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HomeMy WebLinkAboutBuilding Permit #148-14 - 429 MARBLERIDGE ROAD 5/1/2018 w. \ OORTH 1 `� BUILDING PERMIT 06`t`eD TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit N0: y Date Received oN*rap 0,1 c3 ACH SSUS��� Date Issued: ' IMPORTANT: Applicant must complete all items on this page LOCATION Pr t c �� PROPERTY OWNER L �d Q r^r� " YI GN Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration I No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0,Water/Sewer Identification Please Type or Print Clearly) i OWNER: Name: tie w,,, J 2,A 11.APhone: 7 6 66' Address: CONTRACTOR Name: Phone ;)s -g '7 -/ CI ...i Address: ol a� Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Dater 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: $ / Z-a '� y L) FEE: $ /W,- 00 Check No.: Receipt No.: .6 NOTE: Persons contracti rt unregi ered contractors do not have accr;�aranty and Srgna#ure of Agent/Own .: ature of contracto e - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION._.__ - ` - - Print PROPERTY OWNER..-_ - - x Print 100 Year Old Structure yes no MAP NO: - PARCEL. ZONING DISTRICT: _ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Ei Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR' Name: . Phone: Address: _._. Supervisor's Construction License _ _ _ Exp. Date: - Home Improvement License: _ _ Exp. Date: _ _ 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �Signatuie of Agent/Ovvner Sidnature,of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses D Copy of Contract o Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to Issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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) a Building Permit Application u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) La Copy of Contract Li Mass check Energy Compliance Report u 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 apw 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.Building Permit Revised 2012 a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL } Public Sewer ❑ Tanning/Massage/Body Art ❑ .. Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food Packaging/Sales El Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sevier Connection/SDriveway Permit DPW'Tow;: Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes- no Located at'124 Mair, Street ; Fire Department-signature/date ' COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: F 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 de artment use I a I i El Notified for pickup - Date Doc.Building Permit Revised 2010 1� i r Location 7 No. /4/ Date r o • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ t' Building/Frame Permit Fee r� ':3 ;F Foundation Permit Fee $ Other Permit Fee $ 1S TOTAL $ Check# ` 1 17 w 26736 �`uilding Inspector r1ORTH Town Of o - to No. �_T = "- p Z h ver, Mass O LAN• � C0C"1CNEWI[11 %�' 7.4 q°�Areo ►P�,��(5 S U BOARD OF HEALTH Food/Kitchen PERMIT- -T, LD Septic System ��G/`r G�'� ' BUILDING INSPECTOR THIS CERTIFIES THAT ..... .. .........Y... ......... .......�.......�............................................................... p g f� /� �� �r� Foundation has permission to erect .......................... buildings ...�� .................1 .. .�.......`/- .... . .. ...... .................... Rough tobe occupied as ................. ............................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ..............�.... .rr��r.-4G��. .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE Massachusetts Workers' Compensation insurance Plan Acacia Insurance Companv NCCI Carn e-Cote 3339- Berkley AdminiStered by Berkley Ass oned Risk Services C'0 Box 1100 rv4inneaoohs Minnesota 55440.1 100 Phone 505;945-2144 Fax 865-215-81'15 Toll Free t8CCi 53--,1589 ..Avv"bery levassionedrisk, co—_ CERTIFICATE OF INSURANCE —0e InsurQd.