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Home My WebLink AboutBuilding Permit # 8/15/2016 ... ......... 1 NoRTO BUILDING PERMIT ofIYLEo ,.6 -a TOWN OF NORTH ANDOVER a - APPLICATION FOR PLAN EXAMINATION �44...MkwkR 41e Permit No# � Date Received �� °N LrEo rp�K(�J ss a►c14u$� Date Issued: ORTANT: Applicant must complete all items on this page LOCATION 37 If/c(,J ` AA Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: f ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition [I Two or more family L1 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other ❑'Septic ❑1111e1) ❑ Fioodp[ain D WetlandsWatershedistric r L;VIIatETIS'WE� w w 4 Xp f J J fi / DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: 44AL,) Phone: Address: Contractor Name: �L-0)4 AA-�fcp, &,-11 e Phone: 33,9 �L J 1 Email-.-- Address:. mail:Address: ARSPG lb� U07L � � 6 L V.a:t51 i -- Supervisor's Construction License: Exp. Date: 4 Home improvement License.- -71 � _ Exp. Date: ARCH ITECTIENGI NEER 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: 61 S FEE: $ Check No.: �I t�' Receipt No.: � NOTE: Persons contracting with unregistered ontractors do not have access to thegual^a f nd %AORTH 'g Town of 2 �T: Andover No. ? h C, LAK, h ver, Mass, CocM-CMlw1[.. ti S U BOARD OF HEALTH Food/Kitchen PER T LD Septic System r THIS CERTIFIES THAT BUILDING INSPECTOR ............. . N ..............d .... ........................................................ has permission to erect ....... ................ buildings on .. �t.��, ................................. Foundation �� Rough to be occupied as ..... ..... .......... .... ........ Chimney provided that the person accepting 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CS TION Rough Service .. ..... ................ ....... ..... . BUILDING Fina 1 P TO GAS INSPECTOR Occul2ancE Permit Required to OCCURV 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. SerarcenrtlsBl2 ServiceMaster Elite C�estor� Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 Insured: Ana Rojas Home: (978)242-2630 Property: 37 Riverview Street North Andover,MA 01845 Claim Rep.: Robert Swajian Business: (978)655-4994 Estimator: Dennis Cushing Business: (800)338-5311 Reference: Company: Mass Property Insurance Contractor: Company: ServiceMaster Elite Business: 5Wear Pulaski Street Unit L2 Peabody,MA 01960 Claim Number: 407956 Policy Number: Type of Loss: Fire Date Contacted: 7/24/2016 9:30 PM Date of Loss: 7/24/2016 Date Received: 7/24/2016 9:30 PM Date Inspected: 7/25/2016 4:00 PM Date Entered: 8/2/2016 2:20 PM Price List: MAEMSX_JUL16 Restoration/Service/Remodel Estimate: ROJAS_ANA Source:Fire Deductible Collected Y/N:N Amount: $ ITEL Sent YIN: Date/time&Adj approval for extended dry time: CCAPS LLC, 12 Continental Blvd.Merrimack,NH 03054 TAX ID 26-3242142 S'e,Uicenrtlslm1 ServiceMaster Elite liesla�� Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 ROSAS_ANA Main Level Main Level DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 