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31A-175 (2) 32 MAYNARD RD BP-2019-1077 GIS #: COMMONWEALTH OF MASSACHUSETTS Mao:Block:3IA- 175 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TOTHEGUARANTY FUND (MGL e.142A) Categorv� Bath reno -- - BUILDING PERMIT Permit BP-2019-1077 Protect# JS-2019-001751 Est. Cost: $23500.00 Fee: $152.75 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor. License: Use Group? VALLEY HOME IMPROVEMENT INC 077279 Lot Size(so. R); 7492.32 Owner. WELCH EDWARD 7]R Zoning, URB(100)/ Applicant VALLEY HOME IMPROVEMENT INC AT. 32 MAYNARD RD Applicant Address: Phone: Insurance: P O BOX 60627 (413) 584-7522 Workers Compensation FLORENCEMA01062 ISSUED ON:4/212019 0:00:00 TO PERFORM THE FOLLOWING WORK REMODEL 2ND FLOR 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 Occuoancv Signature: FeeTvoe: Date Paid: Amount: Building 4/2/20190:00:00 $152.75 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File#BP-2019-1077 APPLICANT/CONTACT PERSON VALLEY HOME IMPROVEMENT INC ADDRESSIPHONE P O BOX 60627 FLORENCE (413)584-7522 PROPERTY LOCATION 32 MAYNARD RD MAP 31A PARCEL 175 001 ZONE URB000V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E SED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildirm Permit Filled out Fee Paid Typeof Construction: REMODEL 2ND FLOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 077279 3 sets of Plans/Plot Plan THE FO WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: V 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 Delay Z2y/-&/9 Si rte 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 s`ratus of Permit lF Building Department curb CWOnveway Permit - ) 212 Main Street Sewer/SepocAvailabildy �f` Room 100lit- Wate�NVell Avadabtldy Northampton, MA 01060 Two Sets of5trlikural phone 413-587-1240 FaX413-587-1272 PlouSae Othe'rSpeatyt z �' APPLICATION TO CONSTRUCT, VATEOR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION t-SITE INFORMATION Y 1.7 Property Address, MAR ? r� ZQ)9 This section to be completed by office as ffb,yno4d R Map Lot Unit nr r moPTNc , on r,�A 1u Overlay DiStrmt i El.St District CBDistrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1�� WdCh 4. 51-&noLjo e'l as QLaz oa dd Name dnt) „n ' Cunent�Ad ess: (((("')(lam(,/.` bio-a99-5o9s ( (Mti . Telephone Signature 2.2 Authorized Agent: 5l P.?rY SI��er nc� P.p.C�ox l�o�a� �lorencc_ M!a oleX 2 Name(Print) Current Mailing Addr..i Y j-584-1522 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS- Item Estimated Cost(Dollars)to be Oficial Use.Only completed by permit applicant 1. Building a U[) d (a)Building Permit Fee _ 2. Electrical 606 (b)Estimated Total Cast of Construction from 6, 3. Plumbing 5�o BuildingPermit Fee . . 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) ,JQD ' CheckNumber 3 This.Section For Official Use.Only Date - Building Permit Numbs r ' Issued. L/ q/' Signature /-/-`y//q' Building Commissioner/inspector of Buildings - Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Informati Must Be Completed. Permit Can Be Denied Due To Incomplete Information leolotiog Proposed Ralmind by Zoning This calumn to belittled laby Building Dcpazmmt Lot Size Frontage Setbacks Front Side L: 1 R L:! R:I_! �J Rear =--- !—� ESquwe �' ! tageage&paycd j I #of Parking Spaces Fill: �_� __,.I� i;. (volume&LacapoaJ A. Hasa Special Permit/Variance/Finding ever een issued for/on the site? NO 0 DON'T KNOW- Q YES Q IF YES, date issued:,^ IF YES: Was the permit recorded at the Registry of eeds? NO Q DONT KNOW 0 YES 0 IFYES: enter Booki Pa e�_I and/or Document#�� B. Does the site contain a brook, body of wateA� Dtate ? NO ® DONT KNOW YES IF YES, has a permit been or need to be othe Conservation Commission? Needs to be obtained Q Obt , Date Issued: C. Do any signs exist on the property? YES NO Q IF YES, describe size, type and location: D. Are there any proposed changes to or additintend for the property? YES () NO C) IF YES, describe size, type and location:E. Wtll the construction activitydisturb(clearing, graon,or filing over t acreoris itpadofacommonplanthat will disturb over t acre? YES Q N IF YES,then a Northampton Storm Water Management Permit from the DP 's required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alterations) EA Roofing ❑ Or Doors El Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [E:I Siding[0] Other[1:1] Brief Description of Proposed Work gR, k,( 2rI? rl hAfi{ WO C�g4ey D 2��vj(L - NUGGIa. jQ fb Alteration of existing bedroom_Yes�No Adding new bedroom Yes 7,No �Am'Tf . Attached Narrative Renovating unfinished basement _Yes �[ No (/ Plans Attached Roll Sheet) ea.ff.NeW house an&or addition to'existinChousing, com6lete the fol[owin% a. Use of building: One Family Two Family Other b. Number of roams 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? E Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction L Is constmction within 1001.