30A-027 (2) 22 LEXINGTON AVE BP-2016-1469
GIS#: _ COMMONWEALTH OF MASSACHUSETTS
Map:Block:30A-027 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTYFUND (MMGLc.1144/2�A)
Category:INSULATION BUILDING PLLcLR-L'IIT
Permit# BP-2016-1469
Project# JS-2016-002518
Est.Cost:$2400.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
lig Group: AMERICAN INSTALLATIONS LLC 106178
Lot Size(sq.ft.): 20342.52 Owner: BELUZO ASHLEY N&SIMON HILDT
ZoninE: URB(I0u1 Applicant: AMERICAN INSTALLATIONS LLC
AT: 22 LEXINGTON AVE
Applicant Address: Phone: Insurance:
130 COLLEGE ST (413) 552-0200 Liability
SOUTH HADLEYMA01075 ISSUED ON:6/13/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:ATTIC & BASEMENT INSULATION AND AIR
SEALING THROUGHOUT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeTvpc: Date Paid: Amount:
Building 6/13/2016 0:00:00 S65.00
212 Main Street, Phone(413)587-12.40,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1469
APPLICANT/CONTACT PERSON AMERICAN INSTALLATIONS LLC
ADDRESS/PHONE 130 COLLEGE ST SOUTH HADLEY (413)552-0200
PROPERTY LOCATION 22 LEXINGTON AVE
MAP 30A PARCEL 027 001 ZONE URB(I00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Fillcd out .t
Fee Paid Crow 3-7/5 ti QS"—
Typeof Construction: ATTIC&BASEMENT INSULATION AND AIR SEALING THROUGHOUT
New Construction
Non Structural interior renovations
Addition to Existine
Accessory Structure
Building Plans Included:
Owner/Statement or License 106178
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INp'O$MATION 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
Y�a i oli '.n Delay
#ipl
Signa are 0 :lidding
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.
O .. DaparbnaM maedrty
1.. City of Northampton SMka ofP.ermib,
{^..— Building Department Cwb Permit
- 212 Main Street Sewerl5ap5uAvetiabBNy
S 9 Room 100 WaterlWegAya9abRly
,rthampton,MA01060 1O as¢pc�mI
phone 413-587-1240 Fax 413.587-1272 P(eusna plans .
et?
APPLICATION TO CONSTRUCT.ALTER,REPAK RENOVATE OR DEMOLISH A ONE OR TWO FAMLY IWEUJNG
SECTION 1-SITE INFORMATION
i.i pror*tvMdres#: This section to be completed by office
Map Lot Unit.
22 Lexington Avenue Florence,MA 01062
Zone °coney District
Elm St District.- - CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Simon&Ashley Hitch 22 Lexington Avenue Florence,MA 01062
Name(Prot) Current Mating Adders.:
(413) 345-1281
See attached Tedium
Signature
202 Authorized Anent
American Installations 130 College St., Ste 100 South Hadley,MA 01075
Name(Print) Curtail Meting Address:
American Installations 413-552-0200
Signals* TebWme
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Permit applicant
1. Building 2400.00 (a)Building Permit Fee
2. Electical (b)Estimated Total Cost ci
Construction from(6)
3. Plumbing Building Permit Fee
4. Meryanicel(HVAC)
5.Fire Prote on
6. Total=(1+2+3+4+5) 2400.00 Check Number e1.1I S- 40$'
This Section For CONN Use Only
Date
Building Permit Number: Issued:
eta'kig Cam uthnflspecto of& s Date
Section 4. ZONING AU Information Must Be Competed.Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning 7:14
This column to be filled in by
lauBLog Depummt4111
Lot Size
Frontage I I
Setbacks From
Side L:I 1 R LI 1 R: I
Rear J ' i
Building Height
Bldg.Square Footage %Open Space Footage(Lot ere.miens &paved
u % J
ft of Parking Spaces
Fill: ti r
(volume&Location)
A. Has a Special Permit/Variance/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 DON'T KNOW 0 YES 0
IF YES: enter Book I I Page and/or Document PI
B. Does the site contain a brook,body of water or wetlands? NO O DONT KNOW 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:I I
C. Do any signs exist on the property? YES 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 7 YES O NO O
IF YES,describe size,type and location:
E. Will the construction activity disturb(dealing,grading,excavation,or Ming)over 1 sae oris it part of a common plan
that will disturb over l acre? YES O NO O
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
pECIION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Willows Minutiae pre) 0 Roofing ❑
Or Doors 0
Accessory Bldg. ❑ Demolition 0 New Signs pt11 Della (0 Siding tot Other[INI
Brief Deeoptbn of .Si,..ved
Week Attic and basement insulation and air sealing throughout
Alteration of ream lwdoom Yes No Adding new bedoom Yes No
Attached NemeOre Renovating urdsished basement _Yes No
Plane Amdled Roll -Sheet
_ .. . __. .. .. ..