1. Dempster load-Approx.30 yards,5- 1.00 PA 763 AO 0.00 0.00 763.00 7 tons of debris 0 00 0,00 157.28 2. Haul debris-per pickup truck load- 1.00 EA 157.28 including dump fees Haul away refrigerator appliance due to freon-not able to be placed in dumpster 17.50 $.75 148.75 3. Add for personal protective 8.00 EA 0.00 equipment-Heavy duty 9.44 1.18 20.06 4. Respirator cartridge-HEPA only 2.00 EA 0.00 (per pair) T61 0,00 15.22 5. Respirator-Full Face-multi- 2.00 DA 0.00 purpose resp.(per day) 342.43 0,00 342.43 6. Electrical(Bid Item) 1.00 EA 0.00 Electrician contractor called in to restore power and make safe 9.93 1,446.74 Total: Main Level !aOpens Height:7' Kitchen/Dining Room 393.42 SF Walls232.50 SF Ceiling 232.50 SF Floor 625.92 SF Walls&Ceiling 56.92 LF Floor Perimeter 25.83 SY Flooring71.92 LF Ceil.Perimeter y 2' 6" X 6' $" Door into BEDROOMI 51 X 6t 8rt Opens into FAMILY-ROOM Door 2t V X 6' 8" Opens into HALLWAY Door 2' ll" X 7' Opens into STAIRS Missing Wall Window 2' 6" X 4' Opens into Exterior Door 2' 6" X 6' S" Opens into FRONT-PORCH 2' 6" X b' 8" Opens into BEDROOM2 Door DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 9. Remove Paneling 393.42 SP 0.25 0.00 0.00 98.36 0.00 0.00 219.07 10, Remove 112"drywall-hung, 625.92 SF 0.35 taped,heavy texture,ready for paint 8/10/2016 Page:2 ROJAS.ANA Serr�iceei:tsrWla ServiceMaster Elite Rcslo�ti Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 CONTINUED-Kitchen/Dining Room DESCRIPTION QTY REMOVE REPLACE TAX TOTAL ' 11. Remove Cabinetry-upper(wall) 10.00 LF 6.43 0.00 0.00 64.30 units 0.00 0.00 41.80 12. Remove Cabinetry-lower(base) 6.50 LF G.43 units 0.00 0.00 60.06 13, Remove Countertop-Granite or 13.OQ SF 4.62 MarbleDOD 0_fl0 115.94 14. Remove Granite or marble facade 17.00 SF 6.82 18" granite backsplash on wall 0.00 58.37 15. Sink-single-Detach&reset 0.50 EA 0.00 116.73 Detach only 0.00 17.25 16, Remove Range-freestanding- 1.00 EA 17.25 0.00 electric 0.00 0.00 32.14 17, Remove Refrigerator side by side 1.00 EA 32.14 -22 to 25 cfO.OD 0.00 499.88 232.50 SF 2.15 18, Remove Tile floor covering DOD 162.75 232.50 SF 0.70 D.DQ 19. Remove 112"Cement board DDD 320•$5 20. Remove Underlay ment 112"BC 232.50 SF 1.38 0.00 plywood 0.00 0.00 320.85 21. Remove Underlayment- 114" 232.50 SF 1.38 lauan/mahogany plywood 0.00 0.00 260.40 22. Remove Underlay 314"BC 465.00 SF 0.56 plywood 0.00 0.00 367.35 23. Remove Vinyl floor covering 465.00 SF 0.79 (sheet goods) D DO 0.00 29.75 24. Remove Batt insulation-6"-R19- 119.00 SF 0.25 unlaced batt 0.00 0.00 10.08 28.00 LF 0.36 25, Remove Baseboard-2 114" 0.00 38.76 102.00 LF 0.38 0.00 26• Tear out trim 0.08 0.00 0.00 8.00 27. Remove Vapor barrier-vistlueen- 1Q0.00 SF 6mi1 0.00 0.51 U0 237,15 28. NEPA Vacuuming-Light-(PER 465.00 SF SF) 49.42 2.50 51.92 29. Add for I-IEPA filter(for 1.00 EA 0.00 canister/backpack vacuums) 52,51 0.00 52.51 30. Contents-move out then reset 1.00 EA 0.00 2.50 3,067.54 Totals: Kitchen/Dining Room 8/10/2016 Page: 3 ROJAS_ANA Se 7)iWAJASIN? ServiceMaster Elite Restore Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 Height: 8' Hallway 82.00 SF Walls 16.77 SF Ceiling full""� y 98.77 SF Walls&Ceiling 16.77 SF Floor 1.86 SY Flooring 9.42 LF Floor Perimeter 5,. 