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8 PLYMOUTH ST - BUILDING INSPECTION q b I 0,V c ' \\}� The Commonwealth of Massachusetts RECEIY FOR 1r\ Board of Buildihte Re ulations and Standards IN$P t g �CTfON �N IPALITY ! � Massachusetts State Building Code, 780 CMR L1 ' ) s `/ \111vJ Building Permit Application T Construct. Repair, Renovate Orr f t(atp a 0 Revised Adar 2011 One-or Two-Family Dwelling P -t 28 �p This Section For Official Use Only Building Permit Number. Date App izd: __ Building Official(Print Name) Sienature Date SECT ON 1: SITE INFORMATION 1-1 Property jddress: / 1.2 Assessors Map& Parcel Numbers — — Y j a- w L L I a Is this an accepted street^: yes_ no Map Number Parcel Number 1.3-Zoning Information:-- 1.4 Property Dimensions: Zoning District Proposed Use I Lot Area(sq h) Frontage(fl) 1.5 Building Setbacks(ft) ---- Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (NLG.L c.40. §54) 1.7 Food one Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zonc7 p Check if yes❑ Municipal ❑ On site disposal system ❑ SECTIO 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: Name l Pt nt) Cit},State. ,III' No.and 5 ree Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Buildinn (Owner-Occupied Repairs(s) j Alteration(s) ❑ I Addition ❑ Demolition ❑ 1 Accessory Bld,. ❑ Number of Units Other ❑ Spccity:__ Brief Description of Proposed Work'': vait SECTION 4: ESTIMATED C 'STRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) -- 1. Buildin, 1 1. Building Permit Fee: S Indicate how fee is determined: 2. Electrical S ❑ Standard City/Town Application Fee ❑Total Project Cost (Item 6) x multiplier x 3. Plumbing S 2. Other Fees: S_,_ 4. Mechanical (HVAC) S S. Mechanical (Fire S -- Suppression) Total All Fees: S_ _ Check No. _Check Amount: _ Cash Amount: 6.Total Project Cost: $ f J ��' 0 Paid in Full ❑ Outstanding Balance Due: -- SECTION : CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ^ 3 A 6= ,P,,/ e-, 4& License Number Expiration Date Name of CSL liolt r � Lis[CSL,Type(sec below) LLB No, and Street T+' e Description � U Unrestricted(Buildings up to 35.000 Co. 11.) � �,� �_�d Restricted I&2 Family Dwellina Cuty l wn.SlateSlate.Zl' P /— 1\1 vlasann RC Roofinu Covering WS Wmdow and Siding _ SP Solid Fact Burning Appliances Insulation Telephone Email add ess D Demolition 5.2 Registered Home improvement Contractor(HIC) A_A__-I�-A f I-llC Reg stration Number I>xpiration Date 111C Company Name-or HIC Registrant Nam �_� _// �'©/l�1v'�✓' �fY'�A✓ti z�/1 l - r 7 fi l _ No. d Street ��� b:maiI address r� Cit_v! own.State,ZIP Telephone SECTION 6: WORKERS' COMPEN ATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit mu it 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 .......... Nn........... ❑ 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 authorizeh �3 to act on my behalf. in all matter. relative to work authorized by this building permit application. Print Owner's Name(t7ecvouic Signature) Date SECTION 7b: OWNER OR AUTHORIZED AGENT DECLARATION I By entering my name below. I hereby attest un ier the pains and penalties of perjury that all of the information conta ns applicatio is true and accura w to the best of my knowledt e and understanding. Pri Owners or i otherized Agent's Name(Electr me Signature) Date NOTES: I: An Owner who obtains a building permit t 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..ovioca Information on the Co struction Supervisor License can be found at �c++p- 2. When substantial work is planned, provid 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 I "Total Project Square Footage" may be soktituted for-Total Project Cost" 1 Massachusetts -Department of Public Safety i Board of Building Regulations and Standards Constructi n Supenisor License: CS-000230 C/ BARRY S CARNIF 30 ARROWHEAD FARM:RDIF r Boxford MA 0192 .I�. � f Expiration Commis ioner 03/07/2016 Office of Consumer Affairs and Business Regulation 10 Pak Plaza - Suite 5170 Boston Massachusetts 021.16 Home Improv ment Contractor Registration >..: Registration: 176928 Type: Corporation Expiration: 10/10/2015 Trp 245633 AB CARNES ROOFING, INC. BARRY CARNES ' Ykl — ---- -- — — 30 ARROWHEAD FARM RD BOXFORD, MA 01921 — ;_ s Update Address and return card.Mark reason for change. j Address �I Renewal _ Employment L I Lost Card SCA I u 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: 9-29-2014 SIGNATURE OF APPLICANT: ,4coRv® CERTIFICATE OF LIABILITY INSURANCE D / ) `/ 11/121/12/20132013 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 endomement(s). PRODUCER CONTACT Commercial Lines NAME: Harris-Murtagh Insurance Agency,Inc. PHONE . (978)532-2844 q/C No: 30 Central Street EMDDAIL ARE S: INSURERS AFFORDING COVERAGE NAIC 0 Pe MA 01960 INSURER A.