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HomeMy WebLinkAboutBuilding Permit #231-2017 - 57 MILLPOND 9/1/2016 to _ / pORTF� BUILDING PERMIT TOWN OF NORTH ANDOVER ° WO APPLICATION FOR PLAN EXAMINATION * _ I �1 Date Received * `� Permit NO: �9SSAC HUs���y Date Issued: 0! IMPORTANT: Applicant must complete all items on this page LOCATION 6-1 MJ�tG 0600' All 6.. Print PROPERTY OWNER _ Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial 0lAlteration No. of units: 0 Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other G Septic [I Well ❑ Floodplain Q Wetlands , ❑ Watershed District_ ❑,Water/Sewer MOM(/ 0 �✓II S^U*4-M 1nf&* zs p,4144cto 194 ems `•-• Identification Please Type or Print Clearly) OWNER: Name: Po]tA-V Phone: Address: CONTRACTOR Name:SC-143mo Phone: q`�F- cwy _ �-�� Address: Supervisor's Construction Licenser � ijg70 Exp. Date:, >(�;o <<Y t Home Improvement License: Exp. Dater 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: $ 3 - to ( FEE: $ � b Check No.: Receipt No.: y NOTE: Person coktracting with unr'egister'ed contractors do not have access tone,guaranty fund Signature o A t. r4. of contractor w } NORTH BUILDING PERMIT oF�t,Eo '°V6 �- moi. 2 h���• _�k�':6 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION � s e qq coc.ce.. Date Received Permit No#: �SSgC US 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:-HistoricDistrict yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -❑ Septic ❑.Well; 0 E'loodplain, ❑Wetland ❑ Watershed Dis nc. ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: r Address: 1 Phone: Contractor Name: 1 Email: Address: - LSupeLrvisor's Construction License: Exp. Date: rovement License: Exp. Date: f ARCHITECT/ENGINEER Phone: f 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 tnr 'Si aan .Pure of Anent/Ow - - - - - - Building Department FRoofing, ist of the required forms to be filled out for the appropriate permit to be obtained. ng, Interior Rehabilitation Permits 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 dum stet permits require sign off from Fire Department prior to issuance of Bldg Permit OTE: All p i Addition Or Decks 4 Building Permit Application Certified Surveyed Plot Plan Com 4 Workers p Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract �. FI oor/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 OTE: All dum permits ermits require sign off from Fire Department prior to issuance of Bldg Permit p 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 One To Be Returned) to Include Sprinkler Plan And Sets of Building Plans ( Two Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for n offEngineered products In Department prior to issuance of Bldg. Permit OTE: All dumpster permits require sig p eals et this recorded at the Registry of Deeds. One copy and proof of recording In all cases if a variance or special permit was requiredtheTown Clerks office must stamp the decision from the Board o pp that the appeal period is over. The applicantmustst then g must be submitted with the building app Doe:Building Permit Revised 2014 d" .n Plans Submitted ¢,- Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanniug/MassageBody Art ❑ Seng Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dmnpster on Site tEl THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Sic qnature COMMENTS HEALTH Reviewed on Signature 1 COMMENTS e 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: .w " FIREDEPART �' Located 384 Osgood Street � MENT' , , .� �X TernDupsters�oriseay�esa � 'no `9 - -� - I�Located at124Maintreet t • _ :1, .� �,.x;� , a yS ��Fire Department4s�aiignatur&date,�—.,, -�'r l+�,ti._�'L �� ft {• `'x"s .7,`i ; '�'--^� � ,,.,.,«` a .