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0014 CRESSEY AVENUE - BPA-13-913 The Commonwealth of Massachusetts (j I Board of Building Regulations and Standards UIUlf '16 11 Massachusetts State Building Code, 780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a " Revised One-or Two-Family Dwelling March 2011 This Section For Official Us Only Building Permit Numb r. Da ppl' 3 Building Official(Print ame) igoatu Date SECTION 1: SITE INFORMA ION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers A✓ t4L< 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 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? P P y Check if yes❑ Municipal ❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2 wnert of Record: Name(Print) City, State,ZIP /,V � n.eile.y Fug 7 ) , ))�!V, 6v�'Zd No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction ❑ 1 Existing Buildin Owner-Occupied Repairs(s) t Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work : t - SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ 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 $ Total All Fees:$ Suppression) Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ��f4 0 Paid in Full 0 Outstanding Balance Due: 1 SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) O License Number Expiration Date Name of CSL-Hot er D List CSL Type(see below) (iL. T Descri on dress i�J cx/vrD U Unrestricted to 35,000 Cu.Ft. Restricted 1&2 Family D wellitt Si alure M Masonry Only 9 7 n!' eey RC Residential Roofm Coverin Telephone WS Residential Window and Siding SF Residential Solid Fuel BurninE Appliance installation D Residential Demolition 5.2 Re :stered Home Improvement Contractor(HIC) !U o�1 I � L I-IIC Company Name or HIC R strati N e 'Registration Ntvnber 0 ow vt xr �� 6 z 3 �y" o A Expiration Date S arm 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 K 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 as Owner of the subject property hereby authorize �A 1 to act on my behalf in all matters l relative to work uthorized by thus building permit application. ;it",of Own Date SECTION 7b:OWNE -R AUTHORIZED AGENT DECLARATION I 4 % ,as Owner or Authorized Agent hereby declare that the staternerlis and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. 1'rm ame E� 7- Si ture er or Authorized Agent Date Si under the ins and nwlties ofury 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 trader M.G.L.c, 142A Other important information on tine HiC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I lo.R6 and I Io.R5,respectively. 2. When substantial work is planned provide the information below: Total floors area(Sq. Ft.) (including garage,finished basemcm/attics.decks or porch) Gross living area(Sq.Ft.) Habitable room count Ntnnber 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 Inc. 30 Arrowhead farm Rd Page 1 of 1 Boxford, Ma. 01921 978-887-1431 Mass, Builders License No.000230 Contractors Registration.No 100733 Proposal Submitted To: MANUEL PIRES TR Date May 15,2013 14 CRESSEY AVE Project Name PIRES REALTY TRUST SALEM, MA 01970 Address 978-744-6828 We propose to furnish material and labor-in accordance with the specifications below: -- Fifty Five Hundred Dollars($5,500.00) Payment to be made as follows: $300.00 Deposit, Balance Upon Compl IT 1 Notice:All home improvement contractors and subcontractors engaged in home Authorized improvement contracting,unless specifically exempt from registration by provisions Signature ' of Chapter 142A of the General Laws,must be registered with the Commonwealth ' of Massachusetts. Inquiries about registration and status should be made to the Note:This droposal rpay be„withdrawn by us if not accepted within 3D Mass.govhicenses website. days. _ r ROOF PROPOSAL ® STRIP ROOF OF UP TO TWO LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH 15LB ASPHALT COATED UNOERLAYMENT PAPER, COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. ® INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVER ALL HEATED AREA$`Six FEET:WIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS&AROUND ALL ROOF PENETRATIONS. ® 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$15.00PLFT.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 INCLUDED TO ABOVE PRICE. n\REBUILD CHIMNEY FROM ROOF DECK UP WITH NEW OR USED BRICK. ADD =T#- OVE PRICE 11 m4 ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECTURAL LIFETIME RRANTY 240LB SHINGLES. /"�� 4 yH f El REPLACE DEFECTIVE ROOF DECKING WITH 1X8 SPRUCE BOARDS AT AWA'BDITI. AL COST OF$4.50PLFT. tua/1 ❑ COVER ROOF DECK WITH COX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF SHINGLES ARE TO BE STORM NAILED.ESSEX COUNTY BUILDING CODE REQUIRES SIX NAILS INSTEAD OF FOUR. ❑ REPLACE EXISTING SKYLIGHTS WITH NEW VELUX UNITS WITH FLASHING KITS,WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.THERE WILL BE NO LABOR CHARGE IF THEY ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDED. ❑ 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 NO.2 PRIMED PINE,ADD$15.0 PER FOOT TO ABOVE PRICE. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS. MECHANICALLY F CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK ARE t--THE PROPERTY OWNER AUTHORIZES AB CARNES,INC TO OBTAIN ALL PERMITS.WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS FALLING INTO ATTICAREAS-GUSSOMER SHOULD COVER VALUABLEf@EAT CfiRE WILL BE USED TO PRO T THE STRUCTUAND-F-0UAGE Hf)1NEVER SOME MARRING AND OR MINOR DAMAGE COUL OCCUR - —1� PECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES HOUSE AND SHED. SRED�SHINGLES WILL BE APPLIED OVER THE EXISTING SHINGLES. WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH O 130 MPH WITH AN UPGRADE TO THE HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YE-S 1 EMAIL ADDRESS: ",YA Alf�4 i�;ramie (Y N/ l L CO dI 1 r 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;please see the manufacturer's warranty for exact warranty performance. Cancellation: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 !`J Dispute Resolution under Massachusetts Home Improvement Law 142a:All parties ag[ee in advance that any and a)'disputes relating to this proposal shall be settled by binding arbitration.This forum is user friendly and does not require lawyers`.Please see reverse side Customer,)/ d� �Y Da e.fCantracto# s Date p Signing this Proposal means you have accepted all the terms as stated on he front and b2ck of this agreement t, y i 22 - Date of Acceptance z%�r 7/ 9 L/✓ Signature J � Signature PLEASE SEE REVERSE SIDE Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cunstructiun Supcn'isur License: CS-000230 'pt6 BARRY S C S ,ram VV 30ARR0 AD,-FARMRD ' Eki ord MA 01921` oA A' Expiration Commissioner 03/07/2014 L Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 100733 Type: Private Corporation Expiration: 6/2 312 01 4 Tr# 223142 A. B. CARNES, INC. R —_- - Barry Carnes 30 Arrowhead Farm Rd. Z> Boxford, MA 01921 ',^+�;F•:,_s Update Address and return card.Mark reason for change. Address E j Renewal U Employments r,, Lost Card )PS-CA1 O 50M-04tD4-G101216 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, INC. DUMP TRUCKS DATE: 5-21-13 SIGNATURE OF APPLICANT: Be1 kI... Massachusetts Workers' Compensation Insurance Plan y Acadia Insurance Company NCCI Carrier Code 33391 Administered by Berkley Assigned Risk Services ASSIGNED RISK SERVICES P.O. Box 1100, Minneapolis,Minnesota 55440-1100 Phone(605)945-214 866}215-8 S--T.oll ee(800)634-4589 www.berkleyassignedrisk.com CERTIFICATE OF INSURANCE 1. The Insured: WCIP Policy Number: WC-20-20-004717-00 1 American Construction Inc Tax ID#: F 46-1868194 242 Belmont Street Unit 2 Brockton, MA 02301 Policy Period: From: 4/2 412 0 1 3 To: 4124/2014 Date of Mailing: 513/2013 The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or alter the coverage afforded by the Policy listed below. This is to certify that the Policy of Insurance described herein has 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 Policy described herein is subject to all the terms, exclusions and conditions of such Policy. TYPE OF INSURANCE u= ;,LIMITS OF LIABILITY Coverage State(s) Part One Workers'Compensation Statutory MA Part Two Bodily Injury by Accident $1,000,000 each accident. Employers' Liability Bodily Injury by Disease $1,000,000 policy limit. Bodilly Injury by Disease $1,000,000 each employee. Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. All Entities/Insureds: Certific Holder's Name and Address. 1 American Construction Inc Election Election AS Carnes Inc Category Status Name 30 Arrowhead Farm Road Officer Include Manuel 3 Lema Caguam Boxford, MA 01921 Date Issued: 5/312013 Ace Insurance Services Inc 675 Warren Ave Brockton, MA 02301 " Signature_ ' L ' l OP ID: SA A� DATE(MM/DD/YYYYI CERTIFICATE OF LIABILITY INSURANCE 03113113 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 endorsements . PRODUCER 976-744-6715 CONTACT AHMED Insurance Agency,Inc. 976-741.0127 PHONE FAX PO BOX 449 (AIC,No,.Ext): (AIC,No): Salem,MA 01970 E-MAIL Stephen G.Ahmed PRODUCER ABCAR-1 CUSTOMER ID N: INSURER(S)AFFORDING COVERAGE HARD INSURED A arnes Inc INSURER A:Essex Insurance CO Arrowhead Farms Road INSURER B:Safety Insurance Company 33618 Boxford, MA 01921 INSURER C INSURER 0: INSURER E: v INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTP TYPE OF INSURANCE INqR Win POLICY NUMBER MMIDD/YVYY MMIDDNYYV GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 AMAGE TO A X COMMERCIAL GENERAL LIABILITY 3DF9266 03118/13 03118/14 PREMSES(E. ccurnence) $ 50,00� CLAIMS-MADE X OCCUR MED EXP(Any one Person) S 1,00 PERSONAL B ADV INJURY S 1,000,00 GENERAL AGGREGATE S 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,00 X POLICY PRO LOD PD Deduct $ 50 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,00 (Ea ecndanq ANY AUTO BODILY INJURY(Per Person) It ALL COINED AUTOS BODILY INJURY(POT DGtitlentl $ B X SCHEDULEDAUTOS 6213192 05/02/12 05/02/13 PROPERTY DAMAGE B X HIRED AUTOS 6213192 05/02/12 05102/13 (Per accIcen IS in p B X NON-OVVNED AUTOS 6213192 05/02112 05102/13 $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION WC STAT , OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORMARTNERIEXECUTIVE F--1 E L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED' N I A (Mandatary in NH) E L DISEASE-EA EMPLOYEE S Il yes Peso,be under EL DISEASE-POLICY LIMIT 4 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Roofing Contractor CERTIFICATE O CANCELLATION CITYOFS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE WITH THE POLICY PROVISIONS. 120 Washington St. Salem, MA 01970 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents office of Investigations n t , 600 Washington Street `V Boston, MA 02111 wrvry massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El c ease Print umber v Applicant Infor►nation t� Name (Business/Organization/individual.): ! C ,8 Address: 3 ,) a&An�_ P — City/State/Zip: Phone#: 8o°7 /i"'31 Are you an employer?Check the appropriate ex: Type of project(required): I.❑ I am a employer with 4. I am a general contractor and 1 6. ❑New construction employees(full and/or part-time)-* ave hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 7. [3 Remodeling _ These sub-contractors have S. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑ Building addition o workers' co insurance comp. insurance.' ' S. We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 7 1.❑ Plumbing repairs or additions ;.❑ I ys a homeowner doing all work right of exemption per MGL myself. [No workers' comp. e p P 12XRoof repairs insurance required.]t e. 152,employees. [ and or have no 13.❑Other employees. [No workers' comp. insurance required.] *Any applicant that checks box=1 ratio also fill out the section below shoving their workers'compensation policy information- 'Ilomeownem who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sob-contranors 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 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 tine of tip 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. I do hereby ee ' under the ins and penalties of perjury that the information provided above lc true and correct Siena im. f Date: I` 1 Phone#: y 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.Cityrrown Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person- Phone#• FORM 153 The Commonwealth of Massachusetts DIA Use Only " -C\- Department of Industrial Accidents Office of Investigations -Dept. 153 1 Congress Street,Suite 100,Boston,Massachusetts 02114-2017 http://www.mass.gov/dia InvestJSWO ID 1I: k94vi 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, Inc. 30 Arrowhead Farm Rd Boxford, Ma 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. a. 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 checke he appropriate box below my/our name(s) indicating my/our desire to be exempt or not o be pt rin the provisions of M.G.L. c. 152. ed under t pains and penalties of perjury: Barry Carnes, President 04/3/2012 Si nature Print Name&Title Date(mm/dd/yyyy) wish to exercise my right of exemption or I wish NOT to exercise my right of exemption �,^�� Anastasiya Carries, Director 04/03/2012 Signature �° Carries,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) 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 ❑ 1 wish NOT to exercise my right of exemption Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. ]ns&UcttonS on back. Form 153-7/2010 MA SOC Filing Number: 201287835330 Date: 5/30/2012 9:10:00 PM The Commonwealth of Massachusetts No Fee William Francis Galvin r, Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor * ,i_ Boston MA 02108-1512 J f,F• ;y__>�?4` Telephone: (617) 727-9640 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, MA 01921 USA SECRETARY BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA DIRECTOR BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA DIRECTOR ANASTASIYA CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA X Fiscal year end: October X Type of business in which the corporation intends to engage: GENERAL CONTRACTING & MARKETING X Principal office address: No. and Street: 30 ARROWHEAD FARM ROAD City or Town: BOXFORD State: MA Zip: 01921 Country: USA X its principal office _ an office of its transfer agent an office of its secretary/assistant secretary _ its registered office Signed by BARRY S. CARNES , its PRESIDENT on this 30 Day of May, 2012 I ©2001 -2012 Commonwealth of Massachusetts j All Rights Reserved MA SOC Filing Number: 201287835330 Date: 5/30/2012 9:10:00 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: May 30, 2012 09:10 PM WILLIAM FRANCIS GALVIN Secretary of the Commonwealth