32C-200 _ ... Yom....._..
Sold,Famished and Installed by:
Branch Name: � JT�N Dale: a- � THD At-flame Services,Inc.
dlbea The Home Depot Worcester, Services
345A Greenwood Sweet,Worcester,hQA 01607
Branch Number: ..s. _Job#: 3_.__ _ jj Toll Prcc(BOOT 657-5 f 82; Fax:50$-756-2$54
Federal tD#75-2098461):AE Lic#C 02439 Rl Cont.t.tc#t6427
CT Lic�563522: M Dome InrytovCrrxnl'CoittroctenR�g.VA#12b89i C) /
Installation Address: -t_61 lI Ct1 4y Q& gj.mio. ��+ 1060
City. stark. - Zip
last 4 Dlgite of Ddver's
Purebaser(s): Ltc.#&Fx Me/Yr. Work Phone: Home Phone:
li?aF N1n��1 t-s
4 kc�
AomeAdd.ess:���,�" ��3a��tt0.M'i N� _.-��
(lfdi£ferentfrominatallitionAddross) City State Zip
E-mail Address(to receive updates and promotions ffnln The Home Depot):___ _
Project Information: VWe/Vou(`Purchaser'),the ovmers of the property located at the above installation address,offer to
contract with Tll'D At-Horne Services,Inc,('Home to furnish,deliver and arrange for the installation of all materials
as described on the iltaclvrd Spec$hect p FAR L�c.� ,incorporated herein by reference and made a part hereof.
Home:Depot reserves the rihld to"cancel this coutract if,upon re lospecUon of the job,Horne Depot determines that it
cannot perform its obligations due to a structural problem with the home,pricing errors or because work.required to
complete the job was not Included In the Spec Sheet or Contract.
�^ DEPOSIT PAYMFNT OPTIONS
�yy` (Subject to fund verification artdlm credit apnaovat.)
CONTRACT AMOUNT S ,y,�,.t 1" Cha:k•,Ceahlaa Checlt or us Pata1 5(:rYiaC Moray onto
^^� (Made payable In Tad Home beep l).
t LESS DEPOSIT 3i ` 2. Credit Card'"aridrur other payrnent options-Cirde One Relow
BALANCE DUE Vine MasterCard Discover Atnerimnlixpnas
ON COMPLE'r[ON $ y 1 The Home Napa flame lmpr.ww ltta Yuma Depot Credit Cam
j'Minimum 25%of Contract Amount due auto" CI New Aeciaat ❑Eaisnas Aceatnr etNdg
execution of a exntraM Avaaalse C7mdit S^ _ (till.&KWX ONLY)
�?vncan i i cl.
lndieate Payment Met ed I& Asti#: __ Fxp.Date-
BALANCE DUE ON COMPLETIONI Nan
�(( c as it appaant on card:_-
1r rte, C, **By your signature below,U Vc agree w allow Horne De{iot to
(r00 1 ( �> za �>C 7 c the above referenced cieclitt cary—d F osit indicated. !�
*When you provide a cheek as payment.Yon sutborim us either _ ')�f` a,, ]V -,-2 -,9 t3
to use information Irma your click to nuke a ow-t ne eleutruoic Car6weers fltars im- Date
fitrot transfer fr im yaw arxoom or to process One payment us a
aback traossction.'When we u5 iaforraetion frmn ytwr chock w $ZI,or HDCC Audrotizallop Codes
make.an electronic fuai transfer,funds may be Mthdrawm from
year account u awn sa the paynx at kt=*ivod,nod.you will not I Deposit Final Payment
rrxxivc your dw.k bads. # 2�, �'..ZJ_.__. # r'1("yE�j_ �
Purchaser agrees that,immediately u mu wmpletion of the work,Purchaser will execute a Completion Cali Ctcate end pay any
belanc a due. Purchaser also agrees to be jointly and severally obligated and liable hateindu•.
Entire Aereemeni:This agreement and its amchmen.t;,including any financing agreement,contain the complete a6Teornent
between the polies uid can not be alucaded or modified unicas in Writing in a separate agreement signed by both parties.
NOTICE TO PURCHASER
Do not sign this contract before von read it. You are entitled too completely filled4a copy of the contract at the time
you sign. Keep It M protect!tour rights. Do not sigu a Completlgn
Certificate before this Project is complete. Law
prohibits bume repair eontrsctors i'rem requesting or aceepling,p`Eompletien Certificate signed by the owner prior to
tale actual cnntplction of(tic worst to be performed under the contract.
