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HomeMy WebLinkAboutBuilding Permit #357-13 - 77 MARTIN AVENUE 10/5/2013 TOWN OF NORTH ANDOVER Q APPLICATION FOR PLAN EXAMINATION Permit N0: V w p Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page t7 LOCA 10-NI J _ Haf- tl. :hnCSC, r_ PROPERTY°OWNER___ r Prin, 100�Year,Qld,Structure yes no.. MAP NO ��kPARCEL.6 ZONING'DISTRICT: HistoricAstrict yes: no Machine Shop:Village.-, yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ElSeptic D,Welli ❑ Floodplain ❑Wetlands, ❑ Watershed District' D-Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: 3+hp OA rnk; e Anll (bom pn rc Identification Please Type or,Print Clearly) OWNER: Name: rc.he., r A I Phone: t, o7C�y Address: �-1 YY1Q(�in 2 `Rarer o,t'e.,-. 1(YlPF 0 \1igS_ CONTRACTOR Name: &'Wcolle- a '� �lb Phone: Address: C�31 .SU-Ti(SCl -: n ii Supervisor's Construction.Licenser3.5� _. ,. Exp , Date: ,fes Llto I f3 .. _ : _ .P _ �d ��1 Ezp Date: _ _(`� l Home Im _[ovement License: 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: $_ CM6 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of A ent/Owrer ,4..g__.__.�.,_...r . �.9 _.y.. _,. � Sig�ature_of contractor. : Plans Submitted 0 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ CopY Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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 app;al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Builling permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE.DISPOSAL Public Sewer ❑ Tanning/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 CONSERVATION Reviewed on Signature COMMENTS HEAL1'l Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towo ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire DepartineF t-signature/date -t 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.$10041000 fine NOTES and DATA— (For department use ® Notified for pickup - Date j Doc.Building Permit Revised 2010 I Location er No. s, Date • TOWN OF NORTH ANDOVER • SCT LD I . K o _ Certificate of Occupancy �'$ Building/Frame Permit Fee $5� ., Foundation Permit Fee $ , Other Permit Fee $ TOTAL $ Check 26999 Building Inspector DAVID CASTRICONE,PRES. CASTRICONE ROOFING&SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 3 A 40 SUTTON STREET,MgW NO.ANDOVER,MA 01845 In/3onh Andover 978-683-3420 In Boxford 97R-R87-6147 In Haverhi/l 978-374-7314 I/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on premises below described: Owner's Name.......11..e-t.it .....i�a .. 21 .l.G�.kl Jy.t.r................... ............ ephone#.. ,�.�ly..:. �l.�h........ r /� Job Address....77... Sr!. .. ..✓.ell............................City..��t,,..,/../.4)Z?..�(411................State...��........ Specifications: ...................................................................... .......................................... .. . ......... ... ... ..........�c9�1 ... .�.P.. !'arJl.S....................................................................... �..l..r..t ..�- . .41n .red... . ....... .,. r � .... .. e .r..�S............................................................................ ^..�. :.1.(�.�g../..... .....1 ......�/...... .Id. .�...�jpJ: .ld��rr�e.../.��r?....c?.../.t.�. .1..�1.`!.... �...':... .1....... l.�a...J..�..5....E.. ... .::;�� ar'...na..ew ... k' ... �. ... �... ..r....... ;rr�,a.r...1...t _1` .............. -. �;� ..rv.f•'J ..e r..,nr�... .�a l-... ,� 1... ..c.�a...... . .�.............................................. p q . .. .�sl . .r;....� ,1.,,................ . . . / .. ....�Z?.�5 .� Two Year Workm$nship Warranty(Not Transferable) Manufacturer's Warranty as specif y mann ac u The contractor agrees to perform the work and furnish the materials specified above for the SU of .......... Payable.............................on................................. Payable.............................on.................................. Balance payable on completion of job Owner or Owners aro 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.