14.42 LF Ceil.Perimeter 2' 6" X 6' 8+' Door Opens into KITCHEN DINI Missing Wall 2' 11" X 8' Opens into STAIRS 2' 6"X 6' 8" Door Opens into FAMILY ROOM QTy REMOVE REPLACE TAX TOTAL DESCRIPTION 63, Remove Carpet 1b.77 SF 0.23 0.00 0.00 3.86 65. Remove Carpet pad 16.77 SF 0.10 0.00 0.00 t,68 0.00 5.54 Totals: Hallway hron[Yarclt Height:7' Bedroom2 229.93 SF Walls124.26 SF Ceiling 354.18 SF Walls&Ceiling124.26 SF Floor IP 13.81 SY Flooring32.61 LF Floor Perimeter 37.61 LF Ceil.Perimeter I Door 2' 6" X 6' 8" Opens into BATHROOM 2'6" X 6' g'+ Opens into KITCHEN_DINI Door Missing Wall 6' 8 314" X 7' Opens into SAY DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 124.26 SF 0.23 66. Remove Carpet 0.00 0.00 28.58 124.26 SF 0.10 0,00 0.00 12.43 67, Remove Carpet pad 0.00 41.01 Totals: Bedroom2 8/10/2016 Page: 4 ROJAS-ANA 5'et'vicetpfss7�,t ServiceMaster Elite nesfolt Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 Height:7' 3'6" �g•�-+ Bedrooml 176.44 SF Ceiling a 289.81 SF Walls 176.44 SF Floor 466.25 SF Walls&Ceiling Bedrooml 40.81 LF Floor Perimeter Ci 1> 19.60 SY Flooring 3,6„ 53.31 LFCeil.Perimeter TT Chase 2' 6" X 6' S" Opens into NURSERY Door 6 X 6 $ Opens into KITCHEN_DINI " , ,1 Door 2 6 X 6 8 Opens into BATHROOM Door Ki Height:7' 2'1„* Subroom: Closet(1) r a 15.17 SF Ceiling i 112.50 SF Walls 127.67 SF Walls&Ceiling 15.17 SF Floor 1.69 SY Roaring 15.83 LF Floor Perimeter s 20.83 LF Ceil.Perimeter 5'X 6' 811 Opens into BEDROOMI Door TAX TOTAL QTY REMOVE REPLACE DESCRIPTION 44.07 68. Remove Carpet 191.61 SF 0.23 0.00 0.00 69. Remove Carpet pad 191.61 SF 0.10 0.00 0.00 19.16 0.00 63.23 Totals: Bedrooml Height: 7' Front Porch 428.96 SF Walls 123.21 SF Ceiling GN-i^ 123.21 SF Floor X61 e�nn 552.1.7 SF Walls&Ceiling z s 2 er_ 13.69 SY Flooring 63.90 LF Floor Perimeter q 2 68.90 LF Ceil.Perimeter Window 2'6" X 4' Opens into Exterior 2'6" X 4' Opens into BATHROOM Window 2' 6" X 6' S" Opens into I�ITCHEN_DiNI Door Door 2' 6" X 6'8" Opens into Exterior 8/10/2016 Page: 5 R0JAS_ANA Serr�icen�l,srr�,a ServiceMaster Elite Restore Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 CONTINUED-Front Porch DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 5$. Remove Suspended ceiling tile-2' 123.21 SF 0.19 0.00 0.00 23.41 x 4' 0,00 0.00 20.95 61• Remove Suspended ceiling grid- 123.21 SF 0.17 2'x 4' 0.00 0.00 41,89 62. Remove Batt insulation- 12"-R38 123.21 SF 0.34 -paper faced 0.00 86.25 "Totals: Front Porch a Height: 17' Stairs ;Room 174.83 SF Walls 20.17 SF Ceiling 200,01 SF Walls&Ceiling 44.60 5F Floor lairs 4.96 SY Flooring 19.97 LF Floor Perimeter 13.83 LF Ceil,Perimeter 2' 11" X 17' Opens into HALLWAY Missing Wall 2' 11" X 17' Opens into KITCHEN_DINI Missing Wall TOTAL QTY REMOVE REPLACE TAX DESCRIPTION 10.26 70. Remove Carpet 44.60 