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Home My WebLink AboutBuilding Permit #219 - 195 Middlesex Street 9/15/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO.-4XDate Received Date Issued: Il MORTANT: jApplicant must complete all items on this age LOCATION I-1 S H t da l kk J+YC C-'f Print PROPERTY OWNER cSe- 41 1 I nem - Print MAP NO: 0 14 PARCEL: 40(c l ZONING DISTRICT: Historic District yes 0 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building FrOne family ❑Addition ❑Two or more family ❑Industrial ❑Alteration No. of units: ❑Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other "' � � '�Bloodplain TOWelands �t 'aterslied�District; �0 Septic) ❑�W-.-- DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: " SC- ��het A' Phone: 9) (au X? Address: lqS CONTRACTOR Name: Ca-Jf7iCWe- fu--\hO` Phone: Address: �O� �lS �n S'y.-k S uttc- zz(- Na�Arv)&ju Supervisor's Construction License: ` CJ,3 S Exp. Date: Home Improvement License: d� O 1 Exp. Date: I Z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED N$925.00 PER S.F. G v� Total Project Cost: $ FEE: $ Check No.: of& Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaralJn�\ty f/u'nd <Si natdie ofcoritracto Sign ---.__.-___--g-=------------ ------ - I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ F WERAGE DISPOSAL ❑ Tanning/MassageBody Art ❑ Swimming Pools❑ Tobacco Sales ❑ Food Packaging/Salesc 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 Conservation Decision: Comments Water &Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 Doc:.Building Permit Revised 2008 I 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 (VOTE: 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 Pian ❑ 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals at the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. one copy and proof of recording :ist be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location 5r(—! 9 No. Date f ' �aRTM TOWN. OF NORTH ANDOVER o AL F s a Certificate of Occupancy $ s„CHUSE<� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �y TOTAL $ Check # 24 5u' 3 Building Inspector NORTH TO" of 10 - : ,. = o , dower, Mass., LAKE _ COCMICMEWICK ^ AORATED P �C2 `s I BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System mow` jwk e BUILDING INSPECTOR THIS CERTIFIES THAT..... r e '\, .............................................................................................................................................. Foundation has permission to erect..............00%4SW T ... ... ......... buildings on ...(CC........ ��.d..... �►�t........%'t. Rough t0 be occupied as................ . ........ ...........lit &V . ....... ........................ Chimney provided that the person accepting this permit shall in every respect conform he 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 r1S& ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOTS Rough ...................... ............................. ................................... 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 SIDE Smoke Det. 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 HaverhX 978-374-7314 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' es be ow described: �l�r /l r Owner's Name...... ... 't.@.ful— irl..l.f�.E?:14�` ...........Telep e#... �..' l...tz�C�.... /}' ��`"'�.Job Address..../7"-J.••..Ai ,S �r�.....�f�..................City...../...V..4.c.. (LQtC..1�G'd~........State.".', .... Specifications: ..//.................................................................................................................................................................................................................. t strip existing shingles�/�) Apply new drip edge to all edges.W 4i te.8l�"* .......... J........................................................................................g........................................................................................................ pply feet ice and water shield membrane to bottom ed es of house. 3 feet ice and water shield membrane in valleys and bottom edges of any unheated areas of house. .......... .......... Apply felt paper underlayment. stall ridge vent to >;0 ti;67 0 AX —T7- 1.........�.1.r ...-..- r..... ......... ............................................................................................ „Reroof using I ; t p: teY shingles with a ._qCi year warranty. ....................................................................................................................................................................... ...........2, ... -03unterflash chimney. --N"ew vent pipe flashing. "'f:egal disposal of all debris. . .. ...... . .................................... ............� ....c. � � . ,...... Area(s)to be worked on: J Jr— 1 �j .....................I...... {:. .... D...�r.`........�j/fit?p S.. J 1. Sl2/....�f i Ci..fjCG� .... .. L� ....�` L ....ln..... .. a./ 1..� .... J.... .yx t'�$...... Gs�a.srL...a. S.rr............ ................0 r-.....:J... �.��..(�.....—'..�.(1.�.�s...C,... ..a �+.. q . Roof board replacement if necessary @ /eMet ol�� /foot. /�.. f� /� ........................................................................................................................1.... j0. I•...L;e . . -- Two Year Workmanship Warranty(Not Transferable) Mknufacturer's Warranty as specifie yir3_anufac urer The c actor agr s to erf, the work andTia.s the materials specified above for the SU of$......... > (0....... ..... ayable, .�s..p�..�:'.........on. ` ,i ........ Payable.../4.tn.a.......••.on.. e .tr .........,,2 alance payable on completion ofjob Owner or Owners are not responsible for Property DaAage or Liability wht boli is 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).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.It is further agreed that this conuad 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).'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: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 cancellatio IN TNESS WHE OF,the parties have hereunto signed their names this...V9....day of.. 20.1t.... Ac 11 pled C v 011.f,1 0A yl Q�/� yy- / t Xtigned....1. C.k. d:rz.�.r. ../.:Yr.1..... Owner Signed............................................................................. Owner David Castricone,President The Commonwealth of Massachusetts t 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 l * Please Print Legiby Name (Business/Organization/Individual): ,UAV I I CAJTRI(oNC AW F i N(s- '• S1 0/l.)(r INL. Address: ZU Cj Su.TTo o ST(t t r`t & :T& Z L� City/State/Zip: No. AN Da,tEfc NA d IiVS Phone #: TA rads 3341 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with @ 4. ❑ I am a general contractor and I 6. ❑Newconstruction employees(full and/or part-time).* have hired the sub-contractors 2.F_1I 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 12.�oof repairs insurance required.]t employees. [No workers' 13.0 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors acid 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. Insurance Company Name: A (2'r1 S Policy#or Self-ins. Lic.#: ill CO Q H9 7 a 3 Expiration Date:__ a _ Job Site Address: �� City/State/Zip: nV 'f7Y l0 � d�r �►j 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 r t/i ai s anti penalties of perjury that the information provided above is true and correct. . Si nature: C .� Date: Phone 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): I. 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 Building Department o . 27 Charles Street North Andover, Massachusetts 01845 (978) 688-9545 Fax (978) 688-954240 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 e'l 1, sl 50a. The debris will be disposed of in/at: 11� L/ Facility location Signature of Applicant Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector, l)Cl"I.(lJlVll( (11' PWIllit: Safm w naei.1144 :111(i Affairs&III. B"""' �Fxl 61'�llll Office ol'Cujisumei Constructioll Supervisor Specialty License '-HOME IMPROVEMENT CONTRACTOR License: CS SL 99358 Registration. 104569 Type: Restricted IL): RF,VVSExpiration: 7114=12 Private Corporatio' DAVID CASTRICONE 01^v. DA " 6CASTRICONE ROOFING, SIDING 5 .