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 of record in his(their) names(s):Then: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 agreementin 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 the Office of Const titer Affairs and Business Regulations,Tel.(617)973-8700. Any and all nece$saryconstruction-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 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,20 utton St.,No.4ove,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this..... T ay of..DC /i•d c.j 20... Accepted: Signed. ..I.d�,,�...Y.1. �Altl.. Owner DJ' LSigned............................................................................. Owner .. . .. :l��' David Castricone,President r 1 � NORTF� - A . ver. Ail- No. — - 3 � N _ h ��K. h ver, Mass, I® • ( 6 • • C OC NIC 6.44l WICK X01, ��AOR�TEO Akry s U BOARD OF HEALTH Food/Kitchen PERMIT T. LD Septic System THIS CERTIFIES THAT , • ` � r �+ • BUILDING INSPECTOR ............... . .. . ............................. ...... .t a i. .... ,, ,,,,,,,,,,,,, has permission to erect ....... buildings on Foundation ................... - ...... �,. ............. .. y Vtoerms Rough to be occupied as ......1�1 .. .....�1.... (J. ....... ..... .... rft � ►....'�'..... . . .. Chimney rovided that the erson acce tin this ermit shall ' eve res ect con rm to of thea licationp p p 9 p rY ppp 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 CONSTRUC ST RTS Rough 0,.:jj Service . ......... ..................... ............. ........................... Fina DING 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 The Commonwealth of Massachusetts - �-' Department of'Industrial Accidents F Office ofInvestigations 600 Washington Street I ; Boston, MA 02111 tiya ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly /� a Name (Business/Organization/Individual): bAyr e d C-Aa IM c(olN RUILav, 1 A/Nhr N( Address: re a SFac-e r, s,' i 1t A City/State/Zip: No. AlNbeVEK. HA 6. I iis Phone #: 7X_ tj3 ` 2 C Are you an employer?Check the appropriate bog: Type of project(required): 1.7 I am a employer with 1 .4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 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' [No workers' comp. insurance comp. insurance.* 9 Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work offcers have exercised their 11.[] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 oof 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 91 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and 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: (2 1-1 A1: 115 Policy#or Self-ins.Lic.� ``#t: tV�CI J Ci q 111,3 Expiration Date: e f�,� 3 _46 14 Job Site Address: t1 1 ar- o Atnue City/State/Zip: �QY� "&( �� J Or- Attach ��� 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 u—n—deer the pains and penalties of perjury that the information provided above is true and correct: Signature: .t J G1 C Date: Phone#: q 7 :31,9L 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#: Town of North Andover 01 N�krH 1L�p p Building Department 27 Charles Street North Andover, Massachusetts 01845 9 8 688 9545 Fax 97688-9542 ( ) 8 �`SHCHUSE' DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit 4 the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MG-.L c11, sl 50a.. The debris will be disposed of in /at: � Z' �. Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project tluough the Office of the Building Inspector, A�I® CERTIFICATE OF LIABILITY INSURANCE DAo9rMnoM) 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(les)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 NO A Suzanne J.Casey Willows Insurance Agency,Inc. PHONE , 978-475.3414 X 59051 _Ne: 978-475-3165 St Cochichewik Drive ESL SCasey@easteminsurance.com oorzEsa: North Andover,MA.01845 INSURERS AFFORDING COVERAGE MAIC s INSURER A: Western World Insurance Co. 13196 INSURED INSURER e Castricone Roofing 8 Siding,Inc,David Castricone Roofing 8 INSURER C: Siding,Inc. INSURER D: 231 Sutton St.