HomeMy WebLinkAboutBuilding Permit #197-11 - 306 HILLSIDE ROAD 9/7/2010 BUILDING-PERMIT tOO oTN
TOWN OF NORTH ANDOVER o -.
APPLICATION FOR PLAN EXAMINATION
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Permit NO: Date ReceivedArm
�'gSSACHUS�,�'(5 i
Date Issued: J
IMPORTANT:Applicant must complete all items on this page j
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
dd' ' Two or more•family Industrial
No. of units: Commercial
Repair re lacement Assessory Bldg Others:
eolition '` OCher
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DESCRIPTION OF WORK TO BE P EFORMED:
Iden ' cation PleaseT)jw,or Print CI.early)
OWNER: Name: k, / v-e Phone: 72-5 d
Address:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Tota[ Project Cost: $ ( , ��zn O FEE: $ 3 i
Check No.: �� Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guar fun
S.:/: Gil•L1�.34J ' _ -_-' __ _ _ _ice.. �t yl.�yu._- �'�. ar:n-} -
d. --• _gnatU�i-ein���on�rae�'.-�� �u �.�°-- .y�:�•. ,
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
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check.Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
'--,--:-New Construction (Single and Two Family)
❑ Building Permit Application
I M.C., i i iFlt�a�.iI rte- Flt �e- c�
❑ Le. Li....., Pr..2f✓v.sed � lot � lay t.
❑ 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
i
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the 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:Suildina Permit Revised 2008
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Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.: j
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
1
Doc_BuiIding Pemiit Revised 2010
Plans Submitted Plans Waived Certified Plot:Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools
Well Tobacco Sales Food Packaging/Sales
Private(septic tank,etc. Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED-
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
C-MME IvT
a - - •
' HEALTH Reviewed on Signature
l
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
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Location�,
No. Date U
�oRTM TOWN OF NORTH ANDOVER
F w
9
+ Certificate of Occupancy $ `
ACMUsE<�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #4)-
234zG o
Building Inspector
,q.CpR CERTIFICATE OF 'LIABILITY INSUR-NCE - °��(M"�/201"
08/03/2010
'PRODUCER 603.382.4600 FAX-603.,.38Z.2034 THIS-CERTIF'ICATE:IS ISSUED AS A MATTER OF INFORMATION .
Insurance. Solutions Corporation ONLY.AND CONFERS NO,RIGHTS UPON THE,CERTIFjCATE
HOLDER,THIS CERTIFICATE: ES NOT AMEND,EXTEND.011%
60 Westville Rd ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
386 : .. :•. .,..
INSURERS AFFQ DING COVE NAt4#
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KEJO CORP DBA' SERVPI� OF LAWRENCE INSURERA Pho.#n x Lpsurance o, 256.2 ._,•.,,_,
INSURED BIPanX:'
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LAWRfNCf; MA 01841
INSURER C:
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COVERAGES
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.AGGREGATE LIMITS'SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS.
IN D TYPE OF INSURANCE POLICY NUMBER D TECMM/DD TIV6 POLICY
TION LIMITS
'LTR NSR
GENERAL LIABILITYEACH OCS.
COMMERCIAL GENERAL LLABT{.STY PREMISE$ Ea ocpRrpnOe b .
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CLAIMS MAM OCCUR MED 6XP.•(AIIY Me peiaon) S '
pER80NAL;&ADV INJURY.. S
GENERAL:AGGREGATS.
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POLJCY F71:JECT: LOC
AUTOMOBILE11JABIL17Y BA73311_994 10/01/2009 10/01/Z010 COMSINEDSINGLE LIMIT
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ALL OWNED AUTOS BODILY INJURY.
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HIRFD•AUTOS' 60DILY JNJURY
(Per ewW.0 _ $
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oARAGE LIABILITYAUTO ONLY-:0AAC0I0ENf'• i
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WORKERS COMPENSATION WC54SS311 05/01/2010 OS/01/7011 Y IMITs
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' ISPE�IAL FROVISION8 berov
DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL rROVIBTONS
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCR03ED POLICIES 138 CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED To THE LEFT,BUT FAILURE TO DO 50 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPONTHI=INSURER ITS AGENTS OR
K@j o Corp dba Servpro Of Lawrence
PO Box 328 REPR£seNTATNES,
A
Lawrence, MA 01842 7(1�
DREPIiESETITATIVE
ACORD 25(2008/01) FAX' 978.687.7706 @ 1988.2009 A O CORPORATION. All ri8hfs,rss®rved.
