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44-073
IS FAIRWAY DR BP-2017-0692 GIS a: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-073 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2017-0692 Proiectd JS-201.7-001134 Est. Cost: $1500.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: JASM ENTERPRISES LLC 108517 Lot Size(sa. 11.1: 10018.80 Owner: KELLOGG CHRISTOPHER S&TERESA Loving. Applicant: JASM ENTERPRISES LLC AT: 15 FAIRWAY DR Applicant Address: Phone: Insurance: P O BOX 1276 (413)427-5481 WC CH!COPEEMA01201 ISSUED ON:11/18/2016 0:00:00 TO PERFORM THE FOLLOWING WORK::ATTIC OPEN BLOW CELLULOSE 8" OVER 936 SQ FT 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 4 Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Derwrtment Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAYBE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/18/20160:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0692 APPLICANT/CONTACT PERSON JASM ENTERPRISES LLC ADDRESS/PHONE P O BOX 1276 CHICOPEE (413)427-5481 PROPERTY LOCATION 15 FAIRWAY DR MAP 44 PARCEL 073 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OU Fee Paid t//41CBuildinE Permit Filled out Fee Paid Typeof Construction: ATTIC OPEN BLOW CELLULOSE 8"OVER 936 SQ FT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 108517 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: rApproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:$ 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 De e 'tion ao,;ry ��/ /71 /' Signatureof 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 Statue at Pemift: / Building Department Curb CutUDdvewayPemnt 212 Main Street Sewer/Septic Availability <<4.‘ T Room 100 Water/Welt Availability f�/ Northampton, MA 01060 Two Sets of Structural Plans / �, 5,/ phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans '`�o" `� Other Specify !CATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address' / !li{I r Cn.1 � (' This section to be completed by office ` Map Lot Unit Flo re.YIN. r /{i fl Zone Overlay District _ b I 0(P 2 Elml St.District CB District SECTION 2-PROPERTY OWNERSHIP!AUTMORIZED AGENT 2.1 Owner of Record: /teesa Ke//ot� - /5 604-wayOr Name(Print) Current Maaing Address'. //// ‘113 55Z 9788 ,cie_ Aulnorize I%r/!1 Telephone Signature 2.2 Authorized Agent: Sean 6racdshau) 70 BOX /27(o dicro e inn Name(Print) Current Mailing Address: 0/02/ _ ...it 9/3 - 250-97% Signature !r Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building / V 6 nil on (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of _ Construction from Ls) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) �[( 5-Fire Protection +J j z� 6. Total a(l +2+3+4+5) sob 00 _ Check Number low /(� This Section For Official Use Only I Date Building Permit Number: Issued: Signature. Building Commissioner/Inspector of Buiteings Date Section 4. ZONING AB Information Must Be Completed. permit Can Be Denied Due To incomplete Information Existing Proposed Required by Zoning This column m be 61kd in by Building Depanment Lot Size Frontage Setbacks Front Side L: R: L: R. Rear Building Height Bldg.Square Footage .o Open Space Footage (Lot area minus bldg&paved parking) of Parking Spaces Fill: (volume&Location) A, Has a Special Permit./Variance/finding ever been issued for/on the site? NO O DONT KNOW YES O IF YES,date issued: IF YES: Was^tshe permit recorded at the Registry of Deeds? NO (✓ DONT KNOW g YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO ig DON'T KNOW CJ YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained a Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO 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 IF YES, describe size, type and location: E. WI!the construction activity disturb(clearing,gradin excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) n Roofing in Or Doors 0 Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks (0 [g Siding[01 Other BriefDescriptionof Proposed p / c open blew Ce Nu lose S3' over 934 sqF-1- Alteration of existing bedroom /'/ Yes No Adding new bedroom Yes No 2 'SU la'f t do Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building :One Family Two Family Other b. Number of rooms 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? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. 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 AGENT OR CONTRACTOR APPLIES1_I V FOR BUILDING PERMIT (('''' I, Sze ho rat TUf m as Owner of the subject property Q C hereby authorize T43rf9 114/zr,Pnses �L e- to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Q 6 - Date Sean raOI shae , as Owner/Authori Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best omy knowledge and belief. Signed under the pains and penalties of perjury. E rads atJ Print Name � /1-16-/6 Signature /- 1 Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ : .B Name of License Holder. Seen -adshaAJ CS /615/7 License Number PO 8ox /276 d copee inn oiozi /z -/a - i8 Address Expiration Date 9/3 250 4'794 Signalaill Telephone 9.Repletered Home Improvement Contractgr: Not Applicable 0 TRSm tn -'erprlses [LC /(e& 6 Company Name Registration Number Po 8ox /at(0 CAicatyze. inn o/ozl 9-2/-/3 Address Expiration Date Telephone 9/330/ 86/6 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 of the issuance of the building permit Signed Affidavit Attached Yes X No ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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, Sixth Edition Section 108.3.5.1. Definition 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 home 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 building permit. As acting Construction Supervisor your presence on the job 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. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State ofMassachusens General Laws Annotated. Homeowner Signature _ _ _ City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste 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 defined by MGL c 111, S 150A. Address of the work: The debris will be transported by: USA OvmpsFier The debris will be received by: USA °vmes7er Building permit number: // Name of Permit Applicant Stan &aridd / 11-1S -4. Ira`� Date Signa re of Permit Applicant Unrestricted 13U tidtni}n ci au• use stoupnhlch contain less ha II 1.000 cubic (i:cl (')'I I m') of ' .. enclosed space CS-108517 SEAN BRA USIIAW 246 CONN EC ICUT AVENUE Springfield MA 111119 Failure to {mzcvx a 4n+ent rftauni of filo hday.ar hvartz 57 ..- Jji�d+ .. SInto Budding Code t‘ ku !Co/It(.rg3or of Ihu, '¢rose. 12110/2018 Of tmi I It..o.,iir poi om.1 ,11i4 vi.n www�.::, �.,,:Tr, .----1 JASME-1 OP ID:PM a`-ao CERTIFICATE OF LIABILITY INSURANCE ��a10 e J 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 TME 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(la)must be endorsed. N SUBROGATION IS WAIVED,subject to the bans and condition,of The policy,certain policies may require an endorsement t A statement on this certificate doss not confer rights to the cer611tete holder In Eau of such eadonamad(a} C Chews Stewart&Fontana NAME Lukas 101 Stab Street,P.O Box 9031 uct.En.413-788-4531 1 FAX .413-214-8180 Springfield,MA 01102 %r est Luka ,roomse:dukeaajeehasalna.com erauaEllal aFTorEIXIa COVERAGE NMC XINSURE MAIM JASM INSURER II Northland Insurance Com�mnles Enterprises LLC smRcae: Jeff Bradshaw PO Box 1276 _INSURER c:ArhNW Protection 41380 Chicopee,MA 01021 enututo:Torus Specialty ___.. __.