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HomeMy WebLinkAboutBuilding Permit # 11/28/2016 �.--_ � NORTy q BUILDING PERMIT ° �TL�o do TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION41 ; :a Permit No#: : � ! Date Received 1 +rE� ��SsaCHus�� Date Issued: /C IMPORTANT Applicant must complete all items oar this page r � -yr`::y'v E ',,n��� �^✓ ti'f4Fj." �t`�,:'" �� ����< 54..r Irl Fy'rl`^v-S ������ls /�L�` N:;. ,,. c,�/�. .. k ,...,:,tea v .. ;;: s u .c Y, c"'. ,,;,.r^-,,�Y��� y✓ra�":� 'N < J�,v�r� �'.;!"° ':� r „�w Y .r'�,�a �r:�.-.-�,�"� S<. �„ r e c ✓x; l'/" ,c •a 4PC#nt fi ��s �,�� v ss�� �� �5' �/G�n nd/ ',1 r <a :'�,,.�/� �:..4 ���w^ � 3" '.. `u,2�...^w.wr.c',✓'<'w4 �'.',,. �/{`,W �, ., .,... �.,-✓ y��s;r�:�,L'3a�c ,e�� �-"�.r� 'r '°l.�z, ✓,=^r�' z� �" :✓ ^!r"''j—y .:C"e J�„ �/ r r-<.-" F k- ��+'.�'r-a�.rrr dr", ��s > _ '. :;y �vx' y< n < r43i�' 5trduiS �f fnQ y✓"' ' ✓,:':/ /" �Jr�2z, „ 4 F^`i,,,� ,.,w ^-,. c^ � ,,. rr�U]t "C'r r l yra �, d� � fir^� �. ' r ✓^". - 013NG IDISTRIGTy[StOrIC DlstrfCt ..Y PARCEL p�s Fr r Maciue ShaV�IIa e� demo TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family F1 Industrial [I Alteration No. of units: [ mmercial ❑ Repair, replacement ❑ Assessory Bldg 11 Others: emolition ❑ Other Septic ❑ 1lVell Flaadpla[nflIlJetlartds ® ll�latershed ©�str�ct SCRIPTION OF WORK TO BE PERFORMED: 1 O e , lt4 C'.* Identification- Please Type or Print Clearly OWNER: Name: •aC Phone: Address: �. Contractor Name Phon ✓ /2 � C Small r � r y r ` AddreSSF ���� r F � 4 a .. . .✓ .- .r r � � � � l�X ❑ate !� a K,,//: '`�, 5apertsor's Costruct[on L}cense P , _Y r "/-� a?� o- F r r ��� rl rsr ✓' / ate 4 ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S-F. Total Project Cost: $ l Dv9 /S- FEE: $ Check No.: 9 0C, Receipt No.: t NOTE: Persons contracting with unregistered contractors do not have access to!P, guarantyfund S[ nature of con trap tor` S[grjature o. V0 g.- 'T et®RTfy own of 0 i 0 ffi ?, h ver, Mass, _�� ,0 � 6 T O LAKE totfilL HE wtR y1' U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Cr.fC. ..N BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on . ...,..... ,/ ....*.,7......, + Rough . as sk .... / U . + glial,. t0 be occupied as R."..ave..... .... ..... ....... ....,......... ...... ...,......,... ., ......... ........... 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. ���i�� Te ' PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT TA Rough Service .,....... .. .,.. . ..... .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occu anc Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. • • • Authorization to Perform Services and Direction of Payment ........ Mike Charron 11/14/2016 Customer Name: Date of Loss: Loss Address: 109 Main Street City: NORTH ANDOVER State: MA Zip: 01845 Insurance Company: Self Pay Claim Number(if available): The undersigned Customer, being the building owner, owner's representative, or resident, authorizes the Provider identified below to perform any and all necessary cleaning and/or restoration services on Customer's property located at the property address above, and with respect to items that need to be cleaned at a remote location to remove and clean such items as necessary, Customer authorizes self Pay Insurance Company, herein referred to as "Insurance Company,"to pay Provider solely and directly for that portion of the work covered by Customer's insurance policy. If, for any reason, Customer receives a check from Insurance Company made payable to Customer, Customer agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Customer hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Customer's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Customer agrees to pay Customer's deductible in the amount of$ $0.00 that applies to this claim. If any amounts owing to Provider for Provider services are not covered by insurance, Customer agrees to pay those amounts to Provider within fifteen (15) days of Customer's receipt of invoice. It is fully understood that Customer and its agents, successors, assigns, and heirs are personally responsible for any and all deductibles and any costs not covered by insurance. Interest and finance charges will be charged at the maximum allowable by law, or at 1.5% per month, whichever is less, on accounts over thirty(30) days past due. Time is of the essence. Customer agrees that Provider is working for the Customer and not Customer's insurance company or any agent/adjuster. Property Owned By: Mike Charron Remarks: 1 HAVE READ THIS AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT, INCLUDING THE TERMS AND CONDITIONS OF SERVICE ON THE NEXT PAGE HEREOF, AND AGREE TO SAME, Customer Reviewed Customer Information Form: O Y ON Provider's Signature: ^ Customer's Signature: Franchise Legal Name: KEJO CORP Mike Charron ® The Andovers Printed Name: d/bla SERVPRO of: Date: 11/1412016 Date: 11/14/2016 E-mail Address: mike@themegcompanies.com Contractor License#: ©SERVPRO®INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-0517071,0 28000 05116 Each SEH KPRO"franchise is Independently Owned and Operaled Authorization to Perform Services and Direction of Payment Terms and Conditions of Service READ CAREFULLY Note; This Contract includes a limitation of liability and limitation of remedies. 1. SERVPROffi is one of the largest nationwide Cleaning and Restoration Franchise Systems in the United States.The SERVPRO®Franchise owner identified on the front of this Contract(the"Provider')is an independent contractor who agrees to perform the services identified on the front of this Contract(the"Services').Client agrees to purchase,receive,and pay for the Services pursuant to the terms and conditions of this Contract. Servpro Industries,Inc.,the Franchisor,is not a party to any agreement with Client,is not a guarantor of the Provider's Services,and is not subject to liability arising out of such Services. 2. Provider's performance of the Services is limited by,among other things,the pre-existing conditions and characteristics of the premises,material, fabrics,furniture,and/or other items.PROVIDER EXPRESSLY DISCLAIMS ANY RESPONSIBILITY OR LIABILITY FOR ANY PRE-EXISTING CONDITIONS.Client shall retain responsibility and shall be liable for all effects of and costs necessary to correct such conditions,including,by way of example and not limitation,the conditions Identified below: (a) Provider may,in its sole discretion,pre-test materials for removability of spots or stains;dye or color fastness;shrinkage;fading;adhesive breakdown;or other problems.It is not always possible to determine these conditions in advance. PROVIDER DOES NOT GUARANTEE SPOT OR STAIN REMOVAL AND COLOR FASTNESS OR PREVENTION OF SHRINKAGE, FADING,OR ADHESIVE BREAKDOWN. (b) Provider DOES NOT GUARANTEE that wall and ceiling cleaning will restore the original color to painted surfaces. (c) Not all fabrics are conducive to cleaning.Provider shall use reasonable efforts to advise Client of any adverse effects which may be reasonably foreseen due to the nature of the fabric or material involved.PROVIDER DOES NOT GUARANTEE