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18D-012 48 PINE BROOK CURVE BP-2017-0333 GIS4: COMMONWEALTH OF MASSACHUSETTS Map:Block: ISD-012 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-0333 Project# JS-2017-000546 Est.Cost: $1957.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Grouo: AMERICAN INSTALLATIONS LLC 175982 Lot Size(sa.ft.): Owner: BEAUREGARD KATHLEEN A Zoning: URB(100)/ Applicant: AMERICAN INSTALLATIONS LLC AT: 48 PINE BROOK CURVE Applicant Address: Phone: Insurance: 130 COLLEGE ST (413) 552-0200 WC SOUTH HADLEYMA01075 ISSUED ON:9/14/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT 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 9/14/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File k BP-2017-0333 APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200 PROPERTY LOCATION 48 PINE BROOK CURVE MAP 18D PARCEL 012 000 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT , Fee Paid Gk.d3/SO g V^'5 Building Permit Filled out Fee Paid Typeof Construction: ATTIC AND BASEMENT INSULATION AND AIR SEALING THROUGHOUT New Construction Non Structural interior renovations Addition to Existino Accessory Structure Building Plans Included: Owner/Statement or License 175982 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFC9ffrATION 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 Demolition Qelay ?. e0e,P ? /Y/ Si ure ofB '.i gff 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. (3epsrimerd'useoriry .. 0�6 City of Northampton status of Permit e`er 'L Building Department Crab CMIPliveway Pence \e- 212 Main Street 5� . $awer/SapBCAvblabmty . 3 Room 100 ci+ateair4aeA ,erg Northampton, MA 01060oCcIno seta ofstnahuroLPWm phone 413-507-1240 Fax 413587-1272 Pkt/Site PI ns " . .: OOneriSpacify .: ; APPLICATION TO CONSTRUCT.ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING �. SECTION I-SITE INFORMATION 1.1 property Address: This section to be completed by office Map Lot Unit. q In F W. ?J r 4yujL C.Lrwt Zone Overlay District '(\c axM,cmV,..1 Hi\ O10(o0 Elm St District Ott Disbars SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Z,1 Owner of Record: �4 4.e.L-tn, "'lrea •.e-lana 44 , i3n oistCCuna,� Y1rnI'.humfTh, Name(NM) comm Mats Address: MP 010(00 .t See attached ct t''-) ¶ (n — --c12 q TotaPhorat Signature 2.2 Authorised Ment American Installations 130 College St., Ste 100 South Hadley,MA 01075 Noma(MS) Cama t.OMg Address: American Installations (A )pt.t t r.I rsk,c2 413-552-0200 SgoaMe I Twoottone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit eopbcant 1. Bending (a )Building Parfait Fee P1.`� S'7. 6 2 Etembkel (b)Estimated Total Cost of Conswclan 1mm(5) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 0. Toad=(1 +2+3+4+5) '1 11 9 S7. 00 Check Number d' / co 40 This Section For Official Use Only Buildingr.Permit Number. Date Issued: Signature: Bulldog Commissioner/Napalm'of Brading, Oate Section 4. ZONING AU Infonnadon Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This eolom tube filled in by BUBdiug Department Lot Size Frontage I Setbacks Front Side L:I it L:I IRI I Rear I Building Height I Bldg.Square Footage % I I Open Bat area minusSpace e bUH&wpaved I I Parkin) #of Parking Spaces I 1 t I Fill: (volume&Loudon) A. Has a Special PermitNariance/Finding ever been issued for/on the site? NO 0 DONT KNOW O YES 0 IF YES,date hwed:I IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES O IF YES: enter Book Page and/or Document f B. Does the site contain a brook, body of water or wetlands? NO 0 DONT 1040W 0 YES 0 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? Y6 0 NO O IF YES,describe size,type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO O IF YES,describe size,type and location: I E. We the construction activity disturb(Nearing,grading,excavation.or Bens)over Mere or is it part of a common plan that wig disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Penna from the DPW Is required. SECTION 5-DESCRIPTION Of PROPOSED WORK Itheck all apoYeablsl New House ❑ Add:ion ❑ Replacement Windows AMrratlonts) ❑ Roofing ❑ Or Doors 0 Acc.csory Skis. D Demolition r om 0 NSigns Ipl Deets OI Siding Other� Work Attic band balsement insulation and air sealing throughout Aleraaon of adsNg bedroom_Yes_No AMIN new badman Yes No Method Narrae ye Renovating writ ed basement Yee No Plans Attached Roll -Sheet fs. H New house end or addition to existing housing..comolete the following: e. Use of Melding:One Family Two Fen* Other b. Number of rooms in each fatly urs Nombre of Bathrooms c Is there a garage attached? d, Proposed Square footage of new construction. Dimensions e. Number of Merles? f, Method of heating? Fireplaces or Woodsrowes Number of each g. Energy Conservation Compliance. Masschek Energy Compliance roan attached? h. Type of construction I. Is construction within 100 R of wetlands? Yes No. Is construction within 100 yr. noodelete_Yes No I. Depth of bveement or roger Moor below misled grade k Wel building conform is Oe Building and Zoning regalellone7 Yes_No. I. Septic Tank_ City Sewer_ Private wag_ City water Supply_ SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLES FOR BUILDING PERMIT I, es Owner of he subject lnoPerry hereby Whoa= American Installations to act on my behalf.In el matters relative to work authorized by 0*building permit applkadon. See attached Signa.&Owner p.J I, American Installations as OwredAulorted Agan hereby ceche that the statements and Information on the foregoing application am hue end accurate,to the best of my knowledge end belief. Signed undo the pains and pe efee of perjury. American Installations Phot Nem AAmeerriccan��tallaations ('LPX ,? �' c�tall, � /C1/& SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable ❑ Name of License Holder Wesley K. Couture 106178 License Number 130 College St., Ste 100 South Hadley,MA 01075 9/29/17 Address � �1 Emtralion Date 1IL. 1 A51(A yr 413-552-0200 Signature 1 Telephone 9.Registered Nome Improvement Contractor: ... _ _ Not Appliwda ❑ Wesley Couture 175982 Company Name Registralfon Number American Installations 6/27/17 Address Expiration Date 130 College St., Ste 100 South Hadley, MA 01075 Telephone 413-552-0200 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o.152,§25C(6)) Walters Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this afidavitwf resuft in the denial of the issuance of the huldtng permit. Signed Affidavit Attached Yes Ei No 0 11. —Home Owner Exemption The current exemption for"homeowners"was extended to include owner occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor,CMR 780. Sbdh Edition Section 1083.5.1 peflnitlon of 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 borne in a two-year period shall not be considered a homeowner. 