*,..a,.} ' Jew'.:- � -•' 4t �,, M..; '7- 0`1ov tJt;._ x.3s + " J i.7 t. v'�X'-�. + t�':; t �' „4 + '' ;' =4 ----- NORTH�9�._ Dimension Number of Stories:___ Total square feet of floor area, based on Total land area, sq. ft.: Exterior dimensions.__ ELECTRICAL: Movement Of Meter location, mast or service dro re ui p q res approval ®f Electrical Inspector Yes N® ®AI�IGI Z®lVE LI1"ERATURE: MGL Chapter 166 Section 21A—F and G min.$100411000 fine No NOTES and DATA_ (For department use) LI Notified for pickup Call Email � Date — ��� ___Time Contact Name Doc.-Building permit Revised 2014 --- I r Location57 No. " 21,,17 Date 7 l . - TOWN OF NORTH ANDOVERZ . f Certificate of Occupancy $ Building/Frame Permit Fee $ � r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ' Building Inspector if 832 � NORTFf Town of ndover . No. ti h ver, Mass, C26' COCMICNlWK.[ V BOARD OF HEALTH Food/Kitchen PERMIT Septic System THIS CERTIFIES THAT ............................................. BUILDING INSPECTOR ow Foundation has permission to erect .......................... uildings on ..� ...�!....... .. ................................... Rough to be occupied as ..�� ............. ....... .... ... ....... . ...... ....... ..... ...... ... Chimney provided that the person accepting this permit shall in every respect conform to the erms of th application Final on file in this office, and to the provisions.of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS CONST CTION,,Mje Rough Service .. .. .... .. ............ Final BUILDIN IN ECTOR 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. i �• The Common-wealth ofMassachusetts z . . . D1 ep ajtment Of In 'astriaZAceldents 1 Congress street,Suite 100 _ - d Boston,MA 021142017 t Workers'Compeaisationinsurance Mrada-vit:Bunn exs/Contractors)LjgctriciansTlmnbexs. TO 13E,��WJ.TH TBE P�TT.Il�G AUTgORiTY. A Iicant 7:o.�oxxnation • Please Print Leel Name (Business/organizationff di-idual): O Address: � CitylState/Zip: tuA-e_,(i U JA a? �' 2seyou an employer? chechf] e appJr0priate box: Type of project(Tegmr� I.jN I am a employervyitb-_employees(full andlorparttime).* 7.• 0 New Coristraction shi andhavenoemployeesvWorking forme in $. Remodeling 2. - lam a sole propnetosorpar6cer p auy capacity.[No workers'pomp.insurance required.] Demolition 3.Q lam a homeowner doing allworkmyseli[No workers'comp.-insurance required.]i 10 Q Building addition ¢.nIamahomeownerand wiIlbehiringcontractorstoconduct all wo]konmyproperEy Iwill 11 ecfSartTSOr.aC7C�TIOIls ensure the all contractors either have workers'compensation�ncnranee or are sole Q EjScle pa proprietors with no employees. 12--[�Plumbing repairs or additions 5.❑I am a general contractor and Ihave hired the sub-contractors listed m the attached sheet. 13.Q Roaf Yet]airs These sub-contraciershade employees andhaveworkers'comp_m��nee� 1i]•.❑Offer 6.0 tine are a corporaf iou and its officers have exercisedther� of 8xempuon per1VIGZ c. 152,§i(4),and w�haveno.,einpIgyees.TNoworkers'comp.insm:ancerequired] 'Any applicaotthat eheclobox-Al must also SII.outtbe seetionbelow showingthesworkers'compensaiionpolicyinfomiaiion. i Homeowners•who m6b,:i tt x afddadt m icatmgthey are doing all work and thenEre outside contractors muni samit anew affidavit mdicatmg such. ?Contractors that check hi an additional sheet showi ag the name of the sob-contractors and sate whether ornot- ose entities have employees.Ifthesub-coniractarshaveernployees, lieymust proAde•thesworkeis'comp.policy arumber. I amore an erriployer&at is_pY01id iigWorkers9 eompensadon insuraneefor my ernployee.s.'