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HomeMy WebLinkAboutBuilding Permit #963-15 - 370 SUMMER STREET 5/1/2018 Of pORTN 9 t�e�4—, ' t=1''� BUILDING PERMIT 3� g�1``D ° °+�� TOWN OF NORTH ANDOVER ° i APPLICATION FOR PLAN EXAMINATION - Permit NO: Date Received *� o°RAre° Date Issued: 9SSgcHuS�� IMPORTANT: Applicant must complete all items on this page LOCATION—;, Irlm .S` m. r, rintb , PROPERTY OWNER = Print x MAP NCP�PARCEL* ZONING-DISTRICT: =listoric strict yes . n Machine Shop Village r no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Acne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: Af-Demolition ❑ Other .11Septic o Well E Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer 1�-t clL VC MON SAUUaOAO r S Poe TO W,11-dqC 9�14mheevr. Identifcation Please Type or Print Clearly) OWNER: Name: �HACIP AMC Phone: Address: 376 soltwo 5, CONTRACTOR mName` F/q. _ Phone: , N �. Address e E n Supervisor's,,Construction License: � lxp: Date: � -' �;A HomeImprovement License: I pExp, Dater � r /5BC��. a� 4 ". ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Sl���• FEE: $ Check No.: Receipt No.: NOTE: Aer:Zoh5Wontracting with unregistered contractors do not have a cess to't#egifar ty nd Signare.of Agent%Owner i g Ea of'cont turactor_ L ORTF( BUILDING PERMIT °�N�Fo bgao TOWN OF NORTH ANDOVER 0 - APPLICATION FOR PLAN EXAMINATION � 'pa Permit No#: Date Received �,gssgcHus���5 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: 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 El Two or more family El Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other t w® Septic t®Well '$ ® Floodplarn `®Wetlands . ,® Wa .er ed ®is ri�,ct - DESCRIPTION OF WORK TO BE PERFORMED: t Identification- Please Type or Print Clearly - OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date:. Home Improvement License: Exp. Date: 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. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund (�: s f p _ f 6L• F �' ___ _ _ _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 9 TYPE OF SE�GVERAGE DISPOSAL r, 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS T WEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals; Variance, Petition No; Zoning Decisionlreceipf submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer Connection/Signature ®ate Driveway Permit DPW Town Engineer: Signature: 7 Located 384 Osgood Street FIRE DEI?AR� NIT ENl"� �-_ ��'�-� j �' � , -� ,.�.' � ..". _ Temp Du pster�on*'site; y�es { � R' oceted at 124 Main Street ` �t �,�` !z-'N r? + u ; Fire Depa meet signature/dateIL .. =C,®MMEIVT'S ,' � �� ����t� <,,.� .rig E ;�. ' � ;'�}; ,.,�: �t�k. �' � ��.; �• � � �' Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. t.: 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) j L LJ I Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 f 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 OTE: 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 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit 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:Building Permit Revised 2014 Location No. Date • - TOWN OF NORTH ANDOVER 5 6� � Certificate of Occupancy $ w Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ rua TOTAL $ e Check#/ 6 Building Inspector F OORTH .. own of s E �} Andover o - No. T Z y 0Lh ver, Mass, JaC21 Is- A- coc"Ic«1WICK A. 7�ADN�tTED /`Pp�,�S s V BOARD OF HEALTH Food/Kitchen . PERMIT T LD Septic System THIS CERTIFIES THAT .............R.1ChA.r._.d....... ....... BUILDING INSPECTOR has permission to erect buildings on ..3 Foundation Rough to be occupied as .......... .......�..r�4 ..�.,... 0- .... - ...... Chimney R.. ................................ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final -'7 . PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU 0 TARTS Rough Service .......... ... .......... .. ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy 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. • • �� Authorization to Perform Services and Direction of Payment Muckle, Richard 02/26/2015 Customer Name: Date of Loss: Loss Address: 370 Summer St. City: North Andover State: MA Zip: 01845 Insurance Company: 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 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$ 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: Muckle, Richard Remarks: I 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: 6 Y O N Provider's Signature:- Customer's Signature: a Franchise Legal Name: KEJO CORP Printed Name: Muckle, Richard d/b/a SERVPRO®of: The Andovers 04/17/2015 04/17/2015 Date: Date: E-mail Address: Richmuckle@archpres.com Contractor License#: ©SERVPRO®INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1.0 28000 08/14 Each SERVPRO®Franchise is Independently Owned and Operated. 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. SERVPRO®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 Providers Services,and is not subject to liability arising out of such Services. 2. Providers 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. 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. 4. 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/countries 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 08/14 Each SER VPRGP Franchise is Independently Owned and Operated. 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 Client: Muckle,Richarddemo) Property: 370 Summer St North Andover,MA 01845 Operator: PNOTAR6 Estimator: Paul Notartomaso,Jr. Business: (603)475-2447 Company: SERVPRO Of Lawrence-SERVPRO Of The E-mail: PNotar@ServproOfLawrence. Andovers-SERVPRO Of Salem/Plaistow com Business: 8 Blakelin St Lawrence,MA 01841 Type of Estimate: Water Damage Date Entered: 5/19/2015 Date Assigned: Price List: MAEM8X APR15 Labor Efficiency: Restoration/Service/Remodel Estimate: 2015-05-19-1253DEMO T 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 2015-05-19-1253DEMO Main Level $.1 . 6" Piano Room Height:8' 343.33 SF Walls 148.17 SF Ceiling o Piano Room o 491.50 SF Walls&Ceiling 148.17 SF Floor o 16.46 SY Flooring 41.67 LF Floor Perimeter 1 6"1.1-6' 6" 1 49.17 LF Ceil.Perimeter 10' 6'5"� 1'1" Piano Clos t Door 2'6"X 6' 8" Opens into PIANO-CLOSET Door 21691 X 618t' Opens into Exterior Door 21611 X 61811 Opens into KITCHEN DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 1. Tear off plaster on wood lath 476.61 SF 1.39 0.00 662.49 (0.00) 662.49 7'4*10'7+7'4*14+10'7*14 walls+entire ceiling 2. Tear off plaster on wood lath(SELF PAY)* 192.00 SF 1.39 0.00 266.88 (0.00) 266.88 Totals: Piano Room 0.00 929.37 0.00 929.37 14'4"- Office Height:8' 14' a r _I 360.67 SF Walls 176.17 SF Ceiling 1 Office 536.83 SF Walls&Ceiling 1.76.17 SF Floor " T 19.57 SY Flooring 50.67 LF Floor Perimeter -3'-+ F-3' i 1 53.17 LF Ceil.Perimeter 1,8„ '2-7,- 8' Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Door 2'6"X 6'8" Opens into ENTRY Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 3. Tear off plaster on wood lath 288.17 SF 1.39 0.00 400.56 (0.00) 400.56 Ceiling and exterior wall 4. Tear off plaster on wood lath SELF PAY* 270.50 SF 1.39 0.00 376.00 (0.00) 376.00 Totals: Office 0.00 776.56 0.00 776.56 2015-05-19-1253DEMO 5/19/2015 Page:2 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 1.2•r-3•-2'4° 1st Floor Bathroom Height:8' 175.33 SF Walls 40.50 SF Ceiling F stHoorBa215.83 