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31A-269 (7)
43 DRYADS GREEN ST BP-2020-0190 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 A-269 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 reno BUILDING PERMIT Permit# BP-2020-0190 Proiect# JS-2020-000322 Est.Cost: $36158.00 Fee: $234.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: SCAPES BUILDERS & EXCAVATION LLCO21087 Lot Size(sg. ft.): 12153.24 Owner: BERTONE JOHNSON REID&ELIZABETH Zonin :: URA(100) Applicant: SCAPES BUILDERS & EXCAVATION LLC AT. 43 DRYADS GREEN ST Applicant Address: Phone: Insurance: P O BOX 469 (413) 665-0185 0 WC DEERFIELDMA01373 ISSUED ON:811512019 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL 2ND FLOOR BATH 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: Oil: 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: FeeTvpe: Date Paid: Amount: Building 8/15/2019 0:00:00 $234.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0190 APPLICANT/CONTACT PERSON SCAPES BUILDERS&EXCAVATION LLC ADDRESS/PHONE P O BOX 469 DEERFIELD (413)665-0185 Q PROPERTY LOCATION 43 DRYADS GREEN ST MAP 3 1 A PARCEL 269 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out h 1A Fee Paid Typeof Construction: REMODEL 2ND FLOOR BATH New Construction Non Structural interior renovations Addition to Existing Accesso Structure Building Plans Included: Owner/Statement or License 021087 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved 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 emolition Delay 8-�y-ZaiQ 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 Northampton Status of Permit: � r Building Department Curb Cut/Driveway Permit c 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability " .' Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, LTE ll1fVR D�MOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION AUG Pniq 1.1 Property Address: This section to be completed by office 43 Dryads Green DEPT OF:SUILDING INSPEC 9 Lot Unit Northampton, MA NORTHAWTON,MA 01060 01060 Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Reid & Elizabeth Bertone .- 'fin "s 6 43 Dryads Green, Northampton, MA Name(Print) Current Mailing Address: i ` 1 413-687-8935 Telephone Signature 2.2 Authorized Agent: Douglas Blowers 110 North Hillside Dr, Deerfield, MA 01373 Name Current Mailing Address: c'- !�C—Managing Member, LLC 413-665-0185 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $28,398 (a)Building Permit Fee 2. Electrical $975 (b) Estimated Total Cost of Construction from 6 3. Plumbing $6,785 Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = 0 + 2 + 3+4 + 5) $36,158 Check Number 6 7 This Section For Official Use Only Building Permit Number: Date Issued: Signature: �j �y "ZIl Building Commissioner/Inspector of Buildings Date office @scapesbuilders.com EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of ParkingS aces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW O YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO Ox IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ® Roofing ❑ Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding[0] Other[d] Brief Description of Proposed Work: Remodel 2nd floor bath per attached plans dated 6-13-19 Alteration of existing bedroom Yes x No Adding new bedroom Yes x No Attached Narrative Renovating unfinished basement Yes x No Plans Attached Roll -Sheet yes 6a. If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. 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 City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Reid Bertone as Owner of the subject property hereby authorize Douglas A Blowers, Managing Member, Scapes Builders & Excavation, LLC to act on my behalf, in all matters relative to work authorized by this building permit application. 8/13/19 Signature of Owner Date Douglas A Blowers, Managing Member, Scapes Builders & Excavation, LLC 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. Douglas A Blowers Print Name (a e-, ,q ----_ Managing Member, LLC 8/13/19 Signature of O r/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Douglas A Blowers CS-021087 License Number 110 North Hillside Rd, South Deerfield, MA 01373 4/5/20 Address Expiration Date �� 413-665-0185 Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ Douglas A Blowers, Managing Member, 129632 Company Name Registration Number Scapes Builders & Excavation, LLC 10/6/2019 Address Expiration Date 110 North Hillside Rd, South Deerfield, MA 01373 Telephone 413-665-0185 SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c. 152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ® No...... ❑ City of Northampton Massachusetts mow? << G { DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building yeti cb� 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 must be registered as a Home Improvement Contractor("HIC"). M.G.L.Chapter 142A requires that the"reconstruction, 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 registered contractors. Note:If the homeowner has contracted with a corporation or LLC,that entity must be registered Type of Work: Bathroom Remodel Est. Cost: $36,158 Address of Work: 43 Dryads Green, Northampton, MA 01060 Date of Permit Application: 8/13/19 I hereby certify that: Registration is not required for the following reason(s): _Work excluded by law(explain): _Job 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 HOME 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 RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: lb �. l�L------_ 8/13/19 Scapes Builders& Excavation, LLC- Douglas A Blowers Managing Memeber 129632 Date Contractor Name 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 ,ter Massachusetts !. lG l - W; a� DEPARTMENT OF BUILDING INSPECTIONS S M 212 Main Street a Municipal Building Northampton, MA 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: 43 Dryads Green, Northampton, MA 01060 (Please print house number and street name) Is to be disposed of at: F & G Recycling, E. Windsor, Ct (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: Wickles Trucking (Company Name and Address) � "`"` _ ��l c--, Managing Member, LLC 8/13/19 Signature of Permit Applicant or Owner Date 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 Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leuibly Name (Business/Organization/Individual): Seapes Builders& Excavation, LLC Address: 110 North Hillside Rd City/State/Zip: South Deerfield, MA 01373 Phone#: 413-218-8237 Are you an employer?Check the appropriate box: Type of project(required): L®I am a employer with 14 employees(full and/or part-time).