.Belo�u is thepoZicy a7id jog sate infor�r�ation. Insurance Company Name: M I v r(can 2 UT k O ty I�SUY� (1 GQ Co 1"`fou h / -- i policy or Self-ins. �0_ ExpirationDate: (� I UR i f Job Site Address:_ � 1 1 ?011 City/State/Zip: (��(A , f'(r\ Attachacopy®fthe xrox&exs' compensationpolieydeclarationpage(showing the policynnmbexandexp irationdate). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.0 0 and/or one year imp:honment�as well as civilpenalties in the fulm of a STOP WORK ORDER and afine of up to$25'0-00 a day against the violator.A,copy 0f-this sm tatement ay be forwarded to the:Off ce of Investigations of the DIA for instzzance coverage verifcation- � eMtlatthein ormon ovidedabove isPrue old corgi ect.X do hereby certa uler the pains ar�dpenaities J Pr Si afore: Date: t Phone#: official use only. JI o not-write in this area,to be completed by city or town officiax City or Town: Per). itmeense# Issuing AatTiority'(cixcle one): ; 1.Board of HealtT2 2.)Building Departm.ent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbinglnspector 6.Other Coxatact Person: Phone#. Informatio n' and Instructions Massachusetts General Laws chapter X52 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract bf hire, express or Implied,oral or written." An employer is deftned as"an iudividual,pa tuorshzip,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint entexprise,and including the legal representatives of a deceased employer,or the receiver-or trustee of an individual,partnership,asso aMon or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the oocupant of the dwelling house of another who employs persons to do maintenance,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 ageney shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the connxnonwealtl,for any applicant-who li.as notproduced acceptable evidence of compliance-with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements ofthis chapter have been presented to the contracting authority.- Applicants uthority"Applicants Please fill-out-the workers' compensation affidavit dompletely,by checking the boxes that apply to your situation and,if necessary, supply sub=con(ractoi(s)name(s),address(es)and•phonenimber(s)along with theircertidcate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no amployees'otherthan the members orpartners,are notrequiredto carryworkers' compensationinsurance. If an LLC or LLP does have employees,a policy is required. Be advised that this aff davit xray be submitted to the Depaitm.ent of•Industrial Accidents fol-confirmation ofinsurance coverage_ Also be sure to sign and date the a-davit. The afCdavit should be returned to the city or town that the application fox the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regardingthe law ox if you•are regtZ.ired to obtain a wbrkers' compensation.policy,please call the Department at the number listed below. Self-iixsur6d 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 hasprovided a space at the bottom of the affidavit for you to MI out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as areference number. In addition,an applicant that must submit multiple permitUcense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"fob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may b e provided to the applicant as proof that a valid affidavit is on fide for future permits or licenses. A new affidavit must be filled out each year.where 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. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Indust ial.A.ccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.