SF Walls&Ceiling 40.50 SF Floor 11 4,12,6„+2.2 4.50 SY Flooring 23.00 LF Floor Perimeter 1'6' 2'6' 25.50 LF Ceil.Perimeter Door 2'6"X 6'8" Opens into KITCHEN Window Y X 4' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 5. Tear off plaster on wood lath SELF PAY* 142.08 SF 1.39 0.00 197.49 (0.00) 197.49 Totals: 1st Floor Bathroom 0.00 197.49 0.00 197.49 T 13'4"1 Stairs3 Height: 16'9" 330.18 SF Walls 37.50 SF Ceiling �r 1 367.68 SF Walls&Ceiling 64.79 SF Floor 7.20 SY Flooring 30.86 LF Floor Perimeter l 26.47 LF Ceil.Perimeter Missing Wall 2' 10"X 16'91/16" Opens into ENTRY DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 6. Tear off plaster on wood lath SELF PAY* 120.00 SF 1.39 0.00 166.80 (0.00) 166.80 Totals: Stairs3 0.00 166.80 0.00 166.80 2015-05-19-1253DEMO 5/19/2015 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 14'4", Entry ht: 8' 2.101. = Y Hei g t 299.87 SF Walls 72.88 SF Ceiling On �«r 372.75 SF Walls&Ceiling 72.88 SF Floor ~ 8.10 SY Flooring 36.23 LF Floor Perimeter 11�006 43.73 LF Ceil.Perimeter N 2,9„ 2-1 Door 2'6"X 6' 8" Opens into OFFICE Missing Wall 2' 10"X 8' Opens into STAIRS3 Door 2'6"X 6' 8" Opens into LIBRARY Door 21611 X 6'8" Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 7. Tear off plaster on wood lath 72.88 SF 1.39 0.00 101.30 (0.00) 101.30 8. Tear off plaster on wood lath SELF PAY* 132.00 SF 1.39 0.00 183.48 (0.00) 183.48 Totals: Entry 0.00 284.78 0.00 284.78 Piano Closet Height: 8' 103.33 SF Walls 14.00 SF Ceiling ' 117.33 SF Walls&Ceiling 14.00 SF Floor y Piano Clos 1.56 SY Flooring 12.50 LF Floor Perimeter 1 4 1 15.00 LF Ceil.Perimeter -4,8„ Door 2'6"X 6' 8" Opens into PIANO-ROOM DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 9. Tear off plaster on wood lath 35.00 SF 1.39 0.00 48.65 (0.00) 48.65 exterior wall and ceiling Totals: Piano Closet 0.00 48.65 0.00 48.65 2015-05-19-1253DEMO 5/19/2015 Page:4 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 t3'+-7 8" 74" r-- J Kitchen Height: 8' 1st FI or it rrL F4, 4" 1a' 6"1` 685.33 SF Walls 526.42 SF Ceiling '4" � 1 T { 1211.75 SF Walls&Ceiling 526.42 SF Floor N Kit 671 N T N58.49 SY Flooring 91.50 LF Floor Perimeter 101.50 LF Ceil.Perimeter � 2'9 Door 2' 6"X 6'8" Opens into Exterior Missing Wall Y X 8' Opens into STAIRS Door 2'6"X 6'8" Opens into PIANO—ROOM Window Y X 4' Opens into Exterior Door 2' 6"X 6'8" Opens into Exterior Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Door 21611 X 618" Opens into DEF_1ST_FLOO DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 10. Tear off plaster on wood lath 260.00 SF 1.39 0.00 361.40 (0.00) 361.40 11*12 portion of ceiling and 16*8 exterior wall Totals: Kitchen 0.00 361.40 0.00 361.40 Total: Main Level 0.00 2,765.05 0.00 2,765.05 2nd Floor 3'9"�2'6 2nd Floor Hallway Height:8' 42 - 1 a 233.33 SF Walls 67.00 SF Ceiling 300.33 SF Walls&Ceiling 67.00 SF Floor 7.44 SY Flooring 27.50 LF Floor Perimeter 37.50 LF Ceil.Perimeter sv.liv Door 2'6"X 61811 Opens into BEDROOM-3 Door 2'6"X 6' 8" Opens into ROOM2 Missing Wall 4'X 8' Opens into Exterior Door 2'6"X 61819 Opens into TV—ROOM Door 2'6" X 6' 8" Opens into Exterior 2015-05-19-1253DEMO 5/19/2015 Page:5 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 DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 1.1. Tear off plaster on wood lath 67.00 SF 1.39 0.00 93.13 (0.00) 93.13 ceiling 12. Tear off plaster on wood lath SELF PAY* 233.33 SF 1.39 0.00 324.33 (0.00) 324.33 Totals: 2nd Floor.Hallway 0.00 417.46 0.00 417.46 _ 13'3"-3-4-79" Bedroom 3 Height:8' F! Bedmom -7,7. u 358.00 SF Walls 154.13 SF Ceiling T 3 512.13 SF Walls&Ceiling 154.13 SF Floor 2nd o 2nd MBa o 17.13 SY Flooring - 47.33 LF Floor Perimeter 13.6" LF 