THAT SUCH MATERIALS CAN BE CLEANED OR THAT THERE WILL BE NO ADVERSE EFFECTS FROM ANY ATTEMPT TO CLEAN SUCH FABRICS. (d) A variety of materials are used in the manufacturing,upholstery and/or installation process.These materials include backing,lining,tacks,or other unknown substances that may cause discoloration or other adverse effects to the face material.Client acknowledges that it is impossible to determine when such adverse effects may occur and PROVIDER DOES NOT GUARANTEE AGAINST SUCH ADVERSE EFFECTS. (e) Client acknowledges and agrees that mold is commonly found throughout the environment and that it is impossible to eradicate mold, PROVIDER DOES NOT GUARANTEE THE REMOVAL OR ERADICATION OF MOLD. (f) Client acknowledges and agrees that limited photographs or video of the damage and cause may be made solely for work process and insurance claims purposes. 3. PROVIDER SPECIFICALLY DISCLAIMS ANY AND ALL OTHER WARRANTIES AND ALL IMPLIED WARRANTIES(EITHER IN FACT OR BY OPERATION OF LAW)INCLUDING,BUT NOT LIMITED TO,ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR ANY IMPLIED WARRANTY ARISING OUT OF A COURSE OF DEALING,CUSTOM OR USAGE OF TRADE. THIS CONTRACT PROVIDES FOR THE PROVISION OF SERVICES AND DOES NOT PROVIDE FOR A SALE OF GOODS. a. Limitation of Liability: IN NO EVENT SHALL PROVIDER,ITS OWNERS,ANY OFFICERS,DIRECTORS,EMPLOYEES,OR AGENTS, FRANCHISOR,OR AFFILIATES BE RESPONSIBLE FOR INDIRECT,SPECIAL,NOMINAL,INCIDENTAL, PUNITIVE OR CONSEQUENTIAL LOSSES OR DAMAGES,OR FOR ANY PENALTIES,REGARDLESS OF THE LEGAL OR EQUITABLE THEORY ASSERTED, INCLUDING CONTRACT, NEGLIGENCE,WARRANTY,STRICT LIABILITY,STATUTE OR OTHERWISE,EVEN IF IT HAD BEEN AWARE OF THE POSSIBILITY OF SUCH DAMAGES OR THEY ARE FORESEEABLE; OR FOR CLAIMS BY A THIRD PARTY.THE MAXIMUM AGGREGATE LIABILITY SHALL NOT EXCEED THREE TIMES THE.AMOUNT PAID BY CUSTOMER FOR THE SERVICES OR ACTUAL PROVEN DAMAGES,WHICHEVER IS LESS,IT IS EXPRESSLY AGREED THAT CUSTOMER'S REMEDY EXPRESSED HEREIN IS CUSTOMER'S EXCLUSIVE REMEDY,THE LIMITATIONS SET FORTH HEREIN SHALL APPLY EVEN IF ANY OTHER REMEDIES FAIL OF THEIR ESSENTIAL PURPOSE.Some states/Gauntries do not allow the exclusion or limitation of incidental or consequential damages,so the above may not apply to you. 5. Should Provider bring legal action to collect monies due under the Contract or should the matter be turned over for collection,Provider shall be entitled,to the fullest extent permitted under law,to reasonable legal fees and costs of any such collection attempt,in addition to any other amounts owed by Client.This attorney fee provision shall not be effective or enforceable in jurisdictions where attorney fee provisions are made reciprocal or invalid by operation of law.Consent is hereby given for filing of mechanic's liens by Provider for the work described in this contract on the property on which the work is performed if Provider is not paid. 6. Any labor,materials or other work beyond that identified in this Contract shall require a written amendment to this Contract and will result in additional charges. 7. Any claim by Client for faulty performance,for nonperformance or breach under this Contract for damages shall be made in writing to Provider within sixty(60)days after completion of services.Failure to make such a written claim for any matter which could have been corrected by Provider shall be deemed a waiver by Client. NO ACTION, REGARDLESS OF FORM,RELATING TO THE SUBJECT MATTER OF THIS CONTRACT MAY BE BROUGHT MORE THAN ONE(1)YEAR AFTER THE CLAIMING PARTY KNEW OR SHOULD HAVE KNOWN OF THE CAUSE OF ACTION. 