# 617-727-4900 ext.7406 or 1•-877-MASSAFE Fax#617•-727•-7749 Revised 02-23-15 wwwmass.gov/dia I ' •° _ Authorization to Perform Services and Direction of Payment Michael Doran 08/03/2016 Customer Name: Date of Loss: Loss Address: 57 Mill Pond City: NORTH ANDOVER State: MA Zip: 01845 Insurance Company: SAFECO Claim Number(if available): 872014236037 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 SAFECO Insurance Company, herein referred to as"Insurance Company,"to pay Provider solely and directly for that portion of the work covered by Customer's insurance policy. If, for any reason, Customer receives a check from Insurance Company made payable to Customer, Customer agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Customer hereby appoints Provider as attorney-in-fact, authorizing Provider to endorse Customer's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Customer agrees to pay Customer's deductible in the amount of$ $0.00 that applies to this claim. If any amounts owing to Provider for Provider services are not covered by insurance, Customer agrees to pay those amounts to Provider within fifteen (15) days of Customer's receipt of invoice. It is fully understood that Customer and its agents, successors, assigns, and heirs are personally responsible for any and all deductibles and any costs not covered by insurance. Interest and finance charges will be charged at the maximum allowable by law, or at 1.5% per month, whichever is less, on accounts over thirty(30) days past due. Time is of the essence. Customer agrees that Provider is working for the Customer and not Customer's insurance company or any agent/adjuster. Property Owned By: Michael Doran 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: O Y ON O Provider's Signature: Customer's Signature: _ Dkf, Franchise Legal Name: KEJO CORP Printed Name: Michael Doran d/b/a SERVPROO of: The Andovers Date: 08/03/2016 Date: 08/03/2016 michaeldoranarts@gmail.com E-mail Address: Contractor License#: ©SERVPRO®INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1.0 28000 05/16 Each SERVPRO'"Franchise is Independently Owned and Operated. I Authorization to Perform Services and Direction of Paymentmm 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. (f) Client acknowledges and agrees that limited photographs or video of the damage and cause may be made solely for work process and insurance claims purposes. 3. PROVIDER SPECIFICALLY DISCLAIMS ANY AND ALL OTHER WARRANTIES AND ALL IMPLIED WARRANTIES(EITHER IN FACT OR BY OPERATION OF LAW)INCLUDING,BUT NOT LIMITED TO,ANY IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR ANY IMPLIED WARRANTY ARISING OUT OF A COURSE OF DEALING,CUSTOM OR USAGE OF TRADE. THIS CONTRACT PROVIDES FOR THE PROVISION OF SERVICES AND DOES NOT PROVIDE FOR A SALE OF GOODS. 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 05/16 Each SERVPRO®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 Tax ID#02-0353691 Client: Doran Demo Permit Property: 57 Mill Pond North Andover,MA 01845 Operator: PNOTAR6 Estimator: Paul Notartomaso,Jr. Business: (603)475-2447 Company: SERVPRO Of Lawrence-SERVPRO Of The E-mail: Paul@ ServproOfLawrence. Andovers -SERVPRO Of Salem/Plaistow com Business: 8 Blakelin St Lawrence,MA 01841 Type of Estimate: Water Damage Date Entered: 8/25/2016 Date Assigned: Price List: MAEM8X AUG16 Labor Efficiency: Restoration/Service/Remodel Estimate: 2016-08-25-1143 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 2016-08-25-1143 Main Level -T 11"-10'3"- 5'1 "-5'1"" 2'6'f-7'5Living Room Height: 8' j 7'i•• 7 m �•T 7••�--�'I I" N of 1 T 612.00 SF Walls 264.70 SF Ceiling 876.70 SF Walls&Ceiling 264.70 SF Floor „t, 1 g h Li mg R m T 1 .I R 29.41 SY Flooring 76.50 LF Floor Perimeter 1 10*9 - " -1 76.50 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 1. Tear out wet drywall,cleanup,bag,per LF-up to 4' 10.00 LF 4.20 0.49 42.49 (0.00) 42.49 tall 2. Tear out wet carpet pad and bag for disposal 198.53 SF 0.45 0.87 90.21 (0.00) 90.21 3. Tear out wet drywall,cleanup,bag for disposal 198.53 SF 0.81 2.36 163.17 (0.00) 163.17 Totals: Living Room 3.72 295.87 0.00 295.87 Total: Main Level 3.72 295.87 0.00 295.87 Level 2 Sink Room Height: 8' T OB,athroom 172.00 SF Walls 24.30 SF Ceiling ci..