Ba.�IaW house ender addition to eldstlnRhpuslna..comolebe theollowlnG:
a. Use of b.tAig:One Family Two Feely Other
b. Number of room In each family unit Number of Bathrooms
c. Is there a garage attached?
d. PI Se ew1 Spare footage of new transduction. Dlaersions
e. Number of stories?
I. Method of healing? Fireplaces or Woodcaves Numbs of each
g. Energy Coeerdlon Compliance. Maaschoit Energy Compliance form attached?
h. Type of construction
I. le construction viable 100 ft of wetlands? Yee _No. Is construction whir 100 yr. f oodpleln Yes No
J. Depth of besemni or cellar flour below finished grade
It. WH baling ocdorm to tip Btiding end Zoning regulations? Yea_No.
I. Septic Tans_ City Sewer_ Private well City wider Supply__
SECTION?a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, Simon &Ashley Hildt as Ower if the *isles
property
hereby authorize American Installations
toed o my belied,In el mailers relative to work auSeahed by vie bulking pane epdcNwi.
See attached 6/3/2016
spore downer Cele
I, American Installations as Omer/Authorized
Ages hereby declare that the Metemene all Information on the faegodrg eppOmllcn are We and accurate,to the bed of my/ioiiedge
arc belles.
Signed under the pass end painitlss of palm.
American Installations
Pan flew LU
`
American Installations y wRA LC CAU--7- 6(3/2016
s_tn of OwerlAgere llae
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor. Not Applicable ❑
Name of License Bolder: Wesley K. Couture 106178
License Number
130 College St., Ste 100 South Hadley,MA 01075 9/29/17
Address Expiration Date
WG tt. 413-552-0200
SlpnaWre Telephone
9.Registered Rorie Improvement Coniracfor. _.... - _ _ Not Applicable ❑
Wesley Couture 175982
Company Name Registration 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 c.152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide fids affidava will result
In the denial of the Issuance of the bulling permit
Signed Affidavit Agonised Yes. H. No.._. ❑
11. -
Rome 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 ads
as supervisor.CMR 780, Sixth Edition Section 10835.1.
Definition of Homeowner:Person(s)who own a parcel of lend on which he/she raids or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached stmcmres accessory to such use and/or farm
shuchaes.A person who constructs more than one home In a two-rear period shall not be considered a homeowner.
Such"homeowner'.shall submit to the Building Official,on a farm acceptable to the Building Official,that he/she shall be
responsible for all suck work performed under the bundles permit.
As acting Construction Supervisor your presence on the job site will be requrcd from time to time,during end 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 mar beliable for person(s)
you hire to perforin work for you under this permit.
The undersigned'9romeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature _
(„..-- City of Northampton
Massachusetts - ` -1::: 4x
�aass� OF amtasac neearemmurs IA
F
212 sola Street • Municipal Building ,`gym
Martheq,ten, Ms 01069 •t-
Property Address: 22 Lexington Avenue Florence,MA 01062
Contractor
Name: American Installations
Address: 130 College Street Ste. 100
City, State: South Hadley,MA
Phone: 43-552-0200
Property Owner
Name: Simon&Ashley Hilt
Address: 22 Lexington Avenue
City, State: Florence,MA 01062
t,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 p I re `i -
Date June 6th,2016 W 1•��`"�
•
'PIA Amenoanlnnameonvmm
BBB]
ii brenseta Insured
1111104:1
MA 6t a:105178
MA Reglstradonp 175982
American Installations
130 College Street suite 100,South Hadley,MA 01015•Office:4131552.0200 Fm(41315514102•Email:a JppMpamWmnbnHlatIons.com
Hildt,Simon&Ashley 3/31/2016
Far
22 Lexington Ave. Florence MA 01062
iszee
413.345.1281 shlldt@hotmail.com ma
Nee M
433562 Iw.ii 16-0778
rex, isze
Quantity Unit Unit Cost Total
Air Sealing
AIR SEALING 8 man hour.1$ 85.00 $ 68000
Total Air Sealing $ 68000
Total Air Sealing Incentive $ 680.00
Weatherization
CRAWLSPACE WALL RIO RIGID INSL 124 sqft $ 3.70 $ 458.80
INSULATE EXISTING DOOR 1 each $ 73.91 $ 73.91
FIAT-7"OPEN R-25 648 soft $ 1.30 $ 842.40
VENTILATION CHUTES 18 each $ 2.00 $ 36.00
SHEATHING ACCESS 1 each $ 31.31 $ 31.31
DAMMING R-38 80 linear ft $ 2.05 5 164.00
REMOVE INSULATION 120 sqft $ 0.75 $ 90.00
Total Incentivized Weatherization $ 1,606.42
Total Non-Incentivized Weatherization $ 90.00
Total Project $ 2,376.42
Total Utility Contribution $ 1,884.82
Total Customer Contribution) 491.61
WARRANTY mesion installations,LLC will provide the abovestated bomeevner with a 1year rohma nth,p warrantv.
