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HomeMy WebLinkAboutBuilding Permit #635-15 - 419 ANDOVER STREET 2/4/2015pORTII � BUILDING PERMIT 3�0'"�� TOWN OF NORTH ANDOVER ° � APPLICATION FOR PLAN EXAMINATION n Permit NO: Date Received Date Issued: ��� �9SSACHUS�,�� IMPORTANT: Applicant must complete all items on this naize LOCATION wt 16ANcEM,vc" Print j PROPERTY OWNER t -h 4 /1g W Print MAP NO: ,PARCEL% ZONING DISTRICT: Historic District yes no T Machine Shop Village vest 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. ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer OWNER: Name Address: Identification Please Type or Print Clearly) tdic� n /� /Ian +Pur► wkre rTliMay Doo v, s�Phone: q o S (.Ss &S -q f CONTRACTOR Name: _ Vt.') Address: G 6) Supervisor's Construction License: Home Improvement License: Phone: 178 qb_-E ..--7�3- `7-J 5(?r-000 o 4) C5- /vy l'7 Exp. Date: 3/ Z��i� — _ -In — Exp. Date: 1 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: $ E 5 3 5 FEE: $ SO Check No.: o? SG 8 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access tot a guaranty fund igrature of Agent/Owner Signature of contracto — r Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 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 0 New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer UtbL;KIV i 1UN OF- WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone - Address: Supervisor's Construction License: Exp. Date: 'Home Improvement Licenser Exp. Date, - ARCH ITECT/ENGI NEER ate: ARCHITECT/ENGINEER Phone. -- Address: FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED 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 Signature of Agent/OwnerSignature of contractor_: LocationAl - &Jwent - No.(,,,,, 3 —r Date Okh 9 --,- TOWN OF NORTH ANDOVEFJ Certificate of Occupancy $ Building/Frame Permit Fee, Foundation Permit Fee Other Permit Fee $ TOTAL $ Check 26467 lkmdiing Inspector Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TYPF-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH I* COMMENTS c Reviewed on Signature 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: FIRE DEPARTMENT - Temp Dumpster on site yes_ Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no i., Dimension Number of Stories: Total square feet of floor area, based.on -Exterior dimensions. Total land area, sq. ft.: e 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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/Cross Section/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 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 IaLThe Commonwealth of tfassachusetts - Department of. XndustriglAccicienfs office of Investigations 600 Washing -ton Street Boston, MA 02111 www.mass govIdla bers 'p�7orke& Compensation Af idavit: Buil.dens/Contcactoxsl.EXe�c�ticlamfe umbZ A pcan xnformaiian Name (Business/0rganizationitndividaal):^ City/State/Zip: �- o v /'2/a O 1J7r Phare #• 7 qty �S 7 i Are you an employer? Check the approprlate 1301: a coniractox and I 1. ❑ I am. a employer with --� - employees (full and/or pax tame). • general have Nixed the sub -contractors 2. ❑ I am a solepropxietor Or partner- meted on the attached sheet. These sub -contractors have ship an.d'have no employees working for me in any capacity, 'workers' comp. insurance - 5. 1A1*e axe a: corporation audits (No workers' comp. x11 n nce off[cers have exereisedtheir required.] 3. ❑ Z am a homeowner doing all work xight of exemption per MGL myself. [No workers comp. c. 152, §1(4), and we have no employees. [Nb workers' insurancexequired,] comp. insurance required.] Loc -j,= ( Type of project (required): 6. Q New constriction F I. Q Rema ' g g, emoltion 9. Q Building addition. 