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89 MOFFATT RD - BUILDING INSPECTION (2) The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code, 780 CMR RECEI L E['�ItC&6E VE MUNICIPALITY nPIF� Building Permit Application To Construct,Repair, Renovat�P�T �Fish a Revised Mar 2011 One- or Two-Family Dwelling This Section For Official Use Only 101) JUL Building Permit Number: Date Ap ed: Building Official(Print Name) Signature VDate SECTION 1: SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1a Is this an accepted street?yes no Map Number Parcel Number 1 1.3 Zoning Information: 1.4 Property Dimensions: UUU ) 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 a 40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ p p y Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP[ 2.1 %ner of Record- )) Q . v/� n (A Name_(Print) � _/�7 City,State,ZIP~ l p9oF�" t 6/,;, - 31 � No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Buildin Owner-Occupie Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units I Other ❑ Specify: Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ D OV 1. Building Permit Fee: $ 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 $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ �D00 ❑Paid in Full ❑ Outstanding Balance Due: rv1 ra t L-tE:l Cr 0 t-) tff;5 1 y SECTION 5: CONSTRUCTION SERVICES 5.1 ms`Construction Supervisor License(CSL) -.. 0 /6 r S n !L r-V e'A.A .1LP License Number Expiration Date Name of CSL Holde � List CSL Type(see below) o.and Street Ty Description U Unrestricted Buildings u to 35,000 cu.R.) 1� a N�� MA UJ 9 Z/ Restricted 1&2 Family Dwelling City/Town,State,ZIP / M - Masonry RC Roofing Covering WS Window and Siding �] SF Solid Fuel Burning Appliances 1 Insulation Telephone Email address D Demolition 5.2 Registered Horn,Impr ome.lmpr ovement Contractor(HIC, ) A5 K-A&,� S 11"A vG HIC Registration Number Expiration Date HIC Company Name or HIC Regis ant Name �. No.and Street Email address T''2 0�C F� 7 �a q i�l9zr City/Town, State,ZIP 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 Issue the building permit. Signed Affidavit Attached? Yes .......... ff No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize�AP (-A 49 L7 f/NS ;i!� , it to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) I Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By en na below,I hereby attest under the pains and penalties of perjury that all of the information o arced in this app cation is true and accurate to the best of my knowledge and understanding. P int Owner's or Authorized Agent's Name(Electronic Signature) - Date 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(HIC)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 can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at-www.mass.gov/dys 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) 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 cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF SALEM WASTE AFFIDAVIT As a result of the provisions of MGL Ch.40-s54, I 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 ROOFING, INC. DUMP TRUCKS DATE: 7-13-2015 SIGNATURE OF APPLICANT: Proposal AB Carnes Roofing, Inc. 30 Arrowhead farm Rd Page 1 of 1 Boxford, Ma. 01921 978-887.1431 MA.CS-000230 and HIC Reg.176928 Proposal Submitted To: DIANNE MURPHY Date July 8, 2015 89 MOFFATT RD Project Name SAME SALEM, MA 01970 Address 617-312-1008 We propose to furnish material and labor-in accordance with the specifications below: Six Thousand Six Hundred Dollars($6,600.00) Payment to be made as follows: $300.00 Deposit, Balance Upon Completion Notice:All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt from registration by provisions 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 Mass.govMcenses website. ROOF PROPOSAL STRIP ROOF OF UP TO TWO LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE UPGRADED RHINOROOF TITANIUM U20 HIGH PERFORMANCE SYNTHETIC UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ICE DAM PROTECTION:INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVER ALL HEATED AREAS SIX FEET WIDE AT THE L ING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEY( ) AND SKYLIGHT CURBS WITH ICE AND WATER BARRIER. COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. 