--�_ J WCIP Doiic,.f "vuri'r WC-20-20-00471%-00 1 American Construction Inc 'az 15V F 46-1868194 242 Belmont Street Unit 2 Brockton. MA 02301 v� Folicv Period From 412412013 a 412412014 Date of I'%lailin,a 51312013 Certificate is issued as a matter of information onl ano confers no rionts upon the Cerif�cate Holaer e ., y _ a T h s Certificate does not amend extend or alter the coverage afforded by the policy listed below , for. ,c ce+Ifv that the olic} of Insurance described herein has basn issued ',o ­ie Insured n ao above 'fie oolicv period indicated. Notwithstaneinq any requirement 'erne or condition of ary contract o- other 11ocurnent ritn respect to wnich this Certificate may be issueo or may pertain the insurance afforded by-ne Poiicy .Iescr,bec herein is subject to all the terms exclusions ano conditions of such Policy TYPE OF INSURANCE LIMITS OF LIABILITY j Part One i State 'lorkers'Comoensation Statutory MA Part Two Bodily hilly by Accident 51,000.000 each accaceni Employers' Liability Bodily Injury by Disease $1.000,000 oolicy limit Ba iiv injury oy Disease S1 000.000 eacr -inprovee i Sno,;iG anv of the above described policies be cancelled before the expiration cafe ,!,ereo notice 4vili oe delivered n accordance with me policy provisions s All EntltleslInSUreds C�rnffcafe .oln� er's name and Address,-,. 1 American Construction Inc i EleCtion AB Carnes Inc zate00n Status 'gar'e 30 Arrowhead Farm Road Officer Include Manuel 7 Tema Caquan• Boxford. MA 01921 Date 'S Liec 51312013 Ace Insurance Services Inc 675 Warren Ave Brockton. MA 02301 Signature_ �— i Proposal AB Carnes Inc. 30 Arrowhead farm Rd Page 1 of 1 Boxford, Ma.01921 978.887.1431 Mass, Builders License No.000230 Contractors Registration.No 100733 Proposal Submitted To: KEVIN &KIM BARRY Date August 7,2013 429 MARBLERIDGE RD Project Name SAME NORTH ANDOVER, MA 01845-4720 Address 978-688-6420 We propose to furnish material and labor-in accordance with the specifications below: Eleven Thousand Nine Hundred Dollars($11,900.00) k Payment to be made as follows: $300.00 Deposit, Balance Upon Completion Notice:All home improvement contractors and subcontractors engaged in home Authorized improvement contracting,unless specifically exempt from registration by provisions Signature ' of Chapter 142A of the General Laws,must be registered with the Commonwealth of Massachusetts. Inquiries about registration and status should be made to the Note:This proposal may be withdrawn by us if not accepted within 30 Mass.govllicenses website. days. ROOF PROPOSAL ® STRIP ROOF OF ALL LAYERS OF ASPHALT SHINGLES.COVER ROOF DECK WITH TITANIUM RHINOROOF HIGH PERFORMANCE WATERPROOF UNDERLAYMENT MEMBRANE.COVER EXTERIOR WALLS AND FOLIAGE WITH TARPS TO HELP PRE AGE. ® INSTALL CARLISLE HIGH PERFORMANCE ICE&WATER BARRIER OVER ALL HEATED AREA„SIX FEET IDE AT THE LEADING EDGE OF ROOF AND THREE FEET IN ALL VALLEYS&AROUND ALL ROOF PENETRATIONS. ® COVER ALL PERIMETERS WITH EIGHT INCH ALUMINUM DRIP EDGE. ® INSTALL RIDGE VENT AND/OR®AS NEEDED ROOF LOUVERS FOR ADDED ATTIC VENTILATION. ® COVER SOIL PIPES WITH NEW RUBBER FLASHING BOOTS. ❑ REPLACE WALL FLASHING(S)AS NEEDED WITH ALUMINUM OR LEAD AT THE ADDITIONAL COST OF PLFT.WE MAY NEED TO REMOVE THE SIDING TO PERFORM THIS WORK.YOU MAY NEED TO HAVE A CARPENTER REINSTALL THE REMOVED SIDING. ® CHIMNEY FLASHING;CUT ALL EXISTING TAR AND LEAD FROM TWO CHIMNEY(S),CUT NEW REGLET WITH CARBIDE SAW AND SECURE NEW LEAD FLASHING IN PLACE W/LEAD ANCHORS. PROPERLY SEAL REGLET JOINT. PLEASE ADD$350.00 EA IF NEEDED TO ABOVE PRICE. ❑ REBUILD CHIMNEY FROM ROOF DECK UP WITH NEW OR USED BRICK. ADD , ABOVE PRICE. ® COVER ROOF SURFACE WITHCERTAINTEED LANDMARK ARCHITECTURAL. IFETIME ARRANTY 240LB SHINGLES> t} �� a ® REPLACE DEFECTIVE ROOF DECKING WITH 1X8 SPRUCE BOARDS AT AN AtMO1V`AL COST OF$4..50PLFT. - �tw' ® COVER ROOF DECK WITH CDX PLYWOOD AS NEEDED TO REPLACE OR REPAIR DEFECTIVE DECKING,AT AN ADDITIONAL COST OF$4.00PSQFT. SHINGLES ARE TO BE STORM NAILED.ESSEX COUNTY BUILDING CODE REQUIRES SIX NAILS INSTEAD OF FOUR. ❑ REPLACE EXISTING SKYLIGHTS WITH NEW VELUX UNITS WITH FLASHING KITS.WE WILL PROVIDE THE SKYLIGHTS&FLASHING KITS AT OUR EXACT COST FROM OUR SUPPLIER.THERE WILL BE NO LABOR CHARGE IF THEY-ARE THE SAME SIZE.INTERIOR WORK IS EXCLUDED. ❑ REMOVE EXISTING GUTTERS ❑INSTALL NEW SEAMLESS.032 ALUMINUM GUTTERS USING THE POSITIVE LOCKING BAR HANGER SYSTEM. ® REPLACE DEFECTIVE OR ROTTED TRIM BOARDS AS NEEDED WITH NO.2 PRIMED PINE,ADD$15.00 PER FOOT TO ABOVE PRICE. ❑ INSTALL NEW ALUMINUM DOWNSPOUTS. MECHANICALLY FASTEN ALL CONNECTIONS. CLEAN ALL PROJECT RELATED DEBRIS FROM OUTSIDE WORK AREA. THE PROPERTY OWNER AUTHORIZES AB CARNES,INC 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 OF THE HOUSE COMPLETE. CHIMNEY FLASHING:THESE SHOULD BE DONE AS PROPOSED ABOVE OR LEAKS COULD OCCUR. SHINGLE UPGRADE:UPGRADE SHINGLES TO THE LANDMARK 300LB PREMIUM SHINGLES FOR AND ADDED COST OF$1750.00(THIS IS OUR EXACT COST FROM OUR SUPPLIER.LABOR IS THE SAME YES( )NO WARRANTY UPGRADE:THE CERTAINTEED WIND WARRANTY WILL BE UPGRADED FROM 1101MP TO 130 MPH WITH AN UPGRADE TO THE HIGH PERFORMANCE HIP&RIDGE CAPS AND STARTER COURSE AT NO ADDITIONAL CHARGE.YE EMAIL ADDRE ° I✓ @. l ask/F l C � Warranty:All work warranted against installation defects for 5 years;this warranty is_limited to the installed item(s)and its repair only.Material is warranted by the manufacturer against defects for 50 years;please see the manufacturer's warranty for exact warranty performance. Cancellation:Customer has legal right under federal law to cancel this contract without penalty or obligation within four business days from the date of signing this agreement via Priority Mail Delivery Confirmation. Please see reverse side Dispute Resolution under Massachusetts Home Improvement Law 142a:All parties ag#rg"advenee-tbat-any-and•;all disputes relating to this proposal shall be settled by binding arbitrati n.This ovum is user friendly and does not require lawyers'Pleas a see reverse side ' i' L� l r G Customer 7 Dat P contractor, Dater n k, f this agreement. I he terms as stated on the front a d bac o h/v ted all � Signing this Proposal meads you have�p _ Date of Acceptance t Signature Signature PLEASE SEE REVERSE SIDE i 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, INC. DUMP TRUCKS DATE: 8-15-13 SIGNATURE OF APPLICANT: Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen icor License: CS-000230 .: BARRY S CARi�ES 30 ARROWMAD-FA;ttM Boxford MA 01921 r *� Expiration Commissioner 03/07/2014 Office of Consumer Affairs and Business Regulation _ 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100733 Type: Private Corporation Expiration: 6/23/2014 Tr# 223142 A. B. CARNES, INC. ` Barry Carnesw, - J--- - ---- 30 Arrowhead Farm Rd. -- ---`^-i-- - Boxford, MA 01921 Update Address and return card.Mark reason for change. )PS•CA1 Co 50M•04/04G101216 _' Address 17 Renewal FJ Employment 0 Lost Card r *, The Commonwealth of Massachusetts Department of Industrial Accidents a VW Office of Investigations a 600 Washington Street r Boston, MA 021.11 n1jnv.rnass govt-a Workers' Compensation Insurance Affidm it: Builders/Contractors/Electricians/Plumbers Anulicant Information /'lease Print Lei l Name (Business/Organization/Indi\,idual): Address: C:`ity/StatelZip: 1 Phone Are you an employer?Check the appropriate box: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with G. New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. Remodeling 2.® f am a sole proprietor or partner- .1-hese subcontractors have ship and have no employees S. ❑Demolition working for me in any capacity. employees and have workers' q ❑ Building addition f No workers comp insurance comp. insurance 10. Electrical repairs or additions required.] 5.XWe are a corporation and its 3.[ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.. (No workers' comp. right of exemption per MGL 1.2Roof repairs insurance required.] c. 152,§1(4),and we have no q ] employees. (No workers' 1 Oilier 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. tContraetors 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 ant an employer that is providing workers'compensation insarance for myr employees. Below is lire policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/StatefZip: 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. Ido hereby cer ' under the ins acrd penalties of perjury that the hiformation provided above is true and correct. i Si attire' ,Phone_. : / - Off tciai use only. Do not write in this area,to be compided by city or town official. City or Town: PcrmitlLicense# 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 DIA Use Only Department of Industrial Accidents Office of Investigations-Dept. 153 1 Congress Street,Suite 100,Boston,Massachusetts 021.14-2017 http://www.mass.gov/dia p www.mass.gov/dia Invest./SWO.ID#: AFFIDAVIT OF EXEMPTION FOR CERTAIN CORPORATE OFFICERS OR DIRECTORS Clwpter 169 of the Acts of 2002 amended 111: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 Carries, Inc. 30 Arrowhead Farm Rd Boxford, Ma 01921 _a (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 checke he appropriate box below my/our name(s) indicating my/our desire to be exempt or not o be pt fr the provisions of M.G.L. c. 152. ed under t pains and penalties of perjury: Barry Carnes, President 04/3/2012 Si nature Print Name&Title