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406 JEFFERSON AVE - BUILDING INSPECTION (3) 1p-tf- I SS A ,ea, The Commonwealth of Massachusetts RECEI ED . G Board of Building Regulations and Standards INSPECTIONA SER, Massachusetts State Building Code. 780 CIVIR + BuildingPennit Application To Construct. Repair. Renovate Or pW� PP One-orTivo-FamilVDwellinX �14 ����2 P,1.l�ch2011 This Section For Official Use Only Building Permit Number: Date Appf d: Building Onicial(Print Name) Signature Date �Y SECTION 1:SITE INFORMATION I. p rty Add r 04Ue 1.2 Assessors Map& Parcel Numbers 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 Ama(sq o) Frontage(Ii) 1.5 Building Setbacks(ft) Side Yank Yard Front Yard Required Provided Required I Provided Requited Provided 1.6 Water Supply: (M.GJ..c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood lone'? Mu al❑ On site disposal osal system Public❑ Private❑ Check if yes❑ ❑ P p SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Retard: Na�1 Print) City,, tace,11 I' -- jA Lle No.and Street — Telephone Entail Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building Owner-Occupied Repairs(s) Alterations) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Numben)f Units Other ❑ Spccity_ Brief Description of Proposed SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ I, Building Permit Fee: $ indicate how fee is detennined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x I Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) S List:— \ f 5.Mechanical (Fire $ Total All Fees:$ Su ression) Check No._ Check Amount. _Cash Amount:_-_,,,_ 6.Total Project Cost: S 7000� 0 Paid in Full ❑Outstanding Balance Due: I SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) A ti f„r;L�,/Q f License Number Expiration Date Name ol'CSL Hyller /� j List CSI.Type lyre below)_-�_,_- r� �d St r�A i � ~� Type Description No.and Street lJ Unrestricted(Buildings tip ro3i.OlI(1 cu. li.) 130 Fo /) 41,17 TIq R Restricted 1&2 Family Dwelling (I VI !town.State.ZIP�I 1I Masonry RC Rool-ing Covering WS W'indowand Sidin-, SF Solid Pucl Burning.Appliances In sulation Telephone Email address D Demolition 5.2 Registered/Home Improvement Contractor(HIC) 7 h h 9 2 All L- o4&VU I ty" JJ'-zr HIC Registration Number aspiration Date 111C Company Name or I11C Registrant Name 7.1 f` / ro(.✓l✓� C h �4'R_r� R!L-_ C C,t'. F e�PJ �l 0M and Street n h.ntail address 1 ��: or:� 3S 6 A^ .4 pil2,i : 1It:^ iy3 Cit !Town,Stale,ZIP Telc hnne 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 Name(Electronic Signature) uc SECTION 7b: OWNERI OR AUTHORIZED AGENT DECLARATION ) By re • my"namew, I hereby attest under the pains and penalties of perjury that all of the information nn this ap anon is true and accurate to the best of my knowledge and understanding. fiat fhancrs or Authorized Agent's Nnmc(E eclrculic 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 %vwcv nmss.covtocn Information on the Construction Supervisor License can be found at%yy�w�,rnt!.N .y?y dp.± 2. When substantial work is planned,provide the information below: Total floor area(sq. R.) (including garage, finished basementiattics,decks or porch) Gross living area(sq. ft.) _ Habitable room count Number of fireplaces Numberofbedrooms Number of bathrooms Numberal'half(baths_ �m,_ �.�_, 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' 1 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: JOHN BARROWS&JANINE MICHALSKI Date September'17, 2014 406 JEFFERSON AVE Proje:t Name SAME SALEM, MA 01970 Address 978-394-3909 We propose to furnish material and labor-in accordance with the specifications below: Eighty Three Hundred Twenty Five Dollars($8,325.00) 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.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 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®AS NEEDED ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS AND FLANGE. ® REPLACE WALL FLASHING is)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF$25.00PLFT.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 CHIMNEY(S).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY SEAL REGLET JO9dT"Bl_EA ADD$500.00 TO ABOVE PRICE LIFETIME , ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECTURAL WA3RANTY 240LB SHINGLES. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH 1X8 SPRUCE BOARDS AT AN ADDITIONAL COST OF$4.50PLFT. ® COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF$4.00PSQFT. NAILING: SECURE SHINGLES WITH 1 '/;'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 FAST -11 CQNNEQTlQNS- GLEAN-At:QROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. THE PROPERTY OWNER AUTHORIZES AB CARNES ROOFING TO OBTAIN BALL PERMITS-WE CANNOT ACCEPT RESPONSIBILITY FOR DEBRIS RAILING INTO ATTIC AREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT CAREWILL BE USED TO PROTECT THE STRUCTURE AND FOLIAGE=H&WE.VER SOME MARRING AND OR MINOR DAMAGE COULD OCCUR. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES ALL SHINGLED ROOF SECTIONS OF THE HOUSE AND GARAGE. CHIMNEY FLASHING:THIS SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS MAY OCCUR. SKYLIGHTS:INSTALL ONE VELUX D26 FIXED UNIT WITH FLASHING KIT IN BATHROOM.$218.00 PLUS$93.00 FOR THE FLASHING KIT PLUS TAX. INSTALL ONE VELUX C01 VENTING UNIT WITH FLASHING KIT IN THE UPPER BEDROOM. THIS UNIT WILL BE LARGER THAN WHAT IS NOW THERE SO THERE WILL BE A LABOR CHARGE F($1225.00 PER MAN HOUR FOR THE INSTALLLATION.COST$4415.00 PLUS$94.00 FOR THE FLASHING KIT PLUS TAX. 6 � � ! 1� /�'vj� �� G �� �5>T/Le `v�� WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH T0130 MPH Wrr�Ay UPGRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP&RIDGE CAPS AND ST TER CJJOFFUR//,,SE AT NO ADDITIONAL CHARGE.YES EMAIL ADDRESS: " � � rrCiu% � /*r7�c�i, ` �. /� 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 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 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 accepted all the terms as stated on the front and back of this agreement. Please see reverse side. 9 e, *Date of Acceptance L' � �® .21 l T Signature r *Signature Signature _ rf PLEASE SEE REVERSE SIDE .a►s o CERTIFICATE O�F LIABILITY INSURANCE DATE 1/12 ,DD013 �/ 11/12/2013 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 endorsement(s). PRODUCER CONTACT Commercial Lines NAME: Harris-Murtagh Insurance Agency,Inc. PHONE EXU. (978)532-2844 FAX No, AI 30 Central Street E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC a MA 01960 INSURER A:Western World Insurance CO INSURED INSURER B: AB Carnes Roofing, Inc INSURERC: 30 Arrowhead Farm Rd INSURER D: INSURER E: ford 01921 INSURER F: COVERA CERTIFICATE NUMBERCL13111217634 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 TYPE OF INSURANCE POLICY NUMBER MML�DY� MMI�DIf"VV LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurre,ma $ 50,000 A CLAIMS-MADE OCCUR NPP137217 0/11/2013 0/11/2014 MED EXP(Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJFCT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS AUTOS NON-OWNED PRO PER TY DAMAGE $ HIRED AUTOS AUTOS Per ac.1d t 8 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION WC STAT'U OTER H- AND EMPLOYERS'LIABILITY Y I N 11 ANY PROPRIETORIPARTNER/EXECUTIVE❑ NIA E L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS bel. E.L.DISEASE-POLICY LIMIT 1 $ DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,K more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Salem 120 Washington St Salem, MA 01970 AUTHORIZED REPRESENTATIVE J S Scholnick/PJR 'U�'�'�¢' "-'4'-� ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS026mmnnsim Th.ACr1Rr1 mrn¢.nrl Irmo¢en roni¢fnrud make of Arnon 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen'isor License: CS-000230 yy BARRY S CARNE$ 30 ARROWHEAD FARM-RD;e' I Boxford MA 019£t Expiration Commissioner 03/0712016 &Xe ��a ,oatuXcr�,/>7� o ��cirJrJrrr 2ci<1 //1 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. a BARRY CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 Update Address and return card.Mark reason for change. I� Address ul Renewal 1'._l Employment 0 Lost Card SCA i A 2010-0501 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: 9-21-2014 SIGNATURE OF APPLICANT: ' The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I 't c I Congress Street, Suite 100 ` 1Boston, MA 02114-2017 wwminass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibb' Name(RusinessiOrganizationAndividual): 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 appropri 1 ox: Type of project(required): I.❑ I am a employer with 0 1 t a general contractor and 1 6 ❑ New construction employees(full andior part-time).' iave hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ✓❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. employees and have workers' q ❑ Building addition tNo workers' comp. insurance l mp• insurance.- required.] ❑✓ a are a corporation and its It).[] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[] Plumbing repairs or additions myself [No workers' comp. right of exemption per MG I_ 12.2 Roof repairs insurance required.] c. 152, §1(4),and we have no I3.