10.[] Electrical repairs or additions 11.[] Plumbiag.repairs or additions 12.1 Roofxepairs 13.1 Other xAny applicant that checks box#1 mustalsafill outthe section below showingtheir workers' compensationpoHcy information. '''Homeowners who submit this affidavit indicatingthey nre doing allwork and then hire outside contractors must submit anew affidavit indicating such. ?Contractors that cheAthis box must attached an additional sheet showing the name of the sub -conttactors andtheir workers' comp. policy information. X Mn an employers that isproviding workers' compensation insurance for my employees: Below is thepoliey artd job site information. Insurance Company Name• G 1G re,L a /I G ( — O' S / Policy # or S elf -ins. Lic. #: X0000 U 8 / ExpirationDate: I l / /i� %� 4 City/State/Zip: � Job Site Address: ���7 �iIll��'Plt � �•. oy�t. �� ' Attach a copy of the workers' coaMpensation-polley declaration page (showing the policy number and expiration date). Failure to secure coverage as requixed.under Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup to $250.00 a day against the violator. Be advised that a copy of thus statement may be forwarded to the Officer of Investigations of the DIA for insurance coverage verification. Z do hereby rtify ur2der nalti ofpe ry tliat the inforrnaiion,provided alcove is True and correct Date: Si ature• phone#: S �- YSy S7 official use only. Do not write in this area, to lie completed by city or town official City or Town: PermiflLicense # IssuingA.uthority (circle one): X. Board of Health 2. BuildingDepartnaent 3. CitylTowtt Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - t•t....�.�.,f Aoren'n� Phone )a6 The Commonwealth of Massachusetts Business Certificate Date cmt;smo, # -i1 COOOrmity with the provision of Chapter one hundred and ten Section five of the General Laws, as amended, the undersigned hereby dectare(s) that a business under I title o SERVPRO OF LOWELL a� is conducted at 9 WEST ADAMS ST 01851 978- 454-7577 Lowell, MA ass by the following namedPerson(s) or Corp. full name. GRABRO LLC -�' Name/Corp. Signai� .-----,.. Residence (Street, Cjty� 2 * 9 WETS ADAMS. WELL, MASS. 01851 Name/Corp. Signature Residence (Street; City, Zip) Name/Corp. Signature Residence (Street, City, Zip),- Name/Corp. ip)Name/Corp. Signature Residence (Street, City, Zip) Purpose of filing this Business Certificate: ❑ New Business ❑ Renewal of ane ° expiring ❑ Change in a business business certificate address 0 Partial withdrawal ❑ DiscOn nuance of a of an owner business .r M A cert}flcate issued in accordance with this Section shall be in force and effectfor 4 years from the date of issue and shall be renewed each 4 years thereafter so long as such business shall be conducted and shall lapse and be void unless so renewer Middlesex S.S The Commonwealth of Massachusetts 23RD DECEMBER 13 On this day of 20---. public or City Clerk's designee, personally apD 5.. E through satisfactory evidenc of id on, which were Proved to me P ;z10% whose name/s is/ e ' on document, and who swore or affirmed me to that the co of the document e ' and accurate to the best of hiAer/their knowledge and A A „n / n ,1 n n A 1 J " SHANNON GOUM Commission E Notary Pgblic etrtrtonWs1. a1 alp «.. EIYiOffS A �y Commission Expires �� December 16, 2016 The B ess Certificate expires on otarial or City Seal): J r •l' GRABLLC-01 CONNIE1 "PC" - CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 11612 1/6/2015 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(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 