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38B-044 (2) 155 SOUTH sr BP-2019.1253 015#: COMMONWEALTH OF MASSACHUSETTS Mhz .'Block: 38B-044 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath repo BUILDING PERMIT Permit# BP-2019-1253 Proiect# JS-2019-002019 Est Cost521600 00 Fee:$140.40 PERMISSION IS HEREBY GRANTED TO: Const, 1 , Contractor: License: Use Group, VALLEY HOME IMPROVEMENT INC 077279 Lot Size(sa ft.): 21217.48 Owner: CHARREN DEBORAH A Zoning:URB(100)/ Applicant. VALLEY HOME IMPROVEMENT INC AT: 155 SOUTH ST Analic ntt,Address: Phone., Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:5/712079 0:00.00 TO PERFORM THE FOLLOWING WORIG2ND FLOOR BATH RENO POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Qil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeTvve: Date Paid: Amount: Building 5/7/20190:00:00 S140A0 212 Main Street,Phone(413)587.1240,Fax:(413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2019-1253 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESS/PHONE P O BOX 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 155 SOUTH ST MAP 38B PARCEL 044 001 ZONE URB0001/ HISSECTION FOR OEFIVAI,USE ONLY: PERMIT AP ATION l CKLIST E ' L ED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T eof Construction: 2ND FLOOR BATH EN New Construction Non Structural interior renovations Addition to Existine Accessory Structure Building Plans Included: Owner/Statement or License 077279 3 sets of Plans/Plot Plan THE FOL WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO,RMATION PRESENTED: _iZApproved_Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project Site Plan AND/OR___Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit _ Variance' Received&Recorded at Registry of Deeds Proof Enclosed_ _Other Permits Required: _Curb Cut from DPW Water Availability Sewer Availability _Septic Approval Board of Health _Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management D molition Delay Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. Department use only City of Northam ton status o Pe It Building Depart ent 6 Curti Ce bnv ay Pennll 'r 212 Main Stre t MAY r�Se61 , Pbc vallabd y Room 100 Water ell Av Ilablldy '< ` y Northampton, MA 10f� lg ra'f#S ueturel Plans \ PT or run olNri ; "fie r phone 413-587-1240 Fax 13-58.7o99'72r10N I t e 6'j- APPLICATION aAPPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH AA ONE OR TWO FAMILY DWELLING SECTION t-SITE INFORMATION : 11 Prooerty Address This section to be completed by office ISS Sarah C /�f� l7Fye.e,-I- Map . yf3. Lot Unit Zone Overlay District Elm sEDistnd i GB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: (rvt i�hehl 4- rl la rren ISS 134hS1 . (aka-`r-herr a, I`ta oto( Name t I / Current Mailing Address: hera,Q. A-• �iLw✓�E�— N I"3- S'8Y— s l30 � Telephone signalum 2.2 Authorized Adopt: I JCxry)ar) fooba7 'Florence- mil OIC�Co2 Name(Print) Cunent Mailing Address: k13-58y- 522 Signature Telephone SECTION 3.ESTIMATED CONSTRUCTIONCOSTS Item Estimated Cost(Dollars)to be Official Use Only completed bermiiapplicant 1. Building / 9 5-06 (a)Building Permit Fee 2 Electrical � (o)Estimated dtahof QD ,Construction from _ 3. Plumbing 1, 5-06 Building Permit Fee . 4. Mechanical(HVAC) U 5. Fire Protection 6. Total=(1 +2+3 +4+5) 2� �V Check Number This Section For Official Use Only Date Building Permit Nu er ' Issued. q Signature. Building Commissionerflaspector of Buildings - - Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING An Information Must Be Completed. Permit Can Be Denied Due To Incomplete Imor, tion Existing Proposed Required by Zoning Tlda column to be filled m by Building Depastr mt Let Size e Frontage Setbacks Front Side LR:� L:�� R.= r Rear Building Height Bldg. Square Footage � % — -- OpenSpaceFootage ' ' % r (Lot area minus bldg&paved arlau ) 9 fPsukhog S aces Fill: (voh,me&Locatiou) A. Hasa Special Permit/Variance/Finding ever b n issued for/on the site? NO 0 DONT KNOW Q YES Q IF YES, date issued: IF YES: Was the permit recorded at the Reg' try of Deeds? NO © DONT KNOW YES Q IF YES: enter Book Paged and/or Document#F B. Does the site contain a brook, body of ater or wetlands? NO Q DON'T KNOW Q YES IF YES, has a permit been or nee to be obtained from the Conservation Commission? Needs to be obtained © Obtained Q , Date Issued: C. Do any signs exist on the prop rty? YES 0 NO C) IF YES, describe size, type nd location: r D. Are there any proposed c nges to or additions of signs intended for the property? YES C NO O IF YES, describe size, ype and location: I 3 E. Will the construction a - fly disturb(clearing, grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 ere? YES © NO O IF YES,then a No ampton Ste"Water Management Permit from the DPW is required. I SECTION S-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) ® Roofing ❑ Or Ooors � Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [O Siding [01 Other[ Brief Description of Proposed p0 II Work: 2 rLU9k B97N R.E/h00�- "/✓0 G/7A Na1-P. S,[vfw P� M,)' A4jQ. Alteration of existing bedroom_Yes -7`1' No Adding new bedroom_Yes No c�.