HomeMy WebLinkAboutBuilding Permit #151-12 - 850 JOHNSON STREET 8/23/2011 i
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BUILDING-PERMIT OF 'LED ,
TOWN OF NORTH ANDOVER o2 e�t�,ED '4.�,
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
ACM1JSe�h
Date Issued: P-12J 11
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
Addition Two or more.family Industrial
Alteration No. of units: • Commercial
Aepair, replacement Assessory Bldg _ 13o.(-n 7 Others:
Demolition Other
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DESCRIPTION OF WORK TO BE PREFORMED.,
r a K ty) 4b PQ Jd r' n
Identification Please Type or Print CI.early)
OWNER: Name: 0)[f n mrnAng Phone-
Address:
hone Address: Kr\_�bA M'A_
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Tota[ Project Cost: $_ (n (,1 tJv FEE: $ l�06
Check No.: 2�0' Receipt No.: e7 S'Zr/
NOTE: Persons contracting with unr ebaistered contractors-do not have access to the bazsal anty fund
Sa :t�a`tur�:�ro���•�rifil:0aruner�' - x r���- _ _ .��_:� .��.. �.i � �_,�..��;r�,. k-� �-- ,�.�,u,,,,a�
.�?_.�-.�_.�_..��,�.-v__.�.,._... -- - - -_'Signa :ure����con�•raLf�r'.�� �--� ���f•. �•__
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 DATEAPPROVED.
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
UVIV11VIt=1V 1 A
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 Driveway Permit
DPW Town Engineer: Signature:
Located s ood Street
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�' ;!7�:.�..S.f•'.. -y FST � - - r{ !.':c=,•.. .-�..lu
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i
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
i
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
Doc.Building Permit Revised 2010
Building Department
The following is•a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ 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)
❑ IVIMass 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
._..a:-New Construction (Single and Two Family)
❑ Building Permit Application
❑ lie: II:IeU r'ropo %-, ;-►c;i "I
an'•
❑ 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
F
Location
No. �2 Date
�oRTM TOWN OF NORTH ANDOVER
? �. • O
10-3 �
9
L Certificate of Occupancy $
Building/Frame/Frame Permit Fee $ ✓�'1r•GU
s�C1H4 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2445b4.11)3`uilding Inspector
%ORT#q
Town
of
No.
23 /�
o , �` dover, Mass.,
^� 0" A.
COCHICHEWICK V
BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT........ . ...l' .1... '!:�/..C/OJ.v.C'/J................ Foundation
has permission to erect........................................ buildings on 90e2...... ................................... Rough
to be occupied as ��! .. .,< ... /Cr'.....l ,^... .. Chimney
p' y
provided that the person accepting thf"s permit shall in every respec conform to the terms of the application on file in Final
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 CONSTRUCTIgy STARTS Rough
�? '�G t ..................................................... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE S 1 D E Smoke Det.
s The Commonwealth of Massachusetts
I A I 1 Department of Industrial Accidents
t � 1 Office of Investigations
600 Washington Street
Boston, MA 02111
i'-�� www.mass.gov/dia
Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): .DAV 1I C&T,I(ONC RUQ F i N6- ' S1 0/N(r SNC.
Address: ;Z0 Cj 9 TTo&3 ST2 t S r r-L 2 Lto
City/State/Zip: N o. Air Do iee_. NA 6145 Phone #: 6`r;33'12. Q
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with e 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. ❑ We are a corporation and its
required.] officers have exercised their WE Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs
insurance required.]t employees. [No workers' 13 KI Other S ! D I/J
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.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid their workers'comp.policy information.
1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: A r?-TA S
Policy#or Self-ins. Liffe.#: `)_913 9 i3 Expiration Date:
Job Site Address: b )O L tnS pn 1CS1p,
City/State/Zip:A �,,\ Nn
111 61Je/ 60 r
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$250.00 a day against the violator. Be advised that a copy of this statement inay be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify un�derrtthe pains andpenalties of perjury that the information provided above is true and correct.
Signature:
Phone#: —Liril U3 J 4 a0
Official use only. Do not write in this area,to be completed by city or town officiaL
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
T
DAVID CASTRICONE
CASTRICONE ROOFING&SIDING INC.
ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS
HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569
200 SUTTON STREET,SUITE 226,NO.ANDOVER,MA 01845
In North Andover 978-683-3420 In Boxford 978-887-6147
In Haverhill 978-374-7314
I/we the owner(s)of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary
materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and
conditions,on premises below described:
Owner's Name...... r' ....../• 4� A..i7.' hone#...h. i..4r.. 3o
Job Address..... .... .Ct. :$Q 21..... p..........City..f•V.OI /Tj
°r..{...................State...Mh.......
Specifications:
^'Are.as. t.o b..e.covered: ...... ......................................................................
