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HomeMy WebLinkAboutBuilding Permit #176-15 - 81 COTUIT STREET 8/19/2014 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o ' ^, e� Permit N0: Date Received R • °�'( Np `y1_ Date Issued: ��SSACH�35� ORTA.NT Applicant must complete all items on this page A b" R" ,t .. n �, HT., t cYhi 1 Yr^xE 4 j st{ . �t�.-.. ..>s` r c i..-v�� .w-' ,5'. hF i •_r` s '�^rr3 r S r'4f 4 J: �, -r�'� m ?,. F., <3 a. 1+�' i'`�'" s• Al ERA i+.r+ ifr �j-�r s„`esi'n?.ery^a^-r`.3. "'14 § L m i x,, `"''Z• -' r >ti { T-aa• '.4thl "�.-� t�� �1�`�. L r�` ti�� x„�a�'d�s'�n11�,"a�'='�"U` �'S", "_P�'..�+p��'�. {•'. �,L°w'�F� rr a5.t"�'F"-^ -*5�"��-^f t" �nch.s .s:r r i �Y�rn.�y ��D n^�T'• 'h`i s�`Sy1'� f -LJ1��4�' `� � � ,,r~� -:,.{ a 1 1 r r�•I�. � �' - I a� y�€zI�al`11Y3Ya�J.3,i>e?-�s_ _ _ .. m � "'�^�iY� .. ���? �. r7e��r}�sy�y •�i. - -' .r�.tr.•+Err2%� rrs ""�"��.�`�'�.F• '"` § �j� ��'e.`^v 2 YeK b y�wrri•x�.M1-'t'.sa� n,. �'i f 'ri. zr r t - �F 7�`FS 7�,V i t£�. f' M✓ �" _ E z..,t�'t` '�hk ''''•t A7-"�'J11°,':,�'�'�v a+yry 1+ a��n� a ca N' ca'',n' �5w�, tiv,n�.*5-I„ zt"..«,.+`�""' .r -s,�;, ..�1 s:..ytt r. •,.. � .3� �" t 1r, y "c�..iixr• '>a: .y„� •r r f ra� .,5: i ' �F� y .!r as r�a ,An...,� `7€ ^' �� C,r_�',�� �`7�. � �+�.r{.e ���'"•vn��fi hs M ��' 't�s'�. �,��� �e 'ss.dt :�.yt��'.�fl�ra��i �� N C'x+'.r�'�.x 5at,["�. 'eaS�'r ��EL��x 4 .,_�Sjn:z�`�.;'�y.wr,”`�.es: a{.�-.F=-as t :y��6�-fes' ,_-`'�,L��W��� 7t`.-C"Y/"�^aa 1s�`C 5�4 t�C y �L �+,y�] arll k7a�J"1.6�'1'Y���Ad��:e��,-�St �ia"7� �4���`� :•.� TYPE OF IMPROVEMENTPROPOSED USE Residential Non- Residential New Building Onefamily Addition Jfwo or more.family Industrial Alteration No. of units: Commercial ✓Repair, replacement Assessory Bldg Others: Demolition Other ter. . '� r. gF_3A- ..131 �a •rt �'r� l IJw � ., r�t� '. .,�. •r",z tJ., 4 r ,� x r,. s.�; NOeSn ��x� I .s�.a=- r ns�'c.r �.F "t,..��"d" t"L�i'..,�r w,��r r .ya, � r '�'Y`�i"'7'��.,, �• 3 .,_.__.. :r .i_.,�•..3 a .._�s,.,r_r.x a a.,,`r...z�. 'r �.:_s .�,.� .r�,.,"��'�t.��$` :{„ :.,.r, a �� DESCRIPTION OF WORK TO BE PREFORMED: l `1t f64N vne - Identification PIease Type or Print Clearly) ( e p,cont ) OWNER: Name: RrAaolcone, JQ0C ax . non Phone: 9 - ENA lad Address:_ - 3 � �U1 ' �rf�e�' 1�6' "Oyela I PC ( l L(r �Yf -� �..-"e�.r', 'fi 5"-�e1. s'a�-��-T'k'��a+a.. - ,hvt �.�'c� : F '•�rwz `"� ..,m .S'rte'a '�,r� tr-"F�w'oT�s��'� `�` ta^ t`-r-' .,c�x.r .(l�• �.n'M�' ,.'r�, -�; n t`-" im 'rvrr.0 texy� S20 K rte• -i'� ' x �,. "Y " ' .• AryX',` a"' TT r"k ec S; Rill, - 5�'�y� r�i �.. 'baa{ � •��.1'r�,`'w�l �a� � w ^� S �.T^=. ` �-s•-z .�f: � tuR' o-+ '�,c� s '��a� �+- � r •�j���F^�u� 6+ , r s t r4k�l�� s �7 ��' _ _�xM �• �..�s. b ,H,f a t.�' a }���v� �� ; ry�_ - o ���.�SjYitk���1 ,xra�av^,�r.7�.ryr ry ^{ T •a-T' �' „ t i.7a1f is*f,a•C! # "„r £r1. k �.:nn p t -_"%2.''F as A f.y ° kry .•. rlY,-Y,r C'm'E rS 'a'h a'v .rlYJ' 3t-=`l��rG r..e N ':� e� trj� A ?..s*s+ ' 4r� tt F„r`(2 -'b`a'r- za.r .Ja a N`' c:L•y {, ' t F f i �� n. 'r 1"PJ K z.r M�, i'i d�fYe A' � ce+r-•+.s _Sak}ts'•'-i � rN r.�-'� r.5 fie• 5" m x.'{,)`i�G� � � �,i tM :t �, �.: �� �'';�c7''�r�� d:.t� Z�:.�.iz;+n i�'�'!V"zr.- �.•t"Iv';�`�.'aF'rt�*'-�iwu:�'-�'d_ �a��}`�e`'�•-rr el5'�' y,C:�''�z'� :�,;r dri+•.'3!SF9;s' �_p :!t ^3.,,.»4 } ft.«Sifa: ;,. a�.kt"�•7�,:•:,f.�R'�=ra kp�at} -�f yis�Kkt}•"s ��.ti- r;;a.., dy.:t � "3�. �:f i"M1�rF;w., is � �a1. .'��.E ,-a•t' _�s 3r�'�...�F� 9 +'' e'�F? ,u 's, 'Sl z=ar'1%u _'h-"�-1G,-fk; ,i t .� t?•u as :>r.4".