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HomeMy WebLinkAboutBuilding Permit #450-15 - 100 OLD FARM ROAD 11/6/2014 Jt TOWN OF NORTH ANDOVER APPLICATION� FOR PLANEXAMINATION Permit NO: �I Date Received Date Issued: IMPORTANT: A licant must complete all items on this page LOCATION /D� f� ✓��✓�'�v�;/' Print PROPERTY OWNER d C� 3 Print 100 Year Old Structure yesCnoMAP NO: PARCEL:O� 2, ZONING DISTRICT: Historic District yeMachine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Re idential Non- Residential ❑ New Building AOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identificationease Type or Print Clearly) Q OWNER: Name: / ,-)Iti, J Phone: I Address: 11420 CONTRACTOR Name: G Phone:27114 Address: L� Gv ✓ � L3 a Supervisor's Construction License: ---3a Exp. Date:�_z l� Home Improvement License: �����-� Exp. Date:/b ' v `l � ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $19 Oar FEE: $ I, Check No.. Q Z� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have arStamped guara fund Signature of Agent/Owner Siglature of contracPlans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Plans17, ❑ -- i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming ❑ Tanning/Massage/Body Art ❑ _ g Pools R Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ s Private(septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i DATE REJECTED DATE APPROVED I PLANNING & DEVELOPMENT ❑ ❑ I i COMMENTS I CONSERVATION Reviewed on Signature t I COMMENTS ` HEALTH Reviewed on Signature COMMENTS ' A '`toning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .- Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tovv;� Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT =Temp Dumpster on site yes_. no Located at 124 Mair, Street Fire DepartmeiA signature/date r. COMMENTS i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— For department use FNotfified pickup - Date e Doc.Building Permit Revised 2010 — r I � Building Department i . The foll4swing is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofilag, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And j Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases.if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apn,,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location D v ! No. '"� Date . • TOWN OF NORTH ANDOVER ., Certificate of Occupancy $ .. Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check.#lnz Building Inspector NORT11 Town of �. : E : �� ¢ ndover Q No. 41a * � _ ) C h ver, Mass O LAKI COC MICM(WICK y�• �•9 A°R�rEo �`PP,��(5 S U BOARD OF HEALTH Food/Kitchen PER L D Septic System THISCERTIFIES THAT ....... .. ......,,.Wov�w.rJ BUILDING INSPECTOR CERT S ............ ..... ......................................... ........ has permission to erect .... buildings on 1 Foundation ................................................................... Rough to be occupied as .... ... ........ .... f Chimney provided that the person accethis ermit shall in eve respect conform to the terms of the application p p p g p rY Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MO S ELECTRICAL INSPECTOR UNLESS CONSTRU N TS Rough Service ......... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. i i 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: SCOTT BOWMAN Date November 1, 2014 100 OLD FARM RD Project Name SAME NORTH ANDOVER, MA 01845 Address 508-958-9697 We propose to furnish material and labor-in accordance with the�ecifications Wow Eighty Nine Hundred Dollars($9-,99GV0),' q r115 �X t> 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 ALL LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH THE UPGRADED TITANIUM UDL-25 PLUS HIGH PERFORMANCE SYNTHETIC 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. �E COVER ALL PERIMETERS WITH EIGHT INCH PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA RIDGE VENT AND/OR®THREE ROOF LOUVERS FOR ADDED ATTIC VENTILATION. tic31 il— 1-,, ® 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 CHIMNEY(S).CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY SEAL REGLET '�WARO DD$500.00 TO ABOVE PRICE. ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECTU LIFETIME NTY 240L6 SHINGLES. ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH 1 X8 SPRUCE BOA NNAL 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 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 ALL ROOF SECTIONS EXCLUDING SECTION"K"ON THE REAR SIDE OF THE HOUSE. CHIMNEY FLASHING:THIS SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS MAY OCCUR. NEW ADDITION:THE FLASHING WILL BE REMOVED.THE ICE AND WATER BARRIER WILL BE TURNED UP THE WALL.NEW FLASHING INSTALLED WARRANTY UPGR D THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 110 MPH TO 130 MPH WITH PGRADE TO THE CERTAINTEED HIS RFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YES EMAIL ADDRESS: QN d ��� F—� U i✓N 1 JE CzC Lev c-:K-% t�l�i� Po w cfn�z )'Ak 0_'J 1zQ11.9- C-5 (,6 Szcaa t= Z3 0 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 n>'ean ,you have accepted all the terms as stated on the front and back of this agreement. Please see reverse side. *Date of Acceptance lI Signature *Signature Signature PLEASE SEE REVERSE SIDE �— - The ComniQnwealth of Massachusetts FOR I Board of Buildiing Regulations and Standards MUNICIPALITY �tVV Massachusetts Mate Building Code, 780 CMR t1SE P Building Permit Application To Construct, Repair. Renovate Or Demolish a Revised alar 2011 One- or,Two-Fcnnih,Divelling This Section For Official Use Only Building Permit Number: Date Applied: 131.1ilding Official(Print Name) Signature -- Date SECT ON l: SiTE INFORMATION 1.1 Property Address: 11.2 Assessors Map& Parcel Numbers 1.1 a is this an accepted street?yes no flap Number fardel Number —� 1.3 Zoning Information: 1.4 Property Dimensions: 1, Zoning District Proposed Use - -~ ! Lot Area(sq t4) -- Frontage.(ft) - 1.5 Building Setbacks(ft) — Front Yard Side Yards Rear Pard Required Provided Required i Provided Required Provided 1.6 Water Supply: (M.G.1.c.40.§5-t) 1.7 Fjood Zone Information: 1.8 Sewage Disposal Svstem: Zone: Outside Flood/onc'? i Public❑ Private❑ check if vcs❑ Municipal ❑ On site disposal s\'titem ❑ I i SECTION PROPERTY OWNERSHIP' 2.1 Pwrierl of Rurd: i�ume(Print) City.State./11' r' o.and Street i elephone I,nwil Address SECTION 3: DESCRIPTi N OF PROPOSED WORK'(check all that apply) New Construction 17 Existing Building 10vvner-Occupied! - t Repairs(s) ❑ ; Alteration(s) ❑ I Addition ❑ j Demolition ❑ j Accessory Bide. ❑ ' Number oft:nits ! Other ❑ Spccii'v- Bricf Description of Proposed Work: SECTION 4: Ef TIMATED CONSTRUCTION COSTS Item Estimated Cost: Official Use Only(Labor and Materiftls) -- �' 1. Building Permit Fee: $ Indicate hove fee is determined: L Building S �+��a' - --t—' ❑ Standard City Town Application l=ee ,. Electrical $ 01 otal Project Cost'(Item 6)x multiplier —X __ . PlumbinI I $ i_.- 1 2. Other Fees: $ _ FF. Mechanical (I-IVAC) i $ 1 List:_ I ti. Mechanica-1 (1'i Su pression) Total All l=ees: $ _ l Check No. _ Check Amount: Cash Amount: i 6. 'i'otal Pro�cct Cost: q I $/,GLS)+ 0 Paid in Pull 0 Outstanding Balance Duc: -_— SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License:(CSL) l,iccrse?sumher F\piration I)atc � Name of CSI I lolclIr � I ist CSI. 1't pc(`l:e belot�) �✓�Y��� �� ]'`�c Dcscription No.and Street nreSIMIed(BUildings up to 37.000 cu. Il.) v Z ` ' t ami �Restricted Ix_ + rtv Tui+n. l-)��cllin t � State./iI' t 11 MasonrN =J RC-- -Rootin�Co%eriti J VS Willdoa and Si( ma t tit —' Solid Fuel Burning Appliances Telephone Lmail address - _ 1) 1 Demolition 5.2 Registered Home Improvement Contradtor(HIC) , a�✓ � ,? ) �n_.1'"_ !t_-/� -- IIiC Rea(stration\tcmher kxpiration Date t t�am Name or HIC Registrant Namc No. d Street j f Ismail address 