Elliot Whittier Insurance Services, LLC 75 Sylvan Street Suite 8202 Danvers, MA 01923 CONTACT NAME: Connie Parent PHONE FAX C, L E,d : (978) 977-4884 A/C No): (978) 977-0850 ADOREss: cparent@elliotwhittier.com INSURER(S) AFFORDING COVERAGE NAIC q LIMITS INSURER A: Everest National Insurance X COMMERCIAL GENERAL LIABILITY INSURED GraBro LLC DBA ServPro of Lowell INSURER B : Pilgrim Insurance Company 0024 INSURER C :Hanover Insurance Group 22292 , INSURER 0: 9 West Adams St Unit 3 INSURER E: Lowell, MA 01851 INSURER F: 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. INSR LTR TYPE OF INSURANCE ADD AUTHORIZED REPRESENTATIVE POLICY NUMBER POLICY EFF MWDD/YYYY MM/DD/YYYOLICY Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE FXI OCCUR 51GLOO6481-141 11/07/2014 11/07/2015 50,00 PREMISES Ea occurrence $ MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY 7X LOC JE PRODUCTS -COMP/OP AGG $ 11000100 OTHER: AUTOMOBILE LIABILITY COM") 1101111—$ 11000100 B ANY AUTO PGC00001018501 11/17/2014 11/17/2015 BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ . AUTOS AUTOS X NON -OWNED HIRED AUTOS X PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY Y / N S TA ERH E.L. EACH ACCIDENT $ 1,000,00 A ANY ECUTIVE FN7 N / A 5300002408-141 09/30/2014 09/30/2015 OFFICEOPRIET ER/EXCLUDED? (Mandatory in NH) If yes, describe under E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 11000,00 DESCRIPTION OF OPERATIONS below C Bus. Pers. Property RHN980326503 12120/2014 12/2012015 $1000 ded. 29,718 C Contractor Equipment RHN980326603 12/20/2014 12/20/2016 w/RC $1000 ded. 146,61 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ServPro Franchise ". w 111-1t_a 1 F MIL 1 IFIf /-A unL-1 I w T, - W 1 ass -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence of Insurance W 1 ass -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 Super icor License: CS -104798 1,, 4A ,,``-I I r, JiJ VINCENT J GRANflE 117 CLUFF CROSS - �► SALEM NH 030 Expiration COMMSsiOner 03/24/2016 Office of Consumer Affairs & B smess Regulation HOME IMPROVEMENT CONTRACTOR Type: — Registration: 173795 =t Expiration: 11/13/2016 LLC GRABRO LLC. SERVPRO OF LOWELL VINCENT GRANDE 9 W. ADAMS ST 93 LOWELL, MA 01851 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Rn. nEt n `MA 02116 , " / nt" " ) / i ' Not vAiv;0out signature pp�I id H Q W LL.z a'W co O O Y O LL W N O. (n 0 � W a z J O m C N 7 LL to O W N U _ m LL 0 I- W a Z z m J a to O _ )a U- 0 W a Z u _ H J W 7 K W` (n _ co LL O d ? Q O 7 _ LL Z W 2 Q W c 5 6L E In Z W {) r Y O V7 ,,wwn Vl O O �.•: •CL L- O.cc d 4 a E * s c Q L N d ,s d <v W O ' Jo _ �Y d► �,. GHQ• P � i CL t N J L m N O= d O O fA > N E o �o :�coo c I _ � tm Lo - CL Q. F— as Q L L � •a O 2 N = Q cc O m as H .r .-. uj�_ LL H O Q O N O V -0 &.- V O WL v O L H �J• 5 N O -a F-1 N Qd "� J U)OL- O F- t +. CL O c..) > Z m coZ W x H W CL ;v ti w z-- W Ol— in C 00 O Q I Q Cc M J -0 O CD Z N i SERVPRO of Lowell Fra& Winer• 0..p 6 Rem n" SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 Client: Ethan Allen Property: 419 Andover St. N. Andover, MA 01845 Operator: VGRANDE Estimator: Vinny Grande Company: Servpro of Lowell Business: 9 W Adams St #3 Lowell, MA 01851 Type of Estimate: Water Damage Date Entered: 2/3/2015 Price List: MAEM8X FEB15 Labor Efficiency: Restoration/Service/Remodel Estimate: 2015-02-03-1506-2 Date Assigned: Home: (978) 685-3546 Business: (978) 454-7577 E-mail: vgrande @ servprooflowell. com • SERVPRO of Lowell F;. a W- • Cl -p a xenam ' SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978)454-7577 tax. id # 27-3673699 CAT SEL CALC 2015-02-03-1506-2 Main Level Rooml Height: 