'INSTALL GAF COBRA RIDGE VENT AND/OR❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® OVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$25.00PLFT.WE MAY NEED TO REMOVE TH IDING TO PERFORM THIS WORK AND YOU MAY NEED TO HAVE A CARPENTER REINSTALL OR REPLACE THE SIDING THAT WAS REMOVED. CHIMNEY FLASHING'CUT ALL EXISTING TAR AND LEAD FROM TOP& CHIMNEY(S).CUT NEW REGLET WITH CARBIDE SAW AND :,RE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. ERLY SEAL EGLET JOINT. PLEASE ADD$500.00 TO ABOVE PRICE. OVER ROOF SURFACE WITHCERTAINTEED LANDMARK 240 B LIFETIME WA NTY DESIGNER SHINGLES. REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH SIMILAR PT AN-kDD ONAL COST OF$4.00PSFT/PLFT. ❑f�OVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF NAILING: SECURE SHINGLES WITH EIGHT IN TOTAL COATED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. ❑ SKYLIGHTS:REPLACE EXISTING SKYLIGHTS WITH NEW VELUX OR WASCO UNITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.OUR LABOR CHARGE IS$75.00 EACH IF THEY ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDED. ❑ REMOVE EXISTING GUTTERS ❑INSTALL NEW SEAMLESS.032 ALUMINUM GUTTERS USING THE HIDDEN ZIP SCREW HANGER SYSTEM. ❑ REPLACE DEFECTIVE TRIM BOARDS WITH CUSTOMERS APPROVAL USING NO.2 PRIMED PINE,ADD PLFT TO THE ABOVE PROPOSAL. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. THE PROPERTY OWNER AUTHORIZES AS CARNES ROOFING TO OBTAIN ALL PERMITS.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. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ALL SHINGLED ROOF SECTIONS OF THE HOUSE COMPLETE. CHIMNEY FLASHING:THIS SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS COULD OCCUR. SHINGLE UPGRADE:UPGRADE TO THE LANDMARK 300LB HIGH DEF PREMIUM SHINGLES,ADD$990.00 YES( )NO(1-� WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITH UPGRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES FC 1 EMAIL ADDRESS: �y Warranty:All work warranted against installation defects for 5 years;this warranty is limited to the installed item(s)and its repair only.Material is warranted by the manufacturer against defects for 50 years;see the manufacturers warranty for exact warranty performance. Cancellation:Customer has legal right under federal law to cancel this contract without penalty or obligation within three business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side. Dispute Resolution under Massachusetts Home Improvement Law 142a:All parties agree that any and all disputes relating to this proposal shall be settled by arbitration Prior to any other actions.This forum is user friendly and does not require lawyers.Please see reverse side. Signing this Proposal mean you have accepted all the terms as stated on the front and back of this agreement. Please see reverse side. *Date of Acceptance /� Signature_ _ *Signature „c Signature A �� PLEASE SEE REVERSE SIDE 9�f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-000230 BARRY S CARNES 30 ARROWBEADFARIDI Boxford MA 01921 _"' r - Expiration Commissioner 0 310 7/2 01 6 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Ctntr actor Registration c- Registration: 176928 Type: Corporation i Expiration: '10110/2015 Tr# 245633 AB CARNES ROOFING, INC. BARRY CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 A f`qAf si Update Address and return card.Mark reason for change. Q Address Ej Renewal ❑ Employment Lost Card SCA 1 & 20M.W11 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 wwm mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibly Name (Business/Orgmimtion/Individual):AB CARNES ROOFING INC Address:30 ARROWHEAD FARM RD City/State/Zip:BOXFORD, MA 01921 Phone#:978-887-1431 Are you an employer?Check the appropriate box: Type of project(required): I.E]I am a employer with employees(full and/or pan-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for mein any capacity.[No workers'comp.insurance required.] 8. ❑ Remodeling 3.❑I am a homeowner doing all work myself.[No workers'camp.insurance required.]t 9. El Demolition 4.❑I mn a homeowner and will be hiring contractors toconduct all work on my property. 1 will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. ,/ 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. Ir 13.