You may cancel this tranaartit:n any time prior to midnight of the third bashaessv day niter the date of this contract. See
Notice of Cancellation for au explanation of this right. There will he it service charge equal to 141%of the eoatraet
amount if job is cancelled by Purchaser rlt mlk the third business tray,but BEFORE materials are ordered.There will
be a service charge equal to 25°/s of the contract amount if job is cancelled by Purchaser AYFER materials are ordered.
i3Y MY0UR SI iNATUR6 BELOW,I/WE UNDERSTAND THAT THE AGRECMLNT-MAY BF SUBJECT TO REVIEW
OF MY/0111k CREDIT 1F15TOR'i AND VWF AUTBORIZE HUMP DEPOT TO VERIFY AND REV117W MY/OUR
CREDIT RIWORD WITH AN INFHI ENDEN'F CREDIT REPORITNC AGENCY AND RELEASE TIILM FROM AUL.
LIABILITY TNCURRFS)FROM INADVERTENT OMISSIONS OR ERRORS.
F34'MYJOUH. SIONA-lURF AGLOW,11WE AGRL'E' TO BE BOUND BY THE'TERMS OF THIS CONTRACT. VW[_-
ACKNOWLF.D(AT RE.Cf_CPT CIF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE
OF CAM:ELI.ATLON.
SUBMPITEDBY: Sw.GJ�� ----.—___ _ ,� Date:
AC
CEPTED BY Y - Date: V...
rachasar
NOTICE;ADDITIONAL TERMS AND CONDITIONS ARE;STATED ON THE REVERSE-SI'DF
AND ARE PART OF THIS CONTRACT
9-21-07 rev 4-2A7 CSC White-6rench rile Y4ilow-Custernor Pink-$aiea C0Wunanl
.d Xd3 1317213Sd-1 dH WW ,0:9 900a 60 qa3
Sold,Furnished and Installed by:
rs;ro, Date: C) THD At-Home Services,Inc.
Branch Name; Wa The Horn Depot At-Larne Services
345A Greenwood Street Worcester,MA 01.607
Branch Number: Job Toll Free(800)657-51.92; Pax:508-756-2859
Fedarol ID 0 71-269WO WE Lic#C 02439 RI Cont Uctl t 6427
CrLL_,5t5522. M.A Home ImproverecruControctor Reg.N 126993
Installation Address.
City, Stale Zip
purcluosorls); LIB#&E Mo/Yr: Work Phone,. Rome Phone.
FM_11t CA)J C)
Home Address:
(if diffeterit from Installation Address) city State zip
E-mail]Address(to receive updates and promotions frwn.The Rome Depot).--
Project Information, T/Welyou(,,p
�urdinger),the otvvcrs of the property located at the above installation address,otter to
contract with THD At-Home Services,Inc.("Horne Depot"}to furnish,deliver and arrange for the installation of all materials
as described an the attached Spec sheet#_,incorporated herein by reference and made,a part hereof.
Rome Depot reserves the right to cancel Ibis contract if,upon refaIgpectioll of the job,Flonm Depot determines that it
cannot perform Its obligations dac to a structural problem with the home,pricing errors or because work required to
complete the job was not included In the Spec Sheet or Contract.
DEPOSIT PAYMENT OPTIONS
(Subject to fnad VaifiCation BfWof"at*PPrnV&L)
CONTRACT AMOUNT 5 1. Ctxe&*,Cdim Check orU$PosWSftiO Money goiter
tMod.pay.W.to'11-Howw DdPol).
fLM DEPOSIT S 2. Credit Curd"*a&ocothcrpsyoec#toPti(,m-Urels Oar below
f
BALANCE DUE Visa MasterCard! LXwdvcr Aincricun Ex
ON COMPLETION redit d
The Home Depot Hmrie lrnprov;j�=7Ttw Home Depot Credit GA"d
Mo.
tP41nimum 25%of Contract Amount doe upon 0 Now Acculalt [I Lx1elting Account
execationorthis Contract. A,,*Wb*Cndit-S:_:LL&( Inn.&KDCC ONTAO
Indicate Payment Method For A"t#: Exp.Dauc:
a.BAL&N(XQ1QR ON C01-"LX11PK. Name I m pp. on card:
MCOh
N7) q*�wcoz-v S -By ruylour signature below,VWa agm to allow Horne Depot to
&C3�- _aq the above referenced credit card for deposit indicated.