� 196.30 SF Walls &Ceiling 24.30 SF Floor 2.70 SY Flooring 21.50 LF Floor Perimeter 21.50 LF Ceil. Perimeter DESCRIPTION QUANTITY UNIT PRICE TAX RCV DEPREC. ACV 4. Remove Vanity 4.00 LF 6.43 0.00 25.72 (0.00) 25.72 5. Tear out wet drywall,cleanup,bag,per LF-up to 2' 10.75 LF 2.88 0.26 31.22 (0.00) 31.22 tall Totals: Sink Room 0.26 56.94 0.00 56.94 2016-08-25-1143 8/25/2016 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 Tax ID#02-0353691 MnK KO 1 LIOAel Bathroom Height: 8' 1'8" 'fl'6" ,.7„ T r8" -2'7" 202.67 SF Walls 38.94 SF Ceiling Bad. 241.60 SF Walls&Ceiling 38.94 SF Floor 4.33 SY Flooring 25.33 LF Floor Perimeter 1 7 s r 1 25.33 LF Ceil. Perimeter DESCRIPTIONQ UANTITY UNIT PRICE TAX RCV DEPREC. ACV 6. Tear out wet drywall,cleanup,bag,per LF-up to 2' 12.67 LF 2.88 0.31 36.80 (0.00) 36.80 tall Totals: Bathroom 0.31 36.80 0.00 36.80 Total: Level 0.57 93.74 0.00 93.74 Line Item Totals: 2016-08-25-1143 4.29 389.61 0.00 389.61 Grand Total Areas: 1,645.33 SF Walls 570.92 SF Ceiling 2,216.25 SF Walls and Ceiling 570.92 SF Floor 63.44 SY Flooring 205.67 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 205.67 LF Ceil.Perimeter 570.92 Floor Area 633.61 Total Area 1,645.33 Interior Wall Area 1,516.50 Exterior Wall Area 168.50 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length 2016-08-25-1143 8/25/2016 Page: 3 Servpro SERVPRO of Lawrence 2064 SERVPRO of Salem/Plaistow 5389 SERVPRO of The Andovers 5390 978.688.2242 office@servprooflawrence.com PO Box 328 Lawrence,MA 01842 Tax ID#02-0353691 Summary for Dwelling Line Item Total 385.32 Material Sales Tax 4.29 Replacement Cost Value $389.61 Net Claim $389.61 Paul Notartomaso,Jr. 2016-08-25-1143 8/25/2016 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 Tax ID#02-0353691 Recap of Taxes Material Sales Tax(6.25%) Clothing Sales Tax(6.25%) Storage Tax(6.25%) Line Items 4.29 0.00 0.00 Total 4.29 0.00 0.00 2016-08-25-1143 8/25/2016 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 Tax ID#02-0353691 Recap by Room Estimate: 2016-08-25-1143 Area:Main Level Living Room 292.15 75.82% Area Subtotal: Main Level 292.15 75.82% Area: Level 2 Sink Room 56.68 14.71% Bathroom 36.49 9.47% Area Subtotal: Level 2 93.17 24.18% Subtotal of Areas 385.32 100.00% Total 385.32 100.00% 2016-08-25-1143 8/25/2016 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 Tax ID#02-0353691 Recap by Category Items Total % GENERAL DEMOLITION 385.32 98.90% Subtotal 385.32 98.90% Material Sales Tax 4.29 1.10% Total 389.61 100.00% 2016-08-25-1143 8/25/2016 Page: 7 Main Level 17' 10" 1 ' N � Living Room P31 4"-i 00 10' 8" T 10' 8" 00 - 31211- 31 ' 2"3' 10" Main. Level 2016-08-25-1143 8/25/2016 Page: 8 Level 18' 17' 4" N _ Master Bedroom 00 N �t- 2' 8" 5' 9" 8' 7' F-2' Sink Roo Closet �n 11 M 7' 5" 3' 4"—+ 0 Bathroom 8' 1" Level 2 2016-08-25-1143 8/25/2016 Page: 9 DATE(MM/DD/YYYY) ACC>RE) CERTIFICATE OF LIABILITY INSURANCE 08/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the 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 PHONEFAX c/o Collier Insurance A/C No, o Ext: 901 529-2900 A/c No): 901 529-2916 E-MAIL 606 S. Mendenhall;Suite 200 ADDRESS: Memphis,TN 38117 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: American Zurich Insurance Company 40142 INSURED INSURER B: Adams Keegan, Inc. INSURERC: 6750 Poplar Ave Ste 400 Memphis,TN 38138 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15TNO09858085 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IEXP LTR TYPE OF INSURANCE IINSD WVD POLICY NUMBER MMIDDY/YYYY MM/DDEFF YLIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE � OCCUR DAMAGES( RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEML AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 71 PRO LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SIN LE I IT 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 $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER _ A ANY OFFICERMEMBEER/EXCLUDED?ECUTIVE ❑ N/A WC56-11-865-02 12/01/2015 12/01/2016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In 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: 12/01/2015 12/01/2016 Client# 2410-MA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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 Michael Doran SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 57 Mill Pond North THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 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 SEP-01-2016 THU 04,03 PM SERVPRO OF LAWRENCE FAX NO, 9786877706 P. 02 WHITKE1 OP iD:PI . DATE(MM/DWYYYY) A a� CERTIFICATE OF LIABILITY INSURANCE 09/0112016 THIS CERTIFICATE IS 18SUED 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 RF-PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certlflcate holder Is an ADDITIONAL INSURED,the pollcy(IGS)must be endorsed. If SUBROGATION ISWAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certiflcate does not confer rights to the certiflcate holder In lieu of such endorsement(s). Acr James R.MC Donald PRODUCER Stanley McDonald Agency P E •608.788-6160 c o:608-788-7012 1101 Main Street a MAIL Onalaska,WI 64680 James R.Mc Donald INSURER S AFFORDING COVERAGE NAIC# INSURERA:Rockhill Insurance Com an 28053 INSURED KeJo Corporation INSURERB.The Federal insurance Co. 20281 dba Servpro of Lawrence INsuR c:ACE Pro e &CBsual 20699 See Note For Named Insured INSURER D, PO BOX 326 INSURER E: Lawrence,MA 01842 tNauRER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTF-D BELOW HAVE BEEN ISSUED TO THR OTHER DOCUMENT WITH RESPECT TOINSURED NAMED A5OVF_ FOR T)4E LWHICH TICY IHIS ANY. 0 ANY REQUIREMENT, TERM OR CONDITION OF ANY SUBJECT TO ALL THE TERMS, INDICATED. NOTWITHSTANDING CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CIE .LIMITS SHO EXCLUSIONS AND CONDITIONS OF SUCH POLI $ 8 LIMITS L TYPE OF INSURANCE POLICY NUMBER MID M EACH OCCURRENCE $ 2,000,00 A X COMMERCIAL GENER�AL LIABILITY 60,00 CLAIMS-MADE X OCCUR ENVP016006-00 03/0112016 03101/2017 oeo � >s MED P(P(An one ereon 5,00 01 PERSONAL a AAV INJURY $ 2,000,000 OENERALAOGREGATE $ 3,000,000 EGFWL AGGREGATE LIMIT APPLIES PER: 3;000,00POLICY a JFRCT 1:1LOCPRODUCTe-COMP/OP A00 $ $ OTE ' COMB NED SIN L IMIT $ AUTOMOBILE LIABILITY 130DILY INJURY(Por person) S ANY AUTO ODDLY INJURY(Per eooldbnr) LE) X AUTOgRULED AUTO NON OWNED AUTOS $ EACH OCCURRa 9 11000,000 OCCUR O CLAIMS-MADE M00709617 01/1412016 01114/2017 AGGRFGATE3. 