36-214 (10) BP-2023-0144
24
MapIBlock LANE
COMMONWEALTH OF MASSACHUSETTS
36-214-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-0144 PERMISSION IS HEREBY GRANTED TO:
Project# INSULATION 2023 Contractor: License:
DIPIETRO HOME ENERGY
Est. Cost: 2789 SOLUTIONS DBA REVISE 104464
Const.Class: Exp.Date: 03/06/2024
Use Group: Owner: ALLGAIER, JOSHUA &HOLLY HAY
Lot Size (sq.ft.)
DIPIETRO HOME ENERGY SOLUTIONS DBA
Zoning: SR/WP Applicant: REVISE
Applicant Address Phone: Insurance:
32 MIDDLESEX ST (978)203-6736 WCA00573401
HAVERHILL, MA 01835
ISSUED ON: 02/09/2023
TO PERFORM THE FOLLOWING WORK:
INSULATION!WEATH ERIZATI ON
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: I
i yOO
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
FEB! fipn7::: .
i r___.„___ _:_"_, ..„,_,Lil_,.,_
l)itr2' 198to
4, The Commonwealth of Massachusetts
,, 2D23 Board of Building Regulations and Standards FOR
: {w. I--- Massachusetts State Building Code, 780 CMR MUNICIPALITY
. _...-, USE
•l adding Adrta'tit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Buildin Permit Number: gas 01 3•/V ' Date A plied: 02/02/2023
1 c=Ui(J , J� 55
o /// Z _ 2-q-Zbz3
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
24 Birch Ln Florence,MA 01062 36-214-001
1.1 a Is this an accepted street?yes V no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Prov'ded
i
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone?
— Municipal 0 On site disposal system 0
Check if yes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Holly Allgaier Florence, MA 01062
Name(Print) City,State,ZIP
24 Birch Ln 413-588-8738 hollyspice@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
Brief Description of Proposed Work2:Insulation,Weatherization,and Air Sealing
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $2789.55 1. Building Permit Fee:$ Indicate how fee is determined:
2.Electrical $0 ❑Standard City/Town Application Fee
❑Total Project Cost (Item 6)x multiplier x----
3.Plumbing $0 2. Other Fees: $
4.Mechanical (HVAC) $0 List:
5.Mechanical (Fire
Suppression) $0 Total All Fees;1,e $
Check No.0 Check Amount`:: 06 Cash Amount:
6.Total Project Cost: $2789.55 ❑Paid in Full 0 Outstanding Balance Due: 1
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
CS-104464 03/06/24
James Dimopoulos License Number Expiration Date
Name of CSL Holder
List CSL Type(see below) U
32 Middlesex St
No.and Street Type Description
U Unrestricted(Buildings up to 35,090 cu.ft.)
Haverhill,MA 01835 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonr
y
RC Roofing Covering
��— WS Window and Siding
SF Solid Fuel Burning Appliances
978-203-6736 madisonw@callrevise.com I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) HIC-167375 03/11/24
James Dimopoulos Dipietro Home Energy Solutions dba Revise
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
32 Middlesex St madisonw@callrevise.com
No.and Street Email address
Haverhill,MA 01835 978-203-6736
City/Town,State,ZIP Telephone
SECTION 6: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 B No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work authorized by this building permit application.
See attached authorization
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
• - 02/02/2023
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/des
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage, finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Coitriuottwealth of Massachusetts
r Department of Industrial Accidents
1l. .
. , Office of'lii,'ec Investigations
l._ 600 II'ashirrgtou Street
Boston, MA 02111
ovww.mass.gov/dia
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians Plumbers
Applicant Information Please Pant Let ibly'
Name (Rusinessiorganiiatiun/individual►: Dipietro Home Eneray Solutions dba Revise
Address: 32 Middlesex St
City/State/Zip: Haverhill, MA 01835 Pho1C #: 978-203-6736
Are you an employer? Check the appropriate box: .type of project(required):
1.® lam a employer with 30 4. ❑ 1 am a general contractor and 1
employees(toll andior parr-time).` have hired the sub-contractors
(�. ❑ New constriction
2.