+�'aY;g.1; '' �1 rr+ aai .5.� �, 1 �.r� R•»t` �•t' a} U'�':;�f Y o:.: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:n$12.2.00 PER$1000.00 OF THE TOTAL ESTIMATED COST PASEQDD ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund nature Ag n Oaruner 5ignatu -0*0, Location q No. � Date t • • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ - Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Z Check Q0 °' Building Inspector Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Sionature UVIVIrVILIV f HEALTH 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/si nature& Date Driveway Permit DPW Town Engineer: Signature: Located 3 84 Os ood Street Fi� E�P ► ' 1ETI"era�'YDipsfis erbfj--sit ayes'+ ' .SLocated at 1� ailain S#reit r f m G F h h �F�re aeparre� ;s� nrelae s k" = rr = .,.Fall , COMI�YI�'I�1TS: _. .� f , b Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Siqnature i.Vivii'viL f S HEALTH 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 Town Engineer: Signature: Located ate 384 0 e ood Street iFi`I�� c d s re � mss , {F . E.�E�P�►���M�9N�' �fer���D�a�ipster���yt ���e�µ�:� ;.:.��w rax_��. ani,.. :...::� � � � , Located at"lJain 8#ree# 1 r r ITI-Ment,,Si n re a e �COMi EXTS 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 13r% of led 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 � NORT�y Town of - .:�.. , 0 as- T C% ver, Mass, 1 �„9COCHICNEWIC« y�. 7_14 S RATED ►.P�,��y U BOARD OF HEALTH Food/Kitchen PERMI-T L D Septic System Vw�� T&IU coV ` IIS.!W BUILDING INSPECTOR THIS CERTIFIES THAT ... ................................�................. ........... ......6." ..... l."'.f�!��..... has permission to erect g ` cc ' Foundation .......................... buildings ...�.........5�..3........ ..........•.... 00 Rough to be occupied as ..........�.. .. .........' ..... 1.. . . .... .. y provided that the person accepting this permit shall in every respe 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR toe UNLESS CONSTRUCTION6;9ART., Rough Service ...................... . ............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. q CASTRICONE ROOFING & SIDING INC. J �� ROOFING, SIDING & REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 231 R SUTTON STREET UNIT 3A, NO.ANDOVER,MA 01845 In 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 furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the foll tng specifications,terms and conditions,on pre ' es below described: Owner's Name.. iL..YY1.�. L7.t1 C.l.. . yt/�...��,,1!' 1.1.<4. .......... phone#.. f•p.:" Job Address........ A ...4 �.1. ta..........>;.,� ..........City. �.�X� ...............State..J...111.......... Specificalions: ..................................................................................................................................................................................................................... V/Strip existing shingle(o trApply new drip edge to all edges. Wk;*� ......................•............................................................................................................................................................................................... ,-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. .......... t........................................................ ,Apply felt paper uit der Iayment. A a s all ridge vent to W 42 ............................. ......... ....................... ... .