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 buildingnermft, As acting Construction Supervisor your preaeoce on the job site will be required from time to lime,doing and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Wolters'Compensation) and Chapter 153(liabIlity of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,von may be liable for person(s) you hire to rattan for you under this permit The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Lava and State of Massachusetts General Laws Annotated. Homeowner Signature City of Northampton MassachusettsCie �s�* h ` a oaueraserr or aolsalAa al Builtroas $ , 212 Main 6treaY • Municipal Sanding p Northampton, hi 01060 "r*. r' Property Address: q ?LU,,, ani'. CP144ie, V UE/KMprig,-IMF 0066 Contractor Name: American Installations Address: 130 College Street Ste. 100 City, State: South Hadley,MA Phone: 43-552-0200 Property Owne Name: eAAt5r., cl Address: 4(v -0(n, pane -k C,iAA -e � City, State: fl rn fKq Nh M 4k a I O(o U I, American Installations (contractor) attest and affirm that the building I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have provided the property owner with a copy of this affidavit, Contractor signature t „1„eA 1 I (0 W • 4107 ' . t l n n incur Bns Licensed&Insured NES & 1F11 MA CSL m iosva MA Reystrppan%175982 American Installations 130 College Street Suite 119,South Hadky,MA 01075• Mede:(413)5524200 Fax;(413)552-0202 • Email:mppmle&nerbnlnablblons.mm Beauregard,Katheleen 12/23/2015 (r..)46 Pine Brook Curve Northampton MA 01060 awn w«, L413)586-7929 kathi@sanguisdevelopment.com as w•mI uo mown 428976 15-2202 P"ml DAR Quantity Unit Unit Cost Total *Sealing AIR SEALING 6 man hour $ 8500 $ 510.00 Total Air Sealing $ 510.00 Total Air Sealing Incentive $ 510.00 Weaterl ation DOOR WEATHERSTRIPPING W/SWEEP 2 each $ 75.00 $ 150,00 INSULATE BULKHEAD DOOR I each $ 72.22 $ 7122 HATCH SEAL&INSULATE 1 each $ 6000 $ WOO KW FLOOR 4'OPEN R-14 660 soft $ 2,11 $ 732.60 DAMMING R-38 66 linear ft $ 2.05 $ 135,30 VENTILATION CHUTES 44 each $ 2.00 $ 88,00 WHOLE HOUSE FAN COVER I each $ 209.21 $ 209.21 Total Incentrvited Weatherization $ 1,447.33 Total Project $ 1,95783 Pre-Weatherization Incentive $ 250.00 Total Utility Contribution 5 1,845.90 Total Customer Contribution $ 111.83 WARRANTY amemn i natlllaoana,LLC w pmvlde the above stated homeowner with a]yoiir workmanship warientY BaC?eno try ppss¢W agouh all heath end tabor b bhonalete the ahem scope or woo,in award,wins wa above zpev£habm and AS hos and solo buFW rV.il%ioyo U m kr She Teta)Cosdarct 1s t in Naar harem. ACCEPTANCE OF PROPOSAL The above prices,specifications and TOTAL CONTRACT VALUE m $ 111.83 conditions are satisfactory and are hereby accepted.You are authorized to do work as specified.Payment will be 1/3 down prior Down Payment= $ - ❑ to Han o/work.andpplpnce due uponCOSI Setae. PAO Balance Due Upon Completion $ 111.83 w.. 0-A -2n1 t,^.tnm • tar s► ma Baa rorat,trw _2015 ,w_.Hr„m .rm..mne.r !tI pat ro..n.,.,MDTnEasw,taeaaaaiw..� an.�nN,x.usk=mtNana•tn,� as The Commonwealth of Massachusetts j', --',–*T–if 'T"" Department of Industrial Accidents - - Office of Investigations ::_n. ; O`7aau _'r 600 Washington Street Boston, MA 03111 '^+—.4 www.nmss.gov/Ain Workers' Compensation Insurance Affidavit: Bniiders/ContractorstElectricians/Plumbers Applicant Information Please Print Legibly Name(nusin6s,./oraatun.bonnnai.iauul:6_ American Installations,LLC Address: 130 College Street,Suite 100 City/Stateilip: South Hadley,MA 01075 Phoney_ 413-552-0200 Are you an mploer?Check tit appropriat box: r Type of project{required) I S I am o emplover r'r with 3 a. ❑ I am a genual c0nnaaar and I I p ,.1.