36-046 (3) 12 WINCHESTER TER BP-2017-0975
GIS u: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:36-046 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: ROOFING/SIDING BUILDING PERMIT
Permit a BP-2017-0975
Project# JS-2017-001679
Est.Cost:$23000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MAJOR HOME IMPROVEMENTS 103054
Lot Size(sq.R.): 10018.80 Owner: BRAIDMAN MICHAEL A&KATHERINE E HAMILL
Zoning: Applicant: MAJOR HOME IMPROVEMENTS
AT: 12 WINCHESTER TER
Applicant Address: Phone: Insurance:
19 HUNTER SLOPE (781) 913-6405 WC
WESTFI ELDMA01085 ISSUED ON:2/27/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:REPLACE VINYL SIDING, REPLACE ROOF
SHINGLES
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 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:
FeeType: Date Paid: Amount:
Building 2/27/2017 0:00:00 $100.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
M-
,_
r,
�iN ity of Northampton C , �* $r .kt, ` 1.
�2'��1g1 '0 wilding Department
212 Main Street r ` `
Room 100 ,. ;..,° ,,.
X14.. h
i—„_„,.. '' N 4,rthampton, MA 01060 ., . : y -
phone ' -587-1240 Fax 413-587-1272 r
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Properly Address.
This section to becompplatetl by office
ta Ih1 i nc.he5-ler. T-ex.-ex. Map Lot Unit
M Or+k Q4/14--pNln t HA zone Overlay District
Elm St.Eisele CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
0. KCcthzrt n arcu:a man setv>,-e_
/ 1\ Name(Pnnt) Current Mailing Address:
�"�� 1/ `L Telephone
t SignatureI _ 91 3- 64 DS
-
2.2
2.2 Authorized Agent:
1/asJ c -wk k k (9 Nunlex3 Sloiae,tues4eIcf i N
Name(Print) Current Mailing Address:
-'-----Z------ 413- 636 1 .2_
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1 Budding Z v C (a)Building Permit Fee
—
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) /Dc3
5. Fire Protection
6. Total=(1 +2+3+4+5) 2...3, 003 — Check Number 0/6a
This Section For Official Use Only
Building Permit Number: Date
Issued.
Signature:����� �y� 2 7-/77
i /
g'• issioner/Inspector of Bul dings Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomptete Information
Existing Proposed Required o Zoning
This column
to
uDn be filled in by
Building Department
Lot Size _ —
Fronta•e � ���
Setbacks Front [..__I
Side Lis R - �.� Cu
Rear IL
Building Heighttwe-.A-
Bldg.Square Footage Milkithialliarall
Open Space Footage eM �
(tor area minus bldg&paved
•arkm)
r-'
Mn
Fill: IMMillaiNAMIMMI
(volume&location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW O YES O
IF YES, date issued
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW O YES O
IF YES: enter Book Page and/or Document I/ I
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued: !
C. Do any signs exist on the property? YES O NO O
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 O
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation or filling)over 1 acre or Is it part of a common plan
that will disturb over 1 acre? YEE O NO O
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) I I Roofing 1,1
Or Doors D
Accessory Bldg. ❑ Demolition ❑ New Signs 0] Decks 10 Siding e] Other ic7
Brief Description of Proposed()ReplaLC s( dlv,i vm), l) l ZCf�10 (1 V' C QS Q S/kr-1 Si
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Rail -Sheet
.L •A dl!x1._ r •� e .M(j7C ray.. hOUeINC.=contoMettiotlowina
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 APPLIES FOR BUILDING PERMIT
I, rat k eK l hl?- tbC YYhC^-try ,as Owner of the subject
prope
hereby authorize 1i16U4( R LI�:fYl-C 1H)CLUC(HFELL.Si(.LII (1C vLNC-('1Q(C CF
to act on my behalf, in alfrhatters r rive to work authorized by this building perm application.
111 . z - 2 —iiiiimilicI �
Signature of Owner Date
I, VC1J i C Cc*VleCrI
C ( CA K ,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.
Vas ; C Ucwc hu k
Print Name
Signature of Owner/Agent Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction SUDO isor: 1 1( Not Applicable 0
Name of License Holder: VAltu.r I[F c4. `elA. -r�`c K I
/ 11 n I/�� �� /�� fI� License Number,/ Q
Address ore I QU11f`C'Jr�n %vl� (.9r474/�"
C Expiration Date
*5-15i-1-17,2
Signature Telephone
ti1 Gonbeoiar: .., : '" ' Not Applicable 0
/99. )`o/Z 4Le 2Z/'' l7/`-N3
ComvName /// lie
2/f Registration NumberAddress Expiration Date
Telephone 413 56OM
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 rh No 0
++��aa YY
11.v;H a I. $IC A RYai'1,,5 tii:
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 10835.1.