�. — rfteroof using shingles with a_1`0 year warranty. �f/ eJ �l ...................................................................................................................................................................................0.trdf.�.� ............. Counterflash chimney. View venj pi a flashing. eegal disposal of all debris. .............................................r. .'..... r1wa Arca(s)to be worked on: J t f............. .Yl.l �„?. d}.......... ...Q... 1ISJF..................................... ........................................................................................................... ti ................. �.. .Q./-............ I. . ...... . .. .. .... .... .. .. ..... .. .. .......... .....I.D....... rr��. s llJTl.t?..... ' �t .. ..,!�.I..A. . C. S.I.`/................. ............... .. .. . .. ......... ... r .. .... Roof board placement rf necessary @ heet/or /foot. �bD. .................................................................................................................................................................... ...... .................. Five Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as speci by manufacturer The fora es to erform the work d i the materials specified above for the SU f 5...g. 4.Q................ /i yabl ,410.........on .......... Payable.............................on................ alance payable on completion of job Owner or Owners_are not responsible for Property Damage or Liability whi obis 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 ofsbovc 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 warrants)that he is(they are)the owners(s)of the above mentioned premises and that legal title thereto stands of record in his(their) names(s).There are no representations,guaranties or warranties,except such as may be herein incorporated,if any,nor any agreements collateral hereto,nor is the contract dependent upon or subject to any conditions not herein stated.Any subsequent agreement in reference hereto shall be binding only if in writing and signed by all parties. All Home Improvement Contractors shall be registered and any inquiries about a contractor or subcontractor relating to a registration should be directed to 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 excluded from the Guaranty Fund provisions of MGL c.142A. Approximate starting date of work..... ./l.t��'..1./... ............ Completion date..........3....dd".s:................ 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,231R Sutton St.,No.Andover,MA 01845. IN WITNESS WHEREOF,the parties have hereunto signed their names this....... ....day of Accepted: 44i1`}`:4s�iF1. ' 7 Signed ...... Owner Signed.................................................... ......................... Owner ...../....... ........................... .......... . David Castricone,President The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leizibly Name(Business/Organization/Individual): A\/ )D CAS T2 i(6 N e' �QbE­( M Address:—), U i Tb t3 (Z.Er i Uti l T JA City/State/Zip:No, A oN w MA 6M)') Phone#: 017 (A 3 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. ❑Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.."Roof repairs insurance required.] employees.[No workers' 13.ElOther comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. t Insurance Company Name:. 6 H H G k L Policy#or Self-ins.Lic.