1 A Cit_v'Town. State.ZI P 1 elcphone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152. § 25C(6)) Workers Compensation Insurance affidavit mint be completed and submitted with this application. Failure to provide j this affidavit will result in the denial of the issuance of the building permit. Si ned Affidavit Attached' Yes . .......... D SECTION 7a: OWNER (JTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR C NTRACTOR APPLIES FOR BUILDING PERMIT I.as Owner of the Subject property. hereby authorise to act on in-, behalf• in ali matter's relative to work authorized b) t,ik building permit application. � Hint t)«ri©s;Vtimc({;Iccirocic Signa�� SECTION 7b: OWNE ' 011 AUTHORIZED AGENT DECLARATION -�—I Bvl entering my name below. I hereby attest under the pains and penalties of pertury that all of the information j costar us application is true and acew-ale to the hest ofm\ knowicdoe and understanding. Pri Ottner's or, uthorired Agent's Namc(Flectroncc Signature) — I)atc NOTES: I. Ali Owner who obtains it building permit to do his,1icr•own work.or:nt owner t\ho hires an itnreaiste;red contractor i (not retiistered in the Hone Improvement Contractor(IiIC) 111-0-ram), w•iII trot have acceti+to thy arbitration program or guaranty fund under;NI.G.L. c; 1422. Othcr iu1Pol'tant inft),mation on the I(It Prorlrarr.can be tound at www.nt,t�s.�su� ocn Information on the Construction tiuparvisor License can he found at t����t nc,i„ :�c\ dl IN 2 When substantial �\ork is planned. providd the inIortttation below: Total floor arca(sq. ft.) _. _ _ _ (including gai'al,c. finished basemenuattics, decks or porch) Gross living area(sq. tt.) — _ Habitable room count _ Number of tircplaces _ Number of bedrooms Number of bathrooms Number of hall"baths _ Type of heating System ^-1 Number ot'decks torches _ i Type ofcooiino system - - -- Enclosed — open . `-----� 3 "Total Project Square Footage" may be substituted for"T01,11 Project Cost' -- -__ fit Massachusetts -Department of Public Safety Board of BuildiOg Regulations and Standards ConstrucOn Supen-isor License:)CS-000230 I BARRY S CAR S" 30 ARROWHE FARM RD _ Boxford MA 019 1 v-' Expiration Commis$ioner 03107/2016 y I �/Xf' � f����?l�?"l �it�rfllf'fi' 11 fJJ���( Office of Consumor Affairs and Business Regulation 10 Pork Plaza - Suite 51.70 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176928 Type: Corporation Expiration: 10/10/2015 Tr# 245633 AB CARNES ROOFING, INC. _ BARRY CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 Update Address and return card. Mark reason for change. j Address Renewal ` Employment Lost Card SCA 1 0 20WOS/11 TOWN OF NORTH ANDOVER 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: 11-5-2014 SIGNATURE OF APPLICANT: AS Carnes Roofing Premium Report November 3, 2014 19 Ridge Rd, Marblehead, MA 01945-2246 i I I i In this 3D model,facets appear as semi-transparent to reveal overhangs. ff � — 1 Report Details Roof Details Report Contents Report:9809622 Total Roof Area =2,518 sq ft Images.........................................1 Total Roof Facets =9 Length Diagram.............................4 Predominant Pitch =10/12 Pitch Diagram................................5 Number of Stories <=1 Area Diagram................................6 Total Ridges/Hips =78 ft Notes Diagram..............................7 Total Valleys =0 ft Report Summary...........................8 Total Rakes =196 ft Additional Property Information......9 Total Eaves =199 ft I Measurements provided by www.eacileview.com Contact: Barry Carnes j Company: AB Carnes Roofing � Certified Accurate I Address: 30 Arrowhead Farm Rd Boxford MA 01921 TEAGLoEMEw www.ea4leview.com/Guarantee.aspx Phone: 978-887-1431 This document is provided under License by EagleView Technologies to the requester for their Internal Use Only subject to the terms and conditions previously agreed to by the requestor when they registered for use of EagleView Technologies Services. It remains the property of EagleView Technologies and may be reproduced and distributed only within the requestor's company.Any reproduction or distribution to anyone outside of the requestor's company without EagleView's prior written permission is strictly prohibited.All aspects and handling of this report are subject to the Terms and Conditions previously agreed to by the requestor. Copyright @ 2008-2014 EagleView Technologies,Inc.