❑ Other employees. [No workers' _--- --- comp. insurance required.] +Any applicant that checks box is naul also sill out the section helotr showing their%corkers'compensation policy inpirmation. t Ilonneowvere who submit this affidavit indicating they are doing all work and then hire outside contrien+n must submit it new nllidavil indiading such. Contractors that check this bus mist attached an additional sheet showing the name of the sob-contraclor,and sale whelhcr or not(hose entities have employees. II'Ihe soh eontmctors have employees,they nwst provide their workers comp.policy numher. I am an emp/nyer that is providing workers'compensation in.surancefir in.)!eniplayees. Below is the policy and job silt, inj mmation. Insurance Company Name:_ —.-- --_--- - Policy#or Self-ins. Lic.g: ___�� Expiration Date:,__i�._.� Job Site Address: City'State/Zip:_ __. -- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(late). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa fine up to$I.500.00 and/or one-year imprisonment.as well as civil penalties in the form ora STOP WORK ORDER and a tine Of up to$250.00 a day against the violator. Be advised that a copy of this statement only be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby t +under the pins nd enalties o ' er7tr r 1hM the in ornuttion provided shave is trees and correct. Si nature: s. -- -r'L Datc • Phone 4 9 J fi 6'6" A"3 Official use only. Do not write in this area,to be completer/hp 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#: 1 FORM 153 The Commonwealth of,Massachusetts DIA Use Only — Department of Industrial Accidents t— nl Office of Investigations - Dept. 153 y — r 1 Congress Street,Suite 100, Boson,Massachusetts 02114-2017 hUp://www.mass.gov/dia Invest./SWO ID H: 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 add ing the follotPing paretgr(q)h: "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 subiect the corporation to the penalties set forth in section 25C." Pursuant to M.G.L. c. 152, §1(4) as amended. 1/We the undersigned officers of: AB CARNES ROOFING, INC. INaine 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 employeels) 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 exempt fro the provisions of M.G.L. c. 152. g ed under the ains and penalties of perjury: BARRY CARNES, PRESIDENT 09/24/2013 S tr• - Print Name S Title Date(nun/ddAryay) I wish to exercise.mp right of exemption or 1 wish NOT to exercise my right(Wexcmption r ANASTASIYA CARNES, DIRECTOR 09/24/2013 Signature Print Nnnte X title. Date InunAldrpyyv-lvi " i ❑✓ I \visit to exercise my right otexemption or I wish NOT to exercise my right of exemption ;r r rn Zj Signature Print Nama&Title Date tnnnkldlyy) "d I wish to exercise my right of exemption or I wish NOT to exercise my right of exemption Signature Print Name&'Title Dale(nun!ddlvyvy) FJ 1 wish to exercise my right of exemption or ❑ 1 wish NOT to exercise my rightul'excmpiion Note:Ali,F:IJGIBj,E CORPORATE OFFICERS MUST SIGN, FHERE CAN RE NO MORE'I'IIAN i SIGNATUHLS. IIIXtrllction.s on hack. form 15'1-7/Nolo MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM The Commonwealth of Massachusetts Minimum Fee:$250,410 William Francis Galvin 1 " Secretary of the Commonwealth,Corporations Division One .Ashburton Place, 17th Floor Boston, MA 02108-1511 Snecinl Pilhm ingruaim,m 9� t •;` Telephone: (617) 727-9640 • `I ?'- Federal Employer Identification Number: 00 1110484 (must be 9 digits) ARTICLE I The exact name of the corporation is: AB CARNES ROOFING. INC. ARTICLE 11 Unless the articles of organization otherwise provide, all corporations formed pursuant to G.L. C1560 have the purpose of engaging in 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 R INTERIOR REMODELING ARTICLE III 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 :Vnm of Shares Total Par Valli, Nam of Shores 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 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 filing 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: BARRY CARNES No. and Street: 30 ARROWHEAD FARM RD City or Town: BOXFORD 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) First,Middle.Last,Suffix Address.City or Tmvn.State,Zip Code PRESIDENT BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD,MA 01921 USA TREASURER BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD,MA 01921 USA SECRETARY ANASTASIYA V CARNES 30 ARROWHEAD FARM RD BOXFORD,MA 01921 USA DIRECTOR BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD,MAO 1921 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 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 County: USA r 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.tune, 2013 at 6:23:02 PM by the incorporator(s). (ljan existing cotporcnion is acting as incorporator, (vpe in the exact name of the husiness entih, the state or other jurisdiction where i wns »vcorporated the name�l the