__.__ INSURER E: INSURER P: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO L E WFY 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 CONDfON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POMCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. *SR TYPE OF INSURANCEADELRUM wuCtvF POLICY El, - — MD END POLICY NURSER !MMMfrrn daLUWIWYI tars A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 cwnaxwE X OCCUR X W8281416 0600/2018 0600/2017nirrn 100,000 _.__ J kEOEXP(Any person) _ 5,000 _ _ 1 PERSONAL a AM Xulm 1,000,000 mrt AGGREGATE LIT aPRIES PER: GENERAL AGGREGATE 2,000,000 "Mt"'[..J HI LOC PRODUCTS COMP/OP AGG 2,000,000 OTHER AUTOaonE UAfMEIY 1 1cboMOlxEosoddentslNOtt inn 1,000,000 C ANY AUTO 1020008523 110106/2016 10/054017 BODILY Ramo'{Per Pe,vm) AL.OWNEDSCHEDULED AUTOS X AUTOS B____________ODO'INJURY(Por modem)__ X HEED.Autos X Aurr-c OIw.RTYDM X urRE+u LIAR _ Ot•ruR EACH OCCURRENCE 2,000,000 D X arta LRa CLAMS-MADE 78851K/62ALI 06400018 06/20/2017 AGGREGATE 2,000,000 10001 1 nrTbNs 'WORKERS COMPENSATION i AND EMPLOYERS''INSERT YIX I STATUTE ER 1 ANY PROPRIETORc'WTXEPIIXECUTv nI EL.EACH ACCIDENT CFPI¢RMEABEW EXCLUDED? NIA 1 DIaNIMMY In MM I E1 ryrsAps-EA EMPLOYEE X'p drOFO --- OESfJiRrra110NCPERAigN6ptivA' ELDISEASE-POLICY LIMIT 1 I � I 1 DESCRIPTOR OF OPERATIONS I LOCATIONS I VEHICLES(ACORD lM.A6VMI Mans SGEtM,my In aY[Md Einem Rpm*M requited) CERTIFICATE MOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIESSE CANCELLED EDMORE The EX%RATIN DATE THEREOF, NOnCE KILL BE DELIVERED IN A of TMelsch Engineering SE WITH Teff POLICY PROVISIONS. 60 Bhawmut Rd,Suite 2 Canton,MA 02021 Raymond Lukas 01888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo an registered meats of ACORD starrm AceRd CERTIFICATE OF LIABILITY INSURANCE e"'1' 6 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 TRE COVERAGE AFFORDED BY THE POI win 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 pot must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions 0 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 endoeennnt(s). "MICE" CHASE CLARKE STEWART&FONTANAA`T PO BOX 9031 PHONE - I FAz SPRINGFIELD, MA 01102 A`Ho 1aga9as:.. ........—._....... MSU ER4)u_EORmxG COVERAGE 114SURER A: Liberty Mutual Fire Insurance 23035 JAM ENTERPRISES LLC MEOmR°--- - PO BOX 1276 *ISMER C: —„ — CHICOPEEMA 01021 INSURER 0I _ INSURER E: COVERAGES CERTIFICATE NUMBER:32495764 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REDUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO MMICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIWS AND COIAttnONS OP SUCH POLIOES.LIMITS SHOWN MAY HAVE SEEN REDUCED EY PNDCLAMS, NS Polity IWteN�I\ TYPE OF �Wp POLICY YI LIMNS CWaa3Lc1N.GENERAL LYBIUYY EACH OCCURRENCH tlNYn IMOE 11 J OCCUR _ JAM EMIMyone qrunl .... PERSIXMI 4 AW MNRY GENt AGGREGATE URAL MFtES PER. GENERAL AGGREGATE __ThE1u POLIO!POLIO! PosmD FLOG PR000CTW -COMWAGO • IQ 'v , $ AVIONO JLCLIANIfr CC RI___ OMIT i - tett AUTO HOMY INJURY{PMWan} S OVMEG SCHEDULED ROGILY fWRYIPW accident) i - — _ AUTOS ONLY El AUTOS _ :Ramosp&Y ElAAUTW WRY L Nn!ROPE my MW1i3E 5 .— S UMBRELLA qua OCCUR EACH OCCURRENCE 4 -.J EX48S LAB CLAAASAAADE. AGGRKATE 3 __..- MFO REMOTIONS 4 A VANN M MOISB'5ATION 'WC2-315-614501-016 10202015 10120/2017 ,r I�P.C4TE ER ANDEMPLOTERS I mm YIN _.