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HomeMy WebLinkAboutBuilding Permit #153-13 - 432 SALEM STREET 8/23/2012 VIORTJI BUILDING PERMIT 0 Al%-tom -e;�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION H T e Date Received Permit NO: .s SSACHU`�� Date Issued: il�:; IINIPGRTANT:Applicant must complete all items on this page 1'L®CA�TION � x 71 Pnnt ,3' t sa s # SROPERTY ®WNER �. t'�ti -� �t�C'{o �i � � f .< .;; ��rr ������,� o AN- �--IPARCE;l�J"7 �r_ ,ONINIS�TRICTtHisfinc Distnc o achine ShoVillage+ yes no Y S `00 ® - dR1;� d � urea r �I ;ruct _ yxes� n�• I TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9.One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ARepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ® Sp FpWtlanWc ;We ®istnct DESCRIPTION OF WORK TO BE PERFORMED: �`�r cA � �� �G E �L►c� �c1 Identification Please Type or Print Clearly) OWNER: Name: �o� ���uS�a,-� Phone: 97A � o�'3��3�3 Address: q3r, S., A4 54- r+ _ ! ry f rr C&N,ITRACTOR J�a% ��� 1Gtn: t T Aid ess ®r--N , -Su erui'sor's C st'ruction Licensed nye. — Home Im rovement LcenseF m7c'157E�'xp ate 4 n z ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �o 2�0 0 Y FEE: $ Check No.: a �y 0r Receipt No.: a?SLv� NOTE: Per c ti g ith unregistered contractors do not have access to the guaranty fund ignnt rug eofAgenOwner �` ` . .: Si nature of contracto` �'_' " 'aa 9. . _ _. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS i CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments - Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located at 384 Osgood Street—978-685-0950 FIRE DEPAR MENT �Temp Dumpster on1 ite ,yes ' ;> no �Locateat12�4M'a niS reet978688�9590 FireDepart entsgnature/date i i �C®MNI.ENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ® Notified for pickup - Date I Doc.Building Permit Revised 2012 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Li Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan a Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass Check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2012 Location °""' rA ' No. !�? Dat S e - * TOWN OF NORTH ANDOVER Certificate of Occupancy $ a Building/Frame Permit Fee r �.,,.. Foundation Permit Fee $ k , � .,. • Other Permit Fee $ o TOTAL $ Check 25645 'Buiiding Inspector c10RTH own o Andover No. h ver, Mass, 2e,12. COC MIC Ml WKK 1 (i - 4A-rEO C11,04 ��.(5 U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT i.6 BUILDING INSPECTOR �. � MFoundation haspermission to erect .. .................... build' on ......... .........��.�.......�...,.,.....�.....,....,,... i Rough tobe occupied as .......... ., IE.......R,.--rs, ..................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. - PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ...,.... Service ............. ... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected'.and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE i NORTH Tz own ofAndover No. t _ L/H! h ver, Mass, 2! 261z O 1 COC HIC Hit WICK � RATED /•PS S U BOARD OF HEALTH Food/Kitchen PER IT LD Septic System THIS CERTIFIES THAT ........ i. .... ... ..., BUILDING INSPECTOR ............. .. ............. ....... .................. . Wk .'. Foundation ........ . .. has permission to erect.. .................... build'rs, on ......... .�. Rough to be occupied as .......... .. y ....... .. . .. .................................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .. .................................. FinalService ................. .�� Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner 1 Street No. Smoke Det. I SEE REVERSE SIDE � Exam n ttaor -Sc r Rep® t 4 . = L kF `• �, 4 ¢ .-5`�l°' t � .lt IT" tick,, y�q �' tom•:'. ti? Vincent S Colangelo 3 Hodgson Street Tewksbury,MA 01876 Dear Candidate - 17 0- t<. Congratulations on suiicessfulty passing the ResidentiahRoof Covering Conruction Supeiv(sorexanlinatiortadministered on 8i/13%2012 xx, `s ti A minimum score of 70%is required to pass the exam THIS IS NOT YOUR LICENSE~1tSSii1ry 44 y~y ;fix YOU MUST MAIL THE FOLLOWING;TO THE BOARD TO RECEIVE YOUR LICENSE 1)Send the entire form with photo a)1-1/4"x 1"self-photograph(Passport photo preferred) b)Money order,certified check or bank check ONLY,in the amount of$150 made payable to.the address listed on the form telow. Print your name on the money order or check. AllNote:The Board must receive-wfthfn.,f.year of your testdato. ow approximatel30 d y ays tli receive,your license Failure! use your correct mailing address :when mailing the form,fee and photo will restilE to decaying the issuance of your license :. ` .,.,` -.:._._..� :....._•:_ ._....ter - - .._.�........ ,'. 3 , = Commonwealthgf,Massachusetls. + Massachusetts-Department of Public Safety One rtment Ashburton lace,Roo �-�' Board of Building Regulations and Standards �T One Ashburton Place,Room 1301 f Boston'MAo21oA Calistruction Super%i+or Speri;ilt� a Date of License: CSSL-105943 G} �' ' :firth S "%` ,,` � 4 I f ATTACH A VINCENT CO 1-1/4'X 1• L-XNGELO PHOTO:HERE M1 3 HODGSON STREETT,,i• t Tewksbury MA 018768 License Number 7 iamount `w. NOTE+Ti Is application must be sEgned Exam DateType3Registra�n No �- O �/ j�`7��= and returned witti;payment,A'money 03/13P201!j!F i 3 Expiration order;cerbf�dcheckorDa'nkcheek.tr 5150 GOfllrniS5iOr1t'r 03/09/2016 is acceptable.DpNt7r SEND CASH. ' t : Make check payable:to VltlCent S Colangelo : COMM U NWEALTH ORMASSACNSEiTS 3'Hodgson Street ` Tewksbury,MA 01876 please be advised that it may take up to thirty(30)days from the date that your score report form Is received by the Commonwealth of Massachusetts,Department of Public >afety(Department)for you to receive your license card back in the mail.Also,please i note that there is no walk-in service at the Department,score reports and required -attachments must be forwarded to the Department by mail. R _ os$ed seal.a� 0 0 - /�31 .oi-3 PROMETRIC CDROOFI-01 RWALKER ACOR®� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/26/2012 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 