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HomeMy WebLinkAboutBuilding Permit #568-13 - 66 SETTLERS RIDGE ROAD 2/21/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: J �� Date Received Date Issued: 3 IN PO TANT:Applicant must complete all items on this page LOCATION (.G 5*17 I-IE U 1ZI b to IE A j0iest'r( An/Ddva- Print PROPERTY OWNER PAVb Mok)TECALyo Print MAP NO: 6 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 ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other gptic JOW611 ❑.Flood lain ❑Wetlands 0 Watershed;District . D.Water/.Sewer_ DESCRIPTION OF WORK TO BE PERFORMED: r (/ 6,�, L) �-h, J � + r -j- � ✓t� Y, -C 0- Com. Identification Please Type or Prin Clearly) OWNER: Name: 1�- c�J �J v� C.CL.I q tz--D Phone: `17SO 75 3 O q S-1 Address: 66 S \ CONTRACTOR Name: �2�(rC� �� Phone: ?� Y 6 Address: �� c��! 3 LCA c� r 018Lt Supervisor's Construction License: 4 . Exp. Date: aU�. L t� Home Improvement License: Exp. Date: t 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: $ 1. S 37 . 8 7 FEE: $ Check No.: r' S� Receipt No.: a:2 6 /6A5 NOTE: Persons contracting with unregistered contractors do not have access to the ra fu - — - - :.-fir-- --:- ------ ----._ :- _. - -- - ----:� Signature of Agent/Owner nature of contras i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site . ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS R HEALTH • Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments s 'Water & Sewer Connection/Signature& Date DrivewaVPermit bPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Tem Dum ster on site e no s s P p Y Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 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 n NOTES and DATA— For department use ❑ Notified for pickup - Date L � 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. 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 ❑ Co Of Contract ntract ❑ FI . oor/Cross ectlon/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 i must be submitted with the building application Doc: Doc-Building Permit Revised 2008mi 's L Location "'e No.—!5io Date Z Z! • TOWN OF NORTH ANDOVER Icc ,y Certificate of Occupancy $ Building/Frame Permit Fee $ A 7 "r Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ Check# AI �� 26166 Building Inspector NORTH own of . It ndover O 1. y LAK, h ver, Mass, 7_1 1 C0C"1C"2W#CK - S U BOARD OF HEALTH RMI-TPE TFood/Kitchen r . Septic System THIS CERTIFIES THAT �! �'` a P: F c4? .......... BUILDING INSPECTOR ..... ................... ......................................................... Foundation has permission to erect .......................... buildings on ....................... ....yrs............. . ......................... nRough to be occupied as �� �f �, c�- � ...� � ....................... Chimney ........... ..... .............. �................ , ...v. e provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough ° ..................... Service .................. ............. .... ...... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No'Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Authorization to Perform Services and Direction of Payment Customer Name: l�v I e Date of Loss: Loss Address: v / -� �� e 0) t � I'�p City: f t-/�tt � 6V Ur state: 1�.�1 Zip: Client: OV61YU JClaim Number(if available): 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 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 $ 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 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. 