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HomeMy WebLinkAboutBuilding Permit #236-14 - 89 MOODY STREET 9/16/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0:236 ~/ Date Received Date Issued: l�' IMPORTANT: Applicant must complete all items on this page LOCATION OQ i'1°C /fa✓1�i ?t�U �' Print PROPERTY OWNER / 4-fco l/ Print 100 Year Old Structure yesnno MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ,KRepair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: u � / �P tiation Please Type or Print Clearly) 91� � 9 ���O OWNER: Name: 1U W'Itoll Phone Address: q P900d D `i A O CONTRACTOR Name:eQ.STR((okJ�- 064;rN6 +164A)kone: gig (ou • J� 0 Address: 02 3 I SU-"n f ST. SU t T£.. 3 Supervisor's Construction License: CI Q3 S d Exp. Date: I�:- I�O • do 3 Home Improvement License: d S� Exp. Date: r t `f "a U ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �` �1Q °a _FEE: $ `66 •� Check No.: t No.: 2--fa �b 1 Receipt NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - - 1 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I Conservation Decision: Comments `.Water & Sewer Connection/Signature Date Driveway Permit DPW TowL Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no ? Located at'124 MainStreet Fire Department signature/date 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.$100-$1000 fine NOTES and DATA— (For department use El Notified for pickup - Date 4 Doe.Building Permit Revised 2010 Building Department The fol owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits L 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 o 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 o 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 New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan Li 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) o 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.Bui?ding permit Revised 2012 I Location 89 �� No. W !i Date I �P . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 4z, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#fi! a -t Building Inspector • � �.10RTly Town of 2 E ndover No. ZU a- yZ01 h , ver, Mass, I T O LAKE 1 A- COC MIC Nf WICK � 7�ASR^TED aP�`�,�5 S V BOARD OF HEALTH Food/Kitchen PERMI Septic System THIS CERTIFIES THAT ........... .......... .......! 4�i1................................. ............................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... ... .... ............................... • Rough to be occupied as ....... ��0............................................................................. 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE DAVID CASTRICONE CASTRICONE ROOFING& SIDING INC. ROOFING,SIDING&REMODELING REPLACEMENT WINDOWS HOME IMPROVEMENT CONTRACTOR REGISTRATION NUMBER 104569 a3 I R go SUTTON STREET,09*PV*NO.ANDOVER,MA 01845 In North Andover 978-683-3420 ]n Boxford 978-887-6147 ]n HaverbU1978-374-7374 Uwe 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 prem. belo escribed: l �� / U Y� Owner's Name......Y.....!Z�.... r�r.t..54�+C..{.. ............................. ...........Tdte one�'...(esQ..�...�d.. .(1. ... Job Address......Q..../..... (�.p. .. ...... -1••I••r•••.........................City.... p......L{.�� O.V&_(...........State.....]'••�>� Specifications: .. . .... . .................... . ......................................................................... . .................................................................. .. trip existing shingles yCpply new drip edge to all edges. ,� v /r.....................................:............................................................................................................................................................................. V./Apply _feet ice and water shield membrane to bottom edges of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. ........................................................................................................................................................................ ....................I..................... Apply felt paper underlayment. ✓install ridge vent to f t r 4 c� J0_r-_a 5 Z Z ............................p .. .......................... � ......... .............................................................................................. Reroof using { der—Gi-1 t 1!Y shingles with a_1Q_year warranty. ...................................................................................................................................................................................................................... "Counterflash chimney. New vent pipe flashing. LZgal disposal of all debris. .................................................... yl......... .......... ........................................... t�rea(s)to be worked on:... t r................................................. ................. 1..�... S. ....�.. lL`.elt�, ... ..Ga. ......../`�tG�. t.. . ..�.. .t:xf .. ..... .................................................................... .................... Roof board replacement if necessary @ V /sheet /moot. .......................................................................................................................................................................... Two Year Workmanship Warranty(Not Transferable) Manufacturer's Warranty as specifie y anu//factur The ctor agreeStopXrforn the work d sh the materials specified above for the SUM f$... ..4. Z4C)................ ayable... �5..Q.4......on...$ t ........Qf .lp�le Payable........7=— .............on.................... on completion of iuh Owner or Owners are not responsible for Property Damage or Liability wsi 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 wort[,all undersigned agree to execute and deliver to contractor,theirjoint 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 owncr(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.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 thcrcto 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 condkions 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 notice of cancellation). 