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 he 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 of Massachusetts 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: 101, CO ;ma tn.e<1-ctr<
/`ter
The debris will be transported by: kV! \lc // Sir:
The debris will be received by: 71YAn., Aro/yp/2P �N'//4
Building permit number:
Name of Permit Applicant kR5T�ie / <2.fA
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
,t Department of Industrial Accidents
16_'. ,'l Office of Investigations
um.
`5.alien l Congress Street,Suite 100
fr�`�"'� Boston,MA 02114-2 01 7
\.;—se www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information �n A Please Print Legibly
Name(Business//Organizaattion/Indiividual): Widtc ( �ck-t Tv-T sS
Address: I fI � a/JJ�T-ee�m 2lop 42
City/State/Zip: W234C--fel df(A.-DrogS Phone#: X1I3`636-537'2_
Arepyou an employer?Check the appropriate box: Type of project(required):
I.y I am a employer with 4. 0 l am a general contractor and I
employees(full and/or part-time).' have hired the sub-contractors 6. New construction
2. 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g_ 0 Demolition
working for me in any capacity. employees and have workers'
9. a Building addition
[No workers' comp. insurance comp. insuranceat
required.] 5. ® We are a corporation and its 10.0 Electrical repairs or additions
3.0 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 MGL
12.0 Roof repairs
insurance required.]` c. 152,§1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
`Any applicant that checks box @ I must also till out section below showing their workers'compensation policy information
'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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comppolicy 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: _
Policy 4 or Self-ins. Lie.k: 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 ofa 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 DIA for insurance coverage verification.
I do hereby certify under the pains and pe f perjury that the information provided above is true and correct.
Signature: -r, Date: p2—e;97—
Phone#: I /3 — C 36 _S37
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License I
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#:
certificate.pdf 1 / 1 -- 4- it )
ACSRL° CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDfIYYf
b.,--i 06/09/2016
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 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).
w'Y'
PRODUCER AC! Judith Mabee
NAME:
BERKSHIRE INSURANCE GROUP INC. �GNaEp,EMU (413)553-3090 FAX
NW:
AAmrzEx; jmabee@berkshireinsurancegroup.com
60 ALLEN ST. INSURE/VS)AFFORDING COVERAGE NAICv
PITTSFIELD MA 02120-4270 INSURER A: LM INS CORP 33600
INSURED
INSURER B:
MILET INC INSURER C:
DBA MAJOR HOME IMPROVEMENTS INSURER D:
19 HUNTERS SLOPE INSURER E:
WESTFIELD MA 01085 MORE;F.
COVERAGES CERTIFICATE NUMBER:59845 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 REOUIREMENT,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.
Il1RR TYPE OF INSURANCE IADDLSytnn ER- POLICY NUMBER POLICY OF POLICY EXP
I COMMERCIAL GENERAL LIABILITY 1M$EDD IMM�.YYYY, LRNna
EACH OCCURRENCE
CLAIMS-MADE OCCUR ACEI U HEN,EU
M
PREMISES(Ea occurrence)
MED EXP(My one pawn)
I N/A PERSONALS ADV INJURY
GENLAGGREGATE LIMIT APPLIES PEP: GENERAL AGGREGATE
nPG
POucv CT LOC PRODUCTS-COMP/OR AGO
CER. i $
AUTOMOBILE LIABILITY CA, MagfeeR SINGLE LIMB S
ANV AUTO BODILY INJURY(Par ranori) $
ALOWNED I SCHEDULED
N/A BODPINJURY(Per
aytlml $AUTOS N&.8PeE FAMAGE,'HIRED AU-OS AUTOS
r-T _ I S
i1 UMBRELLA LIAS OCCUR EACH OCCURRENCE $
I EXCESS UAB CLA:MSMADE N/A
AGGREGATE $
DEC RETENT,ONS $
WORKERS COMPENSATION I - X t trUTE 12R4-
AND
pili
ANDPEMPLOYEna LIABILITY c¢
OP.PIETORPAPTUER/EXECUTIVE I EL EACH ACCIDENT $ 100,000
A OFFICER,MEMBERE.cwocD, NA1!Na‘ MA WC531S360160056 06/09/2016 08/09/2017
(Mandatory in NH) EL DISEASE-EA EMPLOYEE $ 100.000
i1 a dewnm.rleer E=u-Ns ixm.
sewn-ON orOP E.L DISEASE.POLICY or $ 500,000
N/A
I
DESCRIPTION OF GAMMONS I LOCATIONS/VEHICLES ACORD 101,Additional RemeN Schedule.may be aWtAM ilmmre space is,pulrea)
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date On the above policy precedes the
issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification
Search too'at www.mass.gov/Iwd/workers-compensationinvestigalions/.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
, r>r
Daniel M.Crowley,CPCU,Vice President-Residual Market-WCRIBMA
®1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 2512014/01) The ACORD name and logo are registered marks of ACORD
ACORLI CERTIFICATE OF LIABILITY INSURANCE n"04/21/2016" m
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(its)must be endorsed, if SUSROGAT)ON 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).