SF 0.23 0.00 0'00 71. Remove Carpet pad 44.60 SF 0.10 0.00 0.00 4.46 0.00 14.72 Totals: Stairs Height:7' Nursery 9 115.09 SF Ceiling 280.55 SF Walls c''°`e o 395.64 SF Walls&Ceiling 115.09 SF Floor F3'°�1 Nursery Fvr 12 79 SY Flooring 39.72 LF Floor Perimeter C1 47.22 LF Ceil.Perimeter 2' 6" X 6' 8" Opens into ROOM1 Door Door 2' 6" X 6' 8" Opens into FAMILY ROOM 2' 6"X 6' 8" Opens into BEDROOMl Door TOTAL QT REMOVE REPLACE TAX DESCRIPTION Pa6 8/10/2016 Page: ROJAS_ANA Scruicenr l.slzir ServiceMaster Elite ltestort Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 CONTINUED-Nursery DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 72. Remove Carpet 115.09 SF 0.23 0.00 0.00 26.47 73, Remove Carpet pad 115.09 SF 0.10 0.00 0.00 11.51 0.00 37.98 Totals; Nursery allWa Height:7' Family Room t1r, -sX a5" 225.26 SF Walls108.02 SF Ceiling 333.28 SF Walls&Ceiling 108A2 SF Floor rily Room 12A0 SY Flooring 31.70 LF Floor Perimeter 6 41.70 LF Ceil.Perimeter lF'3" F lS'7� Door 2' 6" X 6' 8" Opens into NURSERY 2' 6" X 6' 8" Opens into HALLWAY Door Opens into KITCHEN_DINI Door 5'X 6' 8" QTY REMOVE REPLACE TAX TOTAL DESCRIPTION 74, Remove Carpet 108.02 SF 0.23 b.00 0.00 24.84 0.00 0.00 10.80 75. Remove Carpet pad 108.02 SF 0.10 0.00 35.64 Totals: Family Room 12.43 4,798.65 Total:Main Level Basement Height: 616" iBasement 652.13 SF Walls 564.23 SF Ceiling 1,3 ! 1,216.36 SF Walls&Ceiling 564.23 SF Floor E 100.33 LF Floor Perimeter 62.69 SY Flooring 100.33 LF Ceil.Perimeter � -T 2'7 15/16" X 6' Or Opens into STAIRS Missing Wall DESCRIPTION QTTAX TOTAL V REMOVE REPLACE 8/10/2016 Page:? ROJAS_ANA SerUicehl t,5a13�{ ServiceMaster Elite Restore Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 CONTINUED»Basement QTY REMOVE REPLACE TAX TOTAL 11ESCRIPTION 143.88 33. HEPA Vacuuming-1,ight-(PER 282.11 SF 0.00 0.51 0.00 SF) Loose debris fell through floor planking 0.00 160.69 76. Equipment setup,take down,and 3.50 HR 0.00 45.91 monitoring(hourly charge) Setup equipment for drying on 07/28/16 and recover equipment on 08/02/16 0.00 137.73 45.91 77. Equipment setup,take down,and 3.00 HR 0.00 monitoring(hourly charge) Follow up on 07/29/16 and 08/01/16 0.00 249.50 49. Air mover(per 24 hour period) 10.00 EA 0.00 24.95 No monitoring 5.00 EA 0.00 101.25 0.00 506.25 50. Dehumidifier(per 24 hour period)- XLarge-No monitoring 0.00 1,198.05 Totals: Basement 0.00 1,198.05 Total:Basement Content QTY REMOVE REPLACE TAX TOTAL DESCRIPTION 0.00 38.50 0.00 558.25 55. Inventory,Packing,Boxing,and 14.50 HR Moving charge-per hour 7.25 HR 0.00 48.20 0.00 349.45 56, Contents Evaluation and/or Supervisor/Admin--per hour 0.00 3.52 17.82 302.94 57. Plastic bag-used for disposal of 81.00 EA contaminated items Bags used to place content after inventory for disposal 17.82 1,210.64 Totals: Content Labor Minimums Applied DESCRIPTION QTY REMOVE REPLACE TAX. TOTAL 1.00 EA 0.00 180.32 0.00 180.32 60. Acoustic ceiling the labor minimum 21.89 0.00 21.89 64. Carpet labor minimum 1.00 EA 0.00 202.21 0.00 