The ACORD name and logo are registered marks of ACORD
[0 'd 50 Ol OIOZ £ $nV
The Commonwealth of Massachusetts
Department o f Industrial Accidents
Ofjace of£nvestigations
600 Washinbeton Street
Boston, MA 62111
Workers' Compensation Insurance Aclavit: gra rs/Contrac
An lieant Information tors/Electricians/Plumbers
. PIease Print LeaiblY
Name (Business/Organization/Individuat):
Address:
City/State/Zip: /
�`7 Phone#: Z2 _ ._ /�C��
Are you an employer? Check t[i ---/ '
�PProPriate boa:
1 I am a employer with. 4. ❑ I am ao Type of project(required):
time) * have hired contractor and I
the sub-contractors 6. ❑New construction
employees(full and/or part
2.❑ I am a sole proprietor or partner_ listed on the attached sheet $ 7• ❑Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity. workers' comp.insurance. "8'� emohhon
[No workers' comp. insurance 5. ❑ We are a corporation and its 9. ❑Building addition
3.0 required.] officers have exercised their 10 0 Electrical repairs
.I am a homeowner doing all work rigt of ex °r addition
emption per MGL I. Plumbing repairs or additions
myself [No workers'comp, c. 152,§I(4) and we have no ❑
insurance required.] t employees. � 12•❑Roof repairs
` [No workers'
__ comp.insurance required.] 13 0 Other
I�omeown ±that bot=? mzct s?so 21L cut fhe sect o^_�:ov o^ny;. y�
ers who submit this affidavit indicating th a*✓doing ,..vo G r works'con r_�+cc. i:".. .
'Contractor that check thi_box must att2cued an additional sheet srl howing the
,ilea hire outside contmetc z submit a new affidavit indicating such.
came of the sub-contractors and their workers'comp.policy information.
I am an emplrryer that is providing workers'compensation insurance for my e
information mployees. Below is the policy and,job site
Insurance ComPin Name: X � � `
Policy#or Self ins.Lic. 3 �
Expiration Date:
Sob Site Address: ���� /lJ/�
/v City/State/Zip:
Attach a copy of the workers' compensation policy declaration pate (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 )
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties of a
Of up to $250.00 a day against the violator. Be advised that a co penalties e the form of a STOP WORK ORDER and a fine
Investigations of the DIA for insurance coverage verification. PY of statement may be forwarded to the Office of
Ido hereby certify and airs a
penadde ury thQr the information provided above is true and correct
Signature:
--
Phone#:
Official use only. Do not write in this area to be completed by cam,or town official
City or Town:
Issuing permitUcense#
Authority(circle one):
Z. Board of Health 2.Bt ldinb Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
Contact Person:
Phone#:
Information am d Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuant to this statute;an employee is defined as"...every p>— on in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise,and including tiie legal representatives of a deceased employer, or the
receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartnz eats and who resides therein,or the occupant of the
dwelling house of another who employs persons to do mainte msnce,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such,employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to c onstruct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of coarnpliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work um-til acceptable evidence of compliance with the ins=e
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary, supply sub-contractor(s)name(s), address(es) and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,,are not required to carry workers' comp ensation irmarance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of hw rance coverage. .Also be svii-e to sign and date the affidavit. The affidavit should
be r t-rned to the city or town that the aUplicaiian for the perl30itQr 12ce�1QP LS being;eplteSt:d,not f1`e DepE.*L..a It OI
Industrial Accidents. Should von have any questions regardiz<g the law or if you zre:.^aired to obtain a workers'
compensation policy,please call the Department at the numbe=r listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permitllicense number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary) and under`.`Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stampesd or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future pernmits or licenses. A new affidavit must be filled out each
year.When a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit
ne Office of Investigations would like to than you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call-
The
allThe Department's address,telephone and.,fax.number.._..
The Coimmonwealthz Of Massachusetts
Department of lmdustrial Accidents
Offiee of Ini este atiions
600 Wasiain£`-tun Streat
Boston,M-A 0.2111
Tel. # 617-72.7-4900 m t 406 or 1-877-MASSAFE
Revised -26-05 Fw. r 6.17-72.7-77'49
UrVTV7-masS..Zov/dla
NORTH
0 of over
No-
/ 07- Ao®® _
-o dover, Mass.,0 LAKE
"
Co C N,C.6 wt CK
%SORATED PPat��
BOARD OF HEALTH
Food/Kitchen
'PERMIT T D Septic System
BUILDING INSPECTOR
THIS CERTIFIES THAT . �'L
...... ..............�"%�--""�.........................�]......................All(-rr
............................................................. Foundation
✓J
has permission to erect......................................... buildings on �,��� . 4 � ,��`�-.............. Rough
...
i V a �� /!y _ Chimney
to be occupied as.........�... .. ....................................:........... ../�...�.......... .. ..............................................................................
provided that the per on accepting this permit shall in every respe onto the 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 N SELECTRICAL INSPECTOR
UNLESSCONS O ST S 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.
—= Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR
Registration:;.,.-,158271
Tr# 291205
Expiration= ;713112011
Type, Pnvate Corporation
KEJO CORPORATION {",
GREGG WHITE '
8 BLAKELIN
LAWRENCE,MA 01841:
Undersecretary
. Massachusetts- Deportment of Public Safet-"
BoalA of Building Regulations and Standards .
Construction Supervisor License
License: CS 67690
Restricted to: 00
GREGG M WHITE
4 CHATBURN RD
WINDHAM, NH 03087
I '
Expiration: 2/20/2012
. ('umiuissiuncr Tr#: 16305
I
AUTHORIZATION TO PERFORM SERVICES and
DIRECTION OF PAYMENT
(STANDARD)
d LCA— u e__ , herein referred to as "Customer",
authorizes SERVPRO of ,4 `,_ ,Ando It-�S , herein.referred to as "SERVPRO",
to perform any and all necessary cleaning and/or restoration services on Customer's property
at: 3CCr: 1J1/1,t51d4 ve4
And with respect to items that need to be cleaned at a remote location, to remove and clean
such items as necessary. Customer agrees that SERVPRO is working for the Customer and not
the Insurance Company or agent/adjuster.
Customer authorizes 0,514/x. Insurance Company,
herein referred to as "Insurance Company", to solely pay SERVPRO directly for that portion of
the work covered by Customer's insurance policy.
If for any reason the check for payment should be signed over or made payable to Customer,
Customer agrees to pay SERVPRO immediately upon receipt of the check from the Insurance
Company. Customer also agrees to pay SERVPRO directly for any amounts not covered by
Customer's insurance company, including deductible.
Customer agrees if payment is not made to SERVPRO within five (5) days of Customer's receipt
of the check from Insurance Company, to pay service charges at one and one half percent
(1.5%) per month or the highest amount allowed by law, whichever is less, plus reasonable
attorney fees, court costs and all costs of collection.
Remarks:
I have read the Terms and Conditions of Service on the reverse side hereof and
agree to same.
Signatur Date
Printed Name
Please Review Terms and Conditions On Reverse Side
White—SERVPRO Yellow—Adjuster Pink—Customer
28001 6/01
SERVPRO of Lawrence
PO Box 328
Lawrence,MA 01842
9/7/2010
Insured: BOURQUE,LT COL GEORGE Home: (978)725-5980
Property: 306 HILLSIDE RD Business: (978)725-5980
north andover,MA 01845 Cell: (978)397-4311
Home: 306 HILLSIDE RD
NORTH ANDOVER,MA 01845
Member Number: 000619784 Policy Number: 000619784/97A L/R Number: 041
Type of Loss: WTR-PLB Cause of Loss:
Coverage Deductible Policy Limit
Dwelling $1,000.00 $307,000.00
Other Structures $0.00 $76,750.00
Contents $0.00 $230,250.00
Date of Loss: 9/2/2010 Date Received: 9/2/2010
Date Inspected: 9/2/2010 Date Entered: 9/2/2010
Price List: MAEM7X_SEP10
Restoration/Service/Remodel
Summar for Dwelling
g
Line Item Total 4,060.34
Total Adjustments for Base Service Charges 155.92
Replacement Cost Value $4,216.26
Less Deductible (1,000.00)
Net Claim $3,216.26
Please contact our adjuster if you believe a supplement to this estimate is needed.Before we will consider a supplement to this
estimate,we must have the opportunity to re-inspect the damages prior to the supplemental work being done.