-#3A INSURER E: North Andover,MA.01845 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE ADOL 8Uvh POLICY POLICY EXP POLI Y NUMBER (MmnryYyYJ UMRs GENERAL UASILRY EACH OCCURRENCE $ 1,000,000 X COMMERCIALGENERALUABILITY UAMAGE TO RENTED —1 PREMISES S 50,000 CLA MS-MADE Xi OCCUR MED EXP ny one person) S 1,000 NPP1350515 09/06/2013 09!06!2014 PERSONAL S ADV INJURY S 1,000,000 ------ .,.---------- GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2.000,000 F7 PRO. POLICY JECT LOC S AUTOMOBILE LIABILITY COMBIN SINGLE LIMIT S Ee accldanI _ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Pa eaydenl) S HIRED AUTOS NON-OWNED AUTOS Pe ERTY AGE S cckldrul --- S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UAB HCLAIMS-MAOE AGGREGATE $ DED I I RETENTIONS S WORX ERS COMPENSATION WC STATUOTH- AND EMPLOYERS'UABILr Y Y I N ANY PROPRIETOPJPARTNERlEXECUTIVE E.L.EACH ACCIDENT S OFFICERMEWOER EXCLUOEDT MIA (Mandatory In NH) Il yes.desu(be uncle, E DISEASE.EA EMPLOYE $ �OESI:FIIPTION01OP5RATIONSbelo. E.L.D!$EASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If mon apace is mgwred) CERTIFICATE HOLDER CANCELLATION Castricone Roofing & Siding SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,Unit 3A ACCORDANCE WITH THE POLICY P'ROV1510NSEICE WILL BE DELIVERED IN 231 R Sutton Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 I O 1988.2010 ACORD CORPORATION. All r hts reserved. ACORD 25(2010105) The ACORD name and"o are registered marks of ACORD t DATE(MM/DD/YYYY) Aco CERTIFICATE OF LIABILITY INSURANCE 9/6/2013 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 NAME: I Eastern Insurance Group LLC Main PHONE E>R; 0 1-77 Alc No:7 1-586 8244 I 233 West Central Street E-MAIL j Natick MA 01760 ADDRESS: le rk a in urn m INSURERS AFFORDING COVERAGE NAIC# INSURER A:Cornmerce Insurance Com an 4754 ! INSURED 31969 INSURER B:Cornmerce&Industcy 19410 David Castricone Roofing&Siding Inc INSURER C: i Castricone Roofing Inc INSURER D: 231 Rear Sutton Street, Unit 3A North Andover MA 01845 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:995779072 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. j INSR ADDLSUBR POLICY EFF POLICY EXP ! i LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS I GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RE COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence $ i CLAIMS-MADE F—I OCCUR MED EXP(Any one person) S I PERSONAL 8 ADV INJURY $ HI GENERAL AGGREGATE $ i GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY I PR0jECT LOC $ AAUTOMOBILE LIABILITY BCNGCV /1/2013 /1/2014 Ea accident $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ j X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident i i $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ $ B WORKERS COMPENSATION VVC003989723 /23/2013 /2312014 WC STATU- OTH- B AND EMPLOYERS'LIABILITY T R YIN C003989723 /23/2012 /2312013 ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? ❑ N 1 A i (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 i ' I i I j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i I I I i I CERTIFICATE HOLDER CANCELLATION I I i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Castricone Roofing Inc. ACCORDANCE WITH THE POLICY PROVISIONS. . 231 Rear Sutton St, Unit 3A j North Andover MA 01845 AUTHORIZED REPRESENTATIVE i i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i I >- �l;u�:ullu�ctfx - t�Cll;ll'f111Cl1f Irl Pulrli� �:rlct� Buai'tl W Bllllllill� ilc_ul:rtiun� antl St;rnrl,rrrl -- Construction Supervisor SpecialtY License License: CS SL 99358 Restricted to: RF,VVS DAVID CASTRICONE 31 COURT STREET `# NORTH ANDOVER, MA 01845 y f� Expiration. 12/16/2013 Tri: 7924 SCA t 0 20M-05m Office of Consumer Affairs& Busirfess Regula tion' E IMPROVEMENT CONTRACTOR j{ Registration: 104569 Type: ,expiration: 7/14/2014 Private Corporation DAVID CASTRICONE ROOFING, SIDING& David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 ( � Und r e secretary