49.83 LF Ceil.Perimeter Window Y X 4' Opens into Exterior Door 21611 X 6' 8" Opens into ROOM1 Window Y X 4' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 13. Tear off plaster on wood lath 249.46 SF 1.39 0.00 346.75 (0.00) 346.75 Ceiling plus exterior wall 7*13 14. Tear off plaster on wood lath SELF PAY* 268.50 SF 1.39 0.00 373.22 (0.00) 373.22 Totals: Bedroom 3 0.00 719.97 0.00 719.97 Bedroom 2 Height:8' Tla'2" 1 + 372.67 SF Walls 175.90 SF Ceiling Bedroom 2 1 548.57 SF Walls&Ceiling 175.90 SF Floor T + 1 m 19.54 SY Flooring 50.67 LF Floor Perimeter 8'9" g 6" - 1 �3� N 53.17 LF Ceil.Perimeter ,2', 2'7"1 Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Door 21611 X 618" Opens into DEF_2ND_FLOO Window Y X 4' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 1.5. Tear off plaster on wood lath 190.62 SF 1.39 0.00 264.96 (0.00) 264.96 Half of ceiling and exterior wall 7'4*14 201.5-05-1.9-1253DEMO 5/19/2015 Page: 6 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 CONTINUED-Bedroom 2 DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV Totals: Bedroom 2 0.00 264.96 0.00 264.96 ,3'>>"-3'--7's" TV Room Height: 8' 366.00 SF Walls 159.61 SF Ceiling TV Room j 525.61 SF Walls&Ceiling 159.61 SF Floor loor Hal 4117.73 SY Flooring 48.33 LF Floor Perimeter ro a, 1 50.83 LF Ceil.Perimeter 14-5" Door 21611 X 618't Opens into ROOMI Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 16. Tear off plaster on wood lath 262.28 SF 1.39 0.00 364.57 (0.00) 364.57 Ceiling plus exterior wall 14*7'4 17. Tear off plaster on wood lath SELF PAY* .1.83.00 SF 1.39 0.00 254.37 (0.00) 254.37 Totals: TV Room 0.00 618.94 0.00 618.94 2nd Floor Bath Height: 8' 1' 2'6" T 240.67 SF Walls 42.70 SF Ceiling 5 4"' 283.37 SF Walls&Ceiling 42.70 SF Floor 1 t-5'4" T 4.74 SY Flooring 29.67 LF Floor Perimeter 2nd F100r Bath 9'z' 1 32.17 LF Ceil.Perimeter 91101, -1 Door 2'6"X 6' 8" Opens into STAIRS_TO_2N DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 18. Tear off plaster on wood lath 69.84 SF 1.39 0.00 97.08 (0.00) 97.08 Affected wall 9'5*75 2015-05-19-1253DEMO 5/19/2015 Page:7 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 CONTINUED-2nd Floor Bath DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV Totals: 2nd Floor Bath 0.00 97.08 0.00 97.08 2nd Floor Landing Height:8' 271.47 SF Walls 62.45 SF Ceiling rba g 333.92 SF Walls&Ceiling 62.45 SF Floor 6.94 SY Flooring 34.60 LF Floor Perimeter 39.60 LF Ceil.Perimeter Door 2'6"X 6'8" Opens into BEDROOM-1 Missing Wall 3'3 3/16"X 8' Opens into Exterior Door 2'6"X 6'8" Opens into BEDROOM-2 Window Y X 4' Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 19. Tear off plaster on wood lath 82.56 SF 1.39 0.00 114.76 (0.00) 114.76 Half of ceiling and exterior wall 7*7'4 20. Tear off plaster on wood lath SELF PAY* 157.33 SF 1.39 0.00 218.69 (0.00) 218.69 Totals: 2nd Floor Landing 0.00 333.45 0.00 333.45 l4-6° Bedroom 1 Height: 8' 14'2" T �II 372.67 SF Walls 175.90 SF Ceiling °° s B�ar�m 1 1 t 548.57 SF Walls&Ceiling 175.90 SF Floor T _+ 19.54 SY Flooring 50.67 LF Floor Perimeter 8;X3lairsd F8 � 53.17 LF Ceil.Perimeter Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Window Y X 4' Opens into Exterior Door 2'6"X 6' 8" Opens into DEF_2ND_FLOO 2015-05-19-1253DEMO 5/19/2015 Page: 8 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 DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 21. Tear off plaster on wood lath 151.67 SF 1.39 0.00 210.82 (0.00) 210.82 14*74 wall and 7*7 ceiling Totals: Bedroom 1 0.00 210.82 0.00 210.82 t2's",-.7'2" Stairs to 2nd Floor/2nd Floor Landing B Height:8' 6]0 _6.. 