be endorsed. If SUBROGATION IS WANED,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 License#PC-904790 NAMTE CT John M.Glover Agency PHONE FAX P.O.Box 700 A/C No Ext:(203)838-5554 ac N.):(203)857-7848 Norwalk,CT 06852 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Montpelier US Insurance Co INSURED INSURER B: Vincent Colangelo dba CD Roofing INSURER C: 3 Hodgson Street INSURER 0: Tewksbury,MA 01876 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 AD L POLICY EFF POLICY EXP LIMITS LTR IN_S_R MWD POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A X COMMERCIAL GENERAL LIABILITY TBD 4/27/2012 4/27/2013 PREMISES Ea oxurrence $ 100,000 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $ 5,000 X $1,000 Per Claim Ded PERSONAL BADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X I POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Tewksbury THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tow TowMain Street ACCORDANCE WITH THE POLICY PROVISIONS. Tewksbury,MA 01876 AUTHORIZED REPRESENTATIVE • ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): (iCS A Address: m� City/State/Zip: Phone#: ��6 ^ �� 7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. []New construction art-time) employees full and/or .* have hired the sub-contractors � ( p am a sole proprietor or partner- listed on the attached sheet.# ?• El Remodeling 2.�.I l ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9• E]Building addition [No workers' comp.insurance 5• ❑ We are a corporation and its 10.El Electrical repairs or additions required.] officers have exercised their right of exemption er MGL 3. 11.❑Plumbing repairs or additions ❑ I am a homeowner doing all work p p myself. [No workers' comp. c. 152, §1(4),and we have no 12.E]Roof repairs insurance required.] employees. workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 5 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 MGL 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 ins nce coverage verification. l do hereby ce er t e p ns and penalties of perjury that the information provided above is trice and correct. Si nature: Date: Phone# 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers Ito 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 a joint 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 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 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 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 contracting 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)name(s),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 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 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 any 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 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 must submit multiple permit/license applications in any given year,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 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 burn leaves etc.)said person is NOT required to complete this affidavit. I ' The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1.877-MASSAFE evised 5-26-05 Fax#617-727-7749 .,n,n,x-- ,.,,.,ia:,. 3 Hodgson St. Residential/Commercial Tewksbury, MA 01876 Masonry Ph: (978) 656-8497 ® Cell: (860) 712-8279 Vincent Colangelo Free Estimates Lic. #170575 ROOFING Fully Insured Proposal Submitted to Homeowner Work To Be Performed At Name r r s5 u- d Street Street If3d 54 e,^l S+ City— A)- Gln d ovef State ZM 'k_ City State Date le//y//� Telephone ,q7$"&83`G373 1 Telephone Complete Description of Work to be Performed: Q — Mew Pe c E r n c •- �d �. / Date work will start Date work will be completed All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from the above specifications must be made in writing on an Add-on/Modification of Contract form and may become an extra charge over and above the amount stated herein. This agreement is contingent upon delays beyond our control.Owners to carry fire,tornado and other necessary insurance.Our workers are fully covered by Worker's Compensation Insurance. Homeowner agrees to pay for all work as set forth below. If the homeowner defaults,homeowner agrees to pay all costs of collection,including reasonable attorneys fees,in addition to other damages incurred by contractor.Full Payment is due upon completion of work. We propose hereby to furnish material and labor-complete in accordance with the above specifications,for the sum of: dollars($ $Q®_ ). Said amount shall be paid as follows: Note: This proposal may be withdrawn by us if not accepted within O days. YOU, THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FOR AN EXPLANATION OF THIS RIGHT. THIS SALE IS SUBJECT TO THE PROVISIONS OF THE HOME SOLICITATION SALES ACT AND THE HOME IMPROVEMENT ACT THIS INSTRUMENT IS NOT NEGOTIABLE. Work will not begin until your right to cancel has expired and you hav ep tt f dollars($ ),unless this agreement provides e Signature of Contractor or authorized representative: *(VWe)have read the terms stated herein,they have bee explained to(me/us),and(VWe)find them to be satisfactory and hereby accept them. r57- Signature of Homeowner(s): I } te O/A� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 - Home Improvement C nt actor Registration _ Registration: 170575 ' f Type: Individual vF_ - _ r Expiration: 11/10/2013 Tr# 218996 VINCENT COLANGELO "/ ,x; VINCENT COLANGELO > 3 HODGESON ST TEWKSBURY, MA 01876 _' �` `) Update Address and return card.Mark reason for change. Address F� Renewal [J- Employment F-] Lost Card DPS-CAt ea 50M-W04-G101216 Office of Consumer Affairs&Businc9s Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR, before the expiration date. If found return to: Registration: 9,70575 Type: � Office of Consumer Affairs and Business Regulation Expiration:`_1 i/10/2013 Individual F 10 Park Plaza-Suite 5170 VIN ENT COLANGE 6 �'k-- -1 Boston,MA 02116 VINCENT COLANGgy ELC ; 3 HODGESON ST T S M 1`876 9 Undersecretary Not valid without signature 1