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. Client's Signature: fl Provider's Signature: '�~` - Printed Name: `�c t�, it 'd t'U + . •L v p Franchise Legal Name: Client Reviewed Customer Information Form: O Y O N d/b/a SERVPRO® of: t J' Date: j'rl Date: White: SERVPRO® Yellow: Claims Professional Pink: Customer ©SERVPRO•INTELLECTUAL PROPERTY,Inc. ALL RIGHTS RESERVED FE-051707 1.0 28000 06/11 Each SER VPRW Franchise is Independently Owned and Operated. Authorization to Perform Services and Direction of Payment Terms and Conditions of Service READ CAREFULLY Note: This Contract includes a limitation of liability and limitation of remedies. 1. SERVPRO'is one of the largest nationwide Cleaning and Restoration Franchise Systems in the United States. The SERVPRO-Franchise owner identified on the front of this Contract(the"Provider")is an independent contractor who agrees to perform the services identified on the front of this Contract(the"Services"). Client agrees to purchase,receive,and pay for the Services pursuant to the terms and conditions of this Contract. Servpro Industries,Inc.,the Franchisor,is not a party to any agreement with Client,is not a guarantor of the 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 06/11 L'urh,SFRV1'R0 f-,rtnr,'hzs,,is[;tdp(,ndejttly ou,;jed,t td Uperittid. DATE(MMIDD/YYYY) A�O CERTIFICATE OF LIABILITY INSURANCE 2/20/2013 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). PRODUCER CONTACT NAME: g Linda BO danowicz INSURANCE SOLUTIONS CORPORATION PHONE (603)382-4600 FAIC No:(603)382-2034 60 Westville Rd EMAIL :lindab@iscinsures.com INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURERA:Safety Insurance INSURED INSURER B:Chartis KeJo Corporation dba Servpro of Lawrence INSURER C: 8 Blakelin Street INSURER D: INSURER E: Lawrence MA 01841 INSURER F: 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 ADL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER (MM/DD[YYYYI IMMIDDINYYYY) GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE I U HhN TED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ CLAIMS-MADE r-1OCCURMED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ COMBINED AUTOMOBILE LIABILITY EacidentSINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNEDSCHEDULED 6214923 10/1/2012 0/1/2013 BODILYINJURY(Peraccident) $ AUTOS NON-OWNED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident Uninsured motorist BI split limit $ 500,000 UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ ATU B WORKERS COMPENSATION TORY WC STIMIT 0TH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? C001609671 /1/2012 /1/2013 E.L.DISEASE-EA EMPLOYE $ 1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below B Pollution x PL15829477 /1/2012 /1/2013 $1,000,000 Each Occurence $2,000,000 Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Paul Montecalvo 66 Settlers Ridge Rd AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Keith Maglia/CLS ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025r5-mnniim Tho Arr)P 1 nnmo and Inn^nro roniefororl mzr4c of Arnon Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperN isor License: CS-067690 / GREGG M WHITS t 4 CHATBURN t W MHAM NH 8308 3 '"� Expiration 02/2012014 Commissioner sm��� ' Office of Co�m ��rs ess Regulation �I HOME IMPROVEMENT CONTRACTOR Type Registration: ,, 158271 Expiration: a?2l 1,2013 Private Corporation; K CORPORATION-� (; SERVPRO OF LAt/1I &$XE,� S. GREGG WHITE , —E- 8 BLAKELIN STREETS LAWRENCE,MA 0184'1,x_;- ¢\4- Undersecretary --• SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Client: Montecalvo,Paul Home: (978)793-0451 Property: 66 Settlers Ridge Rd North Andover,MA 01845 Operator Info: Operator: KMCCARTH Estimator: Kevin McCarthy Business: (603)490-4434 E-mail: kmccarthy@servprooflawrenc e.com Business: 8 Blakelin St Lawrence,MA 01842 Type of Estimate: Date Entered: 2/7/2013 Date Assigned: Price List: MAEM7X JAN13 Labor Efficiency: Restoration/Service/Remodel Estimate: 2013-02-07-0000 SERVPRO@ Fire&Water-Cleanup&RestorationTM Like it never even happened.@ � �C- � � - SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691. 2013-02-07-0000 Main Level ' �1 Living Room Height:8' 669.89 SF Walls 459.82 SF Ceiling 1129.71 SF Walls&Ceiling 459.82 SF Floor 1 51.09 SY Flooring 83.08 LF Floor Perimeter T 87.00 LF Ceil.Perimeter Missing Wall-Goes to Floor 3' 11"X 6'8" Opens into KITCHEN DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 1. Tear out wet drywall,cleanup,bag- 248.93 SF 0.92 229.02 (0.00) 229.02 after business hours 2. Tear out and bag wet insulation- 229.91 SF 0.83 190.83 (0.00) 190.83 after hours 3. Ducting-lay-flat 12.00 LF 0.29 3.48 (0.00) 3.48 4. Containment Barrier/Airlock/Decon. 114.95 SF 0.84 96.56 (0.00) 96.56 Chamber-after hours 5. Dehumidifier(per 24 hour period)- 7.00 EA 101.25 708.75 (0.00) 708.75 XLarge-No monitoring 6. Air mover(per 24 hour period)-No 12.00 EA 25.00 300.00 (0.00) 300.00 monitoring 7. Clean floor 229.91 SF 0.31 71.27 (0.00) 71.27 Totals: Living Room 1,599.91 0.00 1,599.91 Kitchen Height: 8' 483.22 SF Walls 229.17 SF Ceiling 712.39 SF Walls&Ceiling 229.17 SF Floor 25.46 SY Flooring 59.75 LF Floor Perimeter 63.67 LF Ceil.Perimeter Missing Wall-Goes to Floor 3' 11"X 61811 Opens into LIVING_ROOM DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 8. Tear out wet drywall,cleanup,bag- 171.88 SF 0.92 158.13 (0.00) 158.13 after business hours 9. Tear out and bag wet insulation- 229.17 SF 0.83 190.21 (0.00) 190.21 after hours 2013-02-07-0000 2/15/2013 Page: 2 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 CONTINUED-Kitchen DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 10. Negative air fan/Air scrubber(24 5.00 DA 71.95 359.75 (0.00) 359.75 hr period)-No monit. 11. Ducting-lay-flat 10.00 LF 0.29 2.90 (0.00) 2.90 12. Tear out baseboard-after business 29.88 LF 0.48 14.34 (0.00) 14.34 hours 13. Air mover axial fan(per 24 hour 10.00 EA 28.50 285.00 (0.00) 285.00 period)-No monitoring 14. Tear out toe kick and bag for 10.00 LF 2.94 29.40 (0.00) 29.40 disposal-after bus.hours 15. Drill holes for wall cavity drying- 20.00 EA 0.55 11.00 (0.00) 11.00 after hrs 16. Clean floor 229.17 SF 0.31 71.04 (0.00) 71.04 Totals: Kitchen 1,121.77 0.00 1,121.77 --'" Den Height:8' 490.67 SF Walls 231.44 SF Ceiling 722.10 SF Walls&Ceiling 231.44 SF Floor ` - 25.72 SY Flooring 61.33 LF Floor Perimeter 61.33 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 17. Tear out wet drywall,cleanup,bag 100.00 SF 0.68 68.00 (0.00) 68.00 for disposal 18. Containment 115.72 SF 0.57 65.96 (0.00) 65.96 Barrier/Airlock/Decon. Chamber 19. Ducting-lay-flat 10.00 LF 0.29 2.90 (0.00) 2.90 20. Tear out baseboard 61.33 LF 0.30 18.40 (0.00) 18.40 21. Tear out and bag wet insulation 100.00 SF 0.53 53.00 (0.00) 53.00 22. Air mover(per 24 hour period)- 5.00 EA 25.00 125.00 (0.00) 125.00 i No monitoring 23. Clean floor 173.58 SF 0.31 53.81 (0.00) 53.81 Totals: Den 387.07 0.00 387.07 201.3-02-07-0000 2/15/2013 Page: 3 -- SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Total: Main Level 3,108.75 0.00 3,108.75 Basement -. Garage Height: 8' 662.54 SF Walls 428.53 SF Ceiling 1091.07 SF Walls&Ceiling 428.53 SF Floor 47.61 SY Flooring 82.82 LF Floor Perimeter 82.82 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 24. Tear out wet drywall,cleanup,bag 85.71 SF 0.68 58.28 (0.00) 58.28 for disposal 25. Tear out and bag wet insulation 128.56 SF 0.53 68.14 (0.00) 68.14 26. Dehumidifier(per 24 hour period)- 3.00 EA 320.77 962.31 (0.00) 962.31 Desiccant-No monit. 