*W�en you provide a clucak an payment.you authorize no Biter
to upe information f6pa youro k to woke a one-drot aketronic oa liteek's;Xnaum Dole
fund tmrnfw f—your accoani-1 n,proeese ft 1-Ymwt as a
cheek treawtion.When we wo iubminuou ftin your cbcd to
.make an cloctrotuc Rind tranafler,Ainds tiny be withdrawn from BIL or EIDCC Authorkmtion Coda
yournewunt as sonaas thepaymentis received,Bad you witInot Deposit Final PRYMeDt
I I At CIP I C)�
Purchaser agrees that,immediately upon completion of the work,Purchase--will exomto a Completion Certificate and pay any
balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder.
Entire Agreement_This agraerrocid unit its attachments,including any fli-aming agrectricit'17 contain the complete agreement
between the parties and can not be amended or modified unless in writing in a separtue agreement signed by hoth parties.
NOTICE TO PURCHASER
Do nut sign this contract before you read K. You are entitled to a completely filled-in copy of the contract at the time
you sign. Keep it to prouteet y9ur rights. Do not sign a COMP"on Certificate W&ry this project Is complete. Law
prohibits home repair contractors from rcquesting or accepting a Cornpledoll,Certificate signed by the Owner Prkw to
the actual completion of the work to be performed under the contract.
You may cancel this transeedon any time prior to midnight of the third buslatso day after the date of M6 contract. See
Notice.of Cancellation for an explanation of this right. There will be a service charge equal to 10%of the contract
amount if job Is cancelled by Purchaser AFTER the third business day,but BEFORE materials;are ordered.There will
be a service charge equal to 25%of the contract amount It job is canceW by Purchaser AFTER materials are ordered.
BY MYIOIJR SIGNATURE BELOW,I/WE UNDERSTAND T11-AT THE AGREEMENT MAY BE SIJBIFCT TO REVIEW
OF MYIOUR CREDIT HISTORY AND 11WE AUTHORIZE HOME JUR
,E DEPOT To VERIFY AND REVIEW MYK
CREDIT RECORD WITH AN INDEPENDENT CRLIDIT REPORTING AGENCY AND RELEASE TIIFM FROM ALL.
LIABILATY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS.
By My/Oljlk SIGNATURE BELOW, VWE AGREE TO 13E BOUND By THU TERMS OF THIS CONTRAC1- I/wf,
ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO CONVLETED COPIES OF THE NOTICE
OF CANCELLATION.
SUBMITTED BY: Dale:
:Y new:
ACCEPTED B BY
Date:
war
NOTICE;ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE
AND ARE PART Of THIS CONTRACT
9-21-17 rev 4-2-07 C-SC White-BranchFile Yallow-CUMDOW Rinit-SWIRSCOrtsuibird
C; d XHA 13r83SUI dH WHIP T :q 9002 60 qaj
-ito thalliptin
DEPT R-12 v f-E_N'T OF BUILDING LNSPE=CON
NSPEC -../P 212 Main S irtti • Municipal B wilding! I
Nortbampton, MA 01060
TTv -YX rID -CXVN4,PTJON ACKNOWLEDGEMENT
;t,7,N
The State of Massachusetts allows the homeowner the rig.',rL under 780CNM 108-3.4 to
101-3 4 to
Perso I(s)
act ,---, his/her construction sups. .- Sor. The s+LaL-- defines "Homeowner" as, "Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwefling, attached or detached structures accessory to such use and/or farm structur ctures. A
person who constructs more than one home in a two-year-period shall not be considered sidered a
home 0-;"Mer."
The buildingZepartment for the City of Nortliampton wants any person(s)who seek to
use the home owner exemption, to act as their own contraction -
upervis-c- to be a va-e
that by doing, so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation/footings (before backTill).
so-notube holes (before pour). a rough building insz)ection (before work is
concealed). insulation inspection (if required)and-aTmal-buildiazinspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until-the work can-be inspected-
If the homeowner hires other trades to penbrin work(electrical, plumbing&gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
L understand the above_
(Home owner/resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
L '
The Commonwealth of1Y_fassachuse:.ts
—�— Department of Industria,_-iccidents
"w— u11� Office ofIniestigazions
SGG 4ashin9ton Street
Boston,2�LA 02111
W4W.l31 ass-OvIdia
Workers' Compensation Insurance Affiaati-it: Builders/Contractors/Electricians/Plumbers
Armlicant Information Please Print LesibIv
-NaMe(Business/Organim on/Individual):
Address:
P�"�' P ( f �i 1 �. S1 ( x;77 �S�
Cit-/State/Zi �o � ��_ Phone.,,.