�Roof re airs esesob-contractors have employees and have workers'comp.insurance? ✓ p 6 W e are a corporntion and its officers ha a exercised their,ight of exemption per MGL c. 14. Other 32,§I(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tConnactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer nder the dains and penalties ofperjury that the information provided above is true and correct. Signature: Date: Y Phone#:978-897-1431 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: FORM 153 The Commonwealth of Massachusetts 'jJDI9UseOnly Department of Industrial Accidents Office of Investigations - Dept. 153 1 Congress Street,Suite 100, Boston,Massachusetts 02114-2017 - - a hitp://www.mass.gov/dia Invest./SWO+11)4:^,gn-in.'"1 e*'t w-n9f.L, rl SlRk act,r�CNN'LS 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 CARNES ROOFING, INC. (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, I/we 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 checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or not to be empf fra the provisions of M.G.L. c. 152. Ig ed under the sins and penalties of perjury: BARRY CARNES, PRESIDENT 09/24/2013 k,,,h Print Name&Title Date(mm/dd/yyyy) �✓ xercise my right of exemption or I wish NOT to exercise my right of exemption o L.l w ANASTASIYA CARNES, DIRECTOR 09/24/2013 Cl) L Signature Print Name&Title Date(mm/dd/yyyy)rV rTt ❑✓ I wish to exercise my right of exemption or ❑ 1 wish NOT to exercise my right of exemption v7 f-n ce n7 Mt. 3 Signature Print Name&Title Date(mm/dd/yyy9 "t ❑ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption C Signature Print Name&Title Date(mm/dd/yyyy) I wish to exercise my right of exemption or ❑ 1 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—7/2010 MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM :► , The Commonwealth of Massachusetts Minimum Fee.$250.00 , William Francis Galvin i �I r t � ";; Secretary of the Commonwealth, Corporations Division j x One Ashburton Place, 17th floor I r4` Special Fiine Instructions y Boston,MA 02108-1512 !}Telephone: (617)727-9640 (iF Federal Employer Identification Number: 001110484 (must be 9 digits) ". 111 ARTICLE I 1 The exact name of the corporation is: AB CARNES ROOFING, INC. s (I ARTICLE II 11 h Unless the articles of organization otherwise provide, all corporations formed pursuant to G.L. C156D have the purpose ,I of engaging in any lawful business. Please specify if you want a more limited purpose: ell COMMERCIAL&RESIDENTIAL ROOFING AND ROOFING RELATED WORK. THIS SHALL INCLUDE ALL TYPES EXTERIOR& INTERIOR REMODELING t ARTICLE III - 1: State the total number of shares and par value, if any, of each class of stock that the corporation is authorized to !� i issue. All corporations must authorize stock. If only one class or series is authorized, it is not necessary to specify I any particular designation. til 1 �� --Par Value Per Share Total Authorized by Articles Total Issued and Outstandin i Class of Stock Enter 0 if no Par of Organization or Amendments 9 f ; Num o 'Shares Num of Shares Total Par Value - � 1 --- ! i CNP i $0.00000 1,000 } $0.00 1,000 G.L. C156D eliminates the concept of par value, however a corporation may specify par value in Article III. See G.L. ? C156D Section 6.21 and the comments thereto. 4 t i ARTICLE IV i .' If more than one class of stock is authorized, state a distinguishing designation for each class. Prior to the issuance of any shares of a class, if shares of another class are outstanding, the Business Entity must provide a description of the i it preferences, voting powers, qualifications, and special or relative rights or privileges of that class and of each other it class of which shares are outstanding and of each series then established within any class. i fil ARTICLE V I i.. The restrictions, if any, imposed by the Articles of Organization upon the transfer of shares of stock of any class are: ARTICLE VI � i, �i ! Other lawful provisions, and if there are no provisions,this article may be left blank. i4 i it i Note: The preceding six (6) articles are considered to be permanent and may be changed only by filing f appropriate articles of amendment. ARTICLE VII ` i The effective date of organization and time the articles were received for filing if the articles are not rejected within the i{ tt time prescribed by law. If a later effective date is desired, specify such date,which may not be later than the 90th day f I; after the articles are received for filing. Later Effective Date: Time: I ARTICLE VIII 1` The information contained in Article VIII is not a permanent part of the Articles of Organization. a,b.The street address of the initial registered office of the corporation in the commonwealth and the name l tl of the initial registered agent at the registered office: j Name: BARRY CARNES !, No. and Street: 30 ARROWHEAD FARM RD City or Town: BOXFORD State: MA Zip: 01921 Country: USA J l c.The names and street addresses of the individuals who will serve as the initial directors, president, treasurer and secretary of the corporation (an address need not be specified if the business address of the I! officer or director is the same as the principal office location): Title Individual Name ( Address(no PO Box) t i' { t II t First,Middle,Last,Suffix i Address,City or Town,State,Zip Code 11�1 PRESIDENT BARRY S CARNES 30 ARROWHEAD FARM RD i BOXFORD,MA 01921 USA c TREASURERS BARRY S CARNES 1 30 ARROWHEAD FARM RD (( BOXFORD,MA 01921 USA i r SECRETARY 1 ANASTASIYA V CARNES .