Totals: Labor Minimums Applied s/10/2016 Page: $ ROJAS_ANA Ser r�icenr�,tr�rr ServiceMaster Elite Reslol e Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax 1D#26-3242142 30,25 7,409.55 Line Item Totals:ROJAS_ANA Grand Total Areas: 5,465.75 SF Walls 2,385.65 SF Ceiling 7,851.40 SF Walls and Ceiling 2,432.36 SF Floor 270.26 SY Flooring 774.03 LF Floor Perimeter 0,00 SF Long Wall 0.00 SF Short Wall 857.49 LF Ceil.Perimeter 2,432.36 Floor Area 2,589.80 Total Area 5,014.56 Interior Wall Area 344.91 Exterior Perimeter of 2,665.78 Exterior Wall Area Walls 0.00 Surface Area uo Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length Coverage Item Total % ACV Total % Dwelling 6,501.85 87.75% 6,501.85 87.75% Other Structures 0.00 0.00% 0.00 0.00% Contents 907.70 12.25% 907.70 12.25% Total 7,409.55 100.00% 7,409.55 100.00% 8/10/2016 Page: 9 ROJAS ANA .gL1.1)iWA4A37T111 ServiceMaster Elite Reslor, Massachusetts Divisor 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 Summary for Dwelling 6,471.60 Line Item Total 30.25 Material Sales Tax $6,501.85 Replacement Cost Value $6,501.85 Net Claim Denni Cushing 8/10/2016 Page: 10 ROJAS_ANA ServicavASr1,11r ServiceMaster Elite Resrw� Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Pax: 800.443.1819 Tax ID#26-3242142 Summary for Contents 90 .70 Line Item Total $907.70 Replacement Cost Value $907.70 Net Claim d 3� jDe-nnis Cushing 8/10/2016 Page: 11 ROJAS_ANA Set t)ieenrnsTUR ServiceMaster Elite Rerlare Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 Recap of Taxes Clothin Sales Tax(6.25%) Storage Tax(6.25%) Material Sales Tax(6.25%) g 0.00 0.00 30.25 Line Items 0.00 30.25 0.00 Total 8/10/2016 Page: 12 ROJAS_ANA Serulcemslu ServiceMaster Elite Restore Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 800.443.1819 Tax ID#26-3242142 Recap by Room Estimate:ROJAS—ANA 1,436.81 19.47% Area: Main Level 1,436.81 Coverage:Dwelling 100.00% = 3,065.04 41.54% Kitchen/Dining Room 3,065.04 Coverage:Dwelling 100.00% = 5.54 0.08% Hallway 5.54 Coverage:Dwelling 100.00% _ 41.01 0.56% Bedroom2 Coverage:Dwelling 100.00% = 41.01 63.23 0.86% Bedrooml 63.23 Coverage: Dwelling 1Q0.00% 86.25 1.17% Front Porch 86.25 Coverage: Dwelling lOQ.00% _ 14.72 0.20% Stairs 14.72 Coverage: Dwelling 100.00% _ 37.98 0.51% Nursery 37.98 Coverage: Dwelling 1Q0.00% = 35.64 0.4$% Family Room 35.64 Coverage:Dwelling 100.00% _ 4,786.22 64.86% Area Subtotal: Main Level Coverage:Dwelling 100.00%a = 4,786.22 Area:Basement 1,198.05 16.24% Basement 1,198.05 Coverage:Dwelling 100.00% _ 1,198.05 16.24% Area Subtotal: Basement 100.00% = 1,198,05 Coverage: Dwelling 1,192.82 16.16% Content 285.12 Coverage:Dwelling 23,90% _ 76.10% = 907.70 Coverage: Contents 202,21 2.74% Labor Minimums Applied 202.21 Coverage: Dwelling 100.00% _ 7,379.30 100.00% Subtotal of Areas o 6,471.60 Coverage:Dwelling 87.7010 = Coverage:Contents 12.30% = 907.70 8/10/2016 Page: 13 ROJAS_ANA Ser vrceerns7rrrr ServiceMaster Elite Reshwe Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Fax: 