� 31 COURT STREET NORTH ANDOVER, MA 01845 ` r David Castrimie 200 SUTTON ST SUITE 226 NORTH ANDOVER, MA 018.45 UuJcrsccrclury ExPl(Allow 12116/2011 /(/1O�D DATE(MMIDDIYYYY) /may r. CERTIFICATE OF LIABILITY INSURANCE 9/29/2010 PRODUCER Phone: 508-651-7700 Fax: 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 II4SURERA:C1 •3tioj-j I)isurance 10274 Davit Castricone Roofing & Siding Inc 114SURERB:CHART IS 200 Sutton St 114SURER C: ::>lllte 226 N,,-:):th Andover MA 01895 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELO'i: 'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOP. THE POLICY PERIOD INDICITED. NOTWITHSTANDING ANY REQUIREMENT, PERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHIC'M THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM', EXCLUSIONS AND CONDITICNS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. LTR NSRQ 1 POLICY NUMBER POLICYEFFECTIVE POLICY EXPIRATION LIMITS , GENERALLIABIUTV EACH-OCCURRENCE $ AT6R COMMERCIAL GENERAL LIABILITY PREMISES(Eao¢wence) $ CLAIMS MADE 7OCCUR MEDEXP(Anyone paison) S PERSONAL&ADV INJURY $ GENERALAGGAEGA'iE $ GEN'LAGGREGATE LIMIT APPLIESPER: PHODUCTS-COMPIOPAGG S POLICY PRO E T LOC A AUTOMOBILE UABIUTY BCNCCV 8/11,12010 8/1i2011 COMBINED SINGLE LIMIT ANY AUTO (Eaactloera) $ 1, C)00, 000 ALL OWNEDAUTUS BODILY INJURY $ X SCHEDULEDAUTUS (Perperson) , HIREDAUTOS BODILY INJURY X NON4DWNEDAUTOS (Peiaccidere) $ PROPERTY DAMAGE S (Per accidern) GAR AGE UABIUTY AUTO ONLY-EA ACCIDENT S ANYAUTO OTHER THAN EA ACC $ AUTOONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR F-1 CLAIMSMADE AGGREGATE $ S DEDUCTIBLE $ RETENTION $ S B WORKERS.COMPENSATION AND WC003989723 9/23/2010 9/23/2011 X WCSTIMIT IF EMPLOYERS'LIABILITY ANY PROPRIETORIPART14ERIEXGCUTIVE E.L_EACHACCIDENT $100, 000 OFFICERIMEMBEREXCLUDED? IIpyS�suiUewWer E.L.DISEASE EA EMPLOYEE $ 1011 000 SPE�:IALPROVISIOIJSUeIOW E.L.DISEASE-POLICY LIMIT $ 5 OTHER 000 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 DATE THEREOF, THE ISSUING INSURER David Castricone Roofing & Siding Inc WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE 201) Sutton St CERTIFICATE HOLDER NAMED TO THE LD•FT, BUT FAILURE TO DO SO Suite 226 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY BIND UPON North Andover MA 0189$ THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) is,ACORD CORPORATION 1988 DATE ACVRHCERTIFICATE OF LIABILITY INSURANCE 9/9/2/9/2'D°""'"' 011 � 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an A60 ONAI INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condhlons of the policy,certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemen s. PRODUCER CONTACT NAME: _ Willows Inauranca Agcy PK NE 978'-475 3414 1 PAZ N9); _- 51 Coehichewik Dr E-sIA16 -- PRODUCER - - CUIPMER in N. �.. North Andover IIA 01845 INUIRER(9)AFFORDING COVERAGE _ NAIC tl INM'RED INSURER A Maiden Specialty Ins Co DAVID CASTRICONE ROOFING & SIDING INC lNa1JRER p: _ 200 Sutton St Suita 226 —... _.._ INSURER E: • NORTH ANDOVER MA 01045 INSURER F: COVERAGES CERTIFICATE NUMBER:CZ119906255 REVISION NUMEIN; THIS 1S 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. bL tWVD POLICY NUMA R W M --- LIMITS FNS'RR' TYPE OF INSURANCE _ POLICY EFF POLICY EKP GENERAL LIABILITY EACH OCCURRENCE S 1000000 X COMMERCIAL GENERAL LIABILITY PREM�ISEy�1Eyerrunen� 4S.__ - .- __5D000 A _ CLAN34AADE I x l OCCUR 00031600 9/06/2011 /6/2012 .O EXP An enceaten +619 1000 -•••- _• ••_ PEFLWNAL6ADV_INJURY 1000000 GENERAL AGGREGATE S 200000_0 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPlOP AGG S 1000000 POLICY PRO --_.. ... __ ._ .. ._.s .. lOC "' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANT AUTO (E,a Iwddont) S ALL OWNED AUTOS BOOILY INJURY(Per penon) S SCHEDULED AUTOS BODILY INJURY(Per sWdenl) 4 HIREDAUTOS PROPERTY DAMAGE g (P&eprJderlU I_ NON-OWNED AUTOS S UMBRELLA LIAB OCCVR EACH OCCURRENCE g '�CEl3LlAe CLAIMS atIILOE AGGREGATE DEDUCTIBLE S RETENTION ; -- — ---- - WORtEaB COMPENSATION S Alto EMPLOYERS'LIABILITY WC$LIMIT GTI{- AWT PROPRIETORIPARTNERIEXECUTIVE YIN' _ .. TI7.RY LIMIT•$ ,•_�EIS OFMER/MEMBER 6XCLUG Q NI A E.L EACH ACCDENT g (Ma,descr In and E.L DISEASE.EA EMPLOYEEIII yes describe under DESCRIPTION OF OPERATIONS blow E.L.DISEASE-POLICY LIMIT ATT OBSCRU'TION OF OPERATIONS I LOCATIONS I VEHICLES (AIIeeh ACORD tot,Addalsnal Remarks Semdule,N men apace Is mqulred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRAT)ON DATE THEREOF, NOTICE WILL BE DELIVERED IN David Cas trtcone Roofing & Siding Inc ACCORDANCE WITH THE POLICY PROVISIONS. Castricone Roofing 200 Sutton Street Suite 226 AUTNOMMR"RESENTATIVE N Andover, MA 01845 J n ACORD 25(2009!09) V '! IN5025(20MM) The ACORD name and logo are registered marksOf DORD CORPORATION. All rights reserved. OR