�YriU2 Attached Narrative - Renovating unfinished basement YesNo Plans Attached Roll -Sheet sa [f New house artd dr addition to exisk[n4'housinn. com'oletetFie follnwina: - a. Use of building: One Fani Two Family Other b. Number of rooms in each family unit: Number of Bath urns c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodsloves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction 1. Is construction within 100 ft.of wetl ds?—YesNo. Is construction within 100 yr. floodplain_Yes—No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes_No. I. Septic Tank_ CitySewer Private well_ City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUILDING PERMIT I, � y" `J IC41, 1-�e�J�i1G �['rG-r�e� as Owner of the subject property (` hereby authorizey�{-'= I �'PF�'Crl OI�VL✓MQ to an behalf, in all matters relative to work authorized by this building permit application. - �o;���;�a. SignaturtilotOrmer I, }}'_ as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. CJ 1ve Print Name i' A Signature o er/A nl Date ��� 1 , SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructions Supervisor: Not Applicable ❑ Name of License Heidi, < 3Y"eV-2XZ� IIlFer1'Y\Cl.l-\ 01-7a09 License Number &oP) HA 0ii (o laf 1a0 Address E/� piralipn Date am/ 113 58y-�5aa Signature �r r tel phone 9.Registered Hdmelmorovement Cdntrattar . " a Not Applicable 11�Ia� IPu nrnz � nrov�mend - _ IC)55N3 Company Na�ie Registration Number o(0 f-? cwfn o)ozo2 -I I )-) I zo Address pp�� Expiration Date ' Telephone'T)3-S9L1-752 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L e.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes,..... No.._. ❑ City of Northampton s brassachusetts' 1 i DEPARTMENT OF BUILDING INSPECTIONS P. (i 212 Main Stmeet • Municipal Building Northampton, MA 01060 AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application - The Office of Consumer Affairs and Business Regulation("OCABR")regulates the registration of contractors and subcontractors performing improvements or renovations on detached one to four family homes.Prior to performing work on such homes, a contractor most be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstrucfion, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units....or to structures which are adjacent to such residence or building"be done by reostered contractors. Note:If the homemover has contracted with a corporation or LLC, that entity must be registered Type of Work BaitILrmitc n Est. Cost: 500 Address of Work 155 Stu-A'h Date of Permit Appliation 130 1019 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Sob under$1,000.00 _Owner obtaining own permit(explain): Building not owner-occupied Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE ROME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBIITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I``heereby apply for a building permit as the agent of the owner: 4�t134,019 \�a11a �am�Tln�asemm> I»C 1055y3 Date Conirac rName HIC Registration No. OR: Notwithstanding the above notice,I hereby apply for a building permit as the owner of the above property: Date - Owner Name and Signature City of Northampton I/e � Massachusetts G, Y'. =NT OF BUILDING INSPECTIONS P `� \ 212 Main Street • Municipal Building Northanptan, M 01060 Massachusetts Residential Building Code Section 110.R5.1.2 Homeowner: Person (s)who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section 110.R5.13.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 11085, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. City of Northampton s Massachv se tts DSPAR' 'NT OF BUILDING INSPECTIONS 212 Hain Stzeet 4M nicipal Building S CT ' Northampton, HA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the 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 c 111, S 150A. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: ���uoJ �rw - �,�e to (PI a print n �e and loc o n Afar' Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) A z //)A, Signature bf V6Vnit Applicant wner Dat If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite100 Boston,MA 02114-2017 wwynno ss.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERK FTMG AUTHORITY. Applicant Information ,1_ I1 PleasePrint L ild Name(Bn:roes:/o,gar.i�atiowlnalvianap: �E f fi MT,ora I�, -Th L Address:_pq.Qppp lo(�loa—! t -il-kb �IU2.rSy�G�rly� City/State/Zip: f\C)(ertLC �41O\bb7- Phone#: 4.13-584^—ISaa Are you an employer?Check the appropriate box: (� Type of project(required): I.Ellamaemployerwim 1e mploycm(rouanworpart-time)• 7. ❑New construction 2❑lamasolepropnetorerpmkemWpmdbaven =ployeesworkingformem $, Pg Remodeling my capacity.[No workeri comp.imswavec requme L] 3.