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13 LAWRENCE ST - BUILDING INSPECTION The Commonwealth of Massachusetts Bo fIVE6ling Regulations and Standards RE FOR 1 . 1� kegE t�y� wilding Code, 780 CMR INSPECTiQ I tY BuildingP it A lication To Construct, Repair, Renovate Or Demolish a Revised Mar 2 l l >f�'ro(e� ��� NOY 2OnPbamily Dwelling 1014 NOV 24 P 1: 03 This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property A dress: 1.2 Assessors Map& Parcel Numbers I 1.la 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(11) 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: Zone: _ Outside Flood Zone? Municipal❑ On disposal system ❑ Public❑ Private❑ un n s osa Check if yes❑ p p y SECTION 2: PROPERTY OWNERSHIP' 24Owne of Recor / / X le Name(Print) �— City, ZIP No.and Street — Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction ❑ Existing Building Owner-Occupied�Ki Repairs(s) )!11� Alteration(s) ❑ Addition ❑ Demolition ❑ 1 Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': /� I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building 1. Building Permit Fee: $ Indicate how fee is determined: 2. Electrical $ El Standard City/Town Application Fee ❑Total Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees: $ Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ d'ULz2' ❑ Paid in Full ❑ Outstanding Balance Due: Se3ur' ooT, tk j2rs SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) l / AAV 4,—AAAzef License Number Expiration Date Name of CSL Holde List CSL Type(see below) go. Ty Description U Unrestricted(Buildings up to 35,000 co.ft.) E2 d A UJ 9 Restricted 1&2 Family Dwelling City/Town,State,ZIP / M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) /Exyam/ A lA /✓/ on�— HIC Registrati Number Expiration Date HIC Company Name or HIC Regts ant Name � -n AO w PLOD /�i4/t M ✓� No.and Street r-- Email address it /Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuan the building permit. Signed Affidavit Attached? Yes .......... ly 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 authorizeA�(hA f ,er &OO�// . iL to act on my behalf, in all matters relative to work authorized by this building permit application.T7�� rint Owner's Name(Electronic S gnature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contain ' Isis application.is true and accurate to the best of my knowledge and understanding. �l 1//� Z1/ . /L Print wner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dus 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"maybe substituted for"Total Project Cost" 911 Proposal AB Carnes Roofing,Inc. 30 Arrowhead farm Rd Page 1 of i Boxford,Ma.01921 978-887.1431 MA CS-000230 and HIC Reg.176928 Proposal.Suhmiced To. TODD BEKEFHA Date July 22,2014 13 LAWRENCE ST - Projisl Name SAME SALEM,MA 01970 Andrew 504-717-1170 We Propose 10 tannin mawrial and la>or-in accordance with Ine spe4iiCaa0ns Lniow, FIVE THOUSAND Two Hundred Dorars($5,200.001 {{PP�aaFy!!pment to be made as follows:$300.00 Deposit,,BALANCE UPON COMPLETION o➢ .Alt lame rmprpVebvebl P nUacturs am sir ssibrecasa eigagves vl done improwunist conYacag,txikss ham rtyuier an by proa,ywns of ChaIM21 142A of the General Iaws.mull beregwlerxi ah nk DeepnDnW&Ijan urfAassachusens.Irfeu'nds ahwr rog6Valrwl and.Slatus should oe.matle to Ne LWss.gpvaKdnae'a waome ROOF PROPOSAL STRIP ROOF OF UPTO TWO LAYERS OF ASPHALT SHINGLES COVER ROOF DECKWlThTHEja=RHINOROOF HIGH PERFORMANCE WATERPROOF UNDERLAYMENT MEMBRANE COVER.EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PREVENT DAMAGE. Qf r *INSTALL C.ARLISLE HIGH PERFORMANCE ICEE&WATER BARRIER OVER ALLHEATED AREAS *'RIDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS.WRAP THECtiIMNEY151 AND SKYLIGHT CURBS UNDER THE FIASHINGS'WITH SAME + 0 COVERALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE, INSTALL GAF COBRA A9AND!OR[3 ROOFLOUVERSF-0RADOEDAT71CVENTILA'rION COVER.SOIL PIPES WITH NEW RU&SER FLASHING BOOTS AND FLANGE. ❑ REPLACE WALL FLASHING IS)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF PLFT,WE MAY NEED TO REMOVE THE SIDING TO PERFORM THISYYORK AND YOU MAY NEED TO HI A CARPENTER REINSTALL OR REPLACE THE SIDING THAT W.ASREMOVED CUT ALL