i
SERVPRO of Lawrence
BOURQUE,LT COL GEORGE 9/7/2010 Page:2
BOURQUE_LT_COL_GEOR
Basement
$ 1 Basement Height:8'
992.00 SF Walls 880.00 SF Ceiling
1 1872.00 SF Walls&Ceiling 880.00 SF Floor
97.78 SY Flooring 124.00 LF Floor Perimeter
124.00 LF Ceil.Perimeter
I
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
12.WTR LABA Water Extraction&Remediation Technician-after hours
6 6.00 HR 62.43 374.58 (0.00) 374.58
2 techs for 3 hours removing wet items and moving contents
13.WTR GRM Apply anti-microbial agent
.25C+.25F 440.00 SF 0.19 83.60 (0.00) 83.60 /
14.WTR DRY Air mover(per 24 hour period)-No monitoring
4*3 12.00 EA 25.00 300.00 (0.00) 300.00
4 air movers for 3 days
15.WTR DHM>> Dehumidifier(per 24 hour period)-XLarge-No monitoring
1*3 3.00 EA 101.25 303.75 (0.00) 303.75
1 DH for 3 days
Totals: Basement 1,061.93 0.00 1,061.93
Total:Basement 1,061.93 0.00 1,061.93
Main
12'4" 1_ Bedroom Height:8'
N 360.00 SF Walls 126.22 SF Ceiling
b 3 486.22 SF Walls&Ceiling 126.22 SF Floor
l 14.02 SY Flooring 45.00 LF Floor Perimeter
45.00 LF Ceil.Perimeter
7"
2'a" Subroom 1: ROOM3 Height: 8'
200.00 SF Walls 1.9.56 SF Ceiling
219.56 SF Walls&Ceiling 19.56 SF Floor
2.17 SY Flooring 25.00 LF Floor Perimeter
25.00 LF Ceil.Perimeter
2'2"
SERVPRO of Lawrence
BOURQUE,LT COL GEORGE 9/7/2010 Page: 3
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
16.WTR LABA Water Extraction&Remediation Technician-after hours
2 2.00 HR 62.43 124.86 (0.00) 124.86
move and cover contents as needed
17.WTR DRYW Tear out wet drywall,cleanup,bag for disposal
.5C 72.89 SF 0.65 47.38 (0.00) 47.38
18.WTR DHM> Dehumidifier(per 24 hour period)-Large-No monitoring
1*3 3.00 EA 71.00 213.00 (0.00) 213.00
1 DH for 3 days
19.WTR DRY Air mover(per 24 hour period)-No monitoring
4*3 12.00 EA 25.00 300.00 (0.00) 300.00
4 Air movers for 3 days
20.WTR WFD Wood floor drying-Dctd type(per 24 hour period)No monit.
1*3 3.00 DA 95.00 285.00 (0.00) 285.00
1 Injecta dry for 3 days
31.WTR BARR Containment Barrier/Airlock/Decon.Chamber
96 96.00 SF 0.54 51.84 .(0.00) 51.84
21.CLN F- Clean floor
F 145.78 SF 0.30 43.73 (0.00) 43.73
Totals: Bedroom 1,065.81 0.00 1,065.81
711,0 4„ Kitchen Height: 8'
1 11"
T i 486.67 SF Walls 159.33 SF Ceiling
645.99 SF Walls&Ceiling 159.33 SF Floor
17.70 SY Flooring 60.83 LF Floor Perimeter
60.83 LF Ceil.Perimeter
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
22.WTR LABA Water Extraction&Remediation Technician-after hours
2 2.00 HR 62.43 124.86 (0.00) 124.86
move and cover contents as needed
23.WTR DRYW Tear out wet drywall,cleanup,bag for disposal
.75C*2 238.99 SF 0.65 155.34 (0.00) 155.34
reflects 2 layers on ceiling
29.WTR DRYW Tear out wet drywall,cleanup,bag for disposal
24 24.00 SF 0.65 15.60 (0.00) 15.60
wall area removed
28.WTR BASED Baseboard-Detach
8 8.00 LF 0.75 6.00 (0.00) 6.00
SERVPRO of Lawrence
BOURQUE,LT COL GEORGE 9/7/2010 Page:4
CONTINUED-Kitchen
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
24.WTR DHM> Dehumidifier(per 24 hour period)-Large-No monitoring
1*3 3.00 EA 71.00 213.00 (0.00) 213.00
1 DH for 3 days
25.WTR DRY Air mover(per 24 hour period)-No monitoring
4*3 12.00 EA 25.00 300.00 (0.00) 300.00
4 Air movers for 3 days
26.WTR WFD Wood floor drying-Dctd type(per 24 hour period)No monit.