7 IN WITNESS WHEREOF,the parties have hereunto signed their names this... .It.day of.. e... 20.../ Accepted: Signed\��..�. .. ......... .re........ ner Signed............................................................................. Owner David Castricone,President The Commonwealth of Massachusetts - Department oflndustritrlAccidents 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 Lesribly Name(Business/Organization/Individual): AV i b C 11;f rs 1 c i,;N e ROC F t IV,6- `t 'S#a i N G N Address: -�J I ;rCAi SVrL- -r_..r, S. ; I E. 3/1 City/State/Zip: No A N Au�'e lk MA D I HYPhone#: 976 &rk 3 s Are you an employer?Check the appropriate box: Type of project(required): 1.N 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. ❑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 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 12MC Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they ai e doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis 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 pollcy and job site information. ) Insurance Company Name: 1/9/Z 17-1 Policy#or Self-ins.Lie.#: /�L�C1,� j df 7�3 Expiration Date: V 1-3 Job Site Address: e / /�/4 U � V��'G� City/State/Zip: /w' ��d l�✓ ,���l°tel 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certl&under the pains and penalties ofperjury that the information provided above is true and correct. Sip-nature: 5_:—)2 C;)- C Date: Phone#: 716103J7alc1 Of 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#: w Aco CERTIFICATE OF LIABILITY INSURANCEDATE(MMMDIYYYY) 09/11/2013 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(iss)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 N� _%ACT Suzanne J.Casey Willows Insurance Agency,Inc. PHONE tAc No978-475.3414 X 59051 FAX 978-475-3165 51 Cochichewik Drive 94ML AIC Ho DOREss: SCasey@easteminsurance.com North Andover,MA.01845 INSURERS AFFORDING COVERAGE NAIL 0 INSURER A: Western World Insurance Co. 13196 INSURED INSURER 8: Castricone Roofing&Siding,Inc,David Cestricone Roofing& 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. ILS TYPE OF INSURANCE POLI Y NUMBER POLICY EFF MOUCOY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL UABILITY PREMISES Ea o ou n S 50,000 CLA MS-MADE Xj OCCUR MED EXP dna person) $ 1,000 NPP1350515 09/06/2013 09/0612014 PERSONAL I All INJURY $ 1.000,000 ------ I GENERAL AGGREGATE S 2,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AW $ 2.000,000 POLICY 7 P'0. LOC $ AUTOMOBILE LIABILITY COMB9J IN IMIT f Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per parson) $ AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS AUTOS NON-OWNED P ERTY AGE $ AUTOS $ UMBRELLA UAB OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE $ DEO I I RETENTIONS I I ' f _ WORIC£RS COMPENSATION WC$TATU• OTH- AND EMPLOYERS'UABILrTY YIN TO Y LIMITS ANY PROP RIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a NIA E.L.EACH ACCIDENT S (Mandolory in NH) If yes,desaibe under E.L.DISEASE.EA EMPLOYE $ IDESCRIPTION OF OPERATIONS below, E.L.DISEASE-POLICY UAMT S OESCRIPnON OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORO 101.Addldonal Ramarfu Schadulo,If mora apace is ngWrod) 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 StreetQ C North Andover, MA 01845 AUTHORIZED REPRESENTATNE I O 1988-2010 ACORD CORPORATION. All r hts reseryed. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i ^ I DATE(MM/DD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 9/6/2013 i 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 i 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: Eastern Insurance Group LLC-Main PHONE Exti:508-651-7700 a/c No:7 1- - 244 I 233 West Central Street E-MAIL Natick MA 01760 ADDRESS: I rk a in r n m INSURERS AFFORDING COVERAGE NAIC# INSURER A:CoMMerCe Insurance Om an 4754 INSURED 31969INSURER B:Commerce&Industry 19410 David Castricone Roofing&Siding Inc INSURER C: Castricone Roofing Inc INSURER D: 231 Rear Sutton Street, Unit 3A North Andover MA 01845 INSURER E: INSURER F: j 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. INSR TYPE OF INSURANCE ADDLISUBRI POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DO/YYYY MMIDDIYYYY LIMITS GENERAL LIABILITY DA OCCURRENCE $ GENERAL LIABILITY PREA A E OES Ea E EDMISoxurrence $CLAIMS-MADE �OCCUR MED EXP(Any one person) $ 4701MMERCIAL PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ A AUTOMOBILE LIABILITY BCNGCV /1/2013 /1/2014 .=I 1IN1111 nt as tlent $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED _ AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNEDPROPERTY DAMAGE Jx HIRED AUTOS X AUTOS Per a.dZI $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION VVC003989723 /23/2013 /23/2014 QB STATUY OTH- B AND EMPLOYERS'LIABILITY Y/N VVC003989723 /23/2012 /23/2013 ANY PROPRIETOR/PARTNER/EXECUTIVE F--1N/A E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) i I I CERTIFICATE HOLDER CANCELLATION FSHOULD 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 North Andover MA 01845 AUTHORIZED REPRESENTATIVE i ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD i I �I:u.;tvhu�ctt� - Ucllar-tlnrnt of Nulllii ti.tl'ctl Bn;trtl ut Builtlin ' Kc,ul, i,,,,. --- Construction Supervisor tr i tit, 1 tl Specialty licensee License: CS SL 99358 Restricted to: RF,WS DAVID CASTRICONE 31 COURT STREET NORTH ANDOVER, MA 01845 >r� Expiration 12/16/2013 ( uuiu,ainrr Trr: 7924 SCA 1 ce 20M-05/11 _ Office of Consumer Affairs& BusirSess Regulation AR HOME IMPROVEMENT CONTRACTOR Ne istration: I` - 1'1 9 104569 Type: ;;:Expiration: 7/14/2014 Private Corporation DAVID CASTRICONE ROOFING, SIDING& David Castricone 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 01845 — Undersecretary Town of North Andover N�kY o C Building Department o - 27 Charles Street13 ti � North Andover, Massachusetts 01845 i f (978) 688-9545 Fax (978) 688-9542 0R�reo �SNCHU5e DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL cl 1, sl 50a. The debris will be disposed of in /at: 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.