EXISTING TAR AND LEAD FROM ONE CHIMN NS' CCUT NEW'REGLEI WITH CARBIDE SAWAND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS PROPERLY SEAL REGLE CINI E ADD$45D.W TO ABOVE PRICE COVER ROOF SURFACE'AITHCERTAINTEED LMDUAFKARCHITECT4IR�L JFE NTY.24MB SHINGLES REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH iX8 SPRUCE 80ARDSkPA ADDITIONAL COST OF$4 SOPLPT ® COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING.AT AN ADDITIONAL COT�i' 0=A , CURE SHINGLEES WITH i GALVANIZED ROOFING NAILS AS PER CERTAINTEED SPECIFICATIONS V ,�—��/ 0 REPLACE EXISTING SKYLIGHTS WITH NEW VE'd UX UNITS WEWILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.THERE IS NO LABOR CF RGE IF THE r RE THE SAME SIZE.INTERIOR WORK,IS EXCLUDED REMOVE EXISTING GUTI'E`RS 0INSTALL NEW SEAMLESS Lot ALUMINUM GUTTERS USING THE HiDOEN ZIP SCREW HANGER SYSTEM REPLACE ANY ROTTED TRIM BOARDS AS NEEDED WITH 30 EARPRI PER FOOT TO AEOVE PRICE. INSTALL NEW ALUMINUM DOWNSPOUTS AND MECHANICALLY YF IEN ALL CL MECTION CLEAN All PROJ RELATED DEBRIS FROM OUTSIDE WORN EA THE PROPERTY OWNER AUTHORIZES AS CARNES-ROOFING TO OBTAIN ALL PERMITS.WE CANN 'CCEPT RESPONSIBILITY FOR DEBRI ALLING INTO.4TTICAREAS. CUSTOMER SHOULD COVER VALUABLES. GREAT DARE WILL BE' TO PROTECT THE STP.rJCTURE ANOFOL "^' EVER,SOME MARRING AND OftP,91NOR DAMAGE COULD R VE w I PROPOSAL INCWDESALL SHINGLED ROOF SECTIONS WARRANTY UPGRADE;THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITH`9 LF�GRADE TO THE CERTAINTEED HIGH PERFORMANCE HIP 4 RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES( X 1 / EMAIL ADDRESSA2S_I74 -7add [©y l_., r —tom f�r4r✓ GetG f� f c� ' Will iety.All work warranted against a6lailabre,dafects far 5 years,this warranty IS lrr@a to Ind Idstalien rem(s)and 115 repan idey,'Material is warranted by the marlwaClUrer against detects for 50 years,see the mandatlurers warranty for exact warranty pedllnnance Cancellation:Customer has legal right Under faders!law IC Cancel InS COolmCl voihoUl penally or odrgalrerl'wnilln rlree business days Lord the date of srgmng Ims agreement via Priority Mad Deliver}ConFrndalion. Please see reverse side. Dispute Resolution under Massachusetts Home Improvement Law 1423 All paNEs agree that any and all disPOtes relating to this proposal shall be settled by mbhratian.This tenth is use friendly and does nor require lawyers,Please see reverse side. Signing this Proposal means,You have accepted all the tuns as stated on the front and of this agreement Please see reverse side. ADate of Acceptance _fIjZ G_f2011. Slgnalure__.T�___. 1 Signature ( PLEASE SEE REVERIE SIDE Date of Transaction NOTICE OF CANCELLATION You may cancel this transaction,without any penalty or obligation, within three business days from the Date you signed this agreement. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the Contractor of your cancellation notice. In addition,any security interest arising out of the transaction will be canceled. If you cancel,you must make available to the Contractor at your residence, in substantially as good condition as when received,any goods delivered to you under this agreement; or you may, if you wish, comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expense and risk. If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make goods available to the Contractor, or if you agree to return the goods to the Contractor and fail to do so, then you remain liable for performance of all obligations under the agreement. If this agreement is canceled after the three day rescission period has expired,AB Carnes Roofing, Inc. shall be entitled to an amount equivalent to 1/3 of the total contract price as a penalty for the late cancellation. AB Carnes Roofing,Inc. may use any forum arbitration or court 6 to collect the late cancellation penalty. To cancel this transaction please sign and date a copy of this Notice of Cancellation and send via US Priority Mail delivery confirmation to: AB Carnes Roofing, Inc. 30 Arrowhead Farm Rd. Boxford,Ma. 01921 no later than midnight of the 3rd business day after dating and signing the front of this agreement. I HEREBY CANCEL THIS TRANSACTION. Date: Owners Signature Owner's Address If