Are you an employer?Check the appropriate box: Type of project(required):
�, . I am a gene-al contractor and I
i.LEI am a employer with
4 ❑ -
6. ❑New construction
employees (full and/or part-time).* have hired the sub-contractors
rl ldsted on the attached sheet- 7. r1 Remodeling
I am a sole proprietor or parmer-
i,ee These sub-contractors have D li -
shin and have no employees s 8- ❑Lemouilen
worker.- for me m any capacity. employees and have work.' 9 ❑Building addition
[No workers' co=.m=a--ce comp.insurance., IO- Electrical repairs or additions
required] 5. ❑ W e are a corporation and its ❑
❑ I am a homeowner doing all work oficers have exercised their 11.❑Plumbiag repairs or additions
myself. [No workers'comp. ridt of exemption per MGL 12.E]Roof repairs
insurance required_]t c. 152,§1(4),and we have no
employees. [No workers' 13.[c er ( 5
comp.insurance required_]
_------- lean cnert-s ooz�F.mast also nil out me sermon oeiow snowing their woris.°rs'con;xm=on.policy information.
Hoscowne s who submit this aindavit indicating they are doing aD work and then hire outside cont-actors must submit a new affidavit indicating such.
Contractors dial check this box must-attached an additional sheet showing the name of the sub-contractors and sate whether or not those entities have
employees. If the sub-ccnaactors.have employees,they must provide their workers'corm.policy number.
lam an employer that isproviding,workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lic.r: O�L4-a i;P2 Expiration Date:
-:�;J A Irl:A-
Job Site Address: 9�i (�L _ City/State/Z,ip-
Attach a copy of the workers' compensation policy declaration page(showing the policy number and eo ation date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
tine up to S 1 500.00 and/or one-year imprisonment, as well as civil nenalties in the form of a STOP WORK ORDER and a fne
of uD to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
InvestiL7ations of L for ins ce coverage verification.
I do hereby cerw u the Zdpena&1lie-s, of perjury that the tnformation provided abo a is and correct
—� mate:
Phone
LOther e o71ty. LO not wrrte tru thLS area,to be completed bl city or town official
wn: -- _-____ _-P--er-mit/License-r
thority(circle one):
f Health 2.Building Department �.CitviTown Clerk: 4.Electrical Inspector 5.Plumbing Inspector
r son: P h o a e
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:
License Number
Address Expiration Date
Signature Telephone
9.Registered Home Improvement Contqctor: Not Applicable ❑
Company Name Registration Numb U r
z� !
Address, Expiration Date
q!s= ?)Itc0elephone !
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(6))
Workers Compensation Insurance affidavit ust be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildin permit..
Signed Affidavit Attached Yes....... No...... ❑
11. - Home 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 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-vear 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 of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement W' ows Alterations) Roofing
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [M Siding[ET11, Other[0]
Brief Description�fi'rapo < (
Work: �J
Alteration of existing bedroom Yes No Adding new bedroom Yes No
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 APPLIES FOR BUILDING PERMIT
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.
Signature of Owner Date
I , as Owner/Authorized
Agent hereby declare that the sta ements 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.
Prin e
t
S atur of Ow r/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L._ ._,w_.. R: L: ....,_ R:
Rear
Building Height
Bldg. Square Footage
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 0 DONT KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Q Obtained Q , Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO Q
IF YES, describe size, type and location:
E. Will the construction activity disturb(r_.learing, grading,excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO 0
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street SewerlSeptic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets,of Structural Plans`
phone 413-587-1240 Fax 413-587-1272 Plot(Site Plans
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Prin) Current Marling Addr�I
�G. 60K" Telephone
Signature
2.2 Authorized A ent:
Lo
Nam ( ri ) Current Mailing Address:
igna re Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6--Total_ (I±2±3
93 WILLIAMS ST 6 / f n> 3 X4`9.66 0 9/ BP-2008-0715
CIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-200 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
catV—Crx;_ BUILDING PERMIT
Pernut# BP-2008-0715
Project# JS-2008-001126
Est. Cost: $24536.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class. Contractor: License:
Use Group: HOME DEPOT AT HOME SERVICES 126893
Lot Size(sg. ft.): 10105.92 Owner: FELLAH MIRANDA CAMPBELL
7nninu�.URC A1jtplica:ti___!-i7ir'!._F_nFPo 7' •,T 14nN/1._F SFR\/I[`EC
AT. 93 WILLIAMS ST —
Applicant Address: Phone: Insurance:
345 GREENWOOD ST (401)935-2633 O Workers
Compensation
WORCESTERMA01607 ISSUED ON:212512008 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL REPLACEMENT WINDOWS/SIDING
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:x::suiano a:
Final: Smoke FinaLQ/� _�?-Qg' `a-ALL
TINS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGUL ON
Certificate of Occu anC Signature:
FeeType: Date Paid: Amount:
Building 2/25/2008 0:00:00 $50.0021821
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo