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HomeMy WebLinkAboutBuilding Permit #518-13 - 57 Peters Street 1/10/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ` Permit NO: ✓ 1k—/—� Date Received Date Issued: RTANT: Applicant must complete all items on this LOCATION 5 7 Pc -*,y -s <j7 Print // PROPERTY OWNER rLOYL- MANNImb Yl all uNlr*-O M►E1210131 CVlVm"I CF Nd2�H F1Nopy�R.N Print MAP NO: 67-4_PARCEIM5� ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential - El New Building ❑ One family ❑ Addition ❑ Alteration ❑ Two or more family No. of units: ❑ Industrial e'Commercial ❑ Repair, replacement IYDemolition ❑ Assessory Bldg VOther ❑ Others: q `' ®Se tick ®Wella 1ETp LINWAter D Floodplain ®Wetlands 7 ' a® w_x� - c Watershed Districts x , DESCRIPTION OF WORK TO BE PERFORMED: Pnn-f-,Mu1ANV VC"r !11'F -S tN Q1(J0M. L401 I L10 L' . ViENTI.,JG WV-L-S� 1 keAoyoiG SySPf-PID -i CA-% OG "SUES Identification Please Type or Print Clearly) OWNER: Name: L-JYA%T'L Phone: (g-, r -W -1z4 -L Address: $ I&Aftt,W st (,AL ra&rJ(& , MA 01T41 CONTRACTOR Name: Kf-\.,\oj Phone: Address: '? IBLAlr.E.Lt%J ST Lkyiu*-,M A Ol -eti t Supervisor's Construction License: (�5 ()6161b Exp. Date: Home Improvement License:Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. .r FEE SCHEDULE: BULDING PERMIT; $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost:- $ a 901 , gv FEE: $ a� Check No.: I V � ® 0 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th uaran fund] Plans Submitted Q Plans Waived ❑ Certified Plot Plan ❑ ; Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc... r �* ❑ Tanning/MassageBody Art ❑ Tobacco Sales ❑ Permanent Dumpster. on -Site . ❑ Swimming Pools. ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY Y INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS_ r DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS COMMENTS Reviewed on-Si�neture 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: ' • r' a i Located 38.4 Osgood Street FIRE DEPARTMENT.- Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories:_ Total square feet of floor area, based on Exterior dimensions. I,t.cro Total land area, sq. ft.: r 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.$10041000 fine r NOTES and DATA — (For department use r• ® Notified for pickup- Date Doc:.Building Permit Revised 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. em .Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o 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 o Copy Of Contract o Flo or/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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 o 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 o Mass check Energy Compliance Report o 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: Doc.Building Permit Revised 2008mi 1�2 Location 7 ` Check # 26096 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ri r Budding Inspector Authorization to Perform Services and Direction of Payment Customer Name: k,5-1 UNITS-0 MEVOM � ('�(U2cH c+F ADN'Obof oss: I u Loss Address: S -7 Pe'ip-2S T City: A%62.w AmooVf it- State: MA Zip: 0lrcros Client: C�J(JeGW MVTUAI- Claim Number (if ovoilable): The undersigned client, 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 Client'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. Client authorizes Cf gllfGJ /11VVVA L Insurance Company, herein referred to as "Insurance Company," to pay Provider solely and directly for that portion of the work covered by Client's insurance policy. If, for any reason, Client receives a check from Insurance Company made payable to Client, Client agrees to pay Provider immediately upon receipt of the check. In order to expedite payment to Provider, Client hereby appoints Provider as attorney -.in -fact, authorizing Provider to endorse Client's name on Insurance Company checks or drafts, and to deposit Insurance Company checks or drafts for Provider services. Client agrees to pay Client's deductible in the amount of $ 1t�� that applies to this claim. If any amounts owing to Provider for Provider services are not covered by insurance, Client agrees to pay those amounts to Provider within fifteen (15) days of Client's receipt of invoice. It is fully understood that Client and its agents, successors, assigns and heirs are personally responsible foe 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. Client agrees that Provider is working for the Client and not Client's insurance company or any agent/adjuster. Property Owned By: Remarks: I HAVE READ THIS AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT, INCLUDING THE TERMS AND CONDITIONS OF SERVICE ON THE REVERSE SIDE HEREOF, AND AGREE TO SAME. White: SERVPRO® Yellow: Claims Professional Pink: Customer ©SERVPRO° INTELLECTUAL PROPERTY, Inc. ALL RIGHTS RESERVED FE -051707 1.0 28000 06/11 Each SERVPRO' Franchise is Independently Owned and Operated. &umerw airsa dsi✓� Reputation a License or registration valid for individul use only Office o ousumer A airs smess Regulation g y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 158271 Type: Office of Consumer Affairs and Business Regulation ; Expiration: �$2a1/2013 Private Corporation 10 Park Piaza -Suite 5170 Bostbh, MA 02116 K CORPORAT[ = SERVPRO OF LAW, EfftfL7--'I- GREGG WHITE 8 BLAKELIN STREP § _: LAWRENCE, MA 01$41': f, Undersecretaryo ithout ure Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -067690 GREGG M WHIT` 4 CHATBURN RB WINDHAMNH 03087; �c 1, Expiration Commissioner 02/20/2014 SERVPRO of Lawrence PO Box 328 Lawrence, MA 01.842 800 535-6322 Tax Id# 02-0353691 Client: First United Methodist Church North Andover Property: 57 Peters St North Andover, MA 01845 Operator Info: Operator: KMCCARTH Estimator: Kevin McCarthy Business: 30 Parsons St Brighton, MA 02135 Type of Estimate: Date Entered: 1/4/2013 Price List: MAEM7X DEC12 Labor Efficiency: Restoration/Service/Remodel Estimate: 2013-01-04-1813 SERVPRO® Fire & Water - Cleanup & RestorationTM Like it never even happened. Date Assigned: Home: (978) 794-1530 Business: (603) 490-4434 E-mail: kmccarthy@servprooflawrenc e.com SERVPRO of Lawrence PO Box 328 Lawrence, MA 01.842 800 535-6322 Tax Id# 02-0353691 Attic 2013-01-04-1813 Attic 446.25 SF Walls 2,013.06 SF Walls & Ceiling 163.69 SY Flooring 188.57 LF Ceil. Perimeter Height: Peaked 1,566.81 SF Ceiling 1,473.19 SF Floor 186.00 LF Floor Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL ,1Near-outland-bag jwet-insulafiion 44'1 -96 --SF — 0;53 :00�---��234T24i Totals: Attic 234.24 Total: Attic 234.24 T _ s Hallway DESCRIPTION Main Level 788.00 SF Walls 1,003.43 SF Walls & Ceiling 23.94 SY Flooring 98.50 LF Ceil. Perimeter QNTY Height: 8' 215.43 SF Ceiling 215.43 SF Floor 98.50 LF Floor Perimeter REMOVE REPLACE ITOTAL 2. Water extraction from floor 172.34 SF 0.00 0.44 75.83 c3.: Tear -out trim-and�bag for disposal 78:80 iF 55:16 0:70--�` 0:00 4rIDri1'hholes-for wall cavity drying .3.88'EA 0.00 038-28:071 5. Dehumidifier (per 24 hour period) - 7.00 EA 0.00 101.25 708.75 XLarge - No monitoring 6. Air mover axial fan (per 24 hour period) - 12.00 EA 0.00 28.50 342.00 No monitoring 4 Air Movers for 3 days. Totals: Hallway 1,209.81 2013-01-04-1813 1/10/2013 Page:2 -iPZ.9RM>-SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 Foyer a 209.51 SF Walls 260.72 SF Walls & Ceiling 5.69 SY Flooring 26.19 LF Ceil. Perimeter Height: 8' 51.21 SF Ceiling 51.21 SF Floor 26.19 LF Floor Perimeter Missing Wall Y X 8' Opens into STAIRSI Missing Wall 2' 10 9/16" X 8' Opens into STAIRS DESCRIPTION QNTY REMOVE REPLACE TOTAL 7. Water extraction from floor 25.60 SF 0.00 0.44 11.26 Totals: Foyer 11.26 DESCRIPTION 400 646.67 SF Walls 1,033.65 SF Walls & Ceiling 43.00 SY Flooring 80.83 LF Ceil. Perimeter QNTY Height: 8' 386.99 SF Ceiling 386.99 SF Floor 80.83 LF Floor Perimeter REMOVE REPLACE TOTAL 8. Air mover axial fan (per 24 hour period) - 14.00 EA 0.00 28.50 399.00 No monitoring 2 Air Movers for 4 days. . 9. Water extraction from floor 154.79 SF 0.00 0.44 68.11 I.O.--D.rill,holes for-wall_cavity. _dry_ing 4.0.00 - EA 0:00 0.-38--- --1-5:20 Totals: 400 482.31 201.3-01-04-181.3 1/10/2013 Page:3 = SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 DESCRIPTION 401 11. Air mover axial fan (per 24 hour period) - No monitoring 6 Air Movers for 4 days. Height: 8' 666.67 SF Walls 418.03 SF Ceiling 1,084.69 SF Walls & Ceiling 418.03 SF Floor 46.45 SY Flooring 83.33 LF Floor Perimeter 83.33 LF Ceil. Perimeter QNTY _ REMOVE REPLACE TOTAL 30.00 EA 0.00 28.50 855.00 12. Dehumidifier (per 24 hour period) - 7.00 EA 0.00 1.01.25 708.75 XLarge - No monitoring t13: Tear out wet drywall; cleanup; bagfor 41$:03 SF 0:68 0.00-��-284:26 disposal �yTear o- u�nsasalvageable vinyl, cut & 418.03.SF 0.90 0:00 376:23 t65g fog r=d sp'osalr- 1.5. Tear3)ut.a�i d -bag -wet insulation 48;03'SF 0.53 0:00 ----221:56 16. Water extraction from floor 418.03 SF 0.00 0.44 183.93 eq; Tear oimtfimiand-b- g -for disposal 2-501 0.70 0.00 --43.75 --- 1 Drill:holes-for-wall_cavity._drying 62:SO�A 19. Content Manipulation charge - per hour 0.50 HR 0.00 34.42 1.7.21 Move contents away from walls in order to remove baseboard and remove walls. Totals: 401 2,714.44 402 654.67 SF Walls 1,054.07 SF Walls & Ceiling 44.38 SY Flooring 81.83 LF Ceil. Perimeter Height: 8' 399.40 SF Ceiling 399.40 SF Floor 81.83 LF Floor Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 20. Air mover axial fan (per 24 hour period) 15.00 EA 0.00 28.50 427.50 - No monitoring 3 Air Movers for 4 days. 2013-01-04-1813 1/10/2013 Page:4 _- � SERWRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 DESCRIPTION CONTINUED - 402 QNTY REMOVE REPLACE TOTAL 21. Dehumidifier (per 24 hour period) - 3.00 EA 0.00 101.25 303.75 XLarge - No monitoring 22. Water extraction from floor 79.88 SF 0.00 0.44 35.15 23::7ear out non -salvageable vinyl; cut & --399'40=SF - -0:90 0:00----359.46 1bag for -di posal---. Totals: 402 1,125.86 Total: Main Level 5,543.68 4 Hallway la Missing Wall DESCRIPTION Ground Level 730.08 SF Walls 896.04 SF Walls & Ceiling 18.44 SY Flooring 91.26 LF Ceil. Perimeter 2' 10 7/8" X 8' QNTY REMOVE Height: 8' 165.96 SF Ceiling 165.96 SF Floor 91.26 LF Floor Perimeter Opens into STAIRS REPLACE TOTAL 24. Dehumidifier (per 24 hour period) - 3.00 EA 0.00. 101.25 303.75 XLarge - No monitoring 25. Air mover axial fan (per 24 hour period) 18.00 EA 0.00 28.50 513.00 - No monitoring 6 Air Movers for 3 days. 26. Air mover (per 24 hour period) - No 7.00 EA 0.00 25.00 175.00 monitoring 27. Water extraction from floor 124.47 SF 0.00 0.44 54.77 28:Remove wet-suspended7eiliffstile-and--1-65:96 F- 0:30 0 00-49.7 ' 4bag for disposal 29=Dr- l=holes_for w_ali--cavity--drying- -63:88 EA 0:00 0.38-----24-.27 30 --Tear out -trim a1ag for disposal 63:88-IsF 0.-70 0:00---�-44:.72 Totals: Hallway 1,165.30 2013-01-04-1813 1/10/2013 Page:5 SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842. 800 535-6322 Tax Id# 02-0353691 Bathroom 256.00 SF Walls 319.44 SF Walls & Ceiling 7.05 SY Flooring 32.00 LF Ceil. Perimeter Height: 8' 63.44 SF Ceiling 63.44 SF Floor 32.00 LF Floor Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 31. Air mover axial fan (per 24 hour period) 10.00 EA 0.00 28.50 285.00 - No monitoring 2 Air Movers for 4 days. 32. Dehumidifier (per 24 hour period) - 3.00 EA 0.00 101.25 303.75 XLarge - No monitoring 35-17 LF 0:70 -2-476-2) 33. Water extraction from floor 47.58 SF 0.00 0.44 20.94 3 Tear outtr rn: d=bag-fordisposal - ,1 -9:20 -L -F 0:770==========n0. 0 1.3:44 3�S�ri11-holes for wall_cavity-dryi g 1-6:00 EA 0:00 0:38��-6:08 ':T6'Remove-wet suspended~ceiling-tile-and 2013-01-04-1813 bag for disposal Page: 6 Totals: Bathroom 638.73 1-5' 5$={ Storage 281.33 SF Walls 349.88 SF Walls & Ceiling 7.62 SY Flooring 35.1.7 LF Ceil. Perimeter Height: 8' 68.54 SF Ceiling 68.54 SF Floor 35.17 LF Floor Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 37. Air mover axial fan (per 24 hour period) 5.00 EA 0.00 28.50 142.50 - No monitoring 1 Air Mover for 4 days. 38. Water extraction from floor 51.41 SF 0.00 0.44 22.62 9: Tear ou.t tri.m,andrbag for disposal 35-17 LF 0:70 -2-476-2) 0:00 40.-Drill-holes:for_-walheavity drying 35-17,EA 0:38r �13.36 41..- R-emov_e wet-suspended:ceYling=tile-and 68:54 -SF 0:30 0:00 20:56 bag of rdisposal 2013-01-04-1813 1/10/2013 Page: 6 �. II SERVPRO of Lawrence i PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 CONTINUED - Storage DESCRIPTION QNTY REMOVE REPLACE TOTAL 42. Content Manipulation charge - per hour 0.50 HR 0.00 34.42 17.21 Totals: Storage 240.87 Custodian 137.33 SF Walls ft R- "Od'a 155.75 SF Walls & Ceiling 12':6" Tj 2"I y 2.05 SY Flooring 17.17 LF Ceil. Perimeter 3��WdY DESCRIPTION QNTY I REMOVE Height: 8' 18.42 SF Ceiling 18.42 SF Floor 17.17 LF Floor Perimeter REPLACE TOTAL 43. Water extraction from floor 18.42 SF 0.00 0.44 8.10 �4: T -ear out trim'and-bag•-for-disposal 17:17`L'F 0:70 0.00- -12:02 45';�:Driill'holes.far`wallxavity drying 1 -2:88 -EA 0:00 - Q.-3=8 -4:89a Totals: Custodian 25.01 DESCRIPTION Foyer/Entry y i 565.33 SF Walls 1 783.58 SF Walls & Ceiling 24.25 SY Flooring 70.67 LF Ceil. Perimeter QNTY REMOVE Height: 8' 218.24 SF Ceiling 218.24 SF Floor 70.67 LF Floor Perimeter REPLACE TOTAL 46. Air mover axial fan (per 24 hour period) 15.00 EA 0.00 28.50 427.50 - No monitoring 3 Air Movers for 5 days. 47. Air mover (per 24 hour period) - No 7.00 EA 0.00 25.00 175.00 monitoring 48. Water extraction from floor 21.82 SF 0.00 0.44 9.60 4,1 TeT ar out't-Trim and bag.for-disposal35-33,L-F 0-.70----0:00 ----24:73 2013-01-04-181.3 1/10/2013 Page:7 SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 CONTINUED - Foyer/Entry DESCRIPTION QNTY REMOVE REPLACE TOTAL Totals: Foyer/Entry 636.83 106 Height: 8' j 593.33 SF Walls 338.15 SF Ceiling ` I 931.49 SF Walls & Ceiling 338.15 SF Floor 37.57 SY Flooring 74.17 LF Floor Perimeter 74.17 LF Ceil. Perimeter DESCRIPTION QNTY REMOVE REPLACE TOTAL 50. Water extraction from floor 33.82 SF 0.00, 0.44 14.88 Totals: 106 14.88 DESCRIPTION Back Hall 400.00 SF Walls 485.41 SF Walls & Ceiling 9.49 SY Flooring 50.00 LF Ceil. Perimeter QNTY REMOVE Height: 8' 85.41 SF Ceiling 85.41 SF Floor 50.00 LF Floor Perimeter REPLACE TOTAL 51. Air mover axial fan (per 24 hour period) 7.00 EA 0.00 28.50 199.50 - No monitoring 1 Air Mover for 4 days. .52 Tear -out trim-and_bag-for disposal 25'00 -.EF n'7n 53�Dri1�l holes-for-wal]_cav�ty drying 25:00 EA 0:00 0;38 —9:50 Y Totals: Back Hall 226.50 Total: Ground Level 2,948.12 2013-01-04-1813 1/10/2013 Page:8 - SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 Job DESCRIPTION QNTY REMOVE REPLACE TOTAL 54. Haul debris - per pickup truck load - 2.00 EA 154.15 0.00 308.30 including dump fees 55. Equipment setup, take down, and 6.00 HR 0.00 43.72 262.32 monitoring (hourly charge) Totals: Job 570.62 Line Item Totals: 2013-01-04-1813 9,296.66 Grand Total Areas: 7,216.97 SF Walls 4,021.68 SF Floor 0.00 SF Long Wall 4,021.68 Floor Area 3,628.99 Exterior Wall Area 0.00 Surface Area 0.00 Total Ridge Length 2013-01-04-181.3 4,083.56 SF Ceiling 446.85 SY Flooring 0.00 SF Short Wall 4,247.72 Total Area 522.73 Exterior Perimeter of Walls 0.00 Number of Squares 0.00 Total Hip Length 11,300.53 SF Walls and Ceiling 999.42 LF Floor Perimeter 998.18 LF Ceil. Perimeter 6,512.62 Interior Wall Area 0.00 Total Perimeter Length 1/10/2013 Page:9 = SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 Line Item Total Material Sales Tax Replacement Cost Value Net Claim Summary 9,296.66 @ 6.250% x 286.28 17.89 $9,314.55 $9,314.55 Kevin McCarthy 2013-01-044813 1/10/2013 Page: 10 - SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 Recap by Room Estimate: 2013-01-04-1813 Area: Attic Attic Area Subtotal: Attic Area: Main Level Hallway Foyer 400 401 402 Area Subtotal: Main Level Area: Ground Level Hallway Bathroom Storage Custodian Foyer/Entry 106 Back Hall Area Subtotal: Ground Level Job Subtotal of Areas Total 234.24 2.52% 234.24 2.52% 1,209.81 13.01% 11.26 0.12% 482.31 5.19% 2,714.44 29.20% 1,125.86 12.11% 5,543.68 59.63% 1,165.30 12.53% 638.73 6.87% 240.87 2.59% 25.01 0.27% 636.83 6.85% 14.88 0.16% 226.50 2.44% 2,948.12 31.71% 570.62 6.14% 9,296.66 100.00% 9,296.66 100.00% 2013-01-04-1813 1/10/2013 Page:11 SERVPRO of Lawrence PO Box 328 Lawrence, MA 01842 800 535-6322 Tax Id# 02-0353691 Items CONTENT MANIPULATION GENERAL DEMOLITION WATER EXTRACTION & REMEDIATION Subtotal Material Sales Tax Total 2013-01-04-1813 Recap by Category @ 6.250% Total % 34.42 0.37% 2,099.86 22.54% 7,162.38 76.89% 9,296.66 99.81% 17.89 0.19% 9,314.55 100.00% 1/10/2013 Page: 12 9 M W 4 O O M_ O N :I-- ot ;v --4� a3 0. 00 4 N tt;r� WHITKE1 OP ID: PI CERTIFICATE OF LIABILITY INSURANCE DATE 0`11101201 YY) 01110!2013 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: 608-788-6160 Stanley McDonald Agency IL Inc Fax: 608-788-7012 2018 State Road P.O. Box 1446 LaCrosse, WI 54602-1446 James R. Mc Donald NAME: CONTACT PHONE AX Arc No Ext): A1C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # LIMITS INSURER A: Tudor Insurance Company 37982 GENERAL LIABILITY INSURED KeJo Corporation dba Servpro of Lawrence See Note For Named Insured INSURERB:Travelers Property Casualty 25674 INSURER C: INSURER D: PO Box 328 Lawrence, MA 01642 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 POLICY NUMBER POLICY FF MMIDDIYYYY POLICY XP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PGP0759010 03/01/2012 03/01/2013 - DAMAGE RENTED PREMEa occurrence $ 300,00 CLAIMS -MADE F_x1 OCCUR MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 2,000,00 1-1 POLICY PE T LOC J $ AUTOMOBILE LIABILITY MBILIMIT Ee EDISINGLE $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN TORY LIMITSER E.L. EACH ACCIDENT $ ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A E.L. DISEASE- EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Property Section 7107P412 03/0112012 03/01/2013 675,00 B Employee Dishonesty 7107P412 03/0112012 03/01/2013 25,00 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) First United Methodist Church Town of North Andover 1600 Osgood Street North