-Wes tern World Insurance CO ,IfINSURED INSURER B: AB Carnes Roofing, In INSURER C: 30 Arrowhead Farm Rd INSURER D: INSURER E: BOXEArd MA 01921 INSURER F: COVERAGES CERTIFICATE NUMBER:CL13111217634 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 DDLSUum TYPE OF INSURANCE POLICYNUMBER MMIDDY/YYFYY MM/DDT LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurtence $ 50,000 A CLAIMS-MADE OX OCCUR PP137217 0/11/201310/11/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000. GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY PRO LOG $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident _ ANY AUTO BODILY INJURY person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WCSLIMITTATU ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EAPO EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE- LICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/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 C Of Salem ACCORDANCE WITH THE POLICY PROVISIONS. Washington Stem, MA 01970 AUTHORIZED REPRESENTATIVE J S Scholnick/P,TR "'- ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025,?mwSlnl Th.ACnRn nomn and Innn am ennie*orod mark.of annRn Proposal AB Carnes Roofing, Inc. 30 Arrowhead farm Rd Page i o°1 Boxford, Ma. 01921 978.887.1431 MA.CS-000230 and HIC Reg. 176928 Proposal Submitted To: PAUL GILLISSEN Date September 11), 2014 4 PLYMOUTH ST Project Name SAME SALEM, MA 01970 Address 978-621-9087 We propose to furnish material and labor-in accordance with the specifications below: Seventy Two Hundred Dollars($7,265.00) 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 one status should be made to the fviass gov/license=_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 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 LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THE CHIMNEY(S)AND SKYLIGHT CURBS UNDER THE FLASHINGS WITH SAME. ® COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA RIDGE VENT AND/OR❑ ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ❑ COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. ❑ 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 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 ONE CHIMNEYS).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY SEAL REGLET,dt7f�VT. PAL ADD$500.00 TO ABOVE PRICE.�I ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECTUML LIFETIME WARNTY 2401:SHINGLES. ADDI? ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH 1X8 SPRUCE BOARDS-A F,4N IONAL COST OF$4.50PLFT. ❑ COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF ® NAILING: SECURE SHINGLES WITH 1 Y."GALVANIZED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS. ❑ 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. ❑ REPLACE ANY ROTTED TRIM BOARDS AS NEEDED WITH 30 YEAR PRIMED PINE,ADD PER FOOT TO ABOVE PRICE. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. THE PROPERTY OWNER AUTHORIZES AB 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 THE UPPER MAIN ROOF ONLY.THE LOWER ROOF SECTIONS ARE EXCLUDED. ROOF DAMAGE:THE IS EVIDENCE THAT SHINGLES HAVE BLOWN OFF THE ROOF DUE TO HIGH WINOS.THE PROPOSED REPAIR IS IN THE ABOVE PROPOSAL. WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITHVAWUPGRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES.( EMAIL ADDRESS t C c�ItsSeY'k � _C) ti Te"A,gVe- ��;t�N�� Eo �trrie— 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.This forum is user friendly and does not require lawyers, Please see reverse side. Signing this Proposal means,you have acce led all the terms as staled on the front and back of this agreement. Please see reverse side. *Date of Acceptance 91 Signature— It Signature o ,® Signature -° PLEASE SEE REVERSE SIDE I ` e The Commonwealth of'Massaehusetts Print Form _ Depa yntent of Industrial Accidents y , F Office of Investigations l�� Gg. I Congress Street, Suite 100 Boston, MA 0211 4-2 0 1 7 www.mnss.gav/din Workers' Compensation Insuran a Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information I Please Print Legibly Nflnle (13usiness/Oreanization/Individuaq:AB CAI NES ROOFING,INC. Address:30 ARROWHEAD FARM RD City/State/Zip:BOXFORD, MA 01921 Phone #:978-887-1431 Are you an employer'. Check the appropri oa Type of project(required): I.