1*3 3.00 DA 95.00 285.00 (0.00) 285.00
1 Injecta dry for 3 days
27.CLN F- Clean floor
F 159.33 SF 0.30 47.80 (0.00) 47.80
30.WTR BARR Containment Barrier/Airlock/Decon.Chamber
96 96.00 SF 0.54 51.84 (0.00) 51.84
Totals: Kitchen 1,199.44 0.00 1,199.44
Total:Main 2,265.25 0.00 2,265.25
2nd
._..:.......:.
Bathroom Height:8'
T s 192.00 SF Walls 36.00 SF Ceiling
I `
m in bathroom
0 228.00 SF Walls&Ceiling 36.00 SF Floor
4.00 SY Flooring 24.00 LF Floor Perimeter
Y 32" 24.00 LF Ceil.Perimeter
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
1.TIL AV Remove Ceramic tile
F 36.00 SF 1.47 52.92 (0.00) 52.92
3.PLM SNK Remove Sink-single
1 1.00 EA 15.34 15.34 (0.00) 15.34
2.PLM TLT Remove Toilet
1 1.00 EA 20.46 20.46 (0.00) 20.46
4.WTR ULAY Tear out non-salv underlayment&bag for disposal
F 36.00 SF 0.94 33.84 (0.00) 33.84
BOURQUE,LT COL GEORGE SERVPRO of Lawrence 9/7/2010 Page:5
CONTINUED-Bathroom
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
5.WTR GRM Apply anti-microbial agent
F 36.00 SF 0.19 6.84 (0.00) 6.84
6.WTR DRY Air mover(per 24 hour period)-No monitoring
1*3 3.00 EA 25.00 75.00 (0.00) 75.00
1 Air mover for 3 days
7.WTR DHM> Dehumidifier(per 24 hour period)-Large-No monitoring
1*3 3.00 EA 71.00 213.00 (0.00) 213.00
1 DH for 3 days
Totals: Bathroom 417.40 0.00 417.40
Total:2nd 417.40 0.00 417.40
job
CAT SEL DESCRIPTION
CALC QNTY UNIT PRICE RCV DEPREC. ACV
32.DMO PU Haul debris-per pickup truck load-including dump fees
1 1.00 EA 149.44 149.44 (0.00) 149.44
33.WTR EQ Equipment setup,take down,and monitoring(hourly charge)
4 4.00 HR 41.58 166.32 (0.00) 166.32
Totals: job 315.76 0.00 315.76
Line Item Subtotals:BOURQUE_LT_COL_GEOR 4,060.34 0.00 4,060.34
Adjustments for Base Service Charges Adjustment
Floor Cleaning Technician 72.76
Cleaning Remediation Technician 83.16
Total Adjustments for Base Service Charges: 155.92
Line Item Totals: BOURQUE_LT_COL_GEOR 4,216.26 0.00 4,216.26
SERVPRO of Lawrence
BOURQUE,LT COL GEORGE 9/7/2010 Page: 6
i
Grand Total Areas:
2,230.67 SF Walls 1,221.10 SF Ceiling 3,451.77 SF Walls and Ceiling
1,221.10 SF Floor 135.68 SY Flooring 278.83 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 278.83 LF Ceil.Perimeter
I
1,221.10 Floor Area 1,307.60 Total Area 2,230.67 Interior Wall Area
2,149.50 Exterior Wall Area 238.83 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
I
11
SERVPRO of Lawrence
BOURQUE,LT COL GEORGE 9/7/2010 Page:7
Recap by Room
Estimate:BOURQUE_LT_COL_GEOR
Area: Basement
Basement 1,061.93 25.19%
Area Subtotal: Basement 1,061.93 25.19%
Area: Main
Bedroom 1,065.81 25.28%
Kitchen 1,199.44 28.45%
Area Subtotal: Main 2,265.25 53.73%
Area: 2nd
Bathroom 417.40 9.90%
Area Subtotal: 2nd 417.40 9.90%
job 315.76 7.49%
Subtotal of Areas 4,060.34 96.30%
Base Service Charges 155.92 3.70%
Total 4,216.26 100.00%
i
SERVPRO of Lawrence
BOURQUE,LT COL GEORGE 9/7/2010 Page: 8
Recap by Category
Items Total %
CLEANING 91.53 2.17%
GENERAL DEMOLITION 149.44 3.54%
PLUMBING 35.80 0.85%
TILE 52.92 1.26%
WATER EXTRACTION&REMEDIATION 3,730.65 88.48%
Subtotal 4,060.34 96.30%
Base Service Charges 155.92 3.70%
Total 4,216.26 100.00%
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