Andover, MA 01845 ACORD 25 (2010/05) FI RSUN7 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 W 7ytsts-,dU1U AGURU GURPURATION. All rights reserved. The ACORD name and logo are registered marks of ACORD _W 411�: WHITKE1 OP ID: PI 144c"Rte® CERTIFICATE OF LIABILITY INSURANCE �TE IM D 0111 /DD/YYYY) 01 /10/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCERCONTACT Phone:608-788-6160 Stanley McDonald Agency IL Inc Fax: 608-788-7012 2018 State Road P.O. Box 1446 La Crosse, WI 54602-1446 James R. Mc Donald NAME: PHONE FAX A/c No Ext): A/C No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Tudor Insurance Company 37982 INSURED KeJo Corporation dba Servpro of Lawrence See Note For Named Insured INSURER B: Travelers Property Casualty 25674 INSURER C : INSURER D: PO BOX 328 Lawrence, MA 01842 INSURER E INSURER F: O3/O1/2012 COVERAGES CERTIFICATE NUMBER: RI=VICinN NI lUR1=R• 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 ADDL SUB POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR PGP075901 O O3/O1/2012 03/0112013 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident)$ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F—] N / A WC STATU- OTH- T Y IT ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Property Section 7107P412 03/01/2012 03/01/2013 675,000 B EmployeeDishonesty 7107P412 03/01/2012 03/01/2013 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) FIRSUN7 First United Methodist Church Town of North Andover 1600 Osgood Street North Andover, MA 01845 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 CO 1988-2010 ACORD CORPORATION: All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD c. . l`. R CERTIFICATE OF LIABILITY INSURANCE `� D/10/ 201IDDIY3 1/10/3 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 INSURANCE SOLUTIONS CORPORATION 60 Westville Rd Plaistow NH 03865 CONTACT Linda Bogdanowicz PHONE (603) 382-4600 FAx 1C No: (603)382-2034 AIC. EAbMADRLESS:linclab@iscinsures.com INSURERS AFFORDING COVERAGE NAIC # INSURERA;Safety Insurance INSURED Ke Jo Corporation dba Servpro of Lawrence 8 Blakelin Street Lawrence MA 01841 INSURER B :Cha r tl s INSURER C: INSURER D: INSURER E INSURERF: COVERAGES CERTIFICATE NUMBER:CL1292507044 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. INSR LTR TYPE OF INSURANCE ADDL UB POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COM GENERAL LIABILITY CLAIMS -MADE ElOCCUR DAMAGE TO RENTED PREMISES PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY Oaaccident)tINEDSINGLE LIMIT E 1 000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 6214923 0/1/2012 10/1/2013 BODILY INJURY (Per accident) $ X g NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist BI split limit $ 500,000 UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / NJIM ANY PROPRIETOR/PARTNER/EXECUTIVE 0 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under N / A 0001609671 /1/2012 /1/2013 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below B Pollution X CPL15829477 /1/2012 /1/2013 $1,000,000 Each Occurence $2,000,000 Aggregate DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) First United Methodist Church Town of Andover 1600 Osgood Street North Andover, MA 01845 INSn95 r9mnnr� m 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 th Maglia/CLS�7 (��= u'IUBB-2010 ACORD CORPORATION. All rights reserved. Tho 11r'r1RIl name nnrl Inn^ n— ronic}ornrl mnrlrc ^f Ar'nDn I -y �►Eo z CLc.0 .Woo �• c c _ L C 4) c0 ­ C -0 _-0 tm C .S Q L E M _CD CL to 0 W m WC •a - O O LU!R 5 N G P •c s V � r V Uj L v .� Q. G � cn •> ;� N N C c H t .. 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