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71 MOFFATT RD - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF s Massachusetts State Building Code,780 CMR SALEM ,} Revised Mar 2011 OI Building Permit Application To Construct,Repair, Renovate Or Demolish a UUU One-or Two-Family Dwelling This Section For Off aP Use Only Building Permit Number: D e Applied: Building Official(Print Name) Signature D to SECTION 1:SITE INFORMATION 1.1 Property Address: � ^ 1.2 Assessors Map&Parcel Numbers _�7 / �LaNf/+� /to _ I.Ia Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: Name(Print) G OP L City,State,ZIP / / A-c�Ff.A 6/> • 80 No.and Sheet Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Buildin Owner-Occupied ❑ Repairs(s) Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': L ' r P v y SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Labor and Materials) Official Use Only 1. Building $ I. Building Permit Fee: $ 5 Y• Indicate how fee is determined: 2. Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Su ression) Total All Fees: $ ir / yJ Check No.__Check Amount: Cash Amount: 6. Total Project Cost: $ tl �u 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES ;—Na.tane ed construction Supervisor(CSL) it 3—)�/� /Ln V L A 2N��_ Lic®se'RN awber-- Exptration Date L-Ho� List CSL Type(see below)A0 A. /JTDesai on �jrl U Unrestricted to 35000 Ca Ft.Restrictedl&2Fami1 Dwellin M -Masomy Only 9 7�!' ���•�y�� RC Residential Roofing Covering Telephone WS Residerdial Window and Siding SF Residential Solid Fuel Binning A fiance Installation D I Residential Demolition g.2_C/R�ate A Home tmJpruvement Contractor(HIC) /O 0 1l ft��I—Io/m��pany Neme or R/C HIC gtstrmt Ne e 'Registration Number 0 ow 6 z3.4/ J A 9 76 g y Expiration Date S- tua Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes AK No ❑ Current Certificate must be on file in office Yes SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, A�1 �el—7o , as Owner of the subject property hereby authorize 1 5,9 l A.-49J ,O< to act on my behalf,in all[natters relative to work authorized by this building permit application. _ S-�•i z Signature of Owner Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION 1, 13 A k&V F AA& G r L2,<p S as Owner or Authorized Agent hereby declare that the statemeris and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. O are /z- Si tare o er or Authorized Agent Date (Sigiled under the pains and penalties of NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(MC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CUR Regulations 110.116 and 110.115,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.FL) (including garage,finished basement/attics,decks or porch) Gross living area(Sq.FL) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of tooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" SALEM, MA 01970 WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-s54, 1 acknowledge that as a condition of building permit# all debris resulting from the construction activity governed by this building permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL Ch.111-s150A. Waste Disposal or Solid Waste Facility: ALLIED WASTE Address: 300 FOREST ST Town/City, State, Zip: PEABODY, MA 01960 NAME OF HAULER: AB CARNES, INC. DATE: 5-3-2012 V SIGNATURE OF APPLICANT: 7 DAassacnusetts - Department of PuDilc S.a?ety Board of Building Regulations ane Standaras Construction Supers isor tense: CS-000230 - BARRY S CARNES 30 ARROWHEAD FARWRI) Boxford MA01921 Commissioner 03/07/2014 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100733 -- -- Type: Private Corporation Expiration: 6/23/2012 Tr# 298405 A. B. CARNES, INC. Barry Carnes 30 Arrowhead Farm Rd. Boxford, MA 01921 _ - Update Address and return card.Mark reason for change. Address Renewal CI Employment ❑ Lost Card DPS-CAI 0 50M-WOO G101216 FORM 153' The