.. .................................. 4.9'"', .
............................................... t;J?-tJ. L....
... ... ............
--'Apply vinyl siding and corners. Type: �/ :
.......................
!.. ......�c....�l.J.cr..........G.........../......... ...... .(Y
.,Cover fascia boards and rake boards. new-
e...................................................................................................................................................................................................................
ver wood casings around windows. Replace any gable vents attrwaPW.with vinyl.
.......................................................................... ................................................................... 1:...........
iApply underlayment Type: 04, ��i.t,oi. 1/ J—
-Existing siding - stripped / go-over �16egal disposal of all debris. r
........................................................................................................ ..................... .,. ,..-.. ' ..............................
Rotted wood replaced
I _
1G1�G4..r....6t-M... ....... ........... ...5.1..... Ct ..............................................................
`
7.0 — b.. a
r
21P. . .Ja.:�'...�.,,-�... 11 .1'�:,Zi9.1..8.z�......j- ........1,.1.�:1,1'.....�..A....................... .
...........................................................
One Year Workmanship W rranty(Not Transferable)
Manufacturer'srranty ss specified byqanufaMurer
The c9a4futot agrees perform the work and ish the materials specified above for the SUM of
! ayable...... .147.............on....5-, ---
Payable on............—:...............Oalance payable on completionQf iolL-
Owner or Owners are not responsible for Property Damage or Liability while j rs in operation.
Contractor is not responsible for any damage to the interior of property,including preexisting 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).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,conhwwr 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[oris and conditions of the contract and/or any lien in connection herewith.it is further agreed that this contract
may be assigned by contractor,and also that the obligations hereof shall bind and apply to their heirs,successors or estates of the parties.The undersigned warrant(s)
that he is(they are)the owncrs(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,not 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:Director,Home Improvement Contractor Registration, One Ashburton Place, Room 1301,Boston,MA 02108
Tel:617-727-8598
Any and all necessary construction-related permits shall be obtained by the Contractor. Any Owner who secures his own construction-
related permit or deals with unregistered contractors is excluded from the Guaranty Fund provisions of MGL c.142A.
Approximate starting date of work................................................ Completion date.........................................................
Receipt of a copy of this contact is hereby acknowledged,and it is further acknowledged by the undersigned that the foregoing
provisions have been read and the contents thereof understood and that no representation or agreement not herein contained shall be
binding upon the parties and that all of the agreements and understandings of said parties are contained herein.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Owner has three business days to cancel this contract and incur no penalty (see onotice of cancellation).
7
IN WITNESS WHEREOF,the parties have hereunto signed their names this.�?../.W..day of.. ,�y ,20,,,1,,,,
Accepted:
Signed,.-., G .'� � Wil...... ...... Owner
' Signed............................................................................. Owner
David Castricone,President
I
......
.11;t.��;t�lul.�cft� - !k•Ilartrn�•ut ul' PuhGr lafcr� _
1 Buurtl ul' bililditt," 12C;;uJill iun., :ultl .�r.uularlls r. iu4r�cu�zu��z/l/, ..•Lt�.��c�c/u 11J
Construction supervisor $hEClatty License -,,.HOME
u1�Cunsumcr Affairs&lig.incss Rcgutetion
VIHOME IMPROVEMENT CONTRACTOR
License: L'S 5L 99358 �yRegistration: 1D4569 Type:
Restricted to: RF,WS
` � r.', Expiration: 7114l2012 Private Corporatio`
DAVID CASTRICONE `.
DA16CASTRICONE ROOFING, SIDING&
31 COURT STREET
David Castricone
NORTH ANDOVER, MA 01845 rl
- .r
200 SUTTON ST SUITE 226 _
NORTH ANDOVER, MA 01845 `linJerxcrcl,try
E zpiratlun: 12/16/2011
( nwui.<iunrr 1'r 99358
4'
DATE(M"DIYYYY)
ACORD,. CERTIFICATE OF LIABILITY INSURANCE 9_,3-2-old
PRODUCER S08.6S1.7700 FAX TRIS CERTIFICATE IS ISSUED AS A MATT1<R OF INFORMATION
Eastern Insurance Group LLC - Main ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
233 West Central Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Natick, MA 01760
INSURERS AFFORDING COVERAGE NAIC 0
INSURED Davi Castr Cone-Roofing i ng Inc INSURER A: ASPEN SPECIALTY INS CO
200 Sutton St INSURER B:
Suite 226 INSURER C:
North Andover, INA 01845 INSURER 0:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REouIREMENT,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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NfiRC TYPF OF INSURANCE POLICY NUMBER DA (NIM/00M) ATE
MMIDO LIMITS
GENERALLIAe1LITY CP712S310 09/06/2010 09/06/2011 EACH OCCURRENCE $ .000.