Arne roan instollations,LLC hereby proposes to furnish at mateml and labor o complete the above scope of work in accord a MP,/ith the above speak-awns and an local and state building
ACCEPTANCE Or PROPOSAL The above prices,specifications and TOTAL CONTRACT VALUE= $ 491.61
conditions
e tl sfactory and are hereby accepted.Y
authorized todo work as specified.payment will be In down pnota Down Payment= $ 163.00 as 3/31/2016
start of work,and balance due upon completion. p AID
Balance Due Upon Completion= $ 328.61
wee
Hildt,Simon&Ashley C //'H�} nn 3/31/2016
Craig A.Dragovich »G nn< 3/31/2016
THIS ALPFEMOrr 0 COMPOSED CC THIS PAGE W
wRRED10tl c ,
aM+',M the o6T a
eE t}Mn* apilEREIWFURRFFOIUD TO 4rOJEIT.AND NUL NE SUUCT TO ALL AIIII0PRIATE um.REGUATICIMSyq c weayscftxe Etna OF WWoL&,m OR
it\ The Commonwealth of Massachusetts
=ma Department of Industrial Accidents
an rr
Sf Office of Investigations
ti 51 I Congress Street,Suite 100
vel= Boston,MA 02114-2017
+�• www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual) American Installations, LLC
Address: 130 College Street,Suite 100
City/State/Zip: South Hadley, MA 01075 Phone#: 413-552-0200
Are you an employer?Check the appropriate box:
27 4. lama neral contractor and I �of project(required):
L® Iamoyees( u! with ❑ general
employees(full andtor part-timer have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheot. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in any capacity. employees and have workers'
[No workers' comp.insurance comp.insurance.t 9. ❑Building addition
required] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MOL
12.0 Roof repairs
insurance required.)t e. 152,§1(4),and we have no Insulation
employees. [No workers' I3.�Other
comp.insurance required.) _
'Any applicant that checks box a1 must also fill out the section below showing their workers'compensation policy information.
Homeownas who submit this affidavit indicating they are doing all work end then hire outside contractors must submit anew affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the suh-emNa:ron and state whether or not thoseentitics have
employes. If the sub-contactors 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: Guard Insurance Companies
Policy#or Self-ins. Lie. #: ORWC609917 Expiration Date: 09/04/2016
Job Site Address: 22 L Jfl r' C6U. Q„&*v x kA ....,, City/State/Zip: FA/n :Lk-4l M E. 010(02-
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MCI.c. 152 can lead to the imposition of criminal penalties of 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. Be 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 cert(f under the pains and penalties of perjury that the information provided above is true and correct.
Si! Lit
+tr-.[.G�[.. .. : v . J ' Date:
f
phone#: 44S-1576- -naoo
Official use only. Do not write in this area,to be completed by city or town official m �
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 It:
AcoRt, CERTIFICATE OF LIABILITY INSURANCE DA4�4Mi2o"s Y)
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 poliryfes)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the polity,certain policies may require an endorsement A statement on this certificate does not confer rights to the
tenifirata holder in lieu of such endorsement(s).
PRODUCER weittINTAClT Linda Powers
Webber & Grinnell PHONE�Eap (9137586-0111 PAS�.l_(413)696-64x1
B North King Street AQORREee:1pomers@webberandgrinnell,com
INSURERIS)AFFORDING COVERAGE MAIC e
Northampton NA 01060 psURERAEmployers Mutual CasualtY..... ..