—... fi_ �f Ncn c cud ion employees(MI and/or part-lime).' have hind thesub-contractors 2.E.; I am a s tc proprietor or partner. -i.t d on the attached Sheet ; oon—1 Rernnde{ing ' ship and have no employees These sub-con vapors have S. ❑ Demolition workinr tor or me in any capacity, workers'comp, ran o.n I 9 `-1 Building adifition tNo workers pomp_insurance s. We arcae:orp rotten and its required.) officers have exercised their 10 ] Electrical repairs or additions Li t am a homeowner doing all work right of exemption per Wii. CI p,_)Plumbing repairs or additions myself. No workers'comp, c. 152,§1(4),and we have no ri 12.)] Roof repairs I insurance required employees. iN workers" 9 dt=.x Other Insulation romp.insurance required.] —'Viol d uhnm ehfrrougi also mood aunwnlgall Mon ins;hoer voM1)S oomph on ponce omo nran ��rr na yp ,. w d oSu, tam"allauacenn 5 ibirone sweet�ocng anOlMw al Owauidemmcnrmtndthen'ores oohs policytaW1iIWIa,. .oma rsJratilnek this box moat NNfictlun ndrinSnvl sheet,buwin3,hb,marc n(pxsoF,abntmdwsaM then uorkni.rmp policy mro,m yon_ /am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site iufhrmanon. Ins rranee Company Name Guard insurance Companies Policy x 01-Self-ins.L, li ,,qJURWC6;0�9917 f Expiration Date',009/0412017 r� �-,( ob Si[e Address. Li _Tl le, iltokc . { (a(\jc.A _ City/state/zip._ }V�k�� /0C vll.tsd.) Attach a copy of the workerscompensation policy declaration page(showing the policy number and expire ion date). Y-ailare to sva:ure coverage as required under Section 25A of NIGL e 152 can cad to the imposition orcriminai penalties of a fine up to$1.500.00 and/or one-year imprisonment,as well as civil penalties in the forme of STOP WORK ORDER and a The of up to$250.00 a day against the violator_ Be advised that a copy of this state tent may ot forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury ha the information provided above is true and correct tiimature_ nsCP16 � / K -1- A1i Vlione s:,, 413-552-0200 1 i Official use may. Do not write in this area,Os be completed by city or town official li City or Town' Pe mttfLieense._ 1 I Issuing Authority(circle one): L Board of Health 2, Building Department 3.City/Town Clerk 9.filectrieal inspector 5.Plumbing Inspector 1 II4.Other I Contact Person: Phone A: _— o TE A�ane CERTIFICATE OF LIABILITY INSURANCE IMS 01/NOO6m THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the certificate hoHbr is an ADDITIONAL INSURED,the poucyfies)must be andomd if SUBROGATION IS WAIVED.subject to the terms end conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer tights to the certificate holder In Lieu of such endorsemenhs). PRODUCER 'OONIACT brute Powers Webber 6 Grinnell P (413)586-0111 .I cFµ Nal (4151596-N�_gy_ 1u1a11 IMG 861 NorthKing Street q 1fWsexa@aebbexandgr ore INSW1FJt19)AEFOImNOCOVEAAOE__. t_._ MAICa Northampton MA 01060 IN$UREaA$mployera Mutual Casualty INSURED NOIJRER9 Berk hire BwrbaNay CFM107 Ina,. Co.American Installations, LLC INSURER C: i___ .. ..American .. Attn: Wes $ Suzanne Couture esosER el _ I 130 College Street, Suite 100 INSURER 6:__ South Radley tat 01075 INSURERF: COVERAGES CERTIFICATE NU1lBERMaater saga 9-2017 REVISIONNUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY 8E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERME EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LINTS SWAM MAY HAVE SEEN REDUCED 8V PAID CLAIMS._ *a IIM ADDIB ,.