8. A failure of either party to exercise any right provided for herein shall not be deemed to be a waiver of any right hereunder. 9. CLIENT AND PROVIDER EACH WAIVE THEIR RESPECTIVE RIGHTS TO A TRIAL BY JURY WITH RESPECT TO ANY AND ALL CLAIMS OR CAUSES OF ACTION(INCLUDING COUNTERCLAIMS)RELATED TO OR ARISING OUT OF OR IN ANY WAY CONNECTED TO THIS CONTRACT AND AGREE THAT ANY CLAIM OR CAUSE OF ACTION WILL BE TRIED BY A COURT TRIAL WITHOUT A JURY. 10. if any provision of this Contract is found to be ineffective,unenforceable or illegal for any reason under present or future laws,such provision shall be fully severable,and this Contract shall be construed and enforced as if such provision never comprised a part of this Contract.The remaining provisions of this Contract shall remain in full force and effect and shall not be affected by the ineffective,unenforceable or illegal provision or by its severance from this Contract. 11. No modification,termination,or attempted waiver of this Contract shall be valid unless in writing and signed by the party against whom the same is sought to be enforced. SERVPRO®Franchisees are always looking for motivated employees. SERVPRO's individually owned and operated franchises offer a variety of positions including crew chief, production technician, marketing representative,administrative assistant,and many more. 28000 05/1.6 LacIT SF.RVPRO'"Franchise is hrdepwrdend),Owned and Operated. Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office @ servprooflawren ce,co m PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Client: Charron,Mike(Main St.) Home: (603)759-4609 Property: 109 Main St. North Andover,MA 01845 Operator: STEVEN Estimator: Steven Fumero Business: (978) 688-2242 Company: SERVPRO Of Lawrence-SERVPRO Of The E-mail: steven@servprooflawrence. Andovers- SERVPRO Of Salem/Plaistow com Business: 8 Blakelin St. Lawrence,MA 01840 Type of Estimate: Water Damage Date Entered: 11/16/2016 Date Assigned: Price List: MAEM8X SEP16 Labor Efficiency: Restoration/Service/Remodel Estimate: 2016-11-16-2258-1 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salcm/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax 1D##02-0353691 2016-11-16-2258-1 Main Level a R° Barber Office 1 Height: 8' - 278.67 SF Walls 75.54 SF Ceiling B bei LS': : 34.83 354.21 SF Walls&Ceiling 75.54 SF Floor 8.39 SY Flooring 34.83 LF Floor Perimeter LF Ceil. Perimeter 8'6 ----,� DESCRIPTION QUANTI`T`Y UNIT PRICE TAX RCV DEPREC. ACV 1. Tear out wet drywall,cleanup,bag-after business 17,42 SF 1.12 0.21 19.72 (0.00) 19.72 hours 2. Remove Cove base molding-rubber or vinyl,4" high 17.42 LF 0.25 0.00 4.36 (0.00) 4.36 3. Drill holes for wall cavity drying-after hrs 15.00 EA 0.75 0.00 11.25 (0.00) 11.25 4. Tear out and bag wet insulation-after hours 17.42 SF 1.14 0.08 19.94 (0.00) 19.94 Totals: Barber Office 1 0.29 55.27 0.00 55.27 Barber Office 2 Height: 8' 7 s 213.33 SF Walls 43.88 SF Ceiling Barber 01 fico 2 '`°"s a"'l 257.22 SF Walls &Ceiling 43.88 SF Floor 4.88 SY Flooring 26.67 LF Floor Perimeter L 26,67 LF Ceil. Perimeter DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC, ACV 5. Tear out wet drywall,cleanup,bag-after business 89.00 SF 1,12 1.06 100.74 (0,00) 100.74 hours 6. R&R Cove base molding-rubber or vinyl,4"high 26.67 LF 2.20 190 60.58 (0.00) 60.58 7. Drill holes for wall cavity drying-after has 15.00 EA 0.75 0.00 11.25 (0.00) 11.25 8, Tear out and bag wet insulation-after hours 89,00 SF 1.14 0.39 101.85 (0.00) 101.85 Totals: Barber Office 2 3.35 274.42 0.00 274.42 2016-11-16-2258-1 11/22/2016 Page: 2 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawi-ence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Ali Hei ht: 8' x'2 0 Barber Shop g T .6iN z a 890,67 SF Walls 520.44 SF Ceiling 1411.10 SF Walls&Ceiling 520.44 SF Floor ziUer�s 57.83 SY Flooring 111.33 LF Floor Perimeter 1 1 1.33 LF Ceil. Perimeter r J DESCRIP'T'ION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 9. Tear out wet drywall,cleanup,bag-after business 100.00 SF 1.12 1.19 113.19 (0.00) 113.19 hours 10. Tear out and bag wet insulation-after hours 100.00 SF 1.14 0,44 114.44 (0.00) 114.44 Totals: Barber Shop 1.63 227.63 0.00 227.63 Mens Bathroom Height: 8' 74�". 149.33 SF Walls 21.67 SF Ceiling Minns 171.00 SF Walls&Ceiling 21,67 5F Floor Iz2 Nl l 2.41 SY Flooring 18.67 LF Floor Perimeter 18.67 LF Coil.Perimeter DESCRIPTION QUANTITY UNIT PRICK TAX RCV DEPREC. ACV 11. Tear out wet drywall,cleanup,bag-after business 35.47 SF 1.12 0.42 40.15 (0.00) 40.15 hours 12. Tear out and bag wet insolation-after hours 149.33 SF 1.14 0.65 170.89 (0.00) 170.89 13, Add-on for tearing out tritn/base from tile/grout 18.67 LF 0.50 0.00 9.34 (0.00) 9.34 Totals: Mens Bathroom 1.07 220.38 0.00 220.38 Womans Bathroom Height: 8' PB;,ck 149.33 SF Walls 21.67 SF Ceiling 171.00 SF Walls&Ceiling21.67 SF Floor 2.41 SY Flooring 18.67 LF Floor Perimeter 18.67 LF Ceil. Perimeter aliway 2016-11-16-2258-1 11/22/2016 Page: 3 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 14, Tear out wet drywall,cleanup,bag-after business 10.00 SF 1,12 0.12 11.32 (0.00) 11.32 howl 15. Tear out and bag wet insulation-after hours 10.00 SF 1.14 0.04 11.44 (0,00) 11.44 16. Add-on for tearing out trim/base from tile/grout 10.00 LF 0.50 0.00 5.00 (0.00) 5.00 Totals: Woman Bathroom 016 27.76 0.00 27.76 Back Hallway Height: 8' 526.74 SF Walls 97.45 SF Ceiling .. ..Bud, .fif �L.v Away Ofl 7 624.19 SF Walls&Ceiling 97.45 SF Floor inn 10.83 SY Flooring65.84 LF Floor Perimeter o h 6" ink Halhvay �-T 9" 1 10.211 65.84 LF Ceil. Perimeter DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 17. Tear out wet drywall,cleanup,bag-after business 65.84 SF 1,12 0.78 74.52 (0.00) 74.52 hours 18. Tear out and bag wet insulation-after hours 65.84 SF I,i4 0.29 75.35 (0.00) 75.35 19. Remove Cove base molding-rubber or vinyl,4" 65.84 LF 0.25 0.00 16.46 (0.00) 16.46 high Totals: Back Hallway 1.07 166.33 0.00 166.33 Distinctive Office Height: 8' �f{}ck r;dty 1 _ "''"`4"""''1(1" 527.78 SF Walls 244.83 SF Ceiling r' 772.61 SF Walls&Ceiling 244.83 SF Floor E��tdddeuorr s"rs to°+-d6,q„ .1 27.20 SY Flooring 65.00 LF Floor Perimeter 70.83 LF Ceil. Perimeter Missing Wall-Goes to Floor 5' 1011 X 618p' Opens into ROO1M12 DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC, ACV 20. Drill boles for wall cavity drying-after hrs 25.00 EA 0.75 0.00 18.75 (0.00) 18.75 Totals: Distinctive Office 0.00 18.75 0.00 18.75 2016-11-16-2258-1 11/22/2016 Page:4 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@ servprooflawrence.coni PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 42 s` G 2 LazeAwaze Hallway Height: 8' �T 7- 6- 777 - ` ' `Y6Ler',Iw,y 364.67 SF Walls 72.44 SF Ceiling 7 r�,, i 437.1 D 5F Walls&Ceiling 72.44 SF Floor e �' �1 8.05 5Y Flooring 45.58 LF Floor Perimeter a ( 45.58 LF Ceil. Perimeter Missing WaII 3'9" X 8' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 21. 