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Building Permit #827-14 - 30 HOLLY RIDGE ROAD 5/20/2014
i. V TOWN OF NORTH ANDOVER j APPLICATION FOR PLAN EXAMINATION r - Permit NO: Date Received i Date Issued: t IMPORTANT: Applicant must complete all items on this page �. LOGATIONt IV �PR`OPERTY ®WIVER 100yYea.� OIdSttucturew yes no �PA'RCEL" ZO.NINGiRI$TRI .T �HistonciDistrlct es no op Village yes 4Mach .TYPE OF IMPROVEMENT PROPOSED USE OWNER: Name: e Residential Non- Residential ❑ New BuildingOne family Address: ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑-Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ©• Phone ❑ Septic ❑xlNell = -❑ N Floodplain Wetlands 1IVa d� tnct� nr t ��is ❑A ershe D ❑Water/.Sewer _ . , _ _ __r r DESCRIPTION OF VVUKK I U tit 1-tK1-UM1V1t:u: Identification Please Type or Print Clearly) OWNER: Name: e A, 101,6 ab 0 Phone: 32- 7.6 Address: % CONTRACTORarName.. ©• Phone Address f1�d (.F��? b�C J-�lr�✓ Superryis�or's;Constructlon ;License m Exp Date ,�' t. = - r ----- - HnmP 1m-nrnvemerif Licenge _/'`7 �;..9 =Z- . _ _ _- Exp `Date;/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ ZLe FEE: $ Check No.: 3(p 6- Receipt No.: 2-1 NOTE: Persons contracting with unregistered contractors do not have acre a gu °anty fund Ki 6-7 Slg afure"of'iit ractor Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑.: ..;.:Certified Plot Plan ❑ Stamped Plans ❑ ;TYP)J OI :.SEWERAGE"DISP_OSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco Sales 0 :Food Packaging/Sales ❑ Private (septic tank, etc-_ -❑. - -Permanent Dempster on Site ❑ THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF'- U FORM ._r:.. -DATE REJECTED: PLANNING & DEVELOPMENT COMMENTS DATE :APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning 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 Tow;, Engineer: Signature: Located 384 Osgood Street FIRE -DEPARTMENT .Temp'Dumpster on site yes no Located 6t.124air, Street Fire Dep artrne►itasignaturelate COMMENTS :... . R •,.. it' .,F..... 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 j ®ANGER ZONE LITERATURE: -Yes No MGL-.Chapter166.Section 21A—F and G min.$100=$1000.:fine Doc.Building Permit Revised 2010 Building Department - The fol; -)wing is'a=1ist of the re quired.forms to be filled out for:the appropriate:permit to'.be obtained. R.00fivg, Siding, Interior Rehabilitation Permits o Building Permit Application o 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) o Mass check Energy Compliance Report (If Applicable) ❑ 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products MOTE: 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 apo•�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.BuiHing Permit Revised 2012 Location "`� ` O � �21 0- , No. z r — Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other. Permit Fee TOTAL 3 0 H J 2 LL O m N L Y \ O O LL Y T N U Q N V1 _ O0 V LLI N z Z m c .2 m "O 7 O LL L O � N G L U co LL W N Z mW U J O. L m OO cr ro LL O W w Z W J LU L bo O C' U ` v N mj 11 W O V d Z H L O w _ m LL z W a o uiV LL Ql 7 m Z ++ v �, N N 0 N Y O N O z m W z U) LLIuj G a O W a z z 0 a U) O c z V N W z I_. i H E z y .E L a� t ^0 'W V cu a. tv .U) r_ V cc cc CLU) w L N L mm 0s 00 O C^^ �.L C Q i. r Cc M J 'N Z AA, W N Proposa 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: MIKE & GINA RIBAUDO Date April 16, 2014 30 HOLLY RIDGE RD Project Name SAME NORTH ANDOVER, MA 01845 Address 978-376-4476 We propose to furnish material and labor- in accordance with the specifications below: Thirteen Thousand Eight Hundred Thirty Five Dollars ($13,835.00) Payment to be made as follow ' e osit, Balance Upon Completion Notice: All home improvement contractors an 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 tc the Mass.gov/licenses website. ,ROOFPROPOSAL. ® STRIP ROOF OF ALL 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 CHIMNEYS) AND SKYLIGHT CURBS UNDER THE FLASHINGS WITH SAME. ® COVER ALL PERIMETERS WITH EIG NC , PREFORMED ALUMINUM DRIP EDGE. ® INSTALL GAF COBRA RIDGE VEN AND R,La ROOF LOUVERS FOR ADDED ATTIC VENTILATION.h VP 0,00 Poi ® 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 TWO CHIMNEY(S), CUT NEW REGLET WITH CARBIDE: SAW AND SECURE NEW LEAD FLASHING IN PLACE WITH METAL ANCHORS. PROPERLY SEAL REGLE t ADD $650.00 TO ABOVE PRICE} ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECT L LIFETIME _U.ARRANTY 240LB SHINGLES. 