27. Dehumidifier(per 24 hour period)- 3.00 EA 52.25 156.75 (0.00) 156.75 No monitoring DH to duct desiccant exhaust into. 28. Clean floor 214.27 SF 0.31 66.42 (0.00) 66.42 Totals: Garage 1,311.90 0.00 1,311.90 =- Height:8' 1 _ 1 Unfinished g 823.12 SF Walls 290.17 SF Ceiling T 1113.29 SF Walls&Ceiling 290.17 SF Floor -% 32.24 SY Flooring 102.89 LF Floor Perimeter 102.89 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 29. Water extraction from floor-after 290.17 SF 0.63 182.81 (0.00) 182.81 business hours 30. Clean rug-Full service 1.00 EA 72.82 72.82 (0.00) 72.82 31. Tear out and bag wet insulation 193.64 SF 0.53 102.63 (0.00) 102.63 Totals: Unfinished 358.26 0.00 358.26 2013-02-07-0000 2/15/2013 Page:4 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Utility Room Height:8' 351.89 SF Walls 104.28 SF Ceiling 456.17 SF Walls&Ceiling 104.28 SF Floor - 11.59 SY Flooring 43.99 LF Floor Perimeter B 43.99 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 32. Water extraction from hard surface 52.14 SF 0.29 15.12 (0.00) 15.12 floor-after bus.hrs 33. Air mover axial fan(per 24 hour 5.00 EA 28.50 142.50 (0.00) 142.50 period)-No monitoring 34. Content Manipulation charge-per 0.10 HR 34.42 3.44 (0.00) 3.44 hour Totals: Utility Room 161.06 0.00 161.06 T Office Height: 8' 500.00 SF Walls 189.43 SF Ceiling 689.43 SF Walls&Ceiling 189.43 SF Floor "1 21.05 SY Flooring 62.50 LF Floor Perimeter 62.50 LF Ceil.Perimeter I DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 35. Water extraction from floor-after 189.43 SF 0.63 119.34 (0.00) 119.34 business hours 36. Protect-Cover with plastic 100.00 SF 0.26 26.00 (0.00) 26.00 37. Remove wet susp.ceiling tile,bag 142.07 SF 0.41 58.25 (0.00) 58.25 for disp.-after hrs 38. Tear out baseboard 31.25 LF 0.30 9.38 (0.00) 9.38 39. Drill holes for wall cavity drying 20.00 EA 0.37 7.40 (0.00) 7.40 40. Ducting-lay-flat 10.00 LF 0.29 2.90 (0.00) 2.90 41. Containment 142.07 SF 0.57 80.98 (0.00) 80.98 Barrier/Airlock/Decon.Chamber i 42. Dehumidifier(per 24 hour period)- 5.00 EA 101.25 506.25 (0.00) 506.25 XLarge-No monitoring 43. Air mover axial fan(per 24 hour 10.00 EA 28.50 285.00 (0.00) 285.00 period)-No monitoring 44. Content Manipulation charge-per 0.25 HR 34.42 8.61 (0.00) 8.61 hour 2013-02-07-0000 2/15/2013 Page:5 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 CONTINUED-Office DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV Totals: Office 1,104.11 0.00 1,104.11 Living Room Height: 8' 426.18 SF Walls 166.76 SF Ceiling 592.93 SF Walls&Ceiling 1.66.76 SF Floor 18.53 SY Flooring 53.27 LF Floor Perimeter 53.27 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 45. Water extraction from floor-after 166.76 SF 0.63 105.06 (0.00) 105.06 business hours 46. Air mover axial fan(per 24 hour 10.0013A 28.50 285.00 (0.00) 285.00 period)-No monitoring 47. Content Manipulation charge-per 0.25 HR 34.42 8.61 (0.00) 8.61 hour Totals: Living Room 398.67 0.00 398.67 Closet Height: 8' 2,2 90.67 SF Walls 7.58 SF Ceiling C,o �, 98.25 SF Walls&Ceiling 7.58 SF Floor m 1 1 0.84 SY Flooring 11.33 LF Floor Perimeter ?. 11.33 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 48. Drill holes for wall cavity drying 15.00 EA 0.37 5.55 (0.00) 5.55 49. Content Manipulation charge-per 0.25 HR 34.42 8.61 (0.00) 8.61 hour Totals: Closet 14.16 0.00 14.16 2013-02-07-0000 2/15/2013 Page: 6 -� SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Workout Height: 8' 442.67 SF Walls 189.11 SF Ceiling 631.78 SF Walls&Ceiling 189.11 SF Floor 21.01 SY Flooring 55.33 LF Floor Perimeter 1 55.33 LF Ceil.Perimeter DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 50. Tear out wet drywall,cleanup,bag 75.00 SF 0.68 51.00 (0.00) 51.00 for disposal 51. Air mover(per 24 hour period)- 5.00 EA 25.00 125.00 (0.00) 125.00 No monitoring 52. Water extraction from hard surface 37.82 SF 0.29 10.97 (0.00) 10.97 floor-after bus.hrs Totals: Workout 186.97 0.00 186.97 Total: Basement 3,535.13 0.00 3,535.13 Job DESCRIPTION QUANTITY UNIT COST RCV DEPREC. ACV 53. Equipment setup,take down,and 6.00 HR 43.72 262.32 (0.00) 262.32 monitoring(hourly charge) 54. Haul debris-per pickup truck load 1.50 EA 159.24 238.86 (0.00) 238.86 -including dump fees Totals: Job 501.18 0.00 501.18 Line Item Totals: 2013-02-07-0000 7,145.06 0.00 7,145.06 2013-02-07-0000 2/15/2013 Page:7 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Grand Total