900.443.1819 Tax ID#26-3242142 7,379.30 100.00% Total 8/10/2016 Page: 14 ROJAS_ANA ServlcOVASlrx ServiceMaster Elite Restore Massachusetts Divison 12 Continental Blvd Merrimack,NH 03054 Office: 800.338.5311 Bax: 800.443.1819 Tax ID#26-3242142 Recap by Category Total % Items 180.32 2.43% ACOUSTICAL TREATMENTS 1$0.32 Coverage:Dwelling @ 100.00% _ 52.51 0.71% CONTENT MANIPULATION 52.51 Coverage:Dwelling @ 100.00% _ 907.70 1.2.25% CONT:PACKING,HANDLNG,STORAGE 907.70 Coverage: Contents @ 100.00% _ 3,872.24 52.26% GENERAL DEMOLITION 3,872.24 Coverage: Dwelling @ 100.00% = 342.43 4.62% ELECTRICAL 342.43 Coverage: Dwelling @ 100.00% _ 21.$9 0.30% FLOOR COVERING-CARPET 21.89 Coverage: Dwelling @ 100.00% _ 840.25 11.34% HAZARDOUS MATERIAL REMEDIATION 840.25 Coverage: Dwelling �+ 100.00% _ 58.37 0.79% PLUMBING 58.37 Coverage: Dwelling @ 100.00% = 1,103.59 14.$9% WATER EXTRACTION&REMEDIATION 1,103.59 Coverage: Dwelling @ 100.00% = 7,379.30 99.59% Subtotal 30,25 0.41% Material Sales Tax 30.25 100 Coverage: Dwelling @ .00% _ 7,409.55 100.00% Total 8/10/2016 Page: 15 ROJAS_ANA ement 27' 7" 26' 11" i 3' En Basement ca Stairs $asement $11012016 Page: 16 ROIAS_,.ANA in Level 30' 29'4" Front Porch t--6'6" 6'3., 2'9r,�_6,9"-- 2'2 10'7 Bathroom Bedroom2 a o M 14'5" — 4'--'Mtchen/Dining Roo M M 04 V M BedroomlM,, s(qo 00 al 9'3" 10' 11.3,. Chase `O b i Nursery Family Room 3'5" M Closetl 14 Main Level 911012016 Page: 17 ROJAS ANA I Floor 30' F- 61511 "6' S" 22' Closet (1) a` cn Master Bedroom N Bathroom T , g„ m 16' 8" 2' 8t, t � � 23, - N � 3' 10, 111, � � M closet (A) ,o T ' Chs ON3 1 � 1 —! Son's Bedroom Guest Rooms - - cove (2)� Close Q` cy oset24 rnl 3' 11` 711 `V 26' 9" 2nd Floor ROJAS ANA 8/10/2016 Page: 18 Th8 Commonwealth gf.Massachusetts Department ofindlustrialAcctdents 1 Congress street,Suite 104 f Boston,MA 0211421117 www.rM,ss:gov/dza Workexs'CompenTo on I� ce T S GED HE PERAUTTJNG AUTHO TY.txzczansll'�rYmbers. . Please Print Le `bl A licant inform.ationt Nam (Business/orgavizationgndividual.): 1 -� A dross: 1a uw-- '� - / CxylState/Zip: / l CYQ ��1 /I 0Phone#: A,reyou 2n emplayerF Cbeekflie ap�ropriafe box: Type of project()Vequirbd): 1. [I am a employervvith employees(full and/orpart lime). 7. Now corisfrtlotion 2.0I am a sole proprietozorpartaership andhavc no employees nvorking for me in 8. Rerrtoclelirig any capacity.[No workers'comp.insurance required.] g. Demolition J❑lain a homeowner doing all Workmyself[No workers'camp..insurance zequised.l t 0 Building addition 4.Q I am a homeowner and will ba hiring contractors to conduct:all work on ray property. I Will ensure that all contractors either haVe,WorIrers'Compensation insurance or are SDIa 11.0 Electrical spalls or additions proprietors-withno employees. 12: Plumbing repairs or additions a 5.0 I2m,ageneral contractor and T hate hired the sub-eontractazs listed onthe attachedsheet. 1 g.�0,'Roof TBpa33s These sub-contractors)ave eziiployees andhaveworkers'comb.insurance-T a 14.El Otb.er 6.0 We are a cozp=49n Pd its of cern have exercised their rigTrt of exemption perMCrL c. 152,§I(4},andvrehaven0.,enoployeers.