—All Rights Reserved—Covered by U.S.Patent Nos.8,078,436;8,145,578;8,170,840;8,209,152; 8,515,125.Other Patents Pending. ® DATE(MMIDDNYYY) ACRO CERTIFICATE OF LIABILITY INSURANCE 9/26/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 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 11 ISURED, the policy(les) 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). CONT PRODUCER NAMEACT Commercial Lines Harris-Murtagh Insurance Agency,Inc. PHONE (978)532-2844 FAx c 30 Central Street EMAIL INSURERS AFFORDING COVERAGE NAIC p ]? y 01960INSURERA-Western World Insurance Co INSURED INSURER B: Barry Carnes, DBA: AB Carnes Roofing, I INSURERC: 30 Arrowhead Farm Rd INSURER D: INSURER E: Boxford MA 01.921 INSURER F COVERAGES-'— , CERTIFICATE NUMBER CL1492319366 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. rA POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE P LICY NUMBER ! GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000 DAMAGE TO RENI ED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ J 100,000 CLAIMS-MADE -1 OCCUR PP13721 10/11/2014 10/11/2015 MED EXP(Any one person) $ 5,0000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,000 }{ POLICY PRO LOC $ ACOMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accadent) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS (per,cadent P $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION OR LIMITTATU' CTH• AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $ _ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,A JdItIonal Remarks Schedule,If more space Is required) CERTIFICAT CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood Street North Andover, MA 0184 AUTHORIZED REPRESENTATIVE J S Scholnick/SJG ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. INS025(201005),01 The ACORD na a and logo are registered marks of ACORD a CERTIFICATE OF LIABILITY INSURANCE 010-28-2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF NNFORMATION 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 CER FICATE 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(les)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 NAME ACE INS SERVICES INC PHONE. FAX - 675 WARREN AVE N EMAIL BROCKTON,MA 02301 INSURER(S)AFFORDING COVERAGE NAIL n INSURER A AMERICAN AIRICH NVSl1RAN.F COMPANY INSURED INSURER H / APC CONSTRUCTION INC INSURER C 51 FORD STREET UNIT 1 BROCKTON,MA 02301 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMIJER4 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 RESPE T TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TILE INSURANCE AFFORDED BY THE POLICIES DESPRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUB POLICY EFF POUCY EXP LTR TYPE OF B/SIIRANCE INSR WvD P�LKYNUMBER MMOYYYYY MWDD/WW LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED S R IEa Occurnprice) ICI AIMS.MAr)F OCCUR MED EXP(Any nnc ooreon) S PERSONAL 6 ADV INJURY S GENERAL AGGREGATE S GENX AGGREGATE LIMIT APPLIES PER PRODUCTS s;UMP'UP AGQ S POLICY JEC LOC S OM08iLE LIABILITY ml OM91NE0 SINGI.E LIMIT S ar rk ANY AUTO BODILY INJURY(Pm poreon) S ALL SCHEDULED AUTOS OWNED AUTOS 80011 Y INJURY(Per Ac61innU S HIRED AUTOS AUTOS I TOPER^Y AMAGF" S AUTOS S UM hACH OCCURRENCE S XCESS UAB CLAIMS MADE AGER 'ATE S QEq I RETENTION S S WORKERS COMPENSATION X WC 5 rA U I H AND EMPLOYERS'UABILITY TORY LII 5 ER ANY PROPRIETOR/PARTNERIEXECUTIV YIN N/A E L EACH ACCIC)r'NT $1,000.000 