�..._� MCmiVF ^ MIA fit.EACH ACCIDENT 4 1000000 FICHAMEMAERAXCLUOEIOttpttpWpAAWWy In NHI ' r I EL a^BASE-FAEMPLovEE 4 100000 O R 1 tOF OPERATICASbeim .4 L OK'EASE-POUCY LIMIT S 1000010 1 MGCINPTCM OF OPERATIONS/IX:C TICNSI VENOMS IACOIm NO ACWIwW RwInW%IeMAA„ry Sp MYehJalroe sprig Nnp4nl WOKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. This candidate cancels and supersedes ati previously Issued certificates.only as they relate to workers Compensation coverage. CERTIFICATE MOLDER CANCELLATION NATIONAL GRID Tic EXPIRATION DATEHE A �THERDFREOF.F,DESCRIBED POLICIES BSD CANCELLEDBEFORE IIN PO BOX960 MA 01532 ACCORDANCE WITH THE POLICY PROVISIONS. AYTRIplJ2EDREMESENrfATNF A *t /1drj( I Liberty Mutual Fire Insurance d�/ 019884015 ACORD CORPORATION. All rights reserved. AC ORD ZS(2016)03) The ACORD name and logo are registered marks of ACORD vuv B I 1-414507 I 1647 NC I 11e2tl35e I I0/23/2016 c129:06 w IP TI I Palle 1 n. I • The Commonwealth of Massachusetts n t• Department of Industrial Accidents =rkh _t- 2S 1 Congress Street,Suite 100 E th =..0- ! Boston,MA 02114-2017 www.mass.govldia /Yorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING ALTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):JASM Enterprises, LLC. Address: P.O.Box 1276 City/State/Zip: Chicopee, MA 01021Phone It 413-301-8010 Are you ate employer?Check the appropriate box: Type of project(required): I.Ti l am a employer with 9 employees(full and/or part-time)' 7. 0 New construction 201 am a.sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling v capacity.[No workers'comp.insurance emqulvA.; 3.0 I em a homeowner doing all work myself.(No workers comp.insurance required./' 9. ID Demolition 4.01 am a homeowner and will be hirin tractors to conduct all work on m 10 El Building addition g con y proxny- I will ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions pmprinon with no employees. 12.❑Plumbing repairs or additions sC I am a general contractor and I have hired the sub-contractors listed on the attached sheet. l3. ROOf repairs These subcontractors have employees and have workers'comp.insurance., ❑ P 6.0 We are a corporation and its officers have exercised their right of exemption per MGL 14.Mother insulation 15a,944).and we have no employees.[No workers comp.insurance required.] zany applicant that cheeks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner,whosubmit this affidavit indicating they are doing'all work and then hire outside contraclota must submit a new affidavit indicating such. :Contactors that check this box must attached an additional shat showing the name of the sub-contractors and state whether or not those entities have employed. If the subcontractors 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: Liberty Mutual Policy ft or Self-ins.Lie.tit WC2-315-372772-015 Expiration Date: 5' 2- - I'? rob 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 MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the,ins an• •ermines of perjury that the information provided above is true andel correct. Signature: aietDate: //-1/6 Phone a: 413-301-8010 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License if Issuing Authority(circle one): 1.Board or Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: .r54 n 7 O/fdrtorruie(e/a orrice of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 I tome Improvement Contractor Registration Reyisfation: 186074 Type: LLC Expiration 4/21/2018 "Frit 419291 JASM ENTERPRISES LLC JEFFEREY BRAE/SHAW P.O. BOX 1276 CHICOPEE, MA 01201 Update Add rest and return card. Murk reason for chungr. Address Renewal Employment rust Card SCni 10f4 45't -14 'a-.,,,,, „...,db,/' 74/.e..d,,. 61. :.D Wen.of COliamuvr Waits\Ihuiness Itevnlahon Accuse or registration valid for individnl use only I;,,,HOME IMPROVEMENT CONTRACTOR before the eviration date, If found return to: to tRegistration: 566074 Typo: Office of(unsure Affairs:tad nosiness Regulation 7l;'✓J ,t Expiration: 421201$ LLC W Park Pica Suite$170 Boston, MA 02116 JASM ENTERPRISES LLC - JEFFEREY BRADSHAW I t L L �.. 805 NEWBJR`( ST ✓ � SPRINGFIELD, MA 01104 I dersecret111 N I valid without sign:note