>:itis(:;�;ie.`:::. E::zic::.s"�,-_%:°ie :��.:._.:�- _..,.:.r.•:_va-:.• - �Ter . _Dig _ - ".�..: ono......� .. ._,_. l: -+fr - L - - =4 cafe: . . , M..:.- �:r �:. _ :.t - - _I^ - -F tet_ - - - d� - - _•C .T..,"%''fir' - - Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA—(For department use) i i ❑ 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of N.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 o 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 I- New Construction (Single and Two Family) ❑ Building Permit Application n .s _r n i ni n U-el lit•l el—I r-roposed PIoL 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 cops and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 • I r 1 NORTH . W: of A. . -c p R+ No. �(fJ�p�� . }� h ver Mass . Y wnx4� ID 2AK LAN O t• COC NIC Nl!WICK � �d ADRATED A �S S U BOARD OF HEALTH I Food/Kitchen PER .MIT T LD 1 1 Septic System ... i........ ................................................. THIS CERTIFIES THAT BUILDING INSPECTOR �,rA �,/1 .................. Foundation has permission to erect ........................:. buildings on .... .. ........°.'...�..� ........ .................. f-r Rough tobe occupied as ......... . .. ............ 1.. f........................................................................ Chimney provided that the person acceptin 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 MONTH ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS Rough Service ..................:........ .. . . .fir.. ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 J Street No. Smoke Det. I mo,;l;i�j �fcGtsS: 315to,3 C ys SIS C'A iu(Jfta N DAVID CASTRICONE, PRES. CASTRICONE ROOFING & SIDING INC. ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 t 231R SUTTON STREET UNIT 3A,NO.ANDOVER,MA 01845 In North Andover 978-683-3420 In Boxford 978-887-6147 In Haverhill 978-374.7314 IJwe the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,tabor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: pp +� J a 4o � �.,.., �. •�. ... Telephone p-..d.0�.. ..I; .................... Owner's Name.......... .. ........................... ........................... (� L Job Address...... ....}...Ar.n.�......+...............................City...... /..../ )1. .............State..I!.\A......... Specifrcarioru: .............................I........I......I............ ...........................................I............ ..........._........ I/Strip existing shiugtcs.r1) Mpply new drip edge to ail edges. g f 1� 01. .................................................................................................................................. .. �pply 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. y� ............................................... /Apply' felt papA.11 cle a apt. osta11 ridge vent to �0 �T�S L g 0 ........................ ..4 Reroof using P nig h+ Nt shingles with a ear warren _ ................... ... .... .... /. . ... . .. ouater.. flash chimney. ew vent pipe flashing.vLegal d'uposal of all debris. ................................................... ................................. ............................. Ares(s)to be worked on; ....................................... �..5�1 J x •GvI C4�5.....bS......... . Lt_SQ .,........_.................................................... d..............................................................................................................I...................... ..... ............................... r ........r..11J1 W.................................................._...............................I.......................... . . -........[,(, .................................... Root sward rcplacemeui if necessary @ i(G 0/sheet is Five Year Workmanship Warranty(Not Transterabk) Manufacturer's Warranty as specified b as rsr Tlm conasaor�s_ work fb ish the materials specified above for the SUM of 5 ..`��rBQ. Payable......rZ on..... ............. / Payable--...........~.........oat..........�..................... t�alancc payable on completion of job D„ea or Owners arc no respona(bk for property Damage a Inability while job u in opnaum Contractor is not r spauibte for toy damage to tbo inlerict of psoPaty,including pic aOstmg conditions(Le water itaim.aunbliaa Plamr•-DOW ails)OF caditioas resulting that opplicsom of suerWs specified sbovr(Le.objects nomisg loose from wait$,cnw*h i plum,atgasW suit,dao in epic or odea Irving space). bean is attic may and 10 be tweed by honcowm.AS rustmab arc property of contractor. Any dunpea ptacod by aarrarJtr is tot his uO mly.Upon a0 Of abve work ail uodasiyaW age to caesura end daiivrt to contactor.dwr joint rote m scmdnce with his("u)abeas obt4d"as requested by coonictot. Upon rdVL)W 40$o,connector main at eu op000 decree the entire conaw trice or so much as then raaaias u PIA immW ietab'due sod pap'"-It is 4V=d flea[,if patnmsd by law,contractor shall be paid by that ownar(a)all ttasonaW casts,attorney fees std eapmses,In addirim b the enact des sed uepald.cyst shall be ioew,od in me,teieg the coma and conditions of the connect and/or any lien in conttatiian herewith.Property My be sarbJeet tO rnahank•s tka If unl akL It at Nriber agreed diet this contract[say be assigned by convactor.and 4150 that tete obligations husof shall bind and apply to da it bras.mecessm or aura Of the parties.The twedasipsod,watsaN(a)that✓x is(a It ate)the owners(:)of the above mcnhoocd pmaifes and that Iegal title thaws stands of records his(their) Oamu(s).Thms are no rspnsaVAU00s.iurw m a murrina,"caps surly a may be dobe tacorpOnled.U any.nor any agreemeeb eotlan d bean,ott b libo contract degaodan spat or subpol to my onotlaxwu not bercm stated..Any subscqumt agreenrmt m=&nonce bonen shall be binding only if in w"669 and arm by all prdiea. All Home improvement Contractors shall be registered and any inquiries about a contractor or subcontractor minting to a registration should be duteted to the Office of Cotrsurw Affairs and Busincis Regulations,TO.