0FFICFR/MFMRFRFXCIII171171719 6Z( UB 10-22-2014 10-22-2015 F T (Mandatory m NH) 2%52818A )ISI'Afi'F {'n rMPI nvrT $1,000,000 11 yes,destnbe under DESCRIPTION OF OPERATIONS below i E L UIStAStr POLICY UMII $1,000,000 DESCRIPTK7N(FOPERATMS I LOCAT"OI VEHICLES 1Alt+kh AQOftp 101,AdmNNonal Remarks Schedt4sr,H more space Is required) CANCELLATION AB CARNES ROOFING INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 30 ARROWHEAD FARM ROAD CANCELLED BEFORE THE EXPIRATION DATE THEREOF, BOXFORD,MA 01921 -� NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE (g)1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD MA SOC Filing Number: 201499735200 Date: 10/21/2014 1:24:00 PM The Commonwealth of Massachusetts Minimum Fee:5250.410 t William Francis Galvin Secretary of the Commonwealth, Corporations Division + One Ashburton Place, 17th floor Boston, MA 02108-1512 ' Telephone: (017) 727-9040 09G I'ar-M(§AIWW •o,ftkw 9 VA 411)Chi'311 U M) j Federal Employer Identification Number: 00 1149988 (must be 9 digits) ARTICLE I The exact name of the corporation is: A P 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: CONS"I-RUCTION RE-MODELLING AND O"rNER OT TIER SERVICES PERTAINING TO CONSTRU C'rION WORK ARTICLE III State the total number of shares and par values if any, of each class of stock that the corporation is authorized to issue. All corporations must authorize stock. Iflonly 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 Vum n/Shure.s Toial Por I'ulue Num ul shurr% CNP $0.00000 20.000 $0.00 0 G.L. C156D eliminates the concept of par value, however a corporation may specify par value in Article III. See G.L. C156D Section 6.21 and the comments thereto. ARTICLE IV If more than one class of stock is authorized, state a distinguishing designation for each class. Prior to the issuance of any shares of a class, if shares of another clads are outstanding, the Business Entity must provide a description of the preferences, voting powers, qualifications, and;special or relative rights or privileges of that class and of each other class of which shares are outstanding and of each series then established within any class. ARTICLE V The restrictions, if any, imposed by the Articles of Organization upon the transfer of shares of stock of any class are: ARTICLE VI Other lawful provisions, and if there are no provisions,this article may be left blank. Note: The preceding six (6) articles are considered to be permanent and may be changed only by filing appropriate articles of amendment. ARTICLE VII The effective date of organization and time the articles were received for filing if the articles are not rejected within the time prescribed by law. If a later effective date Is desired, specify such date, which may not be later than the 90th day after the articles are received for filing. Later Effective Date: Time: ARTICLE VIII The information contained in Articl$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: ANGELO PINGUIL No. and Street: S 1 FOR I) STREEt UNIT I City or Town: BROOK"I'OPN State: MA Zip: 0230I C'tlunu'}: USA c. The names and street addresses of the individuals who will serve as the initial directors, president, treasurer and secretary of the corporation Ian address need not be specified if the business address of the officer or director is the same as the principal office location): Title Individual Name Address Ino PO Box) First,Middle,Lost,Suffix Address,City or Town.State.Zip Code PRESIDENT ANGELO PINGUIL 51 FORD STREET BROCKTON.MA 02301 USA TREASURER ANGELO PINGUIL 51 FORD STREET BROCKTON MA 02301 USA SECRETARY ANGELO PINGUIL 51 FORD STREET BROCKTON MA 02301 USA DIRECTOR ANGELO PINGUIL b1 FORD STREET BROCKTON.MA 02301 USA d. The fiscal year end (i.e., tax year) of theicorporation: December e. A brief description of the type of business in which the corporation intends to engage: C'ONS'CRUCTION AND