❑ f am a sole proprietor ea pathtu._ listed on the attached sheet. 7. ❑ Remodeling'
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
9. ❑ Building addition
[No workers' comp. insurance comp. insurance.
requir d.j 5. ElWe are a corporation and its 10.❑ Electrical r.'..airs ur additions
officers have exercised their
3. lama homeowner doing ail work 11.0 Plumbing regain or additions
myself. (No workers'comp. right nfexemption per ME 12.0 Roof repairs
insurance required.) t c. 152, §1(4),and we have no
employees. [No workers' 13.® Other WeatheriZation
comp. insurance required_]
'Any applicant that checks box dt I most also till,.ut the suction helix showing their=markets'compensation policy iulitmtatinn.
t I Imnmuwners who submit this affidavit indicating they arc doing all work and that hire outside contractors must submit a new atTidavirindicating such.
('onttactors that cheek this hoe muss attached an additional sheet showing the name ol'the sub-contractors and state whether or not tluwi entities have
employees. Ir the sub-contactors have employees.they must pros ide their workers'comp.policy number.
1 am an employer that is providing ► orkers'compensation insurance for my employees. Below is the policy and job site
information.
insurance Company Name: HUB International New England
Policy#or Self-ins. Lie.#: WCA00573401 Expiration Date: 04/20/2023
Job Site Address:24 Birch Ln city slate izip:Florence, MA 01062
Attach a copy of the workers' compensation policy declaration page(showing the policy number aid e:kpiratinn date).
Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a
tine up to$1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to$250.00 a day against the violator. Bc advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby ccrtifj'under the paifrs uqd penalties of perjuly that the information,provided above is true and correct.
Sitznature: Date:02/02/2023
Phone#: cj i s .-'ct.5 is• 1'
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: Phono•#:
_
��.1 DIPIEHO-01 ___C11QQ. jpE
A CC)RD CERTIFICATE OF LIABILITY INSURANCE CATE(AIMO0'YYYY)
`...."--' 4/4/2022
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
- .__ -..__ _._- �.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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).
PRoaticER License it 1780862 CONTACT
_N k Anya Toteanu S HUB International New England PHONE FAX
300 Ballardvale Street tAtC.No.Ext). - t.'C.Not.
Wilmington,MA 01887 Miss,anya.toteanu@hubintcrnationai.com
tNsuRERts,ArTORDOIG COVERAGE -,_-, AMC It_..
TINSURER AAtlantic Charter Insurance Company _44326
».S'.LxEi1 :INSURER 8:
Joseph A. Oipietro Heating 8 Cooling.Inc., Dipietro Home Ud URERQ
Energy Solutions,Inc.,Revise.Inc.
32 Middlesex Street MSVRER O. _�
Haverhill, MA 01835 INSURERS •
—.--- ------- -- -- INSURER F.__—_._.__--- _1
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TIlL INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'NI IH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALI THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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: EXCESS LIAB CLAtM1S-MN.)t At f;RE^ATE___
1 GED RETENTIONS S
S __.___. .—— -. ----_.--
IR
A WORKERS
PLLOYERS COMPENSATION
X__. A.TV E--._.__._ER... .. .----_
Rwu:F 1F t. >Ai NiRFkF.t:Urr,-: N WCA00573401 4120/2022 4120/2023 _ _ 1,000,0001
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DESCRIPTION OF OPERATIONS,LOCATIONS 1 VEHICLES IACORO lot,Addd onat Re-narks Schedule may be MUM('4 moot spat*4 otduv*dl i
I
.CERTIFICATE HOLDER CANCELLATION
Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
212 Main St THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Northampton, MA 01060 —_- Ji
AUTHORIZED REPRESENTATIVE
'i/A.'-';'"--11`;-9 - '
ACORD 25(2016/03) i)1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
�—.41 *D DATE t1g000tYYro I
AC _ Rn CERTIFICATE OF LIABILITY INSURANCE
Cot 14;2022
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(ics)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 endersement(s).
PROOUC ER CONTACT Litho/C;:STelho
NAME _
Costello Insurance Group PItONC (97R)374•6352 i/Alr
78)521-5127'__ ...