11000,000 ENT a 10000 $ P WORKERS COMPENSATION AND EMPLOYER$'LIABILITY EL PACH ACCIDENT ANY PROPRIETORIPARINERIEXECUTIVE Y� N I A OFFICERMIEMBER F�(C UDED9 EL.DISEASE-EA EMPLOYE i (Mandatary In NH) If g,&v"'be u6RIFTIQN0nder a EL.018EASE-POLICY LIMIT $ A Pollution Llab MNVIao16004-00 03/01;2016 03101/2017 Pollution $2m111$3mi B EmployeeDlshonesty 670-66-47 03/01/2016 03101/2017 Crime 26,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,AddltlonN Remarko$ahedulc,may be ettachod If more spaoo Is required) CERTIFICATE HOL13ER CANCEL TION TOWNNO2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAPICEI-I-EO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 'IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ®1968-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD SEP-01-2016 THU 04;04 PM SERVPRO OF LAWRENCE FAX NO. 9786877706 P. 03 WHITKEI PAQ�2 NOTEPAD INSUREDS NAME Kajo Corporation OP ID: PI Daee 09/01/2016 Named Insured: jo Corporation dba 8ervpro of Lawrence dba 8ervpro of Lawrence-Thr®® dba 8ervpro of Lawrence-Two dba 8®rvpro of Salem/Plaistow dba 8wrvpro of The Ar-dovere i SEP-01-2016 THU 04:04 PM SERVPRO OF LAWRENCE FAX NO, 9786877706 P. 04 �� DATE(MMIDDIYYYY) ACO/� CERTIFICATE OF LIABILITY INSURANCE 09/01/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,the pollcy(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 endamemen s . PRoouceRCT :: Dabney Collier (Alc No.PHONE Ewth 901 529-2900 FAX Not: 901 529.2916 c/a Collier InsuranceE-MAIL 505 S.Mendenhall;Suite 200 A MempMIS,TN 38117 INSURER($)AFFORDING CpvERAGE NAIC to ,- _ _- ?su ERA: American Zurich Insurance Company40142 INSURED INSURER EL-' Adams K®e®an,Inc. 6760 Poplar Ave Ste 400 INSaFJ1 C: _. Memphis,TN 38138 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:15TNO09858085 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, µ_ _ I% TYPE OF INSURANCE POUCY NUMBER Psm MIDD1YYYY LIMIT$ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE E CLAIMS-MADE E OCCUR AMMIfiEfi(En occurrenoa) $ MED EXP(Any one porson $ ....-� PERSONAL&APV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ HLOCPOLICY L-1"T PRODUCTS-COMP/OP,AGG $ _-,- OTHER: AUTOMOBILE LIABILITY Iga 8=1LIV $..,._ ..-. ANY AUTO BODILY INJURY(Por person) $ + AUTO QED SCHEDULED BODILY INJURY(Por acddenq $ NON-OWNED PR PERM`VAMAGE $ HIRED AUTOS AUTOS (per ecclgard) UMBRELLA LIAOOCCUR EACH OCCURRENCE A—EXCESS LIAR HCLAIMS-MAOF AGGREGATE $ ' � -DEC RETENTION $ WORKERS COMPENSATION XTA E OT AND EMPLOYERS'LIABILITY 'r'� ANY PROPRIETOR/PARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? F7 N/A WC 56-11-865-02 12/0112015 12/01/2016 - - I.. (Mandatory In NH) I:.L,DISEASE-HA EMPLQYEE 5 1,000,00_0 II es,describe under D CRIPTION OF OPERATIONS below 1 91,DISEASE•POLICY LIMIT $ 1,000,000 Location Coverage Period: 12101/2015 12/01/2016 Cllent$ 2410-MA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more spaco Is roquired) Coverage Is provided for KEJO Corporation dba;SERVPRO of Lawrence Bi only those co-employooa Weexly 8 BLAKELIN ST of,but not subcontractors to: Lawrence,MA 01842 CERTIFICATE HOLDER CANCE=LLATION Town of North Andover SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 Osgood St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN North Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZg"EPseeeN.T.AMVE._....._.......... -.-.-.-.-.--.- ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20141011 The ACORD name.and logo are registered marks of ACORD I W 1111rviu0wi1�11 r/ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �� HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: k' Registration: 158271 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 t;,•.:z_ Expiration: 12/31/2017 Private Corporation rF. Boston,MA 021 16 KEJO CORPORATION SERVPRO OF LAWRENCE;ET ALS.,: GREGG WHITE J 8 BLAKELIN STREET _--- —._. LAWRENCE, MA 01841 Undersecretary of valid without s'i'gnature 'aassachusetts Department of Public Safety i® Board of BuildingRegulations and Standards 9 License CS-067690 Construction Super.icor { I GREGG M ... WHITE 4 CHATBURN RD r WINDHAM NH 03087 :.Ot1I:lisScrErr 02/20/2018 i I I I i I