❑ 1 am a employer with I i a general contractor and I employees(full and/or part-time). fiave hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑✓ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' q ❑ Building addition [No workers' comp. insurance omp. insurance required.] d Ave are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MG 12.❑� Roof repairs insurance required.] c. 152, §1(4), and we have no 3.❑ Other employees. (No workers' — Other— comp. insurance required.] *Any applicant that checks hos#1 most also till out Ilse seclinn below showing(heir oorkcr., compensation policy information. Homeowners who submit this anidavil indicating they are it ing all work and then hire outside contractors must submit a new affidavit indicating such. mched 'Contractors that check this box most al an additional 511ctt showing the name of the sub-mmraclors and state whether or not those entities hmve employees. If the sub-,rommctors have employees,they most�rovide their workers'estop.policy number. I am an employer that is providing workers'compensation insurance for my emplovees. Below is lire policy and job.Mite information. Insurance Company Name: Policy #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 tine 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 tine of up to$250.00 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. l do hereby l y under the ains ntl enalties o er'ury that the information provided above is trite and correct Si mature: Date Phone#: Official use only. Do not write in this area,it be completed by cio,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 i. Plumbing Inspector 6.Other Contact Person: I Phone#: FORM 153 The Commonwealth of Massachusetts DI A Use Only ' Department of Industrial Accidents Office of Investigations - Dept. 153 I Congress Stree ,Suite 100, Boston,Massachusetts 02114-21117 http://www.mass.gov/din Invest./SWO ID 9: i V AFFIDAVIT OF EX MPTION FOR CERTAIN CORPORATE - OFFICERS OR DIRECTORS Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, §1(4) by adding the Jollmring 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. Sid commissioner shall promulgate regulations to cant' 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 Jhe 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 underst nd that, should the above-named corporation hire or have in its employ any enployee(s) in addition t the undersigned corporate officer(s) or director(s). said corporation is required to obtain worker ' compensation coverage for the employee(s) as prescribed by M.G.L. c. 152, §25A. /We the undersigned have read and and rstand the statements and obligations as delineated above and 1/we have checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or not to be exempt fra 1 the provisions of A.G.L. c. 152. g" ed under the ains and penalties ff perjury: �ARRY CARNES, PRESIDENT 09/24/2013 Print Name&Title Dam pnmiddiyyyy) Q I ,wish to exercise my right of exemption or I wish NOT to exercise mN'right of exemption r� y xc?ll i kNASTASIYA CARNES, DIRECTOR 09/24/2013 f+' Signature Tint Name&Tide Date pnm/dd/yyyy)l I wish to exercise my right of exemption or I Nish NOT to exercise my right ofexcmption „fir a Signature Ir'nnt Name&Title Dam lmm/dd/_vt'yi� I wish it,exercise my right of exanplion or I wish NOT to exercise my right of exemption Signature 'nnt Name&Title Date(mm/dd/wyyy) FJ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Note:ALL ELIGIBLE,CORPORA IT OFFICERS NITS SIGN. "IIIERE CAN HE NO MORE THAN 4 SIGNA"I URES. Instruction on back. form I>3-7/2010 MA SOC Filing Number: 201�40178570 Date: 6/26/2013 6:21:00 PM ,-=•► The Comnjlonwealth of Massachusetts Minimum Fee:$250.00 William Francis Galvin t Secretary of thl Commonwealth. Corporations Division Onti Ashburton Place, 17th floor 6ston.MA 02108-1512 Sneeinl Filin¢J.,m,ainns Ielephone: (617) 727-9640 Federal Employer Identification Number: 001 110484 (must be 9 digits) ARTICLE I The xact name of the corporation is: AB CARNES ROOFING. INC. ARTICLE II Unless the articles of organization otherwise r rovide, all corporations formed pursuant to G.L. C156D have the purpose of engaging in any lawful bus ness. Please specify if you want a more limited purpose: COMMERCIAL & RESIDENTIAL ROOFING AND ROOFING RELATED WORK. THIS SHALL INCLUDE ALL TYPES EXTERIOR & F TERIOR REMODELING i ARTICLE III State the total number of shares and par valuFifny, of each class of stock that the corporation is authorized to issue. All corporations must authorize stock. f only one class or series is authorized, it is not necessary to specify any particular designation. Par Value Per SI are Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding i Nwn of*Shares Taal Par Value Nuni ql Shates CNP 50.00000 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 S T lion 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 cla�s 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 Article)of Organization upon the transfer of shares of stock of any class are: ARTICLE A Other lawful provisions, and if there are no provisions,this article may be left blank, Note: The preceding six (6) articles are cdnsidered 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 90117 day after the articles are received for filing. Later Effective Date: Time: ARTICLE VIII The information contained in Arti le 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 of the initial registered agent at the regist I ered office: Name: BARRY CARNES No. and Street: 30 ARROWHEAD FARM RD City or Town: BOXFORD I State: 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(no PO Box) Firs.Middle,Last,Suffix Address.City or Town.State,Zip Code PRESIDENT BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD.MA 01921 USA TREASURER BURRY S CARNES 30 ARROWHEAD FARM RD BOXFORD,MA 01921 USA SECRETARY ANA TASIYA V CARNES 30 ARROWHEAD FARM RD I BOXFORD,MA01921 USA DIRECTOR BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD,MA 01921 USA DIRECTOR ANASTASIYA 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 busin i ss in which the corporation intends to engage: COMMERCIAL & RESIDENTIAL ROOFING I 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: 0192I 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 acceptadle): - No. and Street: 30 ARRON HEAD FARM RD City or Town: BOXFORD State: MA zip: 01921 Country: USA which is II X its principal office I _ an office of its transfer agent an office of its secretary/assistant secre ary _ its registered office Signed this 26 Day of.lune, 2013 at 6:2 :02 PM by the incorporator(s). (J/an e.cisting corporation is acting as incorporator. (vpe in the exact wine of the business entity, the state or other jurisdiction wher e it was incotporated, the name of the pers n signing on behalf o/said business entity and the title he/she holds or other authority by which such a(tion is taken.) BARRY S CARNES c@ 2001 -2013 Commonwealth of Massachusetts All Rights Reserved MA SOC Filing Number: 2013 0178570 Date: 6/26/2013 6:21:00 PM THE COMMOTN WEALTH 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 articl s; and the filing fee having been paid, said articles are deemed to have been filed with me on: June 26, 2013 06:21 PM WIL-IAM FRAANCIS GALVIN Secretary of the Commonwealth I I i MA SOC Filing Number: 201316881130 Date: 4/23/2013 10:36:00 AM t_+�► ,�. . The Commonwealth of Massachusetts Minimum Fee:S250.00 William Francis Galvin Secretary of the Commonwealth. Corporations Division On Ashburton Place. 17th floor tinnciW Fitton Inslruclians i o T�lephone: (617) 727-9640 " I SWIM Federal Employer Identification Number: (001098338 (must be 9 digits) i ARTICLE I The xact name of the corporation is: 1 AME UCAN CONSTRUCTION INC ARTICLE II Unless the articles of organization otherwise provide,all corporations formed pursuant to G.L. C156D have the purpose of engaging in any lawful busj:ess. Please specify if you want a more limited purpose: ARTICLE III State the total number of shares and par valuT, 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. I Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no P6r of Organization or Amendments and Outstanding Nwn of Shares Total Par Value Alum of Sham, CNP $0.00000 20,000 $0.00 20.000 G.L. C156D eliminates the concept of par vallue, 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, tale 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 lath series then established within any class. ARTICLE V The restrictions, if any, imposed by the Articlefi of Organization upon the transfer of shares of stock of any class are: ARTICLE VI Other lawful provisions, and if there are no provisions, this article may be left blank. i i I I Note: The preceding six (6)articles are cinsidered to be permanent and may be changed only by filing appropriate articles of amendment. ARTICLE VII The effective date of organization and time lhi 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 the initial registered office of the corporation in the commonwealth and the name of the initial registered agent at the registered office: Name: MANUEL LEM -CAGUANA No. and Street: 12 WALL STRUT City or Town: BROCKTON State: MA Zip: 02301 Countrv: USA 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): I Title Inr)ividual Name Address(no PO Box) First,Middle.Last,Suffix Address,City or Town.State,Zip Code PRESIDENT MANUEL LEMA-CAGUANA 12 WALL STREET BROCKTON.MA 02301 USA TREASURER MANUEL LEMA-CAGUANA 12 WALL STREET BROCKTON.MA 02301 USA SECRETARY MANUILLEMA-CAGUANA 12 WALL STREET BROCKTON.MA 02301 USA DIRECTOR M1—]L LEMA-CAGUANA 12 WALL STREET BROCKTON.MA 02301 USA d. The fiscal year end (i.e., tax year) of the corporation: December e. A brief description of the type of business in which the corporation intends to engage: GENERAL CONSTRUCTION f. The street address(post office boxes are i of acceptable)of the principal office of the corporation: No. and Street: 12 WALL STREET City or Town: BROCKTON I State: MA Zip: 02301 County: USA g. Street address where the records of they corporation required to be kept in the Commonwealth are located (post office boxes are not acceptable): I No. and Street: 12 WALL STREET City or Town: BROCKTOM State: MA Zip: 02301 Country: USA which is X its principal office I _ an office of its transfer agent an office of its secretary/assistant secretary _ its registered office I Signed this 23 Day of April, 2013 at 10:37:21 AM by the incorporator(s). (1/'an existing corporation is acting as incorporator. [vpe in the Bract nnme of the business enlih;, the state or other jau•iecliction where it was incorporated. the name o/7he pers)n signing on hehaljol'said husine,tis enfilr and the title helshe holds or other authority by which such a -lion is taken.) MANUEL LL•MA CAGUANA ©2001 -2013 Commonwealth of Massachusetts All Rights Reserved i MA SOC Filing Number: 201316881130 Date: 4/23/2013 10:36:00 AM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that; upon examination of this document, duly submitted to me, it appears that the provisions of the Genera Laws relative to corporations have been complied with, and I hereby approve said articles: and the fling fee having been paid. said articles are deemed to have been filed with me on: April 23, 2013 10:36 AM WI IAM FRANCIS GAL VIN Seci turn of1he Commonwealth I i I I CERTIFICATE OF (LIABILITY INSURANCE H,MMnD.T,w' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO (RIGHTS UPON THE CERTIFICATE HOLDER. THIS UERTIFICATE DOES NOT AFFIRMATIVELY Olt NEGATIVELY , MEiID, EXTEND Olt ALTER THE COVERAGE AFFORDED UY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT ItETWEEN THE ISSUING IDSURER(S), AUTHOIl Izen REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE NO tER. IMPORTANT: N ihe ci rNBcutD holder 1:an ADDITIONAL INSURED,Lhe pdtcy(le%)MUq.he ondnna:d. 11 SUIYIOGATION IS WAIVED %uhjol,In Iho termC and nNldildom Of the Policy, 11Yl.aln PNllchffi may repair�an endon.tYnml. A 1aU."Crl: M tha: cmLlflcate do e:$' nUl. cunft r nghla In the certifIcate.Haider In Real of zurh endar:ement(,} ._- PR000rFa coxTAm &credo 0.R.M nI:A Risk SN)WIIXds Ace Insurance Services Inc AP. ,�Fn il00 fi:YT45B9 rvT:.Nb. 066 215•8118 675 Warren Ave - A IX1RF.SS Poli rvioes(NDerkle iSk.IxmT Brockton,MA 02301 uaras nEcoan r,COVER nnE Ncx HSIREa 9 [242 merican Construction Inc INswca Belmont Street Unit 2ckton,MA 02301 ,xSER INS IRER F. CO CERTIFICATE NUMBER: I REVISION NUMBER: THIS S TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BE OW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATIED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CO ITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE WAYBE ISSUED OR MAY PERTAIN.THE NHIRnai PFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LMITS SHOWN MAY HAVE SEEN REDUCED BY PAD CLAIMS. OR tYPE OF INSURANCE ADVIL INSR WVO POLIC N1,MBEa MMJOOIWY MMNDIYV YYI IIMITS OENBRAI LIABIInY AUTOMOBILE LIABILITY f WORN EIS COMPENSATION WC SI At U- O N AND EMKOYE RS-UABIL ITT WN tOaV nM,fE Fa AN V PROPRIETORIP ARTNE RIE%E C UTVE p P LACN u:.fl0[NI $ 1.ODD.no A OMCFMFMBM ExaUDEO+ N,A WC-20-2 .005407M 7/24/2014 07/242015 IMPPd MU.Y lb NIO 1 1,0D0,00(1 II.a: eo.oAb„unGet 1,000,ROD nFs,, 1wTtlN OF OPF.RAIIONS a�IM OESCRIPTON OF OPERATIONS ILOCAT,ONSI VEHICL S IAIMPb WORD IO.hdd,liI l e,nuk.ScbAdub.O.rn wP ..Prnyu Yndl Coverage Boctioii Category Elect.Statics Nano ems) All EntitieS)Loralims ORicer Include Manuel Caguana MA 1 American Construction Inc 242 Belmont Street Unit 2 Brockton, MA 02301 CS4UIEIGATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICES BE CAW.ELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE W ILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PIAIVIOIONS. AS Cames Roofing Inc AN I"..IL. 30 Arrowhead Form Rd Boxford,MA 01921 Signature: "" ACORD 25(2010105) BRAC 3139