any portion of this agreement is invalid or not in compliance with M.G.L. for any reason, only that portion of the agreement will be affected and all other parts of the agreement will be valid and enforceable. DEFECTIVE ROOF DECKING: When repairing the roof deck with CDX plywood (4x8)and or 1x8x16 foot Spruce Boards the actual footage billed is higher than what has been installed onto the roof. This is because we are billing you for the complete 4x8 sheet and or the full 16' board even though we did not use the full 4x8 sheet of plywood or the full 16 foot board. The reason for this is once the lumber has been cut;the remainder of the wood is now considered waste and cannot be used.The same is true for flat roofs with wood and or steel decks. The cost for repairing/replacing defective decking includes partial and or complete replacement. HIDDEN CONDITIONS AND NECESSARY ADDITIONAL WORK Hidden conditions may require adjustment in the overall price of the necessary work related to this Agreement. In such case the Contractor shall inform the Owner of such conditions forthwith and where necessary a written amendment will be executed if needed by the Contractor and Owner. If the owner is not immediately available to execute an amendment and hidden conditions beyond this agreement exist,we will, where possible, photograph these conditions and make the necessary repairs at$125.00 per man-hour, plus materials. DISPUTE RESOLUTION: Any and all disputes relating to any portion of this proposal shall be settled in arbitration as provided by the American Arbitration Association or equal. All awards and successful defenses to and by AB Carnes Roofing, Inc. shall include all costs and fees. 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: 11-24-2014 SIGNATURE OF APPLICANT: ® DATE(MM/DD/YYYY) CERTIFICATE F LIABILITY INSURANCE 9/26/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORA ATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIV LY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NO CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICAT HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL If BURIED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies ma require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). CONTCT PRODUCER NAME: Commercial Lines Harris-Murtagh Insurance Agency,Inc. PHONE (979)532-2944 FAX 30 Central Street E-MAIL INSURER S AFFORDING COVERAGE NAIL d Peabody MA 019 INsuRERa:Western World Insurance Co INSURED INSURER B: Barry Carnes, DBA: AB Carnes Roofing, Inc INSURERC: 30 Arrowhead Farm Rd INSURER D: NSURER E: B ford MA 01921 INSURER F: COVE—RAGES CERTIE]CAT UMBER CL1492319366 REVISION.NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM C R 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 SHC WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUDL SUBIR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER M/ MM10 GENERAL LIABILITY EACH OCCURRENCE E 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES E c nonce $ 100,000 A CLAIMS-MADE 7OCCUft qPP13721 0/11/2014 0/11/2015 MED EXP(Any one person) $ 5,0000 PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO- LOC $ J(MdEto�InNIH) OBILE LIABILITY COMBIN INGL LIMIT Ee accident Y AUTO BODILY INJURY(Per person) $ L OWNED SCHEDULED BODILY INJURY(Per amdant) $ TOS AUTOS NON-OWNED PROPERTY DAMAGE E ED AUTOS AUTOS Per amidenl E BRELLALIAR OCCUR EACH OCCURRENCE E CESS LIAR CLAIMS-MADE AGGREGATE $ D RETENTIONE $ RS COMPENSATION WRYI MIT- OTH- PLOYERS'LIABILITYOPRIETOR/PARTNER/EXECUTIVE Y/NE.L.EACH ACCIDENT $ RIMEMBER EXCLUDED? NIAory In NH) E.L.DISEASE-EA EMPLOYE $ escribe underE.L.DISEASE-POLICY LIMIT $ IPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,A ddltlonal Remark,Schedule,U 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 Ci7Washington ACCORDANCE WITH THE POLICY PROVISIONS. 