Date(mm/dd/yyyy) ✓❑ wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Anastasiya Cames, Director 04/03/2012 Signature Print Name&Title Date(mm/dd/yyyy) ❑✓ I wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) ❑ 1 wish to exercise my right of exemption or ❑ I wish NOT to exercise my right of exemption Signature Print Name&Title Date(mm/dd/yyyy) ❑ I wish to exercise my right of exemption or ❑ t 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: 201287835330 Date: 5/30/2012 9:10:00 PM ! A. The Commonwealth of Massachusetts No Fee William Francis Galvin Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 '� Cv" 'aII3i'iRQ99� 1. Exact name of the corporation: A. B. CARNES, INC. 2. Current registered office address: Name: BARRY S. CARNES No. and Street: 30 ARROWHEAD FARM ROAD City or Town: BOXFORD State: MA Zip: 01921 Country: USA 3. The following supplemental information has changed: _Names and street addresses of the directors, president, treasurer, secretary Title Individual Name Address (no PO Box) ! First, Middle, Last,Suffix Address,City or Town,State,Zip Code PRESIDENT BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA TREASURER BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA SECRETARY BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA DIRECTOR BARRY S.CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA DIRECTOR ANASTASIYA CARNES 30 ARROWHEAD FARM ROAD, BOXFORD, MA 01921 USA i i X Fiscal year end: October X Type of business in which the corporation intends to engage: GENERAL CONTRACTING &MARKETING X Principal office address: No. and Street. 30 ARROWHEAD FARM ROAD r City or Town: BOXFORD State: MA Zip: 01921 Country: USA OP X its principal office _ an office of its transfer agent an office of its secretary/assistant secretary _ its registered office i Signed by BARRY S. CARNES , its PRESIDENT on this 30 Day of May, 2012 ©2001 -2012 Commonwealth of Massachusetts # All Rights Reserved S i OP ID: SA A`CORO CERTIFICATE OF LIABILITY INSURANCE DAT0311131131IYYYY) 013 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). CONTACT PRODUCER 978-744-6715 NAME: AHMED Insurance Agency,Inc. 978.741-0127 PHONEFA C,No PO BOX 449 (A/C,No,Ext): ( ) Salem,MA 01970 ADDRESS: Stephen G.Ahmed -PRODUCER ABCAR-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE MAIC# INSURED A B Carnes Inc INSURERA:Essex Insurance Co 30 Arrowhead Farms Road INSURERB:Safety Insurance Company 33618 Boxford, MA 01921 INSURER C INSURER 0: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR TYPE OF INSURANCE ADOL SUBRi---- PO,LICY NUMBER MOLICY/EFF POLICY EXP YY LIMITS LTRINSR GENERAL LIABILITY \ AMAGE OCCURRENCE S 1+000,00 xTO X COMMERCIAL GENERAL LIABILITY 3DF9266 / 3/18/13 03/18/14 p EM SES a occurrence)RENTED $ 50,00 CLAIMS-MADE X OCCUR M D EXP(Any one persont S 1,00 ERSONAI.&ADV INJURY $ 1,000,00 _ GENERAL AGGREGATE S 2,000,00 N"LyKit3REG'ATE LIM rl APPLIES PER PRODUCTS-COMPIOP AGG $ 2,000,00 X POLICY PRO LOC PD Deduct $ 500 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 13000,00 tEa accidentl ANYAU70 BODILY INJURY(Per person; S ALL OWNED AUTOS BODILY INJURY(Peraccidenq $ B X SCHEDULED AUTOS 6213192 05/02/12 05/02/13 PROPERTY DAMAGE B X HIRED AUTOS 6213192 05/02/12 05/02/13 (Per accident) inc B X NON-OWNED AUTOS 6213192 05/02/12 05/02/13 S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE S { DEDUCTIBLE RETENTION S WORKERS COMPENSATION WC STA 0TH• AND EMPLOYERS'LIABILITY YIN TORY LIMITS R ANY PROPRIETORfP.ARTNER/EXECUTIVE E L EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? N t A (Mandatory in NH) E L DISEASE•EA EMPLOYEE £ ifyes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required( Roofing Contractor CERTIFICATE HOLDER CANCELLATION TOWNN04 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN To:Main North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 12StreetNdover, MA 0184 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD r ill y MA SOC Filing Number: 201287835330 Date: 5/30/2012 9:10:00 PM THE COMMONWEALTH OF MASSACHUSETTS I hereby certify that, upon examination of this document, duly submitted to me, it appears that the provisions of the General Laws relative to corporations have been complied with, and I hereby approve said articles; and the filing fee having been paid, said articles are deemed to have been filed with me on: May 30, 2012 09:10 PM • t WILLIAM FRANCIS GALVIN Secretary of the Commonwealth