[ oworkers'comp.insurance required.] Any appiicauttbat cheoks box 4l must alsofill outthe section belowshowing their Workers'compensationpolicy information i ITameowners mho s6lina ifla&affidavit indicating they are doing all work and than bira outside contractors must s4bmit a now ai'fidavzl indicating such Contractors that aheclEthis box must'attacJed an additional sheet showing the name ofthe sub-contractors and sfafo whether oz of(hose entities have employees. Ifthe sub-6riUc6have employees,fIiey,must provide their workers'comp.policy number. V' lain an employerthat isprovid'hgworkers'compensation insr�rancefor my employees'Below is thepalicy am yob site in orination. LGA ��. �JC'c�- Insurance Company Name. Policy#k or Self ins.Lac.A ExpirationDate•� y �� rob Site Address- GJ I �" c City/State/Zip: Attach a copy o£theYorlcers' compensation policy declaration page(showingthe policy number and expiration date). Failure to secure coverage as requixed under MGL o. 152, §25A is a criminal violation punishable ley a fne up to$x,500.00 and/or oozeyear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.0 0 a statement may be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this coverage verification. x do hereby certify under tliepains and penalties ofpelp.�ry that the infarmatiorx provided above i3 true and correct Date: Siggat>zre: Phone#: Official use only. Do not1vrite in this area,to he completed by city or toren official City or Town: I?ermitlLfceztse# Issuing Authority(circle one): i I.Board of Health 2,.Building 1Department 3.City/Town CIerk 4.Electrical Inspectax 5.Plumbing inspector 6.other Contact Person'. Phone : CCAPLLC-02 AMORSE DATE(MWDDIYYYY) ,4�o�IzaA CERTIFICATE OF LIABILITY INSURANCE 812()12015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER.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 uire an endorsement. A statement on this certificate does not confer rights to the the terms and conditions of the policy,certain policies may req certificate holder in lieu of such endorsement(s). CONTACT PRODUCER License#AGR8150 NAMES Ann Morse -.- - —_.. — Clark insurance PHaNE 603 B22 2855 1 C Na)_(603)622-2854 80 Canal St EMAIL info clarkinsurance.com Manchester,NH 03101 ADDREss ., �.—__ —.._---_.._.... .. —.. _. —.. INSURERS)AFFORDING COVERAGE NAIC .-.- - _ 24198 �NsuRRA Peerless insurance _ —....-. 24171 ---—._. iNsuRER B:Netherlan s INSURED -- .,, _.—_... ...--- -.......-- CCAPS,LLC dba Service Master Elite&MAJE,LLC dba Elite INSURER C:Nautilus Ins Co Construction INSURER D:__ 12 Continental Blvd INSURERE� ..