� 30 ARROWHEAD FARM RD — �{ iE y BOXFORD,MA at 921 USA l� DIRECTOR ...1-�d BARRY S CARNES 1 30 ARROWHEAD FARM RD 3 r 11 I BOXFORD MA 01921 USA ry } 1 ti I -{ - DIRECTOR ANASTASIYA V CARNES [ 30 ARROWHEAD FARM RD ( BOXFORD,MA 01921 USA }Illi d. The fiscal year end (i.e.,tax year) of the corporation: i October e.A brief description of the type of business in which the corporation intends to engage: If j COMMERCIAL&RESIDENTIAL ROOFING 1 f. The street address (post office boxes are not acceptable) of the principal office of the corporation: t No. and Street: 30 ARROWHEAD FARM RD ;f City or Town: BOXFORD State: MA Zip: 01921 Country: USA g. Street address where the records of the corporation required to be kept in the Commonwealth are y located (post office boxes are not acceptable): �1 I` No. and Street: 30 ARROWHEAD FARM RD City or Town: BOXFORD State: MA Zip: 01921 Country: USA it which is X its principal office _ an office of its transfer agent an office of its secretary/assistant secretary _ its registered office , Signed this 26 Day of June,2013 at 6:23:02 PM by the incorporator(s). (If an existing corporation is i acting as incorporator, type in the exact name of the business entity, the state or other jurisdiction where it was incorporated, the name of the person signing on behalf ofsaid business entity and the title he/she holds or other authority by which such action is taken) i BARRY S CARNES 1� ! r,, ©2001 -2013 Commonwealth of Massachusetts y All Rights Reserved MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 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: June 26, 2013 06:21 PM WILLIAM FRANCIS GALVIN Secretary of the Commonwealth q o CERTIFICATE OF LIABILITY INSURANCE ;aze.2g,4 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: H 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: ACE INS SERVICES INC PHONE FAx 675 WARREN AVE (AM, o E.11Atc.r o EMAIL BROCKTON,MA 02301 INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:AMERICAN ZURICH INSURANCE COMPANY INSURED INSURERB: APC CONSTRUCTION INC INSURERC: 51 FORD STREET UNIT 1 BROCKTON,MA 02301 INsuRER.D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER* REVISION NUMBER6 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 TYPE OF INSURANCE AD SUB POLX:Y NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVO M M GENERAL LIABILITY - EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S PREMISES ISO occurrence) CLAIMS-MADE n OCCUR MED EXP(Any ono parson) S PERSONAL&ADV INJURY $ C GENERAL AGGREGATE S GENLAGGREGATE LIMITAPPLIES PER: - \ PRODUCTS.COMPIOP AGO $ POLICY JEC Lac \! V� (. $ AO MOBILE LIABILITY O MBIi E SINGLE LIMIT $ ANY AUTO / BODILY INJURY(Par person) $ AUTO OS S UTOS tlont) CHEDULED A BODILY INJURY(For acd $ _ HIREDAUTOS AAONOSWNEO ` RTY AMAOE S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE - AGGREGATE S DED RETENTIONS S AM EMRa COMPENSATION - X CRY LIMIT - GER ANDEMPLOOMPENABILITY M TWO OSTATU ER ANY PROPRIETORIPARTNEWEXECUTIV� E.L.EACH ACCIDENT $1.000,000 OFFICERIMEMBER EXCLUDED? LN NtA 6ZZUB 10.2272014 10-22.2015 (Mandatory In NHl 2E52818A E,L.DISEASE-EA EMPLOYEE $1,000,000 II yes,describe under DESCRIPTION OF OPERATIONS bob- E.L.DISEASE-POLICY LIMIT $1,000,000 .DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1Aaech ACORD tet,Addldonal Remarks Schedule,II more space Is required) CERTII CANCELLATION AS CARNES ROOFING INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 30 ARROWHEAD FARM ROAD CANCELLED BEFORE THE EXPIRATION DATE THEREOF, BOXFORD,MA01921 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2010105) The ACORD name and logo are registe©d9markss of ACORDCORPORATION..AII rights reserved. 