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1 MOUNT VERNON ST - BUILDING INSPECTION (2) o3 � � The Commonwealth of Massachusetts Board of Building Re Mations and Stand RECEIVED r g PECTIONAL SERVICES-&"l I Massachusetts State Building Code, 780 Building Permit Application To Construct, Repair, Renoval t�Y gWrORnQl$h A 9 51kevived One-or Two-F'anrih-Dwelling Mach 201/ This Section For Official Use Only Building Permit Number: Dae Ap 'ed: Building Official(Print Name) Signa a Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers //kms z I.I a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: I' Zoning District Proposed Use Lot Arca(sq t1) frontage(ti) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.I.c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone^. Public❑ Private❑ — Check if vcs❑ k9 unicipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) Cin°.State.ZIP No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building Owner-Occupied Repairs(s)X-1 Alteration(s) ❑ I Addition ❑ Demolition D Accessory.Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': ,fig_��✓ ago t SECTION 4: ESTIMATED CONSTRUCTION COSTS i Item Estimated Costs: (Labor and Materials) Official Use Only I. Building $ V. I, Building Permit Fee:S Indicate how fee is determined: ?. Electrical $ ❑ Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing S 2. Other Fees: S 4. Mechanical (HVAC) S List: 5. Mechanical (Fire $ Su ression) Total All Fees:$ Check No._Check .Amount: Cash Amount: 6.Total Project Cost: S -7000, ❑ paid in Full ❑ Outstanding Balance Due: �A pl t, T ) D(ZU�( -VL` 009 )NNgv' MfAtt_1�0 qII i 'A t SECTION 5: CONSTRUCTION SERVICES 5,1 Construction Supervisor License(CSL) Z > e f ) A r. ! NPI Licensc Number Fxpiration Date Name of CSL I I der / List CSI-Type(see below) No.aitd Street Type Description , tJ Unrestricted(Buildings u to 35.000 cu. R.) -1 0^' V'� ��r--�� 012z"! R Restricted 182 Family Dwellin_ Gly/Town.State.ZIP Al A4asonn RC Roofing Covering WS Window and Siding SF Solid Fuel Burning.Appliances ?' UPN I Insulation "Mule hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ZNu A /3 2�cI �utri=itif'. �C 9 /o io-i5 HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name and Street 4 Email address f,�t>� pJj2,i 7IV Cit /Town, Slate,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 Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I.as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. print.Owner's ame(Elecironi ignature) Date SECTION 7b: OWNEW OR AUTHORIZED AGENT DECLARATION I By ente' y name be w. I hereby attest under the pains and penalties of perjury that all of the information on fined in this ap cation is true and accurate to the best of my knowledge and understanding. I int Owner's or Authorized Agent's Name(E ectronic Signature) Date NOTES: I. 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.ntass.gov/oca Information on the Construction Supervisor License can be found at wwo.nrus.gowctps 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" 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: DAVID&SUSAN CAMPBELL Date March 31, 2014 1 MT VERNON ST Project Name SAME SALEM, MA 01970 Address 978-594-1800 We propose to furnish material and labor-in accordance with the specifications below: Fifty Seven Hundred And Fifty Dollars($5,750.00) 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 K 142A of the General.Laws,must be registered with the.Commonwealth of Massachusetts. Inquiries about registration and status should be made tcihe Mass.gov/licenses website. ROOF PROPOSAL ® STRIP ROOF OF UP TO TWO LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE UPGRADED RHINOROOF HIGH PERFORMANCE WATERPROOF UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLSAND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. s ® ICE DAM PROTECTION:INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER,BARRIER OVER ALL HEATED AREAS SIX FEET WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEYS)AND SKYLIGHT CURBS UNDER THE FLASHINGS WITH SAME. ® COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. n ® INSTALL GAF COBRA RIDGE VENT AND/OR MAS NEEDED ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. F ® REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$25,00PLFT.WE MAY NEED TO REMOVE w THE SIDING 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 TAP.AND LEAD FROM ONE CHIMNEY(S).CUTW REGLET WITH CARBIDE SAW AND SECURE NEW s. LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY SEAL REGLET S, ADD$500.00 TO ABOVE PRICE, ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECTU L LIFETIME W,9RRANTY 240LB SHINGLES. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH 1 X8 SPRUCE BOARBSAIANA'DOITIONAL COST OF$4.50PLFT. ❑ COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF ® STORM NAILING:(HURRICANE NAILING)SECURE SHINGLES WITH SIX NAILS AS THIS IS CODE IN ESSEX COUNTY. ❑ SKYLIGHTS:REPLACE EXISTING SKYLIGHTS WITH NEW VELUX UNITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.THERE IS NO LABOR CHARGE 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. N REPLACE ANY ROTTED TRIM BOARDS AS NEEDED WITH 30 YEAR PRIMED PINE,ADD$15.00 PER FOOT TO ABOVE PRICE. ® INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTE r -AN-ALL4&0jECT RELATED DEBRIS FROM OUTSIDE WORK AR THE PROPERTY OWNER AUTHORIZES AB CARNES ROOFING TO OBTAIN ,) ALL PERMITS.WE 9NNOT ACCEPT.RESPONSIBILITY FOR DEBRIS;FAtI NG INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. /y GREAT CARE—WALE BE USED TO PROTECT THE STRUCTURE AND F041AGE-rOWE-VER-SOME_MAREING AND OR MINOR DAMAGE COULD OCCUR. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL.INCLUDES ALL SHINGLED ROOF SECTIONS OF THE HOUSE. CHIMNEY FLASHING:THIS SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS MAY OCCUR. GUTTERS:SEAL ALL MITERS,WATER OUTLETS AND JOINTS WITH GUTTER SEALER.PLEASE ADD$200.00 TO THE ABOVE PROPOSAL.YE "-S DOWNSPOUTS:RECONFIGURE THE REAR CORNER DGlWNSPOUT WITH ELBOWS AND PIPE SO THE WATER DRAINS TO THE REAR OF THE YARD. .p PLEASE ADD$150.00 TO THE ABOVE PROPOSAL. YES WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITH PGRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP 3 RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YE EMAIL ADDRESS Warranty:All work warranted against installation defects f&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;seethe manufacturer's 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 ImprovementLaw142a:All parties agree that any and all disputes relating to this proposal shall be settled by arbitration.This forum is user friendly and does not require lawyers.Please see reverse side. Signing this Proposal means;you have accepted all the terms as stated on the front and back of this agreement. Please see reverse side. Dateof Acceptance A'-T -) SignaturLz_ --- --_ *Signature Signat/e PLEASE SEE REVERSE SIDE 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-000230 BARRY S CARNES ' 30 ARROWHEAL FARM-RD 6 _ Boxford MA 019111 �..�. Expiration Commissioner 03/07/2016 P W49 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration =— Registration: 176928 Type: Corporation Expiration: 10/10/2015 Tr# 245633 AB CARNES ROOFING, INC. BARRY CARNES 30 ARROWHEAD FARM RD { -- BOXFORD, MA 01921 -- ---- Update.Address and return card.Mark reason for change. Address _j Renewal j7 Employment rl Lost Card SCP 1 G 20M-0911 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: 4-9-2014 l L SIGNATURE OF APPLICANT: The Commonwealth of Massachusetts Print Form Department of Industrial Accidents 1. M� ; Office of Investigations I Congress Street, Suite 100 - Boston, MA 02114-2017 ya —iy t S'' wwrv.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/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 approp . i-e')os:� Type of project(required): I.Q t am a employer with !!f ❑� I a a general contractor and I employees(Pull and/or part-time). + \ ave hired the sub-contractors 6. ❑ New construction 2.E1 I am a sole proprietor or partner- listed on the attached sheet. 7. 2 Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity. t loyees and have workers' q Q Building addition [No workers' comp. insurance co p. insurance? required.] /5. D,W are a corporation and its IO.Q Electrical repairs or additions 3.❑ 1 am a homeowner doing all work (, _. officers have exercised their 11.Q Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 17,0 Roof repairs insurance required.] c. 152. §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] "Any applicant that checks box I must also fill out the section below sharing their workers compensation poliey intbmtation. +Homeowners who submit this affidavit indicatine they are doing all work and then hire outside contractors must suhmit a new affidavit indicating such. -Contractors 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,thev must provide their workers'comp.policy number. 1 om an employer that is providing workers'compensation insurance for my employees. Below if ilre policj,and job sire information. Insurance Insurance Company Name: Policy i3 or Self-ins. Lie.#: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby , r y under the pains nd penalties ofperjug that the information provided aboveistrue and correct. Si nature: �~�' Date % 4` Phone#: 9 .7 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#: l FORM 153 The Commonwealth of Massachusetts DIA Use only I Department of Industrial Accidents Office of Investigations - Dept. 153 i- I Congress Street,Suite 100, Boston. Massachusetts 02114-2017 http://www.mass.gov/dia Incest./SWO ID.