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 IIAGENT II G'',^E,N.^T.IIOR'.CONTRACTOR APPLIES FOR BUILDING PERMIT I. 114 tt '�N! d r5h&nrxn P.�0�7✓D , as Owner of the subject property hereby authorize\]41-T t rJrP cfla c71�VC✓MQ to act on in behalf, in all m er relative to work authorized by this building permit application. Signature Owner Date , 5-e)t SI IUtf✓man V Ra: , 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. e,ierl dVCr Print Name r�7f f/�///// 3 Signature of Cwner/Agen I . Date �� /i 1 SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construct Not C Nat Applicable ❑ q Nameof License Holder'. C �iY$U�-Y�. V 11�{'Y(11Q.1'1 017a� L� License Number SUP) Fomif-t'� SoJA+-�O-ti HA oib-i3 (olaI 1a() Address ° Expiration Oate tSid 113 58y-�5aa Sign re Telephone 9.Rediiter'ed HomeImproveinenE Cbntrattor j _ , ,_ __ _ „__ Not Applicable ❑ y(1�Pu rj��. Sm�rovemend 16C5543 Comaan�v Nor reNor re Registration Number i �Ptafpcc w4 OIOIoZ 711-1 12-0 Address Expiration Date Telephone13-Sgy'7vZZ 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 cf the issuance of the building permit. Signed Affidavit Attached Yes......, No...... 0 City of Northampton s � Massachusetts- DEPARTMENT OF BUILDING INSPECTIONS \ 212 Main Street • Municipal Building Northampton, MA 01060 - �M 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"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 he registered Type of Work y-K ezmo(lel Est.Cost: Address of Work oA r-)CtAd 9d Date of Permit Application: $ ( 27 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 ARBrrRATION PROGRAM OR GUARANTY FUND UNDER M.G.L.Chapter 142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBH,ITES 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: \Irallcum _11�rdanmr �rn rlC 10 bqs Date Contrac r Name MC 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 Massachusetts Z y DEPARTMENT OF BUILDING INSPECTIONS 'Pu \ 212 Main street • M niciPal Building Novthampton, FA 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.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5,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 j ob 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 / Massachusetts DEPAETMENT OF BUILDING INSPECTIONS 212 Hain street •Mu—nipal Building Northampton, ! 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.defned by MGL c 111. S 150A. The debris from construction work being performed at: 3a � d na� t omd (Please print house number and street name) Is to be disposed of at: �ato t�1�/+hc�rnQi (HleaYe print n We and loc onon of Or will be disposed of in a dumpster onsite rented or leased from: (Company Name and Address) A� /��j A 3A71� Signature of Permit Applicant or Owner Da e 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. 1 The Commonwealth of Massachusetts Department oflndustrialAeeidents 1 Congress Street,Suite IOO Boston,MA 02114-2017 Bomemass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE MED WITH THE PERN1111ING AUTHORITY, Applicaut Information —[ Please Print Lecibly Nam � f .lyn OYa�e TYi L Address: Q0 CJI)A \o(Xoa—I City/scare/zip: Florence C UP olC�b2 Phone#: 413 58N- 5aa Are you on employer"Check the appropriate box: Type of project(required): rgramacmpmycrwih IS mpoyenoixuam/orpanrwe).• 7. ❑New construction 2❑Iemasolepropriemruparmershipmdhaveno®ployeesworkingfvrmem 8. Remodeling mytapedty.[No workers'comp.msmmce requ i,d] 9. El Demolition 3.❑I m,a homcowaer doing ap wodr myself Mo workers'camp.wsmmmee mquved]t 4.❑Iamahomenwvm macaw be hvio moon to comuc<au wnkann IwJI 10 E]Building addition g can YProPmtY. wsuc mat au cwhactom cimerhave workers'anmpevsatiov ivsamnre oc are son 11,[:]Electrical repairs or additions pcopvemrs wlmao cmpluyaaa 12.❑Plumbing repairs or additions 5I sm a gwaal coahace,r and l have bredme sub-contractors listed oa ffi machedsheet These sub-contractors bare empmyecs shave wodrem'cem13p.irmcome! '❑Roof repairs 6.RWe ar,—,marcc mdesofficas have exc.cdthevrightofexe.,poops MGLu 14.❑Other 152,§I(4),mdwc have ao employees.