'fear out wet drywall,cleanup,bag-after business 4.00 SF 1.12 0.05 4.53 (0.00) 4.53 hours 22. Tear out and hag wet insulation-after hours 4.00 SF 1.14 0.02 4.58 (0.00) 4.58 23. Drill holes for wall cavity drying-after hrs 10.00 EA 0.75 0.00 7.50 (0,00) 7.50 24. Remove Cove base molding-rubber or vinyl,4" 8.00 LF 0.25 0.00 2.00 (0.00) 2.00 high Totals: LazeAwaze Hallway 0.07 18,61 0.00 18.61 Total: Main Level 7.64 1,009.15 0.00 1,009.15 Line Item"Totals: 2016-11-16-2258-1 7.64 1,009.15 0.00 1,009.15 Grand Total Areas: 4,402.96 SF Walls 1,863.00 SF Ceiling 6,265.96 SF Walls and Ceiling 1,863.00 SF Floor 207.00 SY Flooring 548.43 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 560.09 LF Ceil.Perimeter 1,863.00 Floor Area 1,988.08 Total Area 4,441.70 Interior Wall Area 1,653.00 Exterior Wall Area 187.00 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2016-11-16-2258-1 11/22/2016 Page: 5 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salern/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Summary for Dwelling Line Item Total 1,001.51 Material Sales Tax 7.64 Replacement Cost Value $1,009.15 Net Claire $1,009.15 Steven Fumero 2016-11-16-2258-1 11/221201.6 Page: 6 i 1 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawreiice.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Recap of Taxes Material Sales Tax(6.25%) Clothing Sales Tax(6.25%) Storage Tax(6.25%) Line Items 7.64 0.00 0.00 Total 7.64 0.00 0.00 2016-11-16-2258-1 11/22/2016 Page: 7 i Servpro SERVPRO of Lawrence 2064 SERVPRO of'Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978,688,2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Recap by Room Estimate:2016-11-16-2258-1 Area: Main Level Barber Office 1 54.98 5.49% Barber Office 2 271.07 27.07% Barber Shop 226.00 22.57% Mens Bathroom. 219.31 21.90% Womaits Bathroom 27.60 2.76% Back Hallway 165.26 16.50% Distinctive Office 18.75 1.87% LazeAwaze Hallway 18.54 1.85% Area Subtotal: Main Level 1,001.51 100.00% Subtotal of Areas 1,001,51 100.00% Total 1,001.51 100.00% 2016-11-16-2258-1 11/22/2016 Page: 8 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978,688,2242 office @ servproofl awrence,corn PO Box 328 Lawrence,MA 01842 Tax 1D#02-0353691 Recap by Category Items Total % GENERAL DEMOLITION 900.75 89.26% FLOOR COVERING-VINYL 52.01 5.15% WATER EXTRACTION &REMEDIATION 48.75 4.83% Subtotal 1,001.51 99.24% Material Sales Tax 7.64 0.76% Total 1,009.15 100.00% 2016-11--16-2258-1 11/22/2036 Page: 9 Main Level 40'10" $2„ T T' —4'4"— 4'4„ —3,11" 10'4" Barber Office ns Bato s Bath om r LazeAway Office Barber Office I- 3 I � 5e N 1 i ack Hallway '4'9" 1 `" LazeAwaze Hallway s'6" 26' M N Distinctive Office 7 - h 4'1' Barber Shop m rber Cl Distinctive Showroom CF a N 12' Main. Level 2016-11-16-2258-1 11/22/2016 Page: 10 Me Commonwealth of.Massachuse s Depar tMent ofindws,,Y-WAceldents r I Congress Strelet, ,Sr &100 = == -gostov,.119A 02114-2017 w w-ww.mass.govfdza �9 -Wotkers' Compeaasatzoax�nsnxaa�€.ce�idavit:B,r�i�.dexs/Coxz�'actors/EXecLr�czanslE'lxcm�e:rs. T�[NG AUT�C(3 � '- VWMTHEX'� P=leaseprnn Le 'b1 A ''Ii`cant>�axna.atian ', Namo(BusmeBRIOK9 a onlC�dividual): �' Adc�:ess: �b �.2L► ' �" � Ut'��tU Phone# _: (Q�l � ^ city/Stato/zip: ;v .:. ,. : :e. .Axayou azE emploper?Chad tlic appsopriafe box: Type of project(T �ed')' �. a emplayer with employees(full and/or parL time).` 7_ ❑ Tev `donstriction 8. �Renaodelti� I am a sale propzietoror parhxersbip an haYe no employee's ckarlsing formo in g o o any capacity.[Noworlxers'r-aMP,insurance:r quired.] nxl�ers'comp!.insurancerequired.]' 10 E]Btaaldtrig addition a homeonvrtez fining all�wozk mysol£[I�ow ¢,Q am ahorrreowrier andwill be hiring coafractars to eanduct alt work onmy property I wi31 11.