0b Lw L ® REPLACE DEFECTIVE ROOF DECK AS NEEDED WITH CDX PLYWOOD AT-ATA'DDr-10COST OF$4.00PSQF T . ❑ COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING, AT AN ADDITIONAL COST OF ® STORM NAILING: (HURRICANE NAILING) SECURE SHINGLES WITH SIX NAILS AS THIS IS CODE IN ESSEX COUNTY. ® 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 $15:00 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 MINOF, DAMAGE COULD OCCUR. SPECIAL INSTRUCTIONS: THE ABOVE PROPOSAL INCLUDES:ALL_ROOF SECTIONS: CHIMNEY FLASHING: NEW FLASHING -AS. PROPOSED ABOVEMAY'NOT 'NEED. TQ BE.REPLACE HOW VER IF IT IS DEG ERMIN THAT THE FLASHING MAY NOT BE SUITABLE WE WILL REPLACE IT:, f -g; , 1lulU "3'V' �o t� f c' 11- !,�° {� aLVdrvcVf r SKYLIGHTS: WE RECOMMEND REPLACING SKYLIGHTS WITH A NEW ROOF. INSTALLATION. SKYLIGHTS TAKE THE SAME ABUSE FROM THE WEATHER AS THE ROOF SHINGLES. THERE IS NO INSTALLATION FEE WITH THIS WORK. PLEASE SEE AB OV �X X. to r-fr{ctu_ Au WARRANTY UPGRADE: THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FRDM 110 MPH T0130 M 1TWAN UPGRA`DiiE TO THE CERTAINTEED HIGH PE'12FORMANCE HIP & RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE. YES EMAIL ADDRESS: I �� 1C t;ti.5�✓ ��� Warranty: All 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 underfedera! 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 reiating to this proposal shall be settled by arbitration. This forum is user friendly and does not require lawyers. Please see reverse side. ou Have accepted all the terms as stated on the front and back of this agreement. Please see reverse side. Sighing this Proposal.ineans,py *Date of Acceptance €, Signature J *Signature `��/� Signature r �` PLEASE SEE REVERSE SIDE , Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS -000230 BARRY S CARNE5 30 ARROWHEAlJFAR1V[R�D C Boxford MA 01911 ' r Expiration Commissioner 03/07/2016 al d1t Office of Consumer Affairs and Business Regulation _ t7 10 Park Plaza - Suite 5170 Boston, Massachusetts 021.16 Home Improvement Contractor Registration Registration: 176928 Type: Corporation Expiration: 10/10/2015 Tr# 245633 AB CARNES ROOFING, INC. BARRY CARNES=Y ='- 30 ARROWHEAD FARM RD - BOXFORD, MA 01921 _-�; -, -- ---- - -- - ___-- Update Address and return card. Mark reason for change. _ Address i Renewal (_-1 Emplovment `i Lost Card SCA 1 0 20M-05111 A� o® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 11/4/2013 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(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 Harris -Murtagh Insurance Agency,InC. 30 Central Street Peabod MA 01960 CONTACT Commercial Lines NAME: PHONEO.. (978)532-2844 ac No: E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A Western World Insurance CO JASUREDINSURER AB Carnes Roofing, Inc 30 Arrowhead Farm Rd Bo'XZ,, 1921 B: INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:CL1311417584 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 LTR TYPE OF INSURANCE WV POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_x] OCCUR NPP137217 0/11/2013 0/11/2014 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITYCOMB ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED ED HIRED AUTOS AUTOS INE D SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAR EXCESS LIAB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, descr be under DESCRIPTION OF OPERATIONS below N / A WC STATU- I OTH- TORY LIMITS _EE_ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) GEKTIFIGA Town of North Andover 1600 Osgood Street North Andover, MA 01845 ACORD 25 (2010/06) INS025 /gmnn,,i m SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J S Scholnick/PJR Iia` U 99139 -Zulu AGUKD GUKNUKA I JUN. All rights reserVea. Tho Annion namo and Innn aro ronicfororl mnrlrc of Ar:nRn 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: 5-18-2014 SIGNATURE OF APPLICANT: The Commonwealth of Massachusetts Print For Department of Industrial Accidents —r' 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 Lellibly Name (Business/Organization/individual): AB CARNES ROOFING, INC. Address:30 ARROWHEAD FARM RD BOXFORD, MA 01921 Are you an employer? Check the appr 1. ❑ 1 am a employer with employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t Phone 4:978-887-1431 r4. 