RE-MODELLING f.The street address(post office boxes are not acceptable) of the principal office of the corporation: No. and Street: SI FORD S"I'RFE11' City or Town: BR0C'K"l'0N 1 State: MA Zip. 0230I ('uuntrv: USA g. Street address where the records of thei corporation required to be kept in the Commonwealth are v located (post office boxes are not acceptabile): No. and Street: 51 FORD STREET City or Town: BROCKTON State: MA Zip 02301 C u nvv: LISA which is X its principal office — an office of Its transfer agent an office of its secretary/assistant secretary _ Its registered office Signed this 21 Day of October,2014 at 11:26:45 PM b-s. the incorporator(s). 11/un e.riSti'W rnlPlr(Itiull is acting us incur .j)orutor. tl'pe in the exact 11.(117le o the business entity. I/IC.ctulc 01'01/70-fin'LSdiCIii)i7 11410-C it was incnll)orute(I. the nulne o0he person si ming on hchulrol sui(l husincss entity(110 the title he/she holds or other authority hr which such action is taken.) ANGF'L01'INGUIL w 2001 -2014 Commonwealth of Massachusetts All Rights Reserved MA SOC Filing Number: 201499735200 Date: 10/21/2014 1:24:00 PM THE COMMONWEALT14 OF MASSACHUSETTS I hereby certify that, upon gaminotion of this document. duly submitted to mc, it appears that the provisions of'thc General Laws relative to cog-wrations have been complied with. and I hereby approve said article:;, and the tiling fce having been paid, said articles arc deemed to have been filed with me on: October 21, 2014 01:24 PM t WILLIAM FRANCIS GALVIN Sect'c^/my ujthc C'oininomi-vollh The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 - Boston, MA 02114-2017 ��.'•`,11"x= }s. wwxv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/]ndividual): 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): Ln 1 am a em loyer with 2 1 1 a general contractor and I p 6. ❑ New construction � employees(full and/or part-time).* lave 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.] e are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their i 1.❑ Plumbing repairs or additions right of exemption per MGL myself. �No workers' comp. 12.Z Root repairs insurance required.]+ c. 152, §I(4),and we have no l3.❑ Other employees. [No workers' _ comp. insurance required.] *Any applicant that checks box#t must also till out the section beitm sho\\ing their\\orkers'compensation policy inlirrntauon. t Homeowners Who Submit this effidav it indicating lite) are doing all\cork and then hire outside contractors must suhnnt a neµat'tidavit indrealing such. Contractors that check this box must attached an additional sheet showing the name of the sob-contractors and state whether or not those entities have employees. If the sub-contractors have employees.the\ must iprovide their \corkers'comp,polis\ numher. I ant an emplgver that is providing workers'conipensation insurancefir n7i'eniphvees. Below is the policv and fob site information. insurance Company Name: - Policv#or Self-ins. Lic. #: _ ________ Expiration Date: .lob Site Address: CityiStatc/lip:___ _ 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. l do herebi' ' r r under the cains indpenaltie. of er'ury that lite inforntation provided above is true and correct. 4. Si mature: � .r" Date Phone 4: 9 1 Official use only. Do not write in this area,to he completed by city or Ir»rn official. Citv or Town: Permit/License# I ssuinghority(circle one): Health 2. Building Department 3.City/Town Clerk 4. Electrical inspector 5. Plumbing Inspector son: Phone#: FORM 153 The Commonwealth of Massachusetts i)IA Use Only ;�. Department of Industrial Accidents i h Office of Investigations - Dept. 153 =t t• I Congress Street,Suite 100• Boston.Massachusetts 02114-2017 '•' http://v%,m,,A-.imass.gov/dia v �Y AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Chapter 169 of fhe Acts of'2002 cane tded Al G.L. c. 152• §1(41) hY uddin4q 1he.fo110vrtng puragruph: "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. Sitid 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 ol' 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 clairns for benefits as defined in M.G.L. c. 152 for anv 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 employce(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. 