X COMMERCIAL GENERAL LIABILITY �MI ES Ee oel:utrenoe $ S010001
CLAIMS MADE M OCCUR MEO EXP(Any ane porson) $ 1 00
A PERSONAL a ADV INJURY $ 1 000 00
GENERAL AGGREGATE S 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP;OP AOG S 1,000,000
POLICY M JEROT MLOG
AUTOMOBILE LIABIUTV i COMBINED81NOLE UMI S
ANY AUTO j(Ea seddeM)
t
ALL OWNED AUTOS BODILY14JURY S
SCHEDULED AUTOS -I(Por panton)
HIRED AUTO$ BODILY INJURY 3
NON•OWNED AUTOS (Per ecddent)
I
1 PROPERTY DAMAGE 3
(Per ecrioent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO (OTHER THAN EA ACC S
AUTO ONLY; AGO 3
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE S
OCCUR CLAIMS MADE AGGREGATE S
S
OEDUCYIBLE S
RETENTION S S
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN L TORY LIMITSI ER
ANY PROPRIETOWPARTNERIEXECUTNE= t E.L. EACH ACCIDENT i
MFS RtMEMBER EXCLUDED? (� I
EL.DISEASE-EA EtAPLO S
M yes.desmue under
SPECIAL PROVISIONS bel W+ j E.L.DISEASE•POUrY LIMIT $
OTHER
II
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Inc. OATS THEREOF.rHE ISSUING INSURER WILL ENDEAVOR TO MAIL /DAYS WRITTEN
David Castricone Roofing & Siding, INOTICE TO THE CEKTIFICATEHOLDER NAMED TOTHE LEFT.BUT FAILURE TODOSOSMALL
200 Sutton Street, Suite 226 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AQCWTS OR
North Andover,MA 01845 REPRESENTATIVES.
AUTHORIZED R Surrpm
ACORD 25(2009/01) ®1 O < AMMDWIMN. All rights reserved.
The ACORD name and logo are registered marks I A
ACORD,a CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDIYYYY)
9/24/2010
PRODUCER Phoiie: 508-651-7700 Far: 508-653-8089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Eastern Insurance Group LLC -Commercial Lines ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
233 West Central Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
Natick MA 01760 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURERA:C' On Insurance 40274
David Castricone Roofing & Siding Inc INSURER B:CHART IS
200 Sutton St
Suite 226 INSURER C:
N,;rth Andover NIP. 01845 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOY HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, PERM 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. AGGREGATE LIMITS SHOWN MAY HATE BEEN REDUCED BY PAID CLAIMS.
I SR D POLICYEFFECTIVE POLICY EXPIRATION
POLICY NUMBERDATE fMMtDDfYYi LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY EMISET�E
PREMISES Eeoccurence) $
CLAIMS MADE 7OCCUR MEDEXP(Anyone Person) $
PERSONAL&ADV INJURY $
GENERALAGGREGA'rE $
GEN'LAGGREGATE LIMIT APPLIES PER* PRODUCT S-COMPIOPAGG S
POLICY PRT LOC
D AUTOMOBILEUABIUTY BCNGCV 8/11/2010 8/1/2011
COMBINED SINGLE LIMIT
ANYAUTO (Eaaccidero) $1, 000, 000
ALL OWNEOAUTOS
BODILY INJURY
X SCHEDULEDAUTOS (Per person) $
HIREDAUTOS
BODILY INJURY
X NON-OWNEDAUTOS (Per accldem)
PROPERTY DAMAGE $
(Per aczldem)
GARAGE LIABILITY
AUTO ONLY-EAACCIDENT S
ANYAUTO
OTHER THAN EAACC $
AUTOONLY: AGG §
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR CLAIMSNIADE AGGREGATE $
DEDUCTIBLE - S
RETENTION $
S
B WORKERS,COMPENSATION AND WC003989723 9/23/2010 9!23!2011 X WcsrATu 0TH-
EMPLOYERS'LIABILITYIT
ANY PROPRIETOR/PARTNER,IEXECUTIVE E.L.EACHACCIDENT $100 000
PR
OFFICER!MEMBEREXCLUDED4 — -
Ilyyes tlescribeunder E.L.DISEASE-EAEMPLOYEE $ 100 000
SPECIAL PROVISIONS below
OTHER E.L.DISEASE-POLICY LIMIT _S_5,_o 0 0 0
DESCRIPTION OF OPERATIONS)LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SP ECTAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
David Cast.ricone Roofing & Siding Inc BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
200 Sutton St WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE
Suite 226 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
North Andover MA 01845 SHALL IMPOSE NO OBLIGATION OR LIABILIT'x OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE 7.
ACORD 25(2001/08)
oACORD CORPORATION 1988