8' 508.00 SF Walls 251.39 SF Ceiling 759.39 SF Walls & Ceiling 251.39 SF Floor 27.93 SY Flooring 63.50 LF Floor Perimeter 63.50 LF Ceil. Perimeter ACT DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 3. WTR DRYW - Tear out wet drywall, cleanup, bag for disposal .25C 62.85 SF 0.80+ 0.00 = 0.00 50.28 4. WTR INS - Tear out and bag wet insulation .25C 62.85 SF 0.63+ 0.00 = 0.00 39.60 Totals: Rooml 0.00 89.88 �--II'9"- CAT SEL CALC Room2 Height: 8' 424.00 SF Walls 172.20 SF Ceiling 596.20 SF Walls & Ceiling 172.20 SF Floor 19.13 SY Flooring 53.00 LF Floor Perimeter 53.00 LF Ceil. Perimeter ACT DESCRIPTION QTY REMOVE REPLACE TAX TOTAL 13. WTR DRYW - Tear out wet drywall, cleanup, bag for disposal .25C 43.05 SF 0.80+ 0.00 = 0.00 34.44 14. WTR INS - Tear out and bag wet insulation .25C 43.05 SF 0.63+ 0.00 = 0.00 27.12 Totals: Room2 0.00 61.56 2015-02-03-1506-2 2/4/2015 Page: 2 SERVPRO of Lowell Fre & Ww,, . 0..., 8 P -i." SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 434.67 SF Walls Rmn3616.92 SF Walls & Ceiling 20.25 SY Flooring 54.33 LF Ceil. Perimeter CAT SEL ACT DESCRIPTION CALC QTY REMOVE Height: 8' 182.26 SF Ceiling 182.26 SF Floor 54.33 LF Floor Perimeter REPLACE TAX TOTAL 21. WTR DRYW - Tear out wet drywall, cleanup, bag for disposal C 182.26 SF 0.80+ 0.00 = 0.00 145.81 22. WTR INS - Tear out and bag wet insulation C 182.26 SF 0.63+ 0.00 = 0.00 114.82 Totals: Room3 0.00 260.63 24' 10" Room4 Height: 8' -2A'4" 630.67 SF Walls 367.03 SF Ceiling 997.69 SF Walls & Ceiling 367.03 SF Floor Room4 r j 40.78 SY Flooring 78.83 LF Floor Perimeter lI 78.83 LF Ceil. Perimeter CAT SEL ACT DESCRIPTION CALC QTY REMOVE REPLACE TAX TOTAL 29. WTR DRYW - Tear out wet drywall, cleanup, bag for disposal .25C 91.76 SF 0.80+ 0.00 = 0.00 73.41 30. WTR INS - Tear out and bag wet insulation .25C 91.76 SF 0.63+ 0.00 = 0.00 57.81 Totals: Room4 0.00 131.22 Total: Main Level 0.00 543.29 Level 2 2015-02-03-1506-2 2/4/2015 Page:3 SERVPRO of Lowell F.6 W-, • cl-p & P.oforWion• SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 Attic Height: Sloped 852.75 SF Walls 1343.23 SF Ceiling 2195.98 SF Walls & Ceiling 1223.06 SF Floor 135.90 SY Flooring 189.50 LF Floor Perimeter 192.53 LF Ceil. Perimeter CAT SEL ACT DESCRIPTION CALC QTY REMOVE REPLACE TAX TOTAL 38. WTR DRYW - Tear out wet drywall, cleanup, bag for disposal .5C 671.61 SF 0.80+ 0.00 = 0.00 537.29 39. WTR INS - Tear out and bag wet insulation .5C 671.61 SF 0.63+ 0.00 = 0.00 423.11 Totals: Attic 0.00 960.40 Total: Level 2 0.00 960.40 Line Item Totals: 2015-02-03-1506-2 0.00 1,503.69 Grand Total Areas: 2,850.08 SF Walls 2,195.93 SF Floor 0.00 SF Long Wall 2,195.93 Floor Area 2,531.42 Exterior Wall Area 0.00 Surface Area 0.00 Total Ridge Length 2,316.10 SF Ceiling 243.99 SY Flooring 0.00 SF Short Wall 2,328.79 Total Area 356.00 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length 5,166.19 SF Walls and Ceiling 439.17 LF Floor Perimeter 442.20 LF Ceil. Perimeter 2,850.08 Interior Wall Area 0.00 Total Perimeter Length 2015-02-03-1506-2 2/4/2015 Page:4 �SERVRRO Line Item Total SERVPRO of Lowell SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978)454-7577 tax. id # 27-3673699 Replacement Cost Value Net Claim Vinny Grande Summary 1,503.69 $1,503.69 $1,503.69 2015-02-03-1506-2 2/4/2015 Page:5 SERVPRO of Lowell pi., a w,%, • Cl -p a p,—i-- SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 Recap of Taxes 2015-02-03-1506-2 2/4/2015 Page:6 SERVPRO of Lowell fire 6Wore, . CI—p6Rem on' SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978)454-7577 tax. id # 27-3673699 Recap by Room Estimate: 2015-02-03-1506-2 Area: Main Level Rooml Room2 Room3 Room4 89.88 5.98% 61.56 4.09% 260.63 17.33% 131.22 8.73% Area Subtotal: Main Level 543.29 36.13% Area: Level 2 Attic 960.40 63.87% Area Subtotal: Level 2 960.40 63.87% Subtotal of Areas 1,503.69 100.00% Total 1,503.69 100.00% 2015-02-03-1506-2 2/4/2015 Page:7 SERVPRO of Lowell F a 6 Wo , • Cl—, B R— 6-' SERVPRO of Lowell 9 W. Adams St. unit 3 Lowell, Ma. 01851 (978) 454-7577 tax. id # 27-3673699 Recap by Category Items GENERAL DEMOLITION Subtotal Total % 1,503.69 100.00% 1,503.69 100.00% 2015-02-03-1506-2 2/4/2015 Page: 8 i N N O 1-� w (D as C CD .t O O p� - O O N � O N - W - O 41 O 4 C r 16' 1 " m �� •�► _ Authorization to Perform Services and Direction of Payment Customer Name: Loss Address: 419 Andover St City: Insurance Company: Davis, Tammy North Andover Arbella Date of Loss: 02/03/2015 State: MA Zip: Claim Number (if available): 01845 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 Arbella 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: Remarks: Davis, Tammy 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: O Y ON Provider's Signature: Customer's Signature:Franchise Legal Name: Printed Name: Davis, Tammy d/b/a SERVPROO of: 02/03/2015 Date: Date: E-mail Address: info@northandover.ethanallen.com Contractor License #: @SERVPRO® INTELLECTUAL PROPERTY, Inc. ALL RIGHTS RESERVED FE -051707 1.0 Each SERVPRO® Franchise is Independently Owned and Operated. 0 L'J �A� Grabro, LLC Lowell 02/03/2015 28000 08/14 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 Provider's Services, and is not subject to liability arising out of such Services. 2. Provider's performance of the Services is limited by, among other things, the pre-existing conditions and characteristics of the premises, material, fabrics, furniture, and/or other items. PROVIDER EXPRESSLY DISCLAIMS ANY RESPONSIBILITY OR LIABILITY FOR ANY PRE-EXISTING CONDITIONS. Client shall retain responsibility and shall be liable for all effects of and costs necessary to correct such conditions, including, by way of example and not limitation, the conditions identified below: (a) Provider may, in its sole discretion, pre-test materials for removability of spots or stains; dye or color fastness; shrinkage; fading; adhesive breakdown; or other problems. It is not always possible to determine these conditions in advance. PROVIDER DOES NOT GUARANTEE SPOT OR STAIN REMOVAL AND COLOR FASTNESS OR PREVENTION OF SHRINKAGE, FADING, OR ADHESIVE BREAKDOWN. (b) Provider DOES NOT GUARANTEE that wall and ceiling cleaning will restore the original color to painted surfaces. (c) Not all fabrics are conducive to cleaning. Provider shall use reasonable efforts to advise Client of any adverse effects which may be reasonably foreseen due to the nature of the fabric or material involved. PROVIDER DOES NOT GUARANTEE THAT SUCH MATERIALS CAN BE CLEANED OR THAT THERE WILL BE NO ADVERSE EFFECTS FROM ANY ATTEMPT TO CLEAN SUCH FABRICS. (d) A variety of materials are used in the manufacturing, upholstery and/or installation process. These materials include backing, lining, tacks, or other unknown substances that may cause discoloration or other adverse effects to the face material. Client acknowledges that it is impossible to determine when such adverse effects may occur and PROVIDER DOES NOT GUARANTEE AGAINST SUCH ADVERSE EFFECTS. (e) Client acknowledges and agrees that mold is commonly found throughout the environment and that it is impossible to eradicate mold. PROVIDER DOES NOT GUARANTEE THE REMOVAL OR ERADICATION OF MOLD. 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 VPRO®Franchise is Independently Owned and Operated.