Areas: 5,040.90 SF Walls 2,305.77 SF Ceiling 7,346.67 SF Walls and Ceiling 2,305.77 SF Floor 256.20 SY Flooring 628.81 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 636.64 LF Ceil.Perimeter 2,305.77 Floor Area 2,489.99 Total Area 5,040.90 Interior Wall Area 4,170.37 Exterior Wall Area 463.37 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 2013-02-07-0000 2/15/2013 Page: 8 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Summary Line Item Total 7,145.06 Material Sales Tax @ 6.250% x 260.95 16.31 Replacement Cost Value $7,161.37 Net Claim $7,161.37 Kevin McCarthy i I �I 2013-02-07-0000 2/15/2013 Page: 9 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Recap by Room Estimate: 2013-02-07-0000 Area: Main Level Living Room 1,599.91 22.39% Kitchen 1,121.77 15.70% Den 387.07 5.42% Area Subtotal: Main Level 3,108.75 43.51% Area: Basement Garage 1,311.90 18.36% Unfinished 358.26 5.01% Utility Room 161.06 2.25% Office 1,104.11 15.45% Living Room 398.67 5.58% Closet 14.16 0.20% Workout 186.97 2.62% Area Subtotal: Basement 3,535.13 49.48% Job 501.18 7.01% Subtotal of Areas 7,145.06 100.00% Total 7,145.06 100.00% 2013-02-07-0000 2/15/2013 Page: 10 SERVPRO of Lawrence PO Box 328 Lawrence,MA 01842 800 535-6322 Tax Id#02-0353691 Recap by Category Items Total % CONT: GARMENT&SOFT GOODS CLN 72.82 1.02% CLEANING 262.54 3.67% CONTENT MANIPULATION 29.27 0.41% GENERAL DEMOLITION 1,537.87 21.47% WATER EXTRACTION&REMEDIATION 5,242.56 73.21% Subtotal 7,145.06 99.77% Material Sales Tax @ 6.250% 16.31 0.23% Total 7,161.37 100.00% I i 2013-02-07-0000 2/15/2013 Page: 11 Basement 2r 20'S" 16' -- ,s a- W060vttV N 6 1V 79 2 o e 9'9" iffT'— --- 10. v in Vt1Nty Roam 0 o � � t a"1 9'T L5,r i2 o 5 m io 1 10'3"—•---1 7" F T 3- F— h--2'6" uR n a T 3`$' 20'5 tMrt9 Room +'A 25'V F 0 73' Basement 2013-02-07-0000 2/15/2013 Page: 12 Main Level 21'7" 1 „ 1 �I. 13'9' 1 Pia 0 N N 1 �,YW U� Main Level 2013-02-07-0000 2/15/2013 Page: 13 �—� WHITKE1 OP ID: PI CERTIFICATE OF LIABILITY INSURANCE DATE 41201YY) 02!14!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). PRODUCER Pho n e:608-788-6160 CONTACT Stanley McDonald Agency IL IncFax:608-788-7012 PHONE FAX 2018 State Road P.O.Box 1446 AIC No Ext): AIC No LaCrosse,WI 54602-1446 E-MAIL James R.Mc Donald ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 1 INSURER A:Tudor Insurance Company 37982 INSURED KeJo Corporation INSURERS:Travelers Property Casualty 25674 dba Servpro of Lawrence See Note For Named Insured INSURER C: PO Box 328 INSURER D Lawrence,MA 01842 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSR TYPE OF INSURANCE I C F OIC XP LIMITS LTR I POLICY NUMBER MMIDDIYYYY MMIDDM'YY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE To RENTED A X COMMERCIAL GENERAL LIABILITY PGP0759010 03/01/2012 03/01/2013 PREMISES Ea occurrence) $ 300,00 CLAIMS-MADE �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-COMPIOP AGG $ 2,000,00 POLICY JLC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident F 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWCSTATU- 'T'_ - AND EMPLOYERS'LIABILITY YIN TOR IMI S R ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ B Property Section 7107/3412 03/0112012 03/01/2013 675,00 B EmployeeDishonesty 7107/2412 03/01/2012 03/01/2013 25,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHCLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION MONTPA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Paul Montecalvo ACCORDANCE WITH THE POLICY PROVISIONS. 66 Settlers Ridge Road AUTHORIZED REPRESENTATIVE North Andover,MA 01845 4. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD WHITKE1 PAGE 2 NOTEPAD INSURED-SNAME KeJo Corporation OP ID: PI DATE 02/14/13 Named Insured: eJo Corporation dba Servpro of Lawrence dba Servpro of Lawrence-Three dba Servpro of Lawrence-Two dba Servpro of Salem/Plaistow dba Servpro of The dovers.