01/a general contractor and I lave hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' trip. insurance.• _. ❑✓ e are a corporation and its fficers have exercised their right of exemption per MGL c. 152_ j 1(4), and we have no employees. [No workers comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ✓❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 1.❑ Plumbing_ repairs or additions 12.❑✓ Roof repairs 13.❑ Other "Any applicant that checks box ; I must also fill out the section below showing their workers' compensation policy information. f I-lonteowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aniclavit indicatine such. ♦Contractors that check this box must attached an additional sheet showing the name ofthe sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees. they nwst provide their workers' comp. policy number. ant an emplgver that is providing workers' compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: Policy "I or Self -ins. Lie. 9: .lob Site Address: Expiration Date: 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 line 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 5250.00 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 Lerr,6 under the pains nd penalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to he completed by ciA. - or town a ial. City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 6. Other Permit/License # 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: FORM 153 The Commonwealth of Massachusetts, DiA use Only Department of Industrial Accidents :,ice=rb_,74 Office of Investigations - Dept. 153 ' 4 1 Congress Street, Suite 100, Boston, Massachusetts 02114-2017 h"p://www.mass.gov/dia invest.lS�VO'.IfJ #:. ? `Q r r AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE-- OFFICERS OR DIRECTORS Chapter 169 of the ,Mets of 2002 amended IVLG.L. c. 152, §/ 1 y adding the lbll014'ing par'agr-aph: "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 put -pose 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 enlployee(s) in addition to the undersigned corporate officer(s) or director(s), said corporation is required to obtain workers' compensation coverage for the emplovee(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 exempt frim the provisions of M.G.L. c. 152. under the,{ains and penalties of perjury: BARRY CARNES, PRESIDENT 09/24/2013 r,•. Print Name &'ritic X� ish to exercise my right of exemption or ❑ i wish NOT to exercise my right of exemption rul-11 __ ANASTASIYA CARNES, DIRECTOR Signature Print Name & Title ❑✓ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my ri0ht of exemption Signature Print Name & Title ❑ I wish to exercise my right of exemption or F]f wish NOT to exercise. my richt of exemption Sienature Print Naine & Title ❑ I v+ ish to exercise my right of exemption or ❑ i wish ;NOT to exercise my right of exemption Date (mm/dd/yyvy') �r 09/24/2013 Date (mm/dd/yyyy)r\) Date tmrnkid!yyyg ` C Date (nnn/dd/yvy\) Note: ALL ELIGIBLE CORPORATE OFFICERS MUST SiGN. rHF,RE CAN BF, NO MORE liiAN 4 SIGNAIliRLS. Instructions on bock. Form I >3 — 7/2010 MA SOC Filing Number: 201340178570 Date: 6/26/2013 6:21:00 PM The Commonwealth of Massachusetts Minimum Fee: 5250.00 William Francis Galvin Secretary of the Commonwealth. Corporations Division One Ashburton Place, 17th floor f r Boston, IMA 02108-1512 Special Filing instructions Telephone: (617) 727-9640 Federal Employer Identification Number: 001110484 (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. C156D have the purpose of engaging in any lawful business. Please specify if you want a more limited purpose: COMMERCIAL & RESIDENTIA.L ROOFING AND ROOFING RELATED WORK. THIS SHALL INCLUDE ALL TYPES EXTERIOR & INTERIOR REMODELING ARTICLE 111 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 Nun? o/ :Shares Ketal Par l Olue Nana o/ Sharer CNP 50.00000 1,000 $0.00 1,000 G.L. C156D eliminates the concept of par value, however a corporation may specify par value in Article III. See G.L. C156D 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 Vlll 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 Countrv: 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. Citv or Town. 