[No workers'com,ussurmcc required] 'Any wphcmt kmnccd a box pl must ohm fill out me section below ahewiog thev workers'compensation pcU'infornamm. t Homeoamaa who submit this atfidavh ivdicativgmey are dowg all work mdmmhve outside contractors must submit a a<w affidavit wdicatiog such. tCovtrecmm that checkmis box mart attached m additional sheet showing me vane ofine sub-cootmctors aad stale whether or mt nose woes have employees. Itrhe mb<ovtredors Leve®ployees,meymurt provide mer workeri comp.pohcy number. I am an employer that is providing workers'co pensation insurance for my employees. Below is the policy and job site information. ll cc Insurance Company Name: A'Y�Plla I acyarye. t-1 np Policy#or Self-ins.LLi�ic.a�#: (7 ,70302.\`J Expiration Date: a) 1 I Job Site Address: OM f10.I/)t K.m CiTy/State/Zip: !11'1/-/fin uo—A2 A& 01L Attach a copy of the workers'compensatim policy declaration page(showing the policy number a`n'"dexexp[ratiim—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 terrify under thepains and Id of erjury that the information provided above is true and correct Simon ,h/Z Date . r3/tel Phone#: `l�3'Se,>-I—��Jaa Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/Lio use# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/To%m Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: - Phone#: 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 ajmen enterprise,and including the legal representatives of a deceased employer,or the receiver ar 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,construction 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 hearse 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 coutracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)carrots),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,are 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 my 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 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 frill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sane to fill in the permit/licewe number which 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 should 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. A new affidavit must be fdled 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, 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 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 aparhnents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction 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 commouwealth 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 fill out the workers'compensation affidavit completely,by checldng the boxes that apply to your situation and,if necessary,supply your insurance company's time,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 LLP 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 affidavit. The affidavit should be refound 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 pot cy,please call the Department at the number listed below. Self-insured companies should enter their self-instance bcsase 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 which will be used as a reference number.In addition,an applicant that most submit multiple permiNlicense applications in any given yen,need only submit one affidavit indicating anent poficy 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 proofthat 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-MASSAFE Fax# 617-727-7749 www.mass.gov/dia Fmm Rcvns d02-23-15 ®� Commonwealth of Massachusetts ]Ivision of Pmfexzional Licensure Board of Building Regulations and staldard, CanstrycH�Ss i5pervi sor f CS-077279i { E3rnres. 05/2112020 STEVEN A SIL�/ERMArf v j 268 FOM ER ROUND SOUTHAMPTON[dIA-010]] :- �O t7�/.SS33O'�S Commissioner C/ f�ze Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvemne t;Contractor Registration Type: Corporation VALLEYHOME IMPROVEMENT INC {4r7 Registration: 105543 P.O.BOX 60627 x-, Expiration: 07116/2020 FLORENCE,MA 01062 y Y• \V L�.. s1 i� Update Address and Return Card. 1 0 20..rV11177 dJ JA Office m Consuer EME 4Business Regulation HOME IMPROVEMENTCONTRACTOR before the etogthation date. dual Iffouneenly tur TYPE;Carooraftion before th eonsu er date. a dBu return e fleoistraticn. Equitation/200 Office of Ash Consumers-Susand Business Regulation 05 0]/16/2020 One Ashburton Place-Suite 1301 VALLEY HO ME2H0 E t5V C Boston,MA 02108 3 A.SILV 40 AN MANS ,P_CGQ, — ERSIDED NO RIV4 NORlI-IAMPTON,MA2 Undersecretary Not valid without signature