person signing orr hehalf of said busine etvtitr and the title he/she holds or other anthorih+h'v which such action is taken.) BARRY S CARNES 2001 -2013 Commonwealth of Massachusetts 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 tiled with me on: June 26, 2013 06:21 PM WILLIAM FRANCIS GALVIN Secretnry of the C)1I7N90M4;ea11h 1 ' L • t,A IE MMlI1F,Y YYY) r:c�tr CERTIFICATE OF LIABILITY INSURANCE �-. Iumzol4 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 IfY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTMITE A CONTRACT BETWEEN THE ISSUING INSORER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the nxDEcate holder Is an ADDITIONAL INSURED,the pokI les)must he endorsed. If 511HROGAT10N IS WAIVED,sMlj)mY.In Ihn tem and van BdLm of the PIW:y, ceYtain pdichs may retire an endomiTenit A tdal:emerN nm thk rertifl,w, dINS nd.confer dghls lU the ceRlRuaNf holderin Rcuofsuch mdoe.m. &*(s} - P{E)DIIf.ER f,ONTAR Ln. &:Ikln Assigned Risk Survioas Ace Insurance Services Inc A4.IN E,I BOO 6:W-4589 a::.Ne). tl6fi 215•tll ltl 675 Warren Ave nu,RFEs Poll rvice,tiPberkle isk.aDm Brockton,MA 02301 INsuaE s nFFonn D vrsmF cN INSURED INS IRM 9 1 American Construction Inc 242 Belmont Street Unit2 INSURER O Brockton,MA 02301 ,INS W ER E —.-. RI COVERX CERIWCATE NUMBER: REVISION.NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIAnHSTANDING 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 HEfEN IS SUBJECT TO ALL TFE TERMS EXCLUSIONS AND CONDITIONS OF SUCHPOUCES.LMIrS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. LTR IVPE OG INSURANCE INSR WVO POLY CY NUYBfR MM/OOITYV MM,ODIIQLI"WYYI II NITS OPJIRRAL U\pUTY AWONOBIW LIABILITY $ WORN EN COYPOWAYIOM ATU .- AND EYhOYERB'LIABILITY YrN T(X: IT FI: ANY PROPRIFTOWARTNERIF5FC1111YE E L EACII MO ",EN I 1 1,DBQDOO A OMCENEMOMEXa,UDF.DT ® N ❑ WC-20-20-0D5407-00 07124r2014 07242015 TYANa.1.,1.NMI FA 11,DOD,000 n O RIP u f) DEV.SCRIPYON OF OPERATIONS NAma 1 00(t( DFN-RIPDN PERAIONS I Mehl 10N I v Alcl Sfquc ORD101,A0EIUoneIRAmAtM S2AACnb.immA IP�LA1f M0urA01 C- Bacaon Category Elect,Status Name ,tato(S) All EntldeS/Locatims office Include Manuel caguana MA 1 American Construction Inc 242 Belmont Street Unit 2 Brockton,MA 02301 HOLDER CANCELLATION SWU1D ANYOFTHE ABOVE DESMISED P000V1 BE CAWELLED BEFORE THE EXPIRATION DATE THEREOF.NOTIVE WILL BE DELIVERED IN AOI:UIDANCE WITH THE POLICY PNDVISDNS. AS Cames Rooting Ine , 30 Arrowhead Form Rd Boxford,MA 01921 Signature: ACORD 25(2010105) BRAG 3139 MA SOC Filing Number: 201316881139 Date: 4/23/2013 10:36:00 AM •» The Commonwealth of Massachusetts Minimum Fee:5250.00 William Francis Galvin - Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 S,ecW Filin-Imin.owns Telephone: (617) 727-9640 V , — 9 F Federal Employer Identification Number: 001098338 (must be 9 digits) ARTICLE I The exact name of the corporation is: I AMERICAN 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 business. Please specify if you want a more limited purpose: ARTICLE III 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 Num a1 Sha,0, Tw al Pm-1•'ahw Nwpi o/Shnrus CNP $0.00000 20,000 50.00 20,000 G.L. C156D eliminates the concept of par value, however a corporation may specify par value in Article III. See G.L. C1560 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 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 filing 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 LEMA-CAGUANA No. and Street: 12 WALL STREET City or Town: BROCKTON State: MA Zip: 02301 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) 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 MANUEL LEMA-CAGUANA 12 WALL STREET BROCKTON.MA 02301 USA DIRECTOR MANUEL 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 not acceptable)of the principal office of the corporation: No. and Street: 12 WALL STREET City or Town: BROCKTON State: NIA Zip: 02301 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: 12 WALL 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 Signed this 23 Day of April, 2013 at 10:37:21 AM by the incorporator(s). (//an existing carpnratinn i.c acting as incorporator. type in the esaci name ofthe bnsinea)-ss entity, the state n other jurisdiction where i! "gas incorporated, the name of the person signing on behal fql said business entinv and the tide helshe holds at-other ardhorim,by which such action is taken.) MANUEL LEMA CAGUANA J�2001 -2013 Commonwealth of Massachusetts All Rights Reserved MA SOC Filing Number: 201316'881130 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 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 tiled with me on: April 23, 2013 10:36 AM WILLIAM FRANCIS GALVIN Secivr n j: nJ the Commonwealth