INSURED eSt1 EewaGEOWDIBR rnvo
American Installations, LLC eSURERC:
Attn: Wes 5 Susanne Couture MSURERD:
130 College Street Suite 100 INSURER E:
South Hadley MA 01075 INRURERF:
COVERAGES CERTIFICATE NUMBER36aster 4-2015 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. NOTWTHSTANDING ANY REQUIREMENT,TERM DR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VMVICH 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,{�
AOR TYPE OF INSURANCE en YMD POLICY NUMBER IM MMNpTYVY) mWC tY'Y t UNITS
X COMMERCIAL GENERA;MINUTE EACHOCCURRENCE 1,000,000
A en CLAIMS-MADE i ]PAPER PREMISES 50,000
El 503535216 9/4/2015 9/4/2016 MED EXP(AM eimrwncn) 10,000
II PERSONAL.4ADV INJURY 1,000,000
GEESAGGREGATEUNIIT APPLIES PER: GENERALAGGREGATE 2,000,000
X POMC' 1JpRI 1LGC 'PRODUCTS-GOMPAWAGG 2,000,000
OTHER, s
AUTOMOBILE Mann tbM81NEDSINGLE LIMIT ' S 1,000,000
A II ANY AUTO RODNY INJURY(PuPpam) S
ALTCANED SCHEDULED
'IROS R AUTOS 5a3535214 914/2015 9/a/2G16 BODILY INJURY(Per amdm0 $
NONOOYaLO DROPOUT
__ .•. -..y
X KREOAUTQ"a 1 XI
PIP-Eat S 8,000
X UMBRELLA WB OCCUR EACH OCCURRENCE S 1 000,000
A ■ IXOEBa LNB ■CLAIMS-MADE AGGREGATE $ 1,000,000
,DEG X RETENTIONS 10 000 573535216 9/4/2015 9/4/2016 S
WORKERS COMPENSATION . PER t GOT
ANDEMPITHERSLmBIURY 't AN STATUTE iFR
ANY PROPRIETOR/PARTNER/CARAT-DUE EL EACH ACCIDENT $ 500,000
OFFICERmEMOER EXCLUDED? N/A
B
(Mandalay lit Nil) UANC609917 9/6/2015 9/4/2016 E.L DISEASE-EA EMPLOYEES 500,000
if ye[ NnbN Ander
D ••
DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LINR $ 500,000
A Commercial Property 5A3 35216 9/412015 9J4/2916 *Nut STOOP 20,000
dV9ANa stSW 40,000
DESCRIPUON Dc OPERAnON$/LOCATIONS I VEHICLES iACORO In Addmble Remarks 6[Iwdpe,maybe aW[MU If More spate is AgWIad)
Proof of Coverage. Workers' Compensation policy includes class code 5974
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTNOPII£e REPRESENTATIVE
Kevin Joyce/LNF '3 ^'
ID 1988-2014 ACORD CORPORATOR. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS025,xrunn
Massachusetts-Department of Public Safety Unrestricted-Buildings of any use group which
Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m3)of
Con:tractinn Supervisor Inaln enclosed space.
License:(5106178
ss.er is r'e
WESLEY COU1LJi,E p.
166NORM MAS Salli /
South Hadley MXolt(�=j -
VFailure to possess a current edition of the Massachusetts
f _.,a .'a'"'' Expiration --State Building Code is cause for revocation of[Ns license.
Commissioner 09/29/2017 For OPS Licensing information welt nww.Mass.Gov/OPS
3ti V4e V/ 7V//e'Qnwea! V 07 ScAwie .
III Office of Consumer Affairs and Busi- ss Regi lat+on
.. 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor 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.
SCM ozone-ours 0 Address 9 Renewal 9 Employment 9 Lost Card
r-R,'l eez//A,f iter /..,e/GL
Office of Commute Affairs&BusiRegulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to,
teg
mlmdom 175962 Type: Office of Consumer Affairs and Business Regulation
Expiration 627!2017 LLC 10 Park Plera-Suite 5170
_ _ . Boston,MA 02116
AMERICAN INSTALLATIONS,ILO
WESLEY COUTURE /
130 COLLEGE STREET SURE 100 -- o z-`„ ,�_ ///9�r /-.//`/t/
SOUTH HADLEY,MA 01075 Undersecretary - N valid without signature