#: , AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE- - OFFICERS OR DIRECTORS Chapter 169 of the Acts o/'2002 amended Al G.L. c. 152. 511(=1) by adding the.jollowing 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 empt fro n the provisions of M.G.L. c. 152. g ed under the ains and penalties of perjury: BARRY CARNES, PRESIDENT 09/24/2013 S' ur Print Name B Title Date(mnVdd/ryyy) �✓ 1 wish to exercise my right of exemption or E] I wish NOT to exercise my right of exemption o C� ANASTASIYA CARNES, DIRECTOR 09/24/2013 Signature Print Name Nc Title Date(mm/dd/vyyy)r\.r �✓ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption r� ' ,!rr Signature Print Marna&Title Date bnm!ddiyyy`',' I wish to exercise my right of exemption or I wish NOT to exercise m}right of exempt ion CJ 47 Signature Print Name R Title Date(mm/dd!%\%,y) I wish to exercise my right of exemption or Q 1 wish NOT to exercise my right of exemption Note:AU.ELIGIBLE CORPORATE OFFICERSMUST SIGN'. THERE.CAN RF.NO MORF'I'IIAN 4 SIGNATURES. Instructions nit 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 t' Secretary of the Commonwealth. Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Sneeial Filin Instruclinns Telephone: (617) 727-9640 Federal Employer Identification Number: 001110484 (must beg digits) ARTICLE I The exact name of the corporation is: AB CARNES ROOFING, INC. ARTICLE II Unless the articles of organization otherwise provide, all corporations formed pursuant to G.L. C156D have the purpose of engagingin any lawful business. Please specify if you want a more limited purpose: COMMERCIAL& RESIDENTIAL ROOFING AND ROOFING RELATED WORK. THIS SHALL INCLUDE ALL TYPES EXTERIOR& INTERIOR REMODELING ARTICLE 111 State the total number of shares and par value, if any, of each class of stock that the corporation is authorized to issue.All corporations must authorize stock. If only one class or series is authorized, it is not necessary to specify any particular designation. Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding Nuin q/Shares Total Par Value Nun o(Shares CNP $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. ARTICLE IV 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 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. ARTICLE V The restrictions, if any, imposed by the Articles of Organization upon the transfer of shares of stock of any class are: ARTICLE VI . r 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 appropriate articles of amendment. ARTICLE VII The effective date of organization and time the articles were received for fling if the articles are not rejected within the 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: ARTICLE VIII The information contained in Article VIII is not a permanent part of the Articles of Organization. a,b. The street address of theinitial registered office of the corporation in the commonwealth and the name of the initial registered agent at the registered office: Name: BARRY CARNES No. and Street: 30 ARROWHEAD FARM RD City or Town: BOXFORD Stale:MA Zip: 01921 Country: USA 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): Title Individual Name Address Ino PO Box) First,Middle,Last.Suffix Address.City or Town.State,Zip Code PRESIDENT '.BARRY CARNES 30 ARROWHEAD FARM RD BOXFORD.MA 01921 USA TREASURER BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD.MA 01921 USA SECRETARY ANASTASIYAV CARNES 30 ARROWHEAD FARM RD BOXFORD.MA 01921 USA DIRECTOR BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 USA DIRECTOR ANASTASWA:V CARNES 30 ARROWHEAD FARM RD BOXFORD.MA 01921 USA d. The fiscal year end (i.e., tax year) of the corporation: October e. A brief description of the type of business in which the corporation intends to engage: COMMERCIAL & RESIDENTIAL ROOFING f. The street address (post office boxes are not acceptable) of the principal office of the corporation: No. and Street: 30 ARROWHEAD FARM RD 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 located (post office boxes are not acceptable): No. and Street: 30 ARROWHEAD FARM RD 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 Signed this 26 Day of June, 2013 at 6:23:02 PM be the ineorporator(s). (/fair existing corporation is acting as incorporator, type in the ercrct name of tyre business entih, the state or other jurisdiction where it warincotporated. the name of the peeson signing on'hehalf pfsaid business entity and the title helshe holds ar other authority bi,which such action is taken.) BARRY S CARNES ©2001 2013 Commonwealth of Massachusetts All Rights Reserved W MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM THE COMMONWEALTH OF MASSACHUSETTS 1 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 tiling fee having been paid, said articles are deemed to have been filed with me on: June 26, 2013 06:21 PM WILLIAM FRANCIS GALVIN Secretarn ofthe Commonwealth