1 MA SOC Filing Number:201499735200 Date: 10/21/2014 1:24:00 PM The Commonwealth of Massachusetts Minimum Fee:$250.00 $` of jLs r;, William Francis Galvin j Secretary of the Commonwealth,Corporations Division 4 t t jT. One Ashburton Place, 17th floor Boston,MA 02108-1512 t f!i:' roW�. Telephone: (617) 727-9640 t, �I Federal Employer Identification Number: 001149988 (must be 9 digits) � I ARTICLE I3" The exact name of the corporation is: i I j A P C CONSTRUCTION, INC j ARTICLE 11 ',. Unless the articles of organization otherwise provide, all corporations formed pursuant to G.L. C156D have the purpose ii of engaging in any lawful business. Please specify if you want a more limited purpose: 1 j CONSTRUCTION RE-MODELLING AND OTHER OTHER SERVICES PERTAINING TO CONSTRU CTION WORK tl � ARTICLE Ill 1. ':. State the total number of shares and par value, if any, of each class of stock that the corporation is authorized to p issue. All corporations mustauthorize stock. If only one class or series is authorized, it is not necessary to specify any particular designation. +t 9 fff Pam r Value Per Share Total Authorized by Articles Total Issued Class of Stock I Enter 0 if no Par of Organization or Amendments and Outstanding j i Num of Shares Total Par Value Num of Shares 1 CNP ~_ —$0.00000 ��20,000 $6.00 —000 'J G.L. C156D eliminates the concept of par value, however a corporation may specify par value in Article III. See G.L. C156D Section 6.21 and the comments thereto. t i d ARTICLE IV d If more than one class of stock is authorized, state a distinguishing designation for each class. Prior to the issuance of i any shares of a class, if shares of another class are outstanding,the Business Entity must provide a description of the s, preferences, voting powers, qualifications, and special or relative rights or privileges of that class and of each other class of which shares are outstanding and of each series then established within any class. ,` 1 ARTICLE V The restrictions, if any, imposed by the Articles of Organization upon the transfer of shares of stock of any class are: 1 �i ARTICLE VI '1 i t }! Other lawful provisions,and if there are no provisions,this article may be left blank. Note: The preceding six (6)articles are considered to be permanent and may be changed only by filing j appropriate articles of amendment. y ' I i ARTICLE VII The effective date of organization and time the articles were received for filing if the articles are not rejected within the - �i time prescribed by law. If a later effective date is desired, specify such date,which may not be later than the 90th day after the articles are received for filing. Later Effective Date: Time: i+ �'r I I ARTICLE VIII �( The information contained in Article VIII is not a permanent part of the Articles of Organization. ; 1; a,b. The street address of the initial registered office of the corporation in the commonwealth and the name ; of the initial registered agent at the registered office: Name: ANGELO PINGUIL No. and Street: 51 FOR D STREET UNIT 1 I i City or Town: BROCKTOPN State: MA zip: 02301 Country: USA ! l�. 3 I c.The names and street addresses of the individuals who will serve as the initial directors, president, treasurer and secretary of the corporation (an address need not be specified if the business address of the officer or director is the same as the principal office location): j Title _..._.� Individual Name Address (no PO sox) First,Middle,Last,Suffix Address,City or Town,State,Zip Code I. 1 PRESIDENT ANGELO PINGUIL 51 FORD STREET 1 BROCKTON,MA 02301 USA y TREASURER ( ANGELO PINGUIL 51 FORD STREET BROCKTON,MA 02301 USA tt SECRETARY ANGELO PINGUIL 51 FORD STREET Ij r' BROCKTON.MA 02301 USA I DIRECTOR ANGELO PINGUIL 51 FORD STREET !{ BROCKTON,MA 02301 USA :} I� d.The fiscal year end(i.e., tax year) of the corporation: l December e.A brief description of the type of business in which the corporation intends to engage: I CONSTRUCTION AND RE-MODELLING f.The street address (post office boxes are not acceptable) of the principal office of the corporation: ipp 'i No. and Street: 51 FORD STREET i City or Town: BROCKTON State: MA Zip: 02301 Country: USA j g. Street address where the records of the corporation required to be kept in the Commonwealth are 4 located t boxes are not acceptable): ;I (post office 11 }i No. and Street: 51 FORD STREET City or Town: BROCKTON State: MA Zip: 02301 Country: USA + which is X its principal office _ an office of its transfer agent '{ an office of its secretary/assistant secretary _ its registered office 1 Signed this 21 Day of October,2014 at 1:26:45 PM by the incorporator(s). (If an existing corporation is acting as incorporator, type in the exact name of the business entity, the state or other jurisdiction where it was incorporated, the name of the person signing on behalf of said business entity and the title he/she holds or other authority by which such action is taken.) i ANGELO PINGUIL j N I ®2001 -2014 Commonwealth of Massachusetts All Rights Reseed i • MA SOC Filing Number: 201499735200 Date: 10/21/2014 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: October 21, 2014 01:24 PM 1 WILLIAM FRANCIS GALVIN Secretary of the Commonwealth