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HomeMy WebLinkAboutBuilding Permit #279-14 - 29 DELUCIA WAY 9/26/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: TANT:Applicant must complete all items on this page LOCATION a-cl T)JJC.1 Ci (k) 6td N. hn-6 IS-CC . M* a t�lS Print PROPERTY OWNER _R� C-k^o.4-cA 4- Ce l*a epycc Print MAP NO: PARCEII ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: *.Demolition ❑ Other ® Septrc ®��Well (®MFloodplain' I® Wetlands ® tWatershedDistrict i. DESCRIPTION OF WORK TO BE PERFORMED: 1 ` v%A t..QOC'>Ck4y-, A AA P CLC ..�L ooC�".-+q �M.c,�r C� ` S��uFf�,9SJ c&e -�0 5p(1'�k1 er L�k� Identification Please Type or Print Clearly) . OWNER: Name: ► ��a�► -4- CeI�G �ePuGC Phone.18* S-a-603 Address: �%1 ��� G,. 4 I �U N ���r o��`I•.� CONTRACTOR Name: c %r J prt!!, o�-' Lci�%,J C.e Phone: -2$ 1;031g1 3 Address: {� d Supervisor's Construction License: CS-60 6ctc Exp. Date: a`arzl m Home Improvement License: 1 S-2 2-71 Exp. Date: ►a 13 t l L3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.. Total Project Cost: $ � FEE: $ S, 0 SS . S7'( Check No.: Receipt No.: NOTE: P Ysons co tracting with unregistered contractors do not have access to u 'an r - Si nature'ofA #ra ent/OwneS nature ofcon rx ., =� 43_, Location 1 1-P !V G(6 WA � 11 No. Date Q d • - TOWN OF NORTH ANDOVER • � $ Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ � Other Permit Fee d TOTAL $ i { Check# 26912 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ Tanning/MassageBody Art ❑ 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 w 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 i Number of Stories: Total square feet of floor area, based on Exterior dimensions. i Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Yn all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doc.Building Permit Revised 2008mi NORThj own of tAt. ndover No. _ I . M"" �O LANE .W. h , ver, Mass, 6 COC NIC.EWIC. yI' RATED ILPP�,�S S U BOARD OF HEALTH Food/Kitchen PE Septic System l�l10At.44.......4...... �. ,.�,.,... BUILDING INSPECTOR R IT T LD THIS CERTIFIES THAT ........ .. .GI ... .. . .. .. ..�.. G�.�i�1...�............ has permission to e>on buildings onb ....... Foundation Rough to be occupied as .. ..) :!% rJ ,.. ............ .. ....... . .. .. .. ............................... Chimney provided that the pecepting this permit shall in every respect conform 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 EXPIRESt16ONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUN TS Rough Service ....... ... ... ........................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Authorization to Perform Services and Direction of Payment � C"trstorner Name: Date of Loss: Loss Address; -.t„1 - City: - — i �l�`t _ #r State: � � �ig�• ,� 4S — Insurance ..� i Insurance Crsmpany: is m Number(if available): Y4 t The undersigned Customer, beim the building owner, owner's representative, or resident; authorizes the Provider identified below to perform any and all necessary cleaning acrd/car restoration services on Customer's property located at the property address above, and with respect to items that reed to be ciea_ned at a remote location to remove and clean such iters as necessary, Customer authorizes . lit 1 � 0. Inswance Company,herein referred to as"Insurance Company," K 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 b to pay provider immediately upon receipt of the check. In order to expedite payment to Provider, Customer hereby appoints Provider as, attorney-in-fact, authrorizing Provider to endorse Customer's name on Insurance Company checks or drafts,anti to deposit Insurance Company checks or drafts for Provider.services.. Customer agrees to pay Customer's deductible in,the amount of > that applies to this claire, If airy F 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 Custorner'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 assts not covered by insurance. Interest and finance charges will be charged:at the maximum allowable by law, or at 1.5per f month,whichever is less,on accounts over thirty(3 ) 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: rLcCaf Remarks: i k 1 HAVE READ TRIS AUTHORIZATION To PERFORM SERVICES AND DIRECTION:OF PAYMENT,ENT, INCLUDING THE TERMS AND CONDITIONS OF SERVICE ON THE REVERSE SIDE HEREOF,AND AGREE,TO SAME, Customer.Reviewed-Customer frrf'r rma' troy Far ,CO Yf O IV Provider's Signature: - Le � �an�ranchdseCustomer's Si n6ture,e + �- �dtItP# Printed Name:, a SER�+PRt *of ry Date. y Cite: Customer's Email Andress. White: SERVPRO'O Y8110w: Claims Professional Pink: Customer 0$ERVPR0'INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERNED FL-05170:7 7.4 2000 08/12 E h �Fr a n�hi sa is I ndepoidaitlyCMnad aOld Gparat I SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Client: Repucci,Celia Home: (781)475-2603 Property: 29 Delucia Way N.Andover,MA 01845 Operator Info: Operator: WHITE Estimator: White,Brian Business: (978)688-2242 x 13 Business: PO Box 328 E-mail: bwhite@servprooflawrence. Lawrence,MA 01842 com Type of Estimate: Date Entered: 9/26/2013 Date Assigned: Price List: MAEM7X AUG13 Labor Efficiency: Restoration/Service/Remodel Estimate: 2013-09-26-0834 SERVPRO@ Fire&Water-Cleanup&RestorationTM r' Like it never even happened. SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 2013-09-26-0834 Second Floor Main Level -T Master Closet Height:8' +cis-e 6'8" " 260.00 SF Walls 63.89 SF Ceiling 323.89 SF Walls&Ceiling 63.89 SF Floor L 7.10 SY Flooring 32.50 LF Floor Perimeter 12'6"i,, „ I 111 1 32.50 LF Ceil.Perimeter )-,- DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 4. Tear out non-salv solid/eng.wood 63.89 SF 2.30 146.95 (0.00) 146.95 flr&bag for disposal 5. Tear out baseboard 32.50 LF 0.32 10.40 (0.00) 10.40 6. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Master Closet 165.15 0.00 165.15 t P+>= Master Bedroom Height:8' T 629.33 SF Walls 356.19 SF Ceiling T 985.53 SF Walls&Ceiling 356.19 SF Floor 39.58 SY Flooring 78.67 LF Floor Perimeter 78.67 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 7. Tear out non-salv solid/eng.wood 356.19 SF 2.30 819.24 (0.00) 819.24 fir&bag for disposal 8. Tear out baseboard 78.67 LF 0.32 25.17 (0.00) 25.17 9. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Master Bedroom 852.21 0.00 852.21 2013-09-26-0834 9/26/2013 Page: 2 - SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 [2'5"1 Middle Bedroom Closet Height: 8' Middle ed- °° ct°set 85.33 SF Walls 6.77 SF Ceiling m 92.10 SF Walls&Ceiling 6.77 SF Floor 1 n 2'5"4 0.75 SY Flooring 10.67 LF Floor Perimeter Front Bedrot 10.67 LF Ceil.Perimeter Stairs DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 10. Tear out non-salv solid/eng. wood 6.77 SF 2.30 15.57 (0.00) 15.57 flr&bag for disposal 11. Tear out baseboard 10.67 LF 0.32 3.41 (0.00) 3.41 12. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Middle Bedroom Closet 26.78 0.00 26.78 �. "'44 .. 3'.10"1. 1 Hallway Height: 8 •f2'6"i ITB '9"t•3'.10" 1 4' 295.44 SF Walls 48.82 SF Ceiling 344.26 SF Walls&Ceiling 48.82 SF Floor -- 5.42 SY Flooring 37.17 LF Floor Perimeter 37.17 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 13. Tear out non-salv solid/eng.wood 48.82 SF 2.30 112.29 (0.00) 112.29 flr&bag for disposal 14. Tear out baseboard 37.17 LF 0.32 11.89 (0.00) 11.89 15. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Hallway 131.98 0.00 131.98 Hall Closet Height:8' Hallway 69.33 SF Walls 4.67 SF Ceiling ( 4' 74.00 SF Walls&Ceiling 4.67 SF Floor N "a"°'OSe° 0.52 SY Flooring 8.67 LF Floor Perimeter N 1 8.67 LF Ceil.Perimeter 2013-09-26-0834 9/26/2013 Page: 3 - SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 16. Tear out non-salv solid/eng.wood 4.67 SF 2.30 10.74 (0.00) 10.74 fir&bag for disposal 17. Tear out baseboard 8.67 LF 0.32 2.77 (0.00) 2.77 18. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Hall Closet 21.31 0.00 21.31 W---11Rtear Rear Bed Closet Height: 8' 161.33 SF Walls 18.08 SF Ceiling eearoam_ 179.42 SF Walls&Ceiling 18.08 SF Floor 2.01 SY Flooring 20.17 LF Floor Perimeter 20.17 LF Ceil.Perimeter Fz'e°I DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 19. Tear out non-salv solid/eng.wood 18.08 SF 2.30 41.58 (0.00) 41.58 fir&bag for disposal 20. Tear out baseboard 20.17 LF 0.32 6.45 (0.00) 6.45 21. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Rear Bed Closet 55.83 0.00 55.83 tJ::' Rear Bedroom Height: 8' 364.00 SF Walls 124.71 SF Ceiling 488.71 SF Walls&Ceiling 124.71 SF Floor 13.86 SY Flooring 45.50 LF Floor Perimeter 11'.8" 45.50 LF Ceil.Perimeter F 12- DESCRIPTION DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 22. Tear out non-salv solid/eng.wood 124.71 SF 2.30 286.83 (0.00) 286.83 flr&bag for disposal 23. Tear out baseboard 45.50 LF 0.32 14.56 (0.00) 14.56 24. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Rear Bedroom 309.19 0.00 309.19 2013-09-26-0834 9/26/2013 Page:4 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 -j Front Bedroom Closet Height: 8' Fro�1 B�a:�om os� 152.00 SF Walls 15.00 SF Ceiling N 167.00 SF Walls&Ceiling 15.00 SF Floor 1.67 SY Flooring 19.00 LF Floor Perimeter 19.00 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 25. Tear out non-salv solid/eng.wood 15.00 SF 2.30 34.50 (0.00) 34.50 flr&bag for disposal 26. Tear out baseboard 19.00 LF 0.32 6.08 (0.00) 6.08 27. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Front Bedroom Closet 48.38 0.00 48.38 ~9'7" Front Bedroom Height:8' "1 L I 402.67 SF Walls 148.51 SF Ceiling m 551.17 SF Walls&Ceiling 148.51 SF Floor 16.50 SY Flooring 50.33 LF Floor Perimeter 50.33 LF Ceil.Perimeter F3' Y' DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 28. Tear out non-salv solid/eng.wood 148.51 SF 2.30 341.57 (0.00) 341.57 flr&bag for disposal 29. Tear out baseboard 50.33 LF 0.32 16.11 (0.00) 16.11 30. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Front Bedroom 365.48 0.00 365.48 13'7" -' Middle Bedroom Height: 8' F3'S" °' 400.67 SF Walls 142.65 SF Ceiling zsL 543.31 SF Walls&Ceiling 142.65 SF Floor 15.85 SY Flooring 50.08 LF Floor Perimeter a 50.08 LF Ceil.Perimeter 1'1 �7'10"�nalDYtY Missing Wall 3'511 X 8' Opens into STAIRS 2013-09-26-0834 9/26/2013 Page: 5 - -_-•_' SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 31. Tear out non-salv solid/eng.wood 142.65 SF 2.30 328.10 (0.00) 328.10 fir&bag for disposal 32. Tear out baseboard 50.08 LF 0.32 16.03 (0.00) 16.03 33. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 Totals: Middle Bedroom 351.93 0.00 351.93 Total: Main Level 2,328.24 0.00 2,328.24 Total: Second Floor 2,328.24 0.00 2,328.24 First Floor Main Level r Sitting Rm Height:8' y .I352.56 SF Walls 154.29 SF Ceiling 506.85 SF Walls&Ceiling 154.29 SF Floor 17.14 SY Flooring 42.92 LF Floor Perimeter T 49.83 LF Ceil.Perimeter Missing Wall-Goes to Floor 31611 X 6'8" Opens into DINING_ROOM Missing Wall-Goes to Floor 31511 X 618" Opens into EAT_IN_KITCH DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 34. Tear out non-salv solid/eng.wood 154.29 SF 2.30 354.87 (0.00) 354.87 flr&bag for disposal 35. Tear out baseboard 42.92 LF 0.32 13.73 (0.00) 13.73 36. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 43. Tear out wet drywall,cleanup,bag 330.57 SF 0.70 231.40 (0.00) 231.40 for disposal Totals: Sitting Rm 607.80 0.00 607.80 2013-09-26-0834 9/26/2013 Page: 6 -<2=92> SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 j Eat In Kitchen/Living Room Height:8' Te ,tr�,g 1 773.25 SF Walls 529.30 SF Ceiling 1302.54 SF Walls&Ceiling 529.30 SF Floor 58.81 SY Flooring 96.59 LF Floor Perimeter 100.01 LF Ceil.Perimeter Missing Wall-Goes to Floor 31511 X 61811 Opens into SITTING_RM Missing Wall 4'8"X 8' Opens into ENTRY-HALL DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 41. Tear out wet drywall,cleanup,bag 915.92 SF 0.70 641.14 (0.00) 641.14 for disposal 44. Remove Cabinetry-lower(base) 20.00 LF 6.28 125.60 (0.00) 125.60 units 45. Remove Cabinetry-upper(wall) 20.00 LF 6.28 125.60 (0.00) 125.60 units Totals: Eat In Kitchen/Living Room 892.34 0.00 892.34 Garage Height: 8' 686.67 SF Walls 460.42 SF Ceiling 1147.08 SF Walls&Ceiling 460.42 SF Floor 51.16 SY Flooring 85.83 LF Floor Perimeter 85.83 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 42. Tear out wet drywall,cleanup,bag 803.75 SF 0.70 562.63 (0.00) 562.63 for disposal Totals: Garage 562.63 0.00 562.63 2013-09-26-0834 9/26/2013 Page: 7 <12iiat)- SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 1'3F3'6"i0 5'„••--� Dining Room Height:8' 379.33 SF Walls 157.17 SF Ceiling „. 536.50 SF Walls&Ceiling 157.17 SF Floor r 1 m 17.46 SY Flooring 46.83 LF Floor Perimeter 1 3'1"�5'-}-3'S" 50.33 LF Ceil.Perimeter 0'6--A F4 7"� Missing Wall-Goes to Floor 3'611 X 6'8" Opens into SITTING_RM DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 37. Tear out non-salv solid/eng.wood 157.17 SF 2.30 361.49 (0.00) 361.49 flr&bag for disposal 38. Tear out baseboard 46.83 LF 0.32 14.99 (0.00) 14.99 39. Drill holes for wall cavity drying 20.00 EA 0.39 7.80 (0.00) 7.80 40. Tear out wet drywall,cleanup,bag 346.83 SF 0.70 242.78 (0.00) 242.78 for disposal Totals: Dining Room 627.06 0.00 627.06 Total: Main Level 2,689.83 0.00 2,689.83 Total: First Floor 2,689.83 0.00 2,689.83 Line Item Totals: 2013-09-26-0834 5,018.07 0.00 5,018.07 Grand Total Areas: 8,411.37 SF Walls 3,669.04 SF Ceiling 12,080.41 SF Walls and Ceiling 3,720.86 SF Floor 413.43 SY Flooring 1,029.72 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 1,039.26 LF Ceil.Perimeter 3,720.86 Floor Area 3,926.15 Total Area 7,497.18 Interior Wall Area 4,378.53 Exterior Wall Area 486.50 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 2013-09-26-0834 9/26/2013 Page: 8 --• SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Summary for Dwelling Line Item Total 5,018.07 Material Sales Tax @ 6.250% 35.44 Replacement Cost Value $5,053.51 Net Claim $5,053.51 White,Brian 2013-09-26-0834 9/26/2013 Page:9 -_- •_ SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Recap by Room Estimate:2013-09-26-0834 Area: Second Floor Area:Main Level Master Closet 165.15 3.29% Master Bedroom 852.21 16.98% Middle Bedroom Closet 26.78 0.53% Hallway 131.98 2.63% Hall Closet 21.31 0.42% Rear Bed Closet 55.83 1.11% Rear Bedroom 309.19 6.16% Front Bedroom Closet 48.38 0.96% Front Bedroom 365.48 7.28% Middle Bedroom 351.93 7.01% Area Subtotal: Main Level 2,328.24 46.40% Area Subtotal: Second Floor 2,328,24 46.40% Area:First Floor Area:Main Level Sitting Rm 607.80 12.11% Eat In Kitchen/Living Room 892.34 17.78% Garage 562.63 11.21% Dining Room 627.06 12.50% Area Subtotal: Main Level 2,689.83 53.60% Area Subtotal: First Floor 2,689.83 53.60% Subtotal of Areas 5,018.07 100.00% Total 5,018.07 100.00% 2013-09-26-0834 9/26/2013 Page: 10 •____ SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Recap by Category Items Total % GENERAL DEMOLITION 4,924.47 97.45% WATER EXTRACTION&REMEDIATION 93.60 1.85% Subtotal 5,018.07 99.30% Material Sales Tax @ 6.250% 35.44 0.70% Total 5,053.51 100.00% 2013-09-26-0834 9/26/2013 Page: 11 Second Floor-Main Level 45'11" 3`9` 6'6' 13'3' o t�1 ylgs `iD iv d IeBe oo�C t� 1 2'5" Molter Goset ^� d Master Bathoom "� ro M�Jdte Bedroom honk Bedroom ='� .. 12'10• d .IL F—1'10" Font eedroam�toset �i tLewnv m (V UPI Masts Bedroom o_ - 1�:!LnJ�1LBw2t4 LE2Bs4h. Reai Be�hoom Main Level. 2013-09-26-0834 9/26/2013 Page: 12 First Floor-Main Level 52,1„ 71'6" 39'7" r+ SStttnnRm. m5"m rt�n�ntu.rna Rao�n I 23'2" ,� S 21.3... .. Caat❑nfCtC`M m m nnthrnom�.o y lltrHnn Rnnm. Frttrw nall Up m K I .• ev 2n 1 21,11- ll Main Lev®f 2013-09-26-0834 9/26/2013 Page: 13 Basement-Main Level 5P 8' 51' Iliumani �i A'9"--------5. 21'3' m in m 25' 258" c� Main Leve! 2013-09-26-0834 9/26/2013 Page: 14 t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen'isor License: CS-067690 GREGG M WHIT 4 4 CHA'IBURN R$ WINDHAM NH 03087 Expiration �,•ta.-� 02/2012014 Commissioner office*onumer'�A?airs smess Regulation HOME IMPROVEMENT CONTRACTOR Registration: ,�-158271 Type: Expiration: =942/ 1/2013 Private Corporation' F 9C01' PORATIUNN F!' SE PRO OF LAW fEApr �CEi!¢ETLS. GREGG WHITE ,_ k= 8 BLAKELIN STREET � x - LAWRENCE,MA 018411 '' Undersecretary KEJOC-2 OP ID:JS ACORO` TE(MMIOD/YYYY) 709/25/2013 CERTIFICATE OF LIABILITY INSURANCE 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(les)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 Phone:901-529-2900 CONTACT NAME: Collier Insurance Fax:901-529-29 PHONE FAX 606 S Mendenhall Rd Suite 200 A/c No E.0: AIC No): Memphis,TN 38117 E-MAIL Dabney Collier ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance Cos. INSURED KEJO Corp.dba SERVPRO INSURER B: of Lawrence c/o Adams Keegan,Inc. INSURER C: 6055 Primacy Parkway,#300 INSURER D: Memphis,TN 38119 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. IPOLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DDmYY MM DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENT COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS -1 ER A ANY PROPRIETOR/PARTNER/EXECUTIVEC2291-458018-493 05/01/2013 1210112013 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Celia Repucci ACCORDANCE WITH THE POLICY PROVISIONS. 29 Delucia Way North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD �--•', WHITKE1 OR ID: PI ' ACORL7" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) / `. . 09/25/2013 ' 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(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). CONTACT PRODUCER Phone:60.8-788-6160 NAME: Stanley McDonald Agency IL Inc Fax:608-788-7012 PHONE Ext): a No 2018;State Road P.O.Box 1446 vc La Crosse,'WI 54602-1446 EMAIL James'R.Mc Donald ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Tudor Insurance Company 37982 INSURED KeJo Corporation INSURER 8:Travelers Property Casualty 25674 dba Servpro of Lawrence PO BOX 328 INSURERC: Lawrence,MA 01842 INSURER o 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 INDICATEq.' 