(617)973-9700. Any and all.necessary construction-relMod permits shall be obtained by the Contractor. Any Owner who secures his own coosavuiaa- related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MOL c.142A. of work............................................... ApproxiCom lesion slate................................................ slatting title . P � that the hxegoing Receipt of a copy of this oo®ttaci h hereby aclmowhdged,and it is further ad nowledged by the undersigned he foregoing shall be provisions have beam read and tide contents thereof understood and that no representation or agreemeat batt binding upon the pashas and tbat all of the agreements and understandings of said parties aro 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-retettsaeed date.Mail or deliver a signed and dated notice or send a telegram to Castricone Roofing&Siding Inc.23 IR Sutton St,No.Andover,MA 018405. IN WTTNESS WHEREOF,the Frolics have haemic signed their is...........�... Accepted. Signed— Signed igned._Signed .._..... Owner David Castricone,President 1 5 �1 The Commonwealth of Massachusetts Department of Industrial Accidents : - v Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 7br © � Address: C213 1 n Unt-E 3 � City/State/Zip: U 1 Phone #: q�j 6&3 Are ou an employer? Check a appropriate box: Type of project(required): 1. 17 am a employer with N 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.F1 I 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'comp. E] Building addition [No workers' comp. insurance comp. insurance. 5. ❑ We are a corporation and its 10.[:1 Electrical repairs or additions required.] 3.F1 I a homeowner doing all work officers have exercised their 11.E] 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' 1311 Other comp.insurance required.] *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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether 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: G cauak'�L, Policy#or Self-ins.Lic. #: M00 Q 3 U S 12 Expiration Date: "013— Job Site Address: /,3 fat bum ,<:� A City/State/Zip:I )b, f'11'lc'[ae,,. 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. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: C Date: , Phone#• J A ( D 3 3- 44— Official 74Official 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 �J 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 of a dwelling house having not 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 such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the 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-contractor(s)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 has provided 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.) said person is NOT required 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 Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.govfdia ACC? CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 16-. � 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 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 CONTACT Susan Donnell NAME: Eastern Insurance Group LLC PHONE..,,,, (800)333-7234FAX ac No): 233 West Central St E-MAIL ADDRESS:sdonnell@easterninsurance.com INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A:Western World Insurance Co INSURED INSURERB:Commerce Insurance Company 4754 David Castricone Roofing & Siding Inc, DSA: INSURERC:Granite State Insurance Co. 231 Rear Sutton Street, Unit 3A INSURER D: INSURER E: North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBERX4aster 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 A CLAIMS-MADE 7 OCCUR UPP1388404 /6/2014 9/6/2015 MED EXP(Any one person) S 1,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC S AUTOMOBILE LIABILITY (Ea COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) Ser accident ALL OWNED X SCHEDULED CNGCV 8/1/2014 /1/2015 BODILY INJURY PS AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ C WORKERS COMPENSATION WC STATU- O-H- AND EMPLOYERS'LIABILITY Y/N 71 R ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) 0003989723 9/23/2014 /23/2015 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing & siding contractor CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE John Koegel/MET ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSO25 nn�nns m ThA At nPn ..A Inns arA ronicfnrorl morkc of A!flgJ1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards C,n�trurti ;n Sulur�n ,r Sluri;�lh L..,cense: CSSL-099358 DAVID T CASTWCONE� 31 COURT STREETtr NORTH ANDOVER MAS'C 5 Commissioner 12/16/2015 nlr•rrrn('rr���r j .;.ilri'�Ir,r-'��,` • Office of Consumer Affairs& Business Regulation - b'OM E IMPROVEMENT CONTRACTOR egistratiom. 104569 T --• ype: xpiration: 7/14/2016 Private Corporatie DAVID CASTRICONE ROOFING, SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 Undersecretary RTN Towel of North Andover aF"tj`Yo L Building Department 27/ Charles Street wonll . doves Massachusetts 01845 (,,-is) 688 9545 Fax (978) 688-9542 �,9 4^r e o Z•�� CSACHUSE DEBRIS DISPOSAL FOR%,I -o darce with tyle provisions of MGL c 40 s 54, and a condition of n2 permit the debris resulting from the wort: shell be disposed 0i lc a oroper!y licensed solid waste disposal facility as defined by MGL cl 1, 51502 l deb,,s 4�l! he disposed of in ;at Fac)hly location Signature of Applicant 1 Date NOT—,-- A demoi do l pe.rrrut from the Town of North Andover must be obtained For this projcct t!uCuQh tilt OffIC% of the Building Inspector.