— ... POLICY En WLICYGF .... .— CR I TYPE OF INSURANCE Mea evo PIXMYNJMCeR INNONYTYYI Irm9CIXYaYY1 UNITS I COMMERCIAL GENERA/ amain 1 EACH CGGURRENCE 1,000,000 A 4,X CLAIMSMAOE L 'OCCUR A TU EO • 500,000 XI Liquor Liability 1503535211 19/4/2016 9/4/2017 MED EXP meprm70 10,000 _.. _ .. _ PERSONAL A ADV INJURY 1,900,000 • GEM.AGGREGATE LIMITIT �APPLIES PER. GENERAL A016EGATE 2,000,000 !X ECUCn�i'_GT I L ; ". PRODUCTS.CCIATOP AGA' 2,000,000 I OTHER; I AUTOMOBILE LIAMUTY COMBINED 00GLE UNIT 1,000.000 Pae_.. 'ANY AUTOtem,„wow„come A •;ALL OWNED XSCHEDULED 5934352]] 9/9/2016 9/4/2017 BODILY INJURY IaN«J6V,RY I YlN X'NOOEO I PROPERre IAMAOEX.e4rEDMJSOS I AUTOS ___.. .. __.... _... RP-9aNc 8,000 IX UMBRELLA JAB occuR EACH OCCURRENCE IS 1,000,000 A _ EYCEa'Lis C4AI154160E'., AGGREGATE 1i_„ 1 000,000 T CED I X I RETENTIONS 10.607 '.5:353521] 9/6/2016 9/4/2017 I5 WORRhRSCOMPENSA ON i y.PER 1 10116 SNO ENROYERCYan*TY EACH SE ID _ESC t PNY EER A M ORRARIIERrc%ECVTYE YJNI NIA EI EAC ACCIDENT S 500 000 B o adateMEMNER EXCLUDED? IMyagMNay In NM » OMNC60991] 1 9H@016 9/4/2017 :E1 DISEASE AEMMOYEEI 900,000 OE9,CR1Pf10NOEOGERAHON6EpT EL DREAM.POLICY OMIT 5 500,002 A I Commercial Property .5.3535217 9/4/2016 19/4/2017 0e6HubY SIN] 020,000 I „eat..stow040,000 DESCPoMI PUON OF OPERAN$I LOCATIONS I VEWF5 CL (ACORD 101 601111100•1Renal*.hmWNmWCMare .Tay 6 ale Neu N'p.$rsJ CERTIFICATE HOLDER _ CANCELLATION SNOUtD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED geFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A111110112Eb REPRESENTATIVE Kevin Joyce/IDP �e'I' —' C198E-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101 y The AGGRO name and logo are registered marks of ACORD INSe2Ernnu,' Massachusetts-Department of Public Safety Unrestricted-Buildings of any use group which Board of Building Regylations and Standards contain less than 35,000 cubic feet(991m)of Construction Snpenisor enclosed space. License:fS-10017 ' CS-10§17/3 ,.sfl ar< WESLEY COUTUf S • it 166 NORM MA171 South Badley/4/2=01 : Failure to possess a current edition dthe Massachusetts sZ T 10 Expiration' - .State Building Code is rause for revocation of this kerne. J.(.o,d .,i.1Expiration Commissioner 09/29/2017 for DPS ucensingnfmnatIonWi wwwMass.am,/OPS Wry C }� ;' -t -0 aotk l . . , ."GUr ',7 trEreOffice of Consumer Affairs and Busi ss Reg'-lation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement C$ ctor Registration _ Registration: 175982 Type: LLC Expiration: 6/27/2017 Tr% 265208 AMERICAN INSTALLATIONS, LLC WESLEY COUTURE __._ 130 COLLEGE STREET SUITE 100 SOUTH HADLEY, MA 01075 - — Update Address and return card.Mark reason for change SCA, o 20M05/11 Address Q Renewal 0 Employment D Lost Card C Ae few neoleweaa / If nue/e®t2 Office altossumerAffairs&Sunless Replied/3s License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found centro to: titration: 175982 Type: Ogee of Consumer Affairs and Bushiest Regulation Fxgratlon 8272017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 AMERICAN INSTALLATIONS,ad. WESLEY COUTURE ` /r 130 COLLEGE STREET SUITE' 100 yk„,5,...� ///�(Jj//P/ r SOUTH HADLEY,MA 01015' Uvdersecretary N valid without signature