Commonwealth of Massachusetts DIA use only Department of Industrial Accidents Office of Investigations-Dept. 153 1 Congress Street,Suite too,Boston,Massachusetts 02114-2017 http://www.mass.gov/dia InvestJSWOIn#: AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, §1(4) by adding the following paragraph: "This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and outstanding stock of the corporation. Notwithstanding section 46, these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with a written waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set forth in section 25C." Pursuant to M.G.L. c. 152, §1(4) as amended, I/We the undersigned officers of: AB Carries, Inc. 30 Arrowhead Farm Rd Boxford, Me 01921 (Name of Corporation and Address) each holding at least 25%of the issued and outstanding stock in said corporation, do hereby invoke the right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a workers' compensation policy covering the undersigned corporate officer(s) or director(s). I/We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further, Uwe the undersigned do understand that, should the above-named corporation hire or have in its employ any employee(s)in addition to the undersigned corporate officer(s) or director(s), said corporation is required to obtain workers' compensation coverage for the employee(s) as prescribed by M.G.L. c. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated above and I/we have checke a appropriate box below my/our name(s) indicating my/our desire to be exempt or not o be pt fr the provisions of M.G.L. c. 152. ed under t pains and penalties of perjury: Barry Carries, President 04/3/2012 Si re Print Name&Title Date(mm/dd/yyyy) ❑I wish to exercise my right of exemption or I wish NOT to exercise my right of exemption N& Anastasiya Cames, Director 04/03/2012 Signature Print Name&Title Date(mm/dd/yyyy) I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) 1 wish to exercise my right of exemption or I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. Instructions on back. Form 153-72010 MA SOC Filing Number: 201282413560 Date: 4/4/2012 1:24:00 PM The Commonwealth of Massachusetts No Fee William Francis Galvin Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617)727-9640 SupplementalStatement of Change of (General Laws, Chapter 156D, Section r 1. Exact name of the corporation: A.B. CARNES,INC. 2. Current registered office address: Name: BARRY S. CARNES No. and Street: 30 ARROWHEAD FARM ROAD City or Town: BOXFORD State: MA Zip: 01921 Country: USA 3. The following supplemental information has changed: _Names and street addresses of the directors, president, treasurer, secretary Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code PRESIDENT BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD,MA 01921 USA TREASURER BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD,MA01921 USA SECRETARY BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD,MA01921 USA DIRECTOR ANASTASIYA CARNES 30 ARROWHEAD FARM ROAD, BOXFORD,MA 01921 USA _Fiscal year end: October X Type of business in which the corporation intends to engage: GENERAL CONTRACTING& EXTERIOR REMODELING —Principal office address: No. and Street: 30 ARROWHEAD FARM ROAD City or Town: BOXFORD State: MA Zip: 01921 Country: USA X g. Street address where the records of the corporation required to be kept in the Commonwealth are located (post office boxes are not acceptable): No. and Street: 30 ARROWHEAD FARM ROAD City or Town: BOXFORD State: MA Zip: 01921 Country: USA which is X its principal office _ an office of its transfer agent an office of its secretary/assistant secretary _ its registered office J Signed by BARRY S.CARNES , its PRESIDENT f on this 4 Day of April,2012 ©2001 -2012 Commonwealth of Massachusetts All Rights Reserved MA SOC Filing Number: 201282413560 Date: 4/4/2012 