235.33 SF Walls 60.71 SF Ceiling 2ndn �r2„� r landing B 296.04 SF Walls&Ceiling 60.71 SF Floor e 6.75 SY Flooring 27.33 LF Floor Perimeter 1 39.83 LF Ceil.Perimeter 1 Door 2'6"X 6' 8" Opens into Exterior Door 2'6"X 6' 8" Opens into ROOM3 Door 2'6"X 6' 8" Opens into Exterior Door 2'6"X 6' 8" Opens into Exterior Door 2'6"X 6' 8" Opens into Exterior DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 22. Tear off plaster on wood lath 104.17 SF 1.39 0.00 144.80 (0.00) 144.80 6*5 ceiling and 10*7 exterior wall in stairwell Totals: Stairs to 2nd Floor/2nd Floor Landing B 0.00 144.80 0.00 144.80 2nd Floor Bathroom Height:8' 2'8" T ,I 139.33 SF Walls 18.89 SF Ceiling - irloorHallu 2nOaB�t o m 158.22 SF Walls&Ceiling 18.89 SF Floor fi r � 2.10 SY Flooring 17.00 LF Floor Perimeter fV 19.50 LF Ceil.Perimeter Door 2'6"X 6' 8" Opens into ROOMI DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 23. Tear off plaster on wood lath SELF PAY* 158.22 SF 1.39 0.00 219.93 (0.00) 219.93 Totals: 2nd Floor Bathroom 0.00 219.93 0.00 219.93 Total: 2nd Floor 0.00 3,027.41 0.00 3,027.41 2015-05-19-1253DEMO 5/19/2015 Page:9 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 Line Item Totals: 2015-05-19-1253DEMO 0.00 5,792.46 0.00 5,792.46 Grand Total Areas: 5,846.81 SF Walls 2,220.05 SF Ceiling 8,066.86 SF Walls and Ceiling 2,305.05 SF Floor 256.12 SY Mooring 734.18 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 800.55 LF Ceil.Perimeter 2,305.05 Floor Area 2,448.73 Total Area . 4,540.19 Interior Wall Area 4,086.77 Exterior Wall Area 510.55 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 2015-05-19-1253DEMO 5/19/2015 Page: 10 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 Summary for Dwelling Line Item Total 5,792.46 Replacement Cost Value $5,792.46 Net Claim $5,792.46 Paul Notartomaso,Jr. 2015-05-19-1253DEMO 5/19/2015 Page: 11 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 Recap of Taxes Material Sales Tax(6.25%) Clothing Sales Tax(6.25%) Storage Tax(6.25%) Line Items 0.00 0.00 0.00 Total 0.00 0.00 0.00 2015-05-19-1253DEMO 5/19/2015 Page: 12 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 Recap,by Room Estimate:2015-05-19-1253DEMO Area:Main Level Piano Room 929.37 16.04% Office 776.56 13.41% 1st Floor Bathroom 197.49 3.41% Stairs3 166.80 2.88% Entry 284.78 4.92% Piano Closet 48.65 0.84% Kitchen 361.40 6.24% Area Subtotal: Main Level 2,765.05 47.74% Area: 2nd Floor 2nd Floor Hallway 417.46 7.21% Bedroom 3 719.97 12.43% Bedroom 2 264.96 4.57% TV Room 618.94 10.69% 2nd Floor Bath 97.08 1.68% 2nd Floor Landing 333.45 5.76% Bedroom 1 210.82 3.64% Stairs to 2nd Floor/2nd Floor Landing B 144.80 2.50% 2nd Floor Bathroom 219.93 3.80% Area Subtotal: 2nd Floor 3,027.41 52.26% Subtotal of Areas 5,792.46 100.00% Total 5,792.46 100.00% 2015-05-19-1253DEMO 5/19/2015 Page: 13 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 Recap by Category Items Total % GENERAL DEMOLITION 5,792.46 100.00% Subtotal 5,792.46 100.00% i i i 201.5-05-19-1253DEMO 5/19/2015 Page: 14 Main Level 19' 6' 12' Floor Bathr0W" �4' I l0' 111 TT 3'10" � 7 n 5'4 4'4" " o —14'6" 4,4„ 4'4" —4'8" o c� 14,2" 14' it M Kitchen �Entit Library N Office M P — P 3'8" T Sn 7 1 36'6" 1' 14'— Piano 4'Piano Room o _ o 4' 10' ano Cl& i~ u Main Level 2015-05-19-1253DEMO 5/19/2015 Page: 15 2nd Floor i--4' 1" „ 14'6" o• „ 3 3 i` 14'6" 14'2" 14'2" Stairs= 0 - - 10' 2" oor L i g ^" Bedroom 2 Bedroom 1 N if, 9' 6" 0 3,9„� M � 5' 8" `t 5' 8" 7 irs to 2 d or/2nd r Landing B� 36' 35' 11" 13'6" 14' 1" ' 10" �r - - M 5'4" 2' 8" - 1 Bedroom 3 TV Room �_ N `O 5'4" T FloorI id Ha 2nd Floor Bath cn °O M 9'2" M 2nd loor BVI a o m 1 91101, 16' 10" 14'S" 4' 1 J 2n.d Floor 2015-05-19-1253DEMO 5/19/2015 Page: 16 WH.ITKE1 OP ID: PI CERTIFICATE OF LIABILITY INSURANCE DATE 05/22/222/2IY015 055 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)i 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 certificatedoes not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Stanley McDonald Agency IL Inc PIAION James R.Mc Donald FAX 2018 State Road P.O.Box 1446 c No Ext:608-788-6160 we No): 608-788-7012 LaCrosse,W154602-1446 E-MAIL James R.McDonald ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:Tudor Insurance Company 37982 INSURED KeJo Corporation INSURER B:Travelers Property Casualty 25674 dba Servpro of Lawrence INSURER C:ACE Property&Casualty See Note For Named Insured PO BOX 328 INSURERD: 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 yy�D POLICY NUMBER MMIDDIYYYY POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. CLAIMS-MADE 0 OCCUR PGP0794208 03/01/2015 03/01/2016 D ( RENTED PREMISESS Ea occurrence) $ 300,00. MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JE LOC PRODUCTS-COMPIOPAGG $ 2,000,000 . OTHER: $ 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 OCCUR EACH OCCURRENCE $ 1,000,00 C EXCESS LIAB CLAIMS-MADE M00582025 002 01/14/2015 01/14/2016 AGGREGATE $ 1,000,000 DED X RETENTION$ 10000 $" WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Property Section 7107P412 03/0112015 03/01/2016 675,00 " B EmployeeDishonesty 7107P412 03/0112015 03/01/2016 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION MUCKRI1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Richard Muckle ACCORDANCE WITH THE POLICY PROVISIONS. 370 Summer Street North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD . NOTEPADWHITKEI PAGE 2 INSURED'S NAME KeJo Corporation OP ID: PI Date 05/22/2015 Named Insured: Kejo Corporation dba Servpro of.Lawrence _dba Servpro of Lawrence-Three dpa Servpro of Lawrence-Two dba Servpro of Salem/Plaistow dba Servpro of The Andovers ,a COFrn CERTIFICATE OF LIABILITY INSURANCE DATE(M 05/211/2015/2015 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 FAX c/o Collier Insurance A/c No Ext): 901 529-2900 A/C No: 901 529-2916 E-MAIL 606 S.Mendenhall;Suite 200 ADDRESS: Memphis,TN 38117 INSURERS AFFORDING COVERAGE NAIC# INSURERA: American Zurich Insurance Company 40142 INSURED - INSURER B Adams Keegan,Inc. 6055 Primacy Pkwy Suite 300 INSURER c Memphis,TN 38119 INSURER D: INSURER E: INSURER F Ell COVERAGES CERTIFICATE NUMBER:14TNO09858085 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. INSRTYpE OF INSURANCE - ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD MMIDD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FIOCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 1:1JECTPRO ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED FJ RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER A ANY OFFICERIMEM ER EXCLUDED?ECUTIVE F-1 N/A WC 56-11-865-01 12/01/2014 12/01/2015 E.L.EACH ACCIDENT $ 1,000,000 (Mandatoryin NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Location Coverage Period: 12/01/2014 12/01/2015 Client# 2410-MA DESCRIPTION OF OPERATIONS/LOCATIONS/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 only those co-employees Weekly of,but not subcontractors 8 BLAKELIN ST to: Lawrence,MA 01842 CERTIFICATE HOLDER CANCELLATION Richard Muckle SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 370 Summer St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-067690 ` GREGG M WHIT 4 Chatburn Rd Windham NH 03687S.TIF Expiration Commissioner 02/20/2016 II _. aec�� C�vuw�ac�arJeL� (_/fLPr Vi�P�/77/I724�Y[c a' r Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type egistration 58271 7 xpiration: Private Corporation g— KEJO CORPORATION; � SERV PRO OF LAWRERC ET ALS-, I GREGG WHITE 8 BLAKELIN STREET LAWRENCE,MA.01841 Undersecretary