PRODUCER SrACT David R any
Neill&Neill Insurance Agency Inc NAI{ _
662 Riverdale Street PHONE 4137324137 1 PAX No 14137316629
West Springfield,MA01089 OR¢s: d)@nelilins,cim
INBURER(S)AFFORDING COVERAGE NAM A
INSURER A, Northland Insurance 24015
'..NsuaeD Mlet Inc D
Major HomeeImprovements INSURERC:
Gd lasile KukhartNVk INSURER :
19 Hunters Slope INSURERpi
Westfield,MA01065 MEURER E;,
WSllPBt F:
COVERAGES CERTIFICATE NUMBER: REVISION NIAtBER:
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 CONDMON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO ViGeCH 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.
iss l Tsri ? a+ i FdRY6#.., POUC ETF:_.
ME OF INSURANCE ,a POLICY NUMBER 14/29/215 4/29/ 016 LAMS
- ram n
A Ji COMMERCIAL GENERAL MABaITY WS246343 104292015 04/29/2016
EACHOCCURRENCEE 1,000r000
,Ow&-LADE OCCUR jDU202016 04/292017 EN 100,000
I ,_R F.Lzssmmmn E
II ' I MEDDEXP(Any Ciep, onI s 5.000
, PERSONALS ACV INJURY s 1.000,000
GEALAQ3REGAie LINILMVUFS PER: I GENERAL AGGREGATE E 2,000,000
,._..I
i vi PO,c,„. j _._ LOC
I PRODUCTS-COMP/OP AGG i s 2000,000
000
:MITER IE
AUTOMOBILE LM6uttI A'^BBIIN"0 SING LIMIT
li $
..W
i .__ _...
Th
O BODILY INJURY(Pot pco aI S
I— ALT LL AWNED iSCHEDULED `
L_.._{ROOS I AUTOS BODILY INJURY(Pq'P[tlEenn 1 E
ED - GROPER:TbAMAGE '
Y a^D tuT05 1 'AUTOS AUTOS ( I E
I
UMBRELLA LIAR I OCCUR :LEACH OCCURRENCE S
... E%CPSS CAS :
CLAIMSTMFDEi �MbCGAPE 5
fIi
RETENPON5 __.._ E
AND
ANORKERSRSOED COMPENSATION i DER 0TH
OFMPIOYAWBi
S ptt Yy N� - IT— ''--¢ ER ,-
.TPROPRETOR/PARTNEAEXECUTIVE
CTFIC 'MEMBER EXCLUDED? NIA EL_EACH ACCIDENT $
-
Mandstory:a MN EL.CISEASE'EA EMPLOYEE' 5
Noses. esMcet/
C .E r
•OEFCR13110N OF OPERATIONS pelw r L,DISEASE-POLICY LIMIT E
CESCRIpnC:%OF OPERATIONS/LOCATIONS/VEHICLES(A W RD 4ON AC®IbMI RaPMY Yh W uie,may be attached IT mote s pM.Is mquDisa
I
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
ACCORDANCE LATH THE POLICY PROVISIONS.
AUNORESENTADVE �l
®1988-201 CORD CORPO . All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
U. T rn er ai rif^41. A#e/b
Office of Consumer Affairs&Business Regulation License or registration valid for individual use only
a -HOME IMPROVEMENT CONTRACTOR before the expiration date. II found return to:
s ReBisttabotr: 171983 Type. Office of Consumer Affairs and Business Regulation
Expiration 5/9/2018 LLC 10 Park Plaza-Suite 5170
a > Boston,MA 02116
MAJOR HOME IMPROVEMENTS,LW. {/ ^�J
VASLfE KUKl1AREHtJK '"—
19 HUNTERS SLOPE Z ..._
WESTFIELD,MA 01085 Undersecretary Not valid without signature
Massachusetts Department of Public Safety
Vf Board of Building Regulations and Standards
License: CS 103054
Construction Supervisor
VASILIE M KUKHARCHUK.
19 HUNTERS SLOPE
WESTFIELD MA 0108Sze
//
r-1_ ln__ Expiration:
Commissioner 02!24/2018