1:24:00 PM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that,upon examination of this document, duly submitted to me, it appears that the provisions of the General Laws relative to corporations have been complied with, and I hereby approve said articles; and the filing fee having been paid, said articles are deemed to have been filed with me on: April 04, 2012 01:24 PM WILLIAM FRANCIS GALVIN Secretary of the Commonwealth OP ID:SA CERTIFICATE OF LIABILITY INSURANCE -t141osn z0 /05112 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS Y 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(9), 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 endorsemon e. PRODUCER 978-744.6715 NA E: CT AHMED Insurance Agency,Inc. PHONE Fax PO BOX 449 978-741-0127 Arc.NO,Edn};.. __.. _ _ ,INc,x l_ Salem,MA 01970 �lSPIL Stephen G.Ahmed ADDRESS:PRODUCER—gBCAR 1 CVSTOMERIDN; __ — _. INSURER(S)AFFORDING COVERAGE____ INSURED AB Carnes Inc _INSURER A:ESSOX Insurance Cc 30 Arrowhead Farms Road —1 INSURERS Sa!ety Insurance Company.__ ___ 133618 Boxford,MA 01921 INSURER C: INEURER D:__._.._ INSURERS: INSURER F. r COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY--BHA E—P_QLICIES_OF�NSURANCEUBTEO_aELOW.HAVE:eEENUSSUED= -THE NSUREO-NA ABOVE-FOR-TH2'�POLICY-"RIOD " --INDI AC TED, -NOTIMTHSTANDING 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. EXCLUSIONSAND CONDITIONS OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IXSRF - - - ---- --- ADDSSOaR WSLICP€PF—POOCVEXP R,. TYPE OF INSURANCE POUCYNUMBER NMIO 1 MMI00 LWITS GENERAL LABIUTY EACH OCCURRENCE S 1A00,00 A X COMMERCIAL GENEMLLWBILITV i3DF9266 ! D3/19112 0311 DAMAGE TO RENTED B/13 �PREMISES(E.—S 60.00 CWMa.MADE Cj OCCUR j 1 ME�EXP(Nry megmn) y 1,00 ' PERSONAL&AY/INJURY_ S 1,000,0(LC GENERAL AGGREGATE Is 200,00 11 BE'L AGGREGATE IUVT APPLIES PER: I PRODUCTS-COMPIOP AGO IS 2,000A0 n voucr. �PBO- Lac IPD Deduct s se I AUMMOBILE LIABILITY COMBINED SINGLE LIMIT ',3 1,000,DI (Ee eccaenD I ANY AUTO i BODILY INJURY(P.,Per—) f �--�RL OWNED AInpS I' I BODILY INJURY(Pe:ecWm n 3 B % SCHEDULED AUTOS 16213192 05/02/11 05102/12 - PROPERTYOAMACE B X I HIRED AUTOS 6213192 05/02/11 OS/OL $ Inc IpP,acbmN —T B X_�NON-0YMEO AUTOS j6213192 1 06/02111 05102/12 3 3 UMBRELLA LIAB F�OCCUR i EACHOCCURRENCE S 1 EXCESS LABL ICLAIMSMADE AGGREGATE_ _ f DEDUCTIBLE 1' 3 RETENTION $ f INORNERSCOMPENSGTON V63TATLL IOTN. ANDEMPLOYERBIA&LITY y�� -. LTORYLWRS._7-1 ANYPROPRIe—ARTNER�£XECUTIVE I-1'NIAi EL EACH ACCIDENT iE OFFICERMEMBER EXCLUDE. ILJI - --"--- -- (MendaloryInan EL.DISEASE-EA EMPLOYEE 3 Ilym Ee bUMer " DESCflIPTIONOFOPEnATIONSEebw EL DISEASE-POLICY LIMIT I f I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ARMN ACORD 101,Adedwal Rmmelb SNadU10.IIImn apace la rm IN,w) Roofing contractor CERTIFICATE HOLDER CANCELLATION NONE001 .. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE None THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN. ACCORDANCE WRH THE POLICY PROVISIONS, AUTHONIZEDDREPRESENTATVE 01988-2009 ACORD CORPORATION. All rights reserved. ( ACORD 25(20091091 The ACORD name and logo are registered marks of ACORD Proposal AB CARNES, INC. 30 Arrowhead farm Rd Page 1 of 1 Boxford, Ma. 01921 978-887-1431 or781-599-9197 Mass, Builders License No.000230 Contractors Registration.No 100733 Proposal Submitted To: ALBERTO RODRIGUEZ&MARGARITA Date April 19, 2012 71 MOFFATT RD Project Name MARGARITA RUIZ SALEM,MA 01970 Address 71 MOFFATT RD SALEM, MA 01970 617-3884891 We propose to furnish material and labor-in accordance with the specifications below: Sixty Eight Hundred Dollars($6,800.00) Payment to be made as follows: $300.00 Deposit, Balance Upon Completion Notice:Ali home Improvement contractors and subcontractors engaged in home Authorized improvement contracting,unless specifically exempt from registration by provisions Signature of Chapter 142A of the General Laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Note:This oposal m e withdrawn by us if not accepted within 30 Mass.govllicenses wel ite. days. ROOF PROPOSAL ® STRIP ROOF OF TWO LAYERS OF ASPHALT SHINGLES,COVER ROOF DECK WITH 15 POUND FELT PAPER, COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP P AGE. ® INSTALL ICE&WATER SHIEQD SIX'F IDE AT LEADING EDGE ONLY, AND THREE FEET IN ALL VALLEYS AND ALL ROOF PENETRATIONS.UNHEATED AREAS EXCLUDED. ® COVER ALL PERIMETERS WITH EIGHT INCH ALUMINUM DRIP EDGE. INSTALL RIDGE VENT AND/OR®AS NEEDED ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS. ❑ REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF PLFT,WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK.YOU MAY NEED TO HAVE A CARPENTER REINSTALL THE REMOVED SIDING. ® CHIMNEY FLASHING; CUT ALL EXISTING TAR AND LEAD FROM ONE CHIMNEY(S).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE W/LEAD ANCHORS. PROPERLY SEAL REGLET JOINT. PLEASE ADD$500.00 TO ABOVE PRICE. ❑ REBUILD CHIMNEY FROM ROOF DECK UP WITH NEW OR USED BRICK ADD OVE PRICE. ® COVER ROOF SURFACE WITH CERTAINTEED LANDMARK ARCHITECTU LIFETIME RRANTY SHIJNGLES. ® REPLACE DEFECTIVE ROOF DECKING WITH 1X8 SPRUCE BOARDS AT AN A AL COST OF$4.50PLFT. ® COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF $4.00PSOFT. 75FZ SHINGLES ARE TO BE STORM NAILED.(USE SIX NAILS PER SHINGLE) ❑ INSTALL SKYLIGHTS PROVIDED BY CUSTOMER,FRAME ROOF DECK AS NEEDED,PROPERLY FLASH UNITS WITH FLASHING KIT(S)PROVIDED, CUSTOMER TO PERFORM ALL INTERIOR WORK. ADD TO ABOVE PRICE. ❑ REMOVE EXISTING GUTTERS ❑INSTALL NEW SEAMLESS.032 ALUMINUM GUTTERS USING THE POSITIVE LOCKING BAR HANGER SYSTEM. ® REPLACE DEFECTIVE OR ROTTED TRIM BOARDS AS NEEDED WITH#2 PINE PRIMED,ADD$15.00 PER FOOT TO ABOVE PRICE. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS. MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA, OBTAIN ALL PERMITS AND CARRY ALL NECESSARY INSURANCE AS REQUIRED BY LAW. WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTIC AREAS, CUSTOMER SHOULD COVER VALUABLES, GREAT CARE WILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE.HOWEVER,SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. HAND NAIL ONLY,NO NAIL GUNS TO BE USED. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ALL ROOF SECTIONS OF THE HOUSE COMPLETE. REAR LOW PITCHED ROOF:THIS ROOF IS COVERED WITH A RUBBER MEMBRANE.WE WILL PREPARE IT AS IN THE ABOVE PROPOSAL.WE WILL INSTALL NINE FEET OF ICE AND WATERSHIELD THEN APPLY THE ROOF SHINGLES. CHIMNEY FLASHING:THIS SHOULD BE FLASHED AS PROPOSED ABOVE OR LEAKS COULD OCCUR. WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE WED FROM 110 MPH TO 130 MPH WITH AN UPGRADE TO THE HIP& RIDGE CAP AND THE STARTER COURSE AT NO ADDITIONAL CHARGE. YES ) POWER ROOF VENT:THIS WILL BE REMOVED AND BOARDED OVER GUTTERS:IF YOU WANT TO REPLACE THE GUTTERS WITH THE NEW ROOF PLEASE ADD$1350.00 TO THE ABOVE PROPOSAL.YES( )NO( ) WARRANTY-All work warranted to be free of installation defects for 5 years;This is limited to the installed item(s)and their repair only.Material warranted by mfg.to be free of defects for 50 years,see the manufacturers warranty for exact warranty performance. Customer has legal right under federal law to cancel this contract without penalty or obligation within four business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side for cancellation procedures. Once all items in this contract are completed as agreed,customer has 3 days to fulfill payment schedule.All parties agree that all disputes shall be settled by the dispute resolution process on the back of this agreement, Please see reverse side,Dispute Resolution. Signing this Propos �y,have accepted all the terms as stated on the front and back of this agreement. Please see reverse side. Date of Acceptance Signature C��'�I 2 Signal( PLEASE SEE REVERSE SIDE