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ®Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[:]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL e. 14.❑Other 152,§1(4),and we have no employees.[No workers'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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lic.#: XWO59660868 Expiration Date: 6/25/2020 Job Site Address: 43 Dryads Green City/State/Zip: Northampton, MA 01060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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 DIA for insurance coverage verification. I do hereby cert* under the pains and penalties of perjury that the information provided above is true and correct. Signature: !q C----.managing Member, LLC D • 8-13-19 Phone#: 413-665-0185 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Existing Proposed -�Pw ------ 1 m m CA , m --------------- LD m \� NIn i CA 2. 4„ — N LD L--------------- u ' O CD� Qa / C 6 -8 N N 'E Electrical: Overhead Bath Fan Light combo, Vanity Ilght(s), warm up maty'' Plumbing: Tub 2-b w max 5-0 to 6-0 L, toilet, double vanity 15"-20" deep, disconnect/cap radiator-replace cast drain DATE: Tile: Floor the on Ditra with warm up mat, tile to extend under vanity, Shower surround Min 6-4 o.f.f. 6'1"2°l9 G1NB: New MR board level 4 finish, durock/hardie tub surround cut in patch in hall where door is moved. Ceilings 8'4", Prime SCALE: �•v� :r Bath accessories: TP holder, Towel bar behind door, Shower curtain rod, Mirrors) Hook? hand towel? ,E�; Carpentry: Demo, blocking, Insulation, door to be relocated/reused, new trim in room to be painted, Install bath accessories A�.t Existing Proposed ---------------- Co -------------m --------------f cv r C'4 } m m Ca 0) rCo - 2,_4„ _ 71 N Lnl66 O � O � N OO C d I � a�If W If o = N f QZ Q Electrical: Overhead Bath Fan Light combo, Vanity Ilght(s), warm up maty''-,°n Plumbing: Tub 2-8 w max 5-0 to 6-0 L, toilet, double vanity 18"-20" deep, disconnect/cap radiator-replace cast drain Tile: Floor tile on Ditra with warm up mat, tile to extend under vanity, Shower surround Min 6-4 o.f.f. GNB: New MR board level 4 finish, durock/hardie tub surround cut in patch in hall where door is moved. Ceilings 8'4", Prime SCALE: Bath accessories: TP holder, Towel bar behind door, Shower curtain rod, Mirror(s) Hook? hand towel? SxEE1: Carpentry: Demo, blocking, Insulation, door to be relocated/reused, new trim in room to be painted, Install bath accessories A1.1 SCAPBUI-01 ANGELA 14 14. R CERTIFICATE OF LIABILITY INSURANCE FDATE(M/201YYY) � 7/24/2019 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 have ADDITIONAL INSURED provisions or 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 Angela DiAugustino NAME: Phillips Insurance Agency,Inc. PHONE -- -- FAX —_ - 97 Center Street A/C,No,Ext):(413)594-5984 (A/C,No):(413)592-8499 Chicopee,MA 01013 E-MAIL an ela hilli sinsurance.com -ADDRESS: g @P p --INSURER(S)AFFORDING COVERAGE _ - NAIC 9 INSURER A:Liberty Mutual Insurance CO INSURED INSURER B:Safety Insurance Company 33618 Scapes Builders 8:Excavation,LLC INSURER C: P.O.Box 469 INSURER D: South Deerfield,MA 01373 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY 1,000,000 CLAIMS-MADE X OCCUR BKS59660868 6/25/2019 EACH OCCURRENCE _. 612512020 DAMAGE TO RENTED 300,000 PREMISE$(Ea oc n MED EXP(Any one person 15,000 I_PERSONAL 8 ADV INJURY $. 1,000,000 - I - 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE ----$ POLICY X JECT LOC _PRODUCTS-COMP/OP AGG 2,000,000 OTHER: III B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO S909568 8/25/2019 6125/20211 BODILY INJURY Per OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accidad HIRED NpN�WNEp OPERTY AMAGE AUTOS ONLY AUTOS ONLY Per accident _ III A X UMBRELLA LIAR X OCCUR EACH OCCURRENCE 3,000,000 EXCESS UAB CLAIMS-MADE US059660868 1111=2019 6/25/2020 AGGREGATE 3,000,000 DED I X RETENTION$ 10,000 A I WORKERS COMPENSATION I PERTUTE I I OTH- AND EMPLOYERS'LIABILITY TA ER 6/25/2019 6125/2020 ANY PROPRIETOR/PARTNER/EXECUTIVE iY I NXW059660868'' EL EACH ACCIDENT _E 1,000,000 QQF�FICER/MEM"R EXCLUDED? N :N/A (Mandatory in NH) - E.L.DISEASE_-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT A Equipment Floater BKS59660868 6/25/2019 6/25/2020 Leased/Rented 200,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 707,Addidonal Remarks Schedule,may be attached H more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts ®� Division of Professional Licensure Board of Building Regulations and Standards Constrttcti'on Supervisor CS-021087 Expires: 04105/2020 DOUGLAS A BLOWERS 851 ROARING BROOK RD CONWAY MA 01341 Commissioner C4 Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition ofthe Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dp: Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Individual DOUGLAS BLOWERS * Registration: 129632 Expiration: 10/06/2019 851 ROARING BROOK RD. CONWAY, MA 01341 ,f r� ry Update Address and Return Card. SCA 1 20M-05/17 11/ r'Tv 1 1WANON"Ie"1�fi r��z7alta��rat /�1 Office of Consumer Affairs& Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE: Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 129632 10-062019 10 Park Plaza - Suite 5170 DOUGLAS BLOWERS TEL Boston, MA 02116 �7 Y DOUGLAS BLOW ERS �,ccsir 351 ROARING BROOK RD. .' UU CONWAY. MA 01341 Undersecretary Not valid without signature Undersecretary