1/We the undersigned have read and understand the statements and obligations as delineated alcove 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 i the provisions of M.G.L. c. 152. gged under the ains and penalties of perjury: BARRY CARNES, PRESIDENT 09/24/2013 N Print Name&l itle Date(nmr'd(V t y\1 ✓❑ I tt•ish to exercise my richt ofexemption or ❑ i tvish NOT to exercise im right o1•exemption c ANASTASiYA CARNES. DIRECTOR 09/24/2013 Shmature )Tint Name K Title Date(nun%ddr\ Itx'Ir ❑✓ Li-\%ish to exercise my right ofe,xrmhtion or ❑ I wish NOT to eNercise mt right of e\emptiun C`r Signautre Print Namc& Title I tush to exercise my right ofexemption or ElI-,fish NOT to exercise m �em } right ol�eption F-1 r•� tiignature print Name K I iUr Date(11111% • MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM The Commonwealth of Massachusetts Minimum Fee:$250.00 William Francis Galvin Secretary of the Commonwealth, Corporations Division Ong Ashburton Place, 17th Iloor Boston, MA 02108-1512 Special Filin-Instruction, Telephone: (617) 727-9640 Federal Employer Identification Number: 00 1110484 (must be 9 digits) ARTICLE I The exact name of the corporation is: ABI CARNES ROOFING, 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: COMMERCIAL &RESIDENTIAL RQQFING AND ROOFING RELATED WORK. -1-1IIS SHALL INCLUDE ALL TYPES EXTERIOR & II TER10R 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 SIN71()/.Short's Total Par I'ui714' Num o(shures { 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 trach 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 tater 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 Counu-V: USA c. The names and street addresses of the lindividuals who will serve as the initial directors, president, treasurer and secretary of the corporationj(an address need not be specified if the business address of the officer or director is the same as the principal office location): Title Individual Name Address Ino PO Box) FirsQ Middle.Last,Suffix Address,City or Town,State.Zip Code PRESIDENT BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD.MAO 1921 USA TREASURER BARRY S CARNES 30 ARROWHEAD FARM RD BOXFORD,MA 01921 USA SECRETARY ANAS,TASIYA 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 ROOTING f. The street address (post office boxes are not acceptable)of the principal office of the corporation: No. and Street: 30 ARROWHF41D FARM RD City or Town: BOXFORD State: IN1A Zip: 011921 Country: USA g. Street address where the records of the corporation required to be kept in the Commonwealth are located (post office boxes are not acceptable): No. and Street: 30 ARROAHEAD FARM RD City or Town: BOXFOR[) 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 Dar of.lune, 2013 at 6:23:02 PM by the incorporator(s). (1f an existing c ot-Imi-aticm is claing as incol-poraloi% type in the excict Mime o the htisutess entity. the.state or other Im-isdirtion wheiv it wvs ineoi pirated. the nanie of'the pei-su)n signh g on hehcilJ(; said husiness entity rind the title he/she holds nr whet-authol-itr br which such ciction is taken.) BARRY S CARNES 2001 -2013 Commonwealth of Massachusetts All Rights Reserved 0 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 mc, it appears that the provisions of the General Laws relative to corporations have been complied with, and I hereby approve said articim and the filing fee having been paid, said articles are dcemedl to have been filed with me on: June 26, 2013 06:21 PM WILLIAM FRANCIS CALVIN Secrelen,t,of`Ihc C oninionweullh