❑I..bomeowner doing all work ca clf(No workers'eomp.Ivsur-aoce regordl t 9. ❑Demolition 4E I am a hemeownv andwilt be 1-mg contactors k conduct all work on my property. Iwla 10 E]Building addition ensure matancoatackm mmcrhavew.6,m,'omrrpcnmtommourenceorareaole 11.0 Electrical repairs or additions proprimnrs within employees. 12.❑Plumbing repairs or additions s lamageneml con➢ecarmll havelvedme subcmmckrs nand en[he utocnedcheet. These sub-contactors have employees and have workers'comp.imvmace.I 13.E]Roof repairs 6.❑Weare a corymnon and its officers have exercised[hek ngh[of exempnov pv MGL c. 14.❑Other 152,§I(4),and we have ao employees.[No wmkcrs'comp.msunace required.] 'Anyappkcxmthetcbecks bowel marts o 511outme sectionbelowshowingthen women'compensationponcywmmatim T Homeowner who submit this affidavit iodicatingtnry arc dourg all work and thenhire outman covRec[ms must mbmit a new affidavit indicating such. ICoatractms that checkthis box mustattachedmaddocrod,heetsbowurgthe come ofthe sub-aoanacton andstate whetherornotthosee noc,have employees. rime mb<=Mckrs have®ployen,theymnat pmvide their workers'comp.poncy number. I am an employer that isproviding workers'compensation insurance jar my employees. Below is the policy and job site - information. L Insurance Company Name: kLDfIl0. b,:,u(-arYe �l yn42 Policy#or Self-ins.Lia#: OUEifj Q�50'2. S \Expiration Date: ���� g� al '� ""''�� at ,, Jab Site Address: ISS SCX—" t-t �1-,-Qzs}' City/State/Zip: r�+lY`Y���'y`�',,',�'y�",'r-vt / oloia6 Attach a copy of the workers'compensation policy declaration page(showing the policy number aad expiration date). Failure to secure coverage as required under MGL Q. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. Ido hereby certify under thepa' sand engin oPerjury that the information provided above is dues and correct Sinnatme Ift Date 4 2--'. 1 I Phone#: qV-5-bSq--1 6J )a Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermitUm ase# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitglTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Nnou: Phone#o Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constivction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please 81]out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)morels),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the - members or partners,no not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you no required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number wbich will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given yen,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant sbould write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each yen.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc)said person is NOT'required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as''-every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,conshgction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required," Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its pofi0 cat subdivisions shall enter into any contract for the performance of public work and acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name, address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or TTP does have employees, a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidarit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter thea self-insurance imease number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of fnvestigations has to contact you regarding the applicant. Please be sure to fill in the permiblicense number which will be used as a reference number.In addition,an applicant that most submit multiple penraVlicense applications m any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street - Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSA-FE Fax# 617-727-7749 www.mass.gov/dia Form Reviscd 02-23-6 U Commonwealth of Massachusetts Division of Professional Licensure Board of(Blildir,Regulations and 3,rd,,d, - Cons tryc4br0§0porvi scr �J CS4)77279i a jf- i Fires:06/21/2020 STEVENASILVERMP ^ 268 FOMER ROAD t{ SOUTHAMPTOWP,q-0107] �t7J//.�5753io mmissioner CJ, Co Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement»Contractor Registration Type: Corporation VALLEY HOME IMPROVEMENT INC 2 Registration: 105543 I I Expiration: 07/16/2020 P.O.BOX 60627 1 FLORENCE,MA 01062 t Update Address and Return Card. 1 o 20Movn .� r n «ea�f�gF P9asca�er1u OtfiConsumer Affairs easiness Regulation H - OMEIMPROVEMENTCONT6ACTOR beforeteexpiatvalid for Inddate. dual Iffouneonly etur TVPE:�Caroora0on before the expiration date. a fauns return to: Reoistratlonh Expirati� Office of Consumer Affairs and Business Regulation 07/16/2020 One Ashburton Place-Suite 1301 VALLEY HOME 2-BMOM BOV"EE INC Boston,MA 02109 STEVEN A.SILVIcHN_�, 340 RIVERMEDF '�l4 - NORTHAMPTON,MA 01962 undersecretary Not valid without signature