❑�lecixicI rPp_�ixS or additions ,,,stud that all conarantbis eifiherbaveworlcere aompensat[ozi insozaace or are sole 1,-1•�1 i3t[g xa1753rS D afld]1107]5 p des. l2.Ls. . proprietors withno em�QY for and T have hiredthe sub-coniraders listed oatho aatacbed sheet. 13: Rb6f repait's 5.❑i am a general conugc: z;,„-.,• ccs andhavo worlters'comp.insuranee.� 'These sub-contractors Lava employ 1¢.M Otb er (,❑�e are a aarpoz�€inn.and zLs,of�esliaYe e�rcis od.theis zigTat of exemptionper MGL o. ' 152,§l{4},arrd e haYa no employees.IN--w-kers°comp.ins:uance required] * yapPlioant atr ecksbox#I mustalsa outtha are doinglow aliw kandfhenhicaDutssidekGcoonira torsmonstsubmitanewafidaritindioatingsuel� i Homeowners who submiEfbis affidavit indicating they Contractors that c ieckiLis I3`ox must a€taclied'an additional s oviho-thein workers'ame aomp_-policy im7bez statewhetber orxtatfhose entities have employees. if the sub-oc; i6ctors have cmplayeca,they eta lv er t7iat is ar o�rdingrvorkers'compensation insurance for 17V employees Bela7v is Ilse poticy aradja�site Y ursi axx em y information. o q 7vsurance CompanyName: � r ' ExpirationD�.te: 2• 11 Policy#or Self inns.uo;.#:. �•�1 o CitylState/7a�p: N•A`++' Job Site Address: �� Oc► . Attach a copy of fAe wukers' couzpextsation polxep decTaxatiaxz p age(s al vi olatfonpounishanumber by a fde up to 4,50011-00 Failure to secuxe coverage as t•ecitxtted-uazderMGL o.152,§Z5A is a rtzrarn anrl/ox ane-yea hraprisoralxaent,as e as civil penalties in the ff),rm ofa STOP WORK ORDER and a fila,,ofnli to $250.00 a day against theviolatoa,A copy Cf this statetne may bo forwarded to the OfSoe ofTnvest[gatioaz5 oftheD1A fbritasurance ' COYerage-Varif.Gat!011- do liereliy certify rarcder triepuirzs anpenalties ofpe�jury that the information piavided above is arse and correct Date: 6l 2 a I Si ature: P1,_oaae#: Of arse only. Do mot wrzte ire glis area,to die cnrrzpleted�y city or Ia stJn officiu2 • Pe>"mitlLiceuse� City or To - ZssuiugAnthaxitY(eia"cie ozie): p ector 1..Board nl �eJtY Z.By X gBepaxtauent 3.Cit s Clexir .EiectrzcaXSras ectox 5.Plumbingp 6.Offter Thone#- Cozatact X'ersont. ,t► _�''+ � WHITKE1 OP ID, Pl f�Qf�LJ® DATE(MMIDDlYYYYI CERTIFICATE OF LIABILITY INSURANCE 11/11/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT., If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must he endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT James R. Me Donald Stanley McDonald Agency PHONE FAX 1101 Main Street c Xt.608-788-6160 AIc No:60$-788-7012 Onalaska,WI 54650 ADORILss: James R.Mc Donald INSURER(S) AFFORDING COVERAGE NAIC# INSURERA:Rockhlll Insurance Cam an 28053 INSURED KeJo Corporation INSURER B:The Federal Insurance Co. 20281 dba Servpro of Lawrence INSURER 0ACE Pro e &Casual 20699 See Note For Named Insured PO BOX 328 INSURER°: Lawrence,MA 01842 INSURER E: 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. ILTR TYPE OF INSURANCE p p POLICY NUMBER h6MIOMYIYEYY MMIDODY E(YYP1 I LiWIITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 21000,000 CLAIMS-MADE � OCCUR ENVP016006-00 03/01/2016 03/01/2017 PREMISES eoccu e e $ 50,000 MED EXP.(Any one parson) $ 51000 PERSONAL&ADV INJURY $ 2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: GENERALAGGREGATE $ 3,000,000 POLICY❑PRO-JECT D LOC PROD UCTS-COMPIOPAGO $ 3,000,040 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per parson) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Par acc dent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 11000,000 C EXCESS LIAB CLAIMS-MADE M00798617 01/1412016 01/14/2017 AGGREGATE $ 1,000,000 DEO} I X I RETENTION$ 10000 $ WORKERS COMPENSATION STER U EOTH- TF AND EMPLOYERS'LIABILITY AMY PROPRIETORIPARTNERIEXECUTIVE YE!