12Sa AUTHORIZED REPRESENTATIVE J S Scholnick/SJG ACORD 25(20110/05)- -' ©1988-2010 ACORD CORPORATION. All rights reserved. INS0251201005).01 The ACORD na a and lcao are registered marks of ACORD }�f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-000230 '' I BARRY S CARNES` - 30 ARROWHE,VFA,1 RD Boaford MA 019g1 Expiration Commissioner 03/07/2016 � C���re Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cdn�tractor Registration �- Registration: 176928 -- = Type: Corporation i 1 �w Expiration: 10/10/2015 Tr# 245633 AB CARNES ROOFING, INC. ; - BARRY CARNES " 30 ARROWHEAD FARM RD , w BOXFORD, MA 01921 T 1 <� Update Address and return card.Mark reason for change. Q Address ❑ Renewal ❑ Employment ❑ Lost Card SCA 1 Ci 20M-0"I _C\ The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ' I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 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 appropri ox: Type of project(required): I.❑ I am a employer with ❑✓ 1 a general contractor and I 6. ❑ New construction employees(full and/or part-time).* ave hired the sub-contractors 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' 9. ❑ Building addition [No workers' comp. insurance omp. insurance.$ required.] ❑✓ a are a corporation and its 10.❑ Electrical repairs or additions 3.❑ q ] officers have exercised their 1 L Plumbing repairs or additions I am a homeowner doing all work ❑ g P myself. [No workers' comp. right of exemption per MGL 12.❑✓ Roof repairs insurance required.] ' c. 152, §1(4),and we have no employees. [No workers' 131-1 Other comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance jar my employees. Below is the policy and job site 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. 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 f under the pains Tndpenafties of perjury that the information provided above is true and correct. Si nature: Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: FORM 153 The Commonwealth of Massachusetts APDIA Use OnI j Department of Industrial Accidents Office of Investigations -Dept. 153 - 1 Congress Street,Suite 100,Boston,Massachusetts 02114-2017 W' V,� http://www.mass.gov/dia Invest/SWOIID, -7?�nr`--1 y JCrt uF 1NLU,3rA1ALACuuLNM AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Chapter 169 of the Acts of 2002 amended M.G.L. c. 152, §1(4) by adding the following paragraph: "This chapter shall be elective for an officer or director of a corporation who owns at least 25 percent of the issued and outstanding stock of the corporation. Notwithstanding section 46, these provisions shall apply only if the corporate officer provides the commissioner of industrial accidents with a written waiver of his rights under this chapter. Said commissioner shall promulgate regulations to carry out the purpose of this paragraph. Violations of this paragraph shall subject the corporation to the penalties set forth in section 25C." Pursuant to M.G.L. c. 152, §1(4) as amended, I/We the undersigned officers of: AB CARNES ROOFING, INC. (Name of Corporation and Address) each holding at least 25% of the issued and outstanding stock in said corporation, do hereby invoke the right to be exempt from the provisions of M.G.L. c. 152, §25A and therefore are not required to carry a workers' compensation policy covering the undersigned corporate officer(s) or director(s). I/We the undersigned do also waive any and all rights to make claims for benefits as defined in M.G.L. c. 152 for any injuries that may be sustained while in the employ of the above-named corporation. Further, I/we the undersigned do understand that, should the above-named corporation hire or have in its employ any employee(s) in addition to the undersigned corporate officer(s) or director(s), said corporation is required to obtain workers' compensation coverage for the employee(s) as prescribed by M.G.L. c. 152, §25A. I/We the undersigned have read and understand the statements and obligations as delineated above and I/we have checked the appropriate box below my/our name(s) indicating my/our desire to be exempt or not to be cerrlpt f o the provisions of M.G.L. c. 152. 