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. MA 01921 USA DIRECTOR ANASTASIYA V CARNES 30 ARROWHEAD FARM RD BOXFORD, MA 01921 USA d. The fiscal year end (i.e., tax year) of the corporation: October e. A brief description of the type of 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): No. and Street: City or Town: which is X its principal office 30 ARROWHEAD FARM RD BOXFORD State: MA Zip: 01921 Country: USA an office of its secretary/assistant secretary _ an office of its transfer agent its registered office Signed this 26 Day of June, 2013 at 6:23:02 PM by the incorporator(s). (# 'on e_xhoii,g corporation is acting as incog7orator, type in the exact name of the business entity, the state or other jurisdiction i hel-e it was incorporated, the name of the person signing on hehalf of said husiness entit11 and the title he%shc: holds or other authority by which such action is taken.) BARRY S CARNES C 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 1 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 Secretor}, of'the Commomivolth CERTIFICATE OF LIABILITY INSURANCE DATE 4/15120iDDNYYY, 4/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR 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 Ace Insurance Services Inc CONTACT NAME. Berkley Assigned Risk Services 675 Warren Ave A No. Ext): (800) 634-4589 FAX No.): 866 215-8118 Brockton, MA 02301 ao6ResS Polic Services berkle risk.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Acadia Insurance Co. 31325 }I5URED / 1 American Construction Inc INSURER B: INSURER C: 242 Belmont Street Unit 2 INSURER D: Brockton, MA 02301 INSURER E INSURER F: DAMAGE TO RENTED PREMISES (Ea occurrence)$ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM!DDIYYYY) POLICY EXP (MMIDDtYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurrence)$ ❑CLAIMS -MADE ❑ OCCUR ❑ ❑ MED EXP (Any oneperson) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT .APPLIES PER: PRODUCTS— COMP;OP AGG $ 1:1PRO- POLICY JECT1:1 LOC $ AUTOMOBILE LIABILITY ❑ ❑ MINED IN LE LIMI $ (Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY JPer accident) $ ALL OWNED❑ SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE 'Pe; accident) $ ❑ $ UMBRELLA LIAB ❑ OCCUR ❑ ❑ EACH OCCURRENCE $ EXCESS LIAB ❑ CLAIMS -MADE AGGREGATE S DED ❑ RETENTION $ S .A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE © OFFIC&MEMBEREXCLUDED? (Mandatory in NH) NIA ❑ WC -20-20-004717-01 04/24/2014 04/24/2015 WC STA.TU- OTH- TORY LIMITS ER E.L EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 ❑ ❑ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Election Category Election Status Name All Entities/Insureds: Officer Include Manuel 3 Lema Caguana 1 American Construction Inc CER-TIFICATE HOLDER \ / CANCELLATION AB Carnes Roofing, Inc. 30 Arrowhead Farm Rd Boxford, MA 01921 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. nature: ACORD 25 (2010/05) BRAC 3139 .�, MA SOC Filing Number: 201316881130 Date: 4/23/2013 10:36:00 AM tit. ,jr The Commonwealth of Massachusetts Minimum Fee: $250.00 William Francis Galvin Secretary of the Commonwealth. Corporations Division One Ashburton Place, 17th floor -I51 Special FilinC Instructions Boston., MA 02108 Telephone: (617) 727-9640 Federal Employer Identification Number: 001.095338 (must be 9 digits) ARTICLE 1 The exact name of the corporation is: I AMERICAN CONSTRUCTION INC ARTICLE 11 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 ri'um of Shares Total Par Falae- A4.1117 c>/'Shares CNP 50.00000 20.000 $0.00 20.000 G.L. C156D eliminates the concept of par value. however a corporation may specify par value in Article III. See G.L. 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 Vlll 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: MA 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). (lf arr existing co:I)orcalion is acting as incorporator, tbe in the G'a"aet naine o the business entitY, the Slate or other jurisdiction M -l' ere it vv(.'ts incorporated. the naive of the person stgning on hehalfof Sciid business enlllb and the title helshe holds or other author-itv hi, which such action is taken.) MANUEL LE.y1A CAGUANA Q 2001 - 2013 Commonwealth of Massachusetts All Rights Reserved dam° MA SOC Filing Number: 201316881130 Date: 4/23/2013 10:36:00 AM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that, upon examination of this document, duly submitted to me, it appears that the provisions of the 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 Secrretai-; of the C0177 zaorl41'ealth