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. ILT R TYPE OF INSURANCE _ ADDL SUER POLICY NUMBER MMIDD EFF MM/DDS LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 1Zi T E A X COMMERCIAL GENERAL LIABILITY X POP0759539 03/01/2013 03/01/2014 PREMISES Ea occurrence)' $ 300,00 CLAIMS-MADE.I'k I'OCCUR MED EXP(Any one person). $ 5,00 PERSONAL&ADV INJURY $ 1,000100 GENERAL AGGREGATE $ .2,000,00 GEN'L4GGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG. POLICY M PROECf- 7LOC $. . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT. Ea accident BODILY INJURY(Per person) $ ANY AUTO: ALL OWNED. SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ . UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB. CLAIMS-MADE AGGREGATE $ DED I 'RETENTION$ $ . . ... WORKERS COMPENSATION WC STATU- I I OTH= TORY LIMITS I I ER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? .. NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ ItyS describe under . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Property Section 7107/2412 03/01/2013 03/01/2014 675,00 B Employeebishonesty 7107/3412 03/0112013 03/01/2014 25,00 DESCRIPTION.OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace Is required) Certificate Holder Is Additional Insured A.T.I.M.A.. Poli4#.PGP0759539; . CERTIFICATE HOLDER CANCELLATION REPUCE1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION .DATE THEREOF, NOTICE .WILL :BE DELIVERED IN ACCORDANCE WITH THE POLICY.PROVISIONS, Celia Repucci 29 Delucia Way North Andover;MA-01845 AUTHORIZED REPRESENTATIVE James R. Mc Donald ©1988-2010 ACORD CORPORATION. All rights reserved.. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD WHITKE1 PAGE 2 NOTEPAD INSURED'S NAME KeJo Corporation OP ID:Fi DATE 09/25/13 Named Insured: ejo .Corporation dba Servpro of Lawrence dba Servpro of Lawrence-Three dba Servpro of Lawrence-Two dba Servpro of Salem/Plaistow dba Servpro of .The Andovers. This Endorsement Modifies Your Policy (Effective At Inception Unless Another Date Shown Below) ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The insurance afforded by this policy for"bodily injury,""property damage"and/or"personal and advertising injury" shall also apply to the "additional insured" listed below for claims, suits, and/or damages made against the "additional insured," but only to the.extent the "additional insured" is being held responsible for the acts,omissions and/or negligence of the"nmed insured." This insurance afforded shall not apply to claims, suits and/or damages arising out of the acts, omissions and/or negligence of the"additional insured(s)." The inclusion of the''additional insured(s)"shall not operate to increase the Limits of Insurance. To the extent, if any, that this policy affords coverage to an "additional insured,"the "additional insured" is subject to all of the terms of the policy. Our obligation to provide coverage to an "additional insured" is further limited by the interest.of the "additional insured"as defined below. Interest of the Additional Insured(s)Defined: PER CONTRACT,AGREEMENT OR PERMIT FOR CLEANING SERVICES. For the purpose of this.endorsement,the"named insured"is the person(s)and/or party(les)designated on the Declarations Page of the policy or on any endorsement. The"additional insured"is the persons)and/or party(ies)identified below. Identity of Additional,Insured(s): CELIA REPUCCI 29 DELUCIA WAY. NORTH ANDOVER,MA 01845 (Complete this section if endorsement is added after policy is issued.) PGP0759539 4 9/25/2013 Policy Number Endorsement Number Endorsement Effective Date 00516 Signature of Authorized Representative Producer Number WW180(03/10) INSURED