A.C,No Exit INC.flea
2 S.Kimball St. 1-MAI:JORL�S: ecbstello@ccstellorisLiatioa.com
A
?O BOX 52413 _ __ INSUREESS1 AFFORDSIG COVERAGE NAIC I
3ra(ifnM `IA 01835 t mum A. Colony A:gnlnst:ranre -- -- ----
INSURED issuf LR s Commerce Insurarce Co 34754
Ctp utro Home Energy SCAUTSA i.Inc. INsuRER C:
CSA Revise INSURER D..
32 Middlesex S:rt •INSURER E.
Bratfford MA 018-35 INStiRLR F:
COVERAGES CERTIFICATE NUMBER: CL22414023sh; REVISION NUMBER:
I t-IS iS 10 CERTIFY THAT THE F0L:CIES CF ITISJRANCE LIS-:EL;t ELOW HAVE SEEP'.iSSUEJ TC THE INSLR_J NAME)ABOVE FOR THE POLICY."'ERI00
INDICATED NOTWITHSTANDING AN"REOJIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CAM r tF ICAT I:MAY tit.ISc;UC D OH MAY PERTAIN.THI:INSURANCE.At-F ORDL C BY THE F'OL ICIE S OL SC RILTL D tit REIN IS SUBJE C t TO ALL I HE. FLRMS
EYCLUSICNS AND CONDITIONS OF SJCH POLICIES URIIES SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
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CERTIFICATE HOLDER CANCELLATION
Town of Northampton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECO4NCELLED BEFORE
212 Main St THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS
Northampton, MA 01060
A.1HORIZED REPRESENTAI YE
I
1988-2015 ACORD CORPORATION All rights reserved.
ACORD 25(2016.031 The ACORD name and logo are registered marks of ACORD
DocuSign Envelope ID:78DDBC7F-C23F-4BCB-A953-330712CED129
RE
l
the way .•—
Permit Authorization Form
Site ID:
Street Address:
City:
To be filled out by Subcontractor (if applicable)
Contractor Name: Dipietro Home Energy Solutions DBA Revise
Contractor Address: 32 Middlesex St Bradford Ma 01835
Holly Allgaier
owner of the property listed above hereby authorize Revise Energy or my assign d
subcontractor listed above to act on my behalf and obtain a building permit to
perform insulation and/or weatherization work on my property under the Mass Save
Home Energy Services Program.
—DocuSigned by:
Owner Signature:
7DABD 137B0B3456...
Date: 1/10/2023
DocuSign Envelope ID:78DDBC7F-C23F-4BCB-A953-330712CED129
Revise Energy
IIIREVISE
the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - YY�/�/
Z
1-800-885-7283
Page 1
PROGRAM
CMA-HPC
CUSTOMER PHONE DATE CLIENT WORK ORDER
Holly Allgaier (413) 588-8738 12/14/2022 520315 42204
SERVICE STREET BIWNG STREET PROPOSED BY:
24 Birch Lane 24 Birch Lane Revise Energy
SERVICE CITY,STATE,BP BIWNG CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062
DESCRIPTION QTY COST INCENTIVE TOTAL
INCENTIVE 75%
For eligible weatherization measures, Eversource is offering an
incentive of 75%for insulation measures and 100%for the air sealing
measures, both with no limit. You are eligible to apply for the 0% Heat
Loan to finance your co-pay, applications must be submitted before
the weatherization work begins.
HOME AIR SEALING 6 $565.98 $565.98
Provide labor and materials to seal areas of your home against
wasteful,excess air leakage. Materials to be used to seal your home
can include caulks,foams and other products. Primary areas for
sealing include air leakage to attics, basements, attached garages
and other unheated areas(windows are not generally addressed.)
TRANSITIONS-DENSE PACK 19 $76.00 $76.00
Provide labor and materials to dense-pack the kneewall transitions
with Class I Cellulose.
TRANSITIONS-FLOORED 8 $109.44 $109.44
Provide labor and materials to air seal the floored kneewall
transitions of your home against wasteful, excess air leakage.
WEATHERSTRIP AND ADD DOOR SWEEP 6 $347.52 $347.52
Provide labor and materials to install Q-lon weatherstripping and a
doorsweep to door(s)to restrict air leakage.
KNEEWALL-2"RIGID BOARD 203 $881.02 $660.77 $220.25
Provide labor and materials to install rigid board at R-10 or greater
with the required fire rating to a kneewall area.