- Merrimack,NH 03054 — 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 POLECY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOGUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN 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. ... _ —.. _ __ —" POLICY EFF pOLIGY EXP . — — LIMITS bD SUBR ... tL7R TYPE OF INSURANCE INSD WVD POLICY NUMBER MMlDD1YYYV MMIDD(YYYY 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $,—_-, C13P8869089 08!2912015 0812912016 MAGA Tb RENTT l5 100,000 CLAIMS-MADE OCCUR PREMISES,-(Ea Occurrence $ , MED EXP(Any ,one person) $ 5,000 10()0,000 - ---- PERSONAL 8,ADV INJURY $ ' GENERAL AGGREGATE — __ , __ GEN'L AGGREGATE LIMIT APPLIES PER: -- 2000,000 PRO- PRODUCTS-COMPIOPAGG $ 2,000,000 _ POLICY�X]JECT C1 LOC $ OTHER: COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY X ANY AUTO BA8867299 08129!2015 08129/2016 BODILY INJURY(Per person) $ _ - -- ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE— $ .` NON-OWNED Per acddent] X HIRED AUTOS X AUTOS $ EACH OCCURRENCE $ 10,000,00 X UMBRELLA LIAR X OCCUR A EXCESS LIAB CLAIMS-MAGE CU8862891 08/2912015 08129!2016 AGGREGATE - ,,. $,,,.__ 10000,000 DED X RETENTION$ 10,000 PER OTH- WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY YIN WC8994621 08!2912015 08/2912016 E.L,EACH ACCIOENr _ $ _ 1,00(),0()() A ANY PROPRIETORIPARTNERIEXECUTIVE F1 N I A D 1,000,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYE $ (Mandatory In NH) 1,000,000 IT yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 2,000,000 C' ContractorsPollution CCP201258311 08!29!2015 0812912016 Each Occurrence CCP201258311 0812912015 0812912016 Includes Mold C Liability DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Alan DeGeorge&Matt Troyer are excluded from Workers Compensation coverage. 3A States: NHIMAIMENTINY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CCAPS,LLC ACCORDANCE WITH THE POLICY PROVISIONS. 12 Continental Blvd Merrimack,NH 03054 AUTHORIZED REPRESENTATIVE 1. O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and Toga are registered marks of ACORD ► vJ : = Officc of Consumer Affairs (n'd(�-DB/u&sinZess Regu anon _ 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement.Contractor Registration Registration: 165712 Type: Supplement Card Expiration; 3/22/261 a MADE LLC.Idba Elite Construction ALAN DEGEORGE 12 CONTINENTAL BLVD MERRIMACK, NH 03054 "- - Update Address And return card.Nlark reason for change. Address ❑ Renewal L Employment — Lost Card SCA 1 0 20M-05111 ��e`�cruarrrr.,rrmerrll�n/rG'��La.;.lrm�a7�/!d free of Consumer Affairs&Business Regulation License or registration valid for individual use only -= before the expiration date. 1f found return to: OME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regulation Registration165712 Typo= 10 Park Plaza-Suite 5170 ` 4 Explratlpn:- 3122120.18 Supplement Card Boston,MA 021 l6 MAJE LL.CJdba EI1te.constructton ELITE CONSTRUCTJON ALAN DEGEORGE 12 CONTINENTAL BLVD MERRIMACK,NH 03054 Undersecretary Hat valid without sign Pure Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-106109 Construction Supervisor ALAN DEGEORGE 12 CONTINENTAL_BLVD MERRIMACK NH 03064 V Expiration: Commissioner 03/1612018 0 i J Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation ofthis license. DPS Licensing information visit: WWW.MASS.GOVfDPS