#: W C d() 3 q 7 Expiration Date: Job Site Address: D�'�,� ( rtkA %Ce—eA City/State/Zip: t� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 pain(s�and penalties ofperjury that the information provided above is true and correct. Sip-nature: / ('� Date: Phone#: 97& ��3 3i )-(D 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#: ACOR6 CERTIFICATE OF LIABILITY INSURANCEDATE(MWDDtYYYY) 10;7'2013 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(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). PROOUCER NAME: Eastern Insurance Croup LLC Main PHONEAJC No 8-61-7700 %ac No):781-586-8244 233 West Central Street EMAIL Natick MA 01760 ADDRESS: I c k r nsur nce.com _ INSURER(S)AFFORDING COVERAGE NAIC Jf INSUREPA.COMMerCe Insurance Company '347 •1 __ INSURED 31969 INSURER B: Industry _-- David Castricone Roofing& Siding Inc INSURER C CC)Castricone Roofing inc 231 Rear Sutton Street, Unit 3A INSURER D Nath Andover MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 170101 1967 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. NOTYVITHSTAN DING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE P.AAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLU51ONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INIRI TYPE OF INSURANCE A POLICY EFF POLICY EXP LTR: INSR VIVO POLICY NUMBER MM/DDrvVYYI IMM/001YYYY) LIMITS C C'N'ERELLIABILITY NPPI350515 1612013 16/2014 EACROCC:URRENGE 51,000,000 T CO.':IMERCIAL GENERAL LIABILITY rPA M u«enoe $50.000 CL.IMs rcIADE 17x i rCCLIR 'NIED EXP(Any oce pamn) $1,000 I� PERSONAL R ADV INJURY 51,000,000 GENERAL AGGREGATE $2,000,000 GErrt:GGREGATEUMIT?.PPLESPEA I I PRODUCTS Co 52,000.000 71 ,PRO. I L�.— lX I x>ury LOC $ A ! AUTOMOBILE LIABILITYCOMBINED BCNGCv /112013 ft;2014 ;Eaaccide ' n1,000,000 vn'su TO &)DILY INJURY IPer person) $ ?LLO;iNp xx�SiHEDULED BODILY £ _ :LTOS I 'UTOS NON OWNED PROPERTY DAMAGE�— REU.aUTf?S Ix��AUTOS !Peiacxtlenq UMBFE LLA LIAR OCCUR EACH C>CCUARENCE S excess LIAS CLAIN-IS MADE AGGREGATE 5 I DED I RETENTIONS 5 g YC'nKERSCOtAPEN50.TI0N 6NC003989?23 23./2013 N23/201d VIGSTATU OCH AND EMPLOYERS'LIABILITY Y!N r Y T ?.Idv PaOPPI;TOR.?.aRTNERIEXECUTIvE E.L.EACH ACCIDENT $100,000 CFF10ERr-,i6`nSER EXCLUDED? NIA (Idarm_6sc,ibE UIZ/Ef xy in NH) II dESCiE L.DISEASE EA EMPLOYEE 5100,000 ':'6 S, DESCRIPTIONOFOPERATONSbelow E.L.DISEASE PULICYLtMrr 5500,000 I i DESCRIPTION OF OPERATIONS;LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule.If more space is required) CERTIFICATE HOLDER CANCELLATION Castricone Roofing & 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 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010;05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards CunNhructiun SuperN Mir Specialt% License: CSSL-099358 DAVID T CASTRItONE _._ 31 COURT STREET NORTH ANDOVER MAY018 5 11 ./Sl�c,. Expiration Commissioner 12/16/2015 ���e�Oar�zi�rn,rcneal/�c/C��I�r�Jcic�cr�c,�/j �. Office of Consumer Affairs&Business Regulation l DOME IMPROVEMENT CONTRACTOR �r eegistration: 104569 Type: xpiration: 7/14/2016 Private Corporatio DAVID CASTRICONE ROOFING,SIDING& David Castricone 231 R SUTTON ST SUITE 3A NORTH ANDOVER, MA 01845 � P Undersecretary Town of North Andover O I,_eo Q G ry O Building Department o 27 Charles Street '� p No.r1h Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 7 O"Area 'Pr�A, cSACHU5- 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 slill be disposed of in a properly licensed solid waste disposal facility as defined by MOL cl 1, s150a. The debris will be disposed of in /at: � Z' >S - Facility location J—, Z]2—L�L�� 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,