KNEEWALL FLOOR- 10"DENSE R-32 CELLULOSE 72 $200.88 $150.66 $50.22
Provide labor and materials to install a 10"layer of dense packed R-
32 Class I Cellulose to the kneewall floor.
PULL DOWN STAIR:THERMADOME 1 $253.21 $253.21
Provide labor and materials to install an easily moved, insulating
cover for the attic access folding stair. The cover has integral weather-
stripping to restrict air leakage.
DocuSign Envelope ID:78DDBC7F-C23F-4BCB-A953-330712CED129
Revise Energy
REVISE
the way you save 5 South Summer Street,Bradford,MA 01835 CONTRACT - YY�/��
Z
1-800-885-7283
Page 2
PROGRAM
CMA-HPC
CUSTOMER PHONE DATE CLIENT N WORK ORDER
Holly Allgaier (413) 588-8738 12/14/2022 520315 42204
SERVICE STREET BILLING STREET PROPOSED BY-
24 Birch Lane 24 Birch Lane Revise Energy
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
Florence, MA 01062 Florence, MA 01062
DESCRIPTION QTY COST INCENTIVE TOTAL
BASEMENT SILLS-R19 FIBERGLASS BATT 150 $355.50 $266.63 $88.87
Provide labor and materials to install R-19 unfaced fiberglass
insulation to the perimeter of the basement ceiling at the house sill.
Total: $2,789.55
Program Incentive: $2,430.21
Customer Total: $359.34
WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Three Hundred Fifty-Nine & 34/100 Dollars $359.34
l DocuSigned by:
�—DocuSigned by:
COMPANY RM0NTA9IVE CUSTOMER SfGNA Q D137B 0B3456
1/10/2023
NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE
SIGN DATE
DAYS.
Virtual Circle One In-Home
Revise Energy Planview Diagram
Customer: rA > \\ Advisor Name: Jun /1/4v7e,I(t
Address: .4 fk;xc,_ Lotot Any limitations to access by truck? Y/re
Town: I'I c7,rence. 44A 01OL Site ID: j kcy *Use the greater of the two BAS#'s when calculatirg for MVR
#of stories 1 1.5 2 2.5 3 I BAS 1: 15 cfm X#occupants X n-factor = L/
n-factor 19 16 15 14.4 13.7 BAS 2: .00S83 X area X height X n-factor =
Mechanical Ventilation Recommended:BAS>final C,FM50> (0.7 X BAS) Mechanical Ventilation Required:(0.7 X BAS)>final CFM50
Is this part of a multi-unit workscope?Y or w )A/s Multiplier? N/A >6"Loose Insulation Cross-Batt >6"Mix Loose/x-batt Truss
Workscope:
(3) k q,,1 11 floor /O 'nPC— 7
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THE COMMONWEALTH OF MASSACHUSE_TTS
Office of Consumer Affairs and Business Regulation
1000 Washington-Street - Suite 710
Boston, Massachusetts 02118
Home Improvement-Contractor Registration
Type: Individuni
.ftegt5Tration: 167375
JAMES G.OIMOUOUI OS Expiration: 03/11/2021
25 SEVEN SISTER RD
HAVERHILL,MA 01830 •7
•
Update Address nil Return Card.
THE COMMONWEALTH OF MASSACHUSETT"
Office of Consumer Affairs&Business Regulation Registration valid for individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE Individual Office of Consumer Affairs and Business Regulation
Regist►elien Expiration 1000 Washington Street -Suite 710
167376 03/11/2024 Boston,MA 02118
JAMES G.D,MOUOULbS
JAMES DIMOUOULOS •,'
25 SEVEN SISTER RD A/,,,..d•;' '•rG(rx y/ N1iS
IAVERHILL.MA 01830
tar (jd withoutsignature
Undersecre �_.
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® Commonwealth at Massachusetts
Division of Occupational Licensure
Board of Building Reg ulations and Standards
t
Canstttit}iorl SS4wrvisor
CS-104.64 x " Aires:03/06/2024
JAMES G DIMOPOULOS ..
25 SEVEN SISTER RD
HAVERHILL MA 01830 i
J. )L
Cc unmissioner ud.24 1 - , 'A-