4��d under the sins and penalties of perjury: BARRY CARNES, PRESIDENT 09/24/2013 S Print Name&Title Date(mm/dd/yyyy) Q to exercise my right of exemption or ❑ 1 wish NOT to exercise my right of exemption o w r ANASTASIYA CARNES, DIRECTOR 09/24/2013 Signature Print Name&Title Date(mm/dd/yyyy)rV •Mgt Q I wish to exercise my right of exemption or I wish NOT to exercise my right of exemption y ry`'y n'I r r7 Signature Print Name&Title Date(mm/dd/yyyg I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption CID L? Signature Print Name&Title Date(mm/dd/yyyy) I wish to exercise my right of exemption or ❑ 1 wish NOT to exercise my right of exemption Note:ALL ELIGIBLE CORPORATE OFFICERS MUST SIGN. THERE CAN BE NO MORE THAN 4 SIGNATURES. Instructions on back. Form 153—7/2010 MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM The Commonwealth of Massachusetts Minimum Fee:$250.00 William Francis Galvin 4 Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Soecinl Filine Instructions 1 Telephone: (617) 727-9640Articles f it ofOrganization Chapter 156D, Section 2.02: 1 ip Federal Employer Identification Number: 001110484 (must 6e 9 digits) ; i, ARTICLE I I ! The exact name of the corporation is: i l AB CARNES ROOFING,INC. I 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: i COMMERCIAL &RESIDENTIAL ROOFING AND ROOFING RELATED WORK. THIS SHALL INCLUDE ALL TYPES EXTERIOR& 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. - I Par Value Per Share �~ Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par i of Organization or Amendments ¢ and Outstanding r I Num of Shares Total Par Value I Num of Shares i CNP 9 $0.00000 1,000 $0.00 { 1.000 t' 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. f i a ii 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 j preferences, voting powers, qualifications, and special or relative rights or privileges of that class and of each other ,l 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: t 1. ARTICLE VI f Other lawful provisions, and if there are no provisions,this article may be left blank. i i {i Note: The preceding six(6) articles are considered to be permanent and may be changed only by filing appropriate articles of amendment. i �i ARTICLE VII !: The effective date of organization and time the articles were received for filing if the articles are not rejected within the �# f: time prescribed by law. If a later effective date is desired, specify such date, which may not be later than the 90th day ; I'. after the articles are received for filing. ii I Later Effective Date: Time: f ARTICLE VIII I r The information contained in Article Vlll 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 i' 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 i officer or director is the same as the principal office location): Title Individual Name ----,.-�V Address (no PO Box) '— t # First,Middle,Last,Suffix Address,City or Town,State,Zip Code j 11 ��v PRESIDENT BARRY S CARNES 30 ARROWHEAD FARM RD g BOXFORD,MA 01921 USA 1 TREASURER 3 BARRY S CARNES y 30 ARROWHEAD FARM RD I t BOXFORD,MA 01921 USA f..._..,—Y_SECRETARV ANASTASIYA V CARNES f 30 ARROWHEAD FARM RD vu_� BOXFORD,MA 01921 USA —_ F DIRECTOR i BARRY S CARNES 30 ARROWHEAD FARM RD 7 'I BOXFORD,MA 01921 USA J{{ ���DIRECTOR t ANASTASIYA V CARNES 30 ARROWHEAD FARM RD j — 9 BOXFORD,MA 01921 USA � C 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): j No. and Street: 30 ARROWHEAD FARM RD i 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 iI Signed this 26 Day of June,2013 at 6:23:02 PM by the incorporator(s). (If an existing corporation is . acting as incorporator, type in the exact name of the business entity, the state or other jurisdiction where it was incorporated, the name of the person signing on behalf of said business entity and the title he/she holds or other authority by which such action is taken.) BARRY S CARNES O 2001 -2013 Commonwealth of Massachusetts �i All Rights Reserved N MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that, upon examination of this document, duly submitted to me, it appears that the provisions of the General Laws relative to corporations have been complied with, and I hereby approve said articles; and the filing fee having been paid, said articles are deemed to have been filed with me on: June 26, 2013 06:21 PM WILLIAM FRANCIS GALVIN Secretary of the Commonwealth Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-079875 1 vl Is n 1 DAVID E LAUR19 183 LISLE ST x y BRAWREE MR 02 • Expiration Commissioner 05/18/2015 o