�''I N r A E.L,EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? J (Mandatary in NH) E.L.DISEASE-EA EMPLOYEE $ esdescribe under ndescdRIPTION OF OPERATIONS below E,L,DISEASE-POLICY LIMIT $ 13 Property Section 670-66.47 03101/2016 03/01/2017 B Crime 670.66-47 03/01/2016 031011.2017 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Add€t€oval Remarks Schedule,maybe attached If more space N requlredl Certificate Holder Is Additional Insured Per Attached CG 2037(07104)And CG2010 (07104)A.T.I.M.A.Policy#ENVP016006-00 CERTIFICATE HOLDER CANCELLATION TOWNN03 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN ACCORDANCE WITH THE;POLICY PROVISIONS. Town of North Andover Building Department AUTHORIZED REPRESENTATIVE 120 Main Street North Andover,MA 01845 1 ©1988.2044 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD DATE{MM1DDlYYYY) ACORa CERTIFICATE OF LIABILITY INSURANCE 11111120[6 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(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: __ ... Dabney Collier PHONE HC No Ext (901)529-2900 �n1c,No): (901)529-2916 c/o Collier Insurance EMAIL 606 S.Mendenhall;Suite 200 ADDRESS: Memphis,TN 38117 INSURER(5)AFFORDING COVERAGE NAIC N INSURER A: American Zurich insurance Company _ 40142 INSURED INSURER B: Adams Keegan,Inc. W 6750 Poplar Ave Ste 400 INSURER G: Memphis,TN 38138 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:15TNO09858085 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. !NSR ADDL SU9R - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE p D POLICY NUMBER MMfDDIYYYY MMIDDIYYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 10 RENTED E] CLAIMS-MADE L ] OCCUR PFt MISES!Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY C�jE O LOC PRODUCTS-COMPlOP AGG $ OTHER: IN AUTOMOBILE LIABILITY COa acc deD SINGLE LIM T $ ANY AUTO BODILY INJURY(Per person) $ _ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS !AVOS ON--OWNED PROPERTY DAMAGE $ HIRED AUTOS F AUTOS Per accidenD UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTF ERH _ AND EMPLOYERS'LIABILITY Y 1 ry E.L.EACH ACCIDENT $ t,DO0,00U A OFFECFRIMEMBEREXCLUDED?ANY PROPRIETORIPARTNEPdr: ECUTIVE ❑ NIA WC 56-11-865-02 12/01/2015 12/01/2016 -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 I4 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Location Coverage Period: 12101/2015 12/01/2016 Client# 2410-MA DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Coverage Is provided for KEJO Corporation dba:SERVPRO of Lawrence Bi Weekly only those co-employeeS 8 Weekly BLAKIN 5T of,but not subcontractors to: Lawrence,MA 01842 CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Building Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE_ ............... ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Ol"fiee of Consumer Arfairs&Business Regtibitiou Ucensc or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: •, RecJistratinn: 158271 Type: Office of Cnnsurner Affairs and 13usiuess Regulation r r Expiration: 12131/2017 Private Corporation10 Paris Plaza-Suite 5170 Boston,MA 02116 KEJO CORPORATION SERVPROOF LAWRENCE, ET ALS. GREGG WHITE 8 BLAKELIN STREET LAWRENCE, MA 01841 _it__.. Undersecretary iof valid�vhaut signature "Iassacnm.iset[5Ot �'-UDHC; J,3Tr t'1 Board of Building -?4gu;-Ir,ol)s :incl 5tancaras _cense CS-067690 GREGG M WHITE e+ "" 4 CHATBURN RD WINDHAM NH 03087 W0L . 02/2012018