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COMPLAINT SHEET
How received: Telephone ( ) Complaint No./ r5 p .-._
Personal)Q Date: /0?d79iJ
Letter ( ) Time/a L'A.M. _ P.M.
Telephone No. .�
Complainant's Name: Patricia McElroy
Complainant's Address: 40 Dunphy Drive Northampton
7
Complaint received by: -A% tr4 a./ 1
VIOLATIONS OF:
O Chapter 44 Zoning Ordinances,City of Northampton
❑ Chapter 802 As Ammended Mass. State Building Code
O Sanitary Code, Art.2
Complaint reported against:
Name: Vicki Joyce Tot, 586-7065
Address: 48 Dunphy Drive Northampton
Location of complaint: Map# 7 Lot it /�L9
Signature of Complanants:
Nature of complaint:
Tharp is a steady stream of traffic going in and out of the drivaway of tit .
, . . . r- • du- t he ow.. _ . r Loss ; - ik._ 1 . ..ty salon husinaca nut of
her home . This has been ongoing for at least 5 years that T am aware of. I
don' t believe she has either a permit or the proper zoning for this business .
This business is in a room within the house, not built onto the home .
Investigation:Yes ( )No ( ) Investigated by:
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S1h, DIVISION OF RHGIS
OFFICE OF INVE TIGATION
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617-17-727-74406
Please complete this complaint form as fully as possible.
This form must be printed in ink and be legible:
COMPLAINT ISSUED BYy, Z 47/4pccwa .,,�� �p_�� /
Name: EN �/VY�6je ti rSSiewne C/T7 0r ded247M"ylo�
Last Name First Name M.I.
Address: 2/2 A7/t" S% %a-$89 /ZYO
Number Street Daytime Phone
x04477//7.724-011/ ,42111 00 60
City State Zip Code Evening Phone
C/T� OF yaf$sn, OA-V
Busines Name,Business Address Professional License ft
(if applicable)
COMPLAINT ISSUED AGAINST:
Name: - falfe ycF UiCKfa
Last Name First Name M.I.
Address: //8 L)CIAJ fit Di°lu,E 4-,R6—
Number Street // Daytime Phone
No.gWAi ekltdk, A7edli 0/aaa0
City State Zip Code License Number
Name,
Business Name
Address
Number Street Daytime Phone
City' State Zip Code Professional License
Please check the trade or profession that this complaint pertains to:
Accountant Psychologist
Aesthetician X Hairdresser
Architect Health Officer
Athletic Trainer Landscape Architect
Audiologist/Speech Pathologist Land Surveyor
Barber Manicurist
Chiropractor Mental Health Counselor
Complaint Against School Marriage&Family Therapist
Dental Hygienist Nurse
Dentist Nursing Home Administrator
Drinking Water Plant Operator Occupational Therapist
Electrician Occupational Therapist Assistant
Electrologists Optician
Engineer Optometrist
Fire&Burglar Alarm Physician's Assistant
Funeral Director Real Estate Appraiser
Pharmacist/Pharnacy _ Real Estate Broker/Salesperson
Physical Therapist Rehabilitation Counselor
Physical Therapist Assistant Respiratory Care
Plumber/Gas Fitter Sanitarian
Podiatrist Social Worker
Radio or Television Technician Veterinarian
-Continued on other side-
Pleasedien)c�horeasonfm-,rhe '
Breach of contend $s'r� •• ;-Mi presentati L'- 'F
Disaupipation Patient neglect
Drug oralcoholahuse -- Setmal misconduct
Unprofessional or unethical conduct Unable to obtain records c.
Failure to fill presaiplionpmperly Un icensed
Failure to return a deposit Unsanitary Conditions
Inferior work or materials Other:
Description of the Complaint:
Briefly describe the incidents that led to your complaint and note the times and dates that events occurred. List
the names of all individuals involved.
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,
Attach additional infomation needed to a plain the details of your complaint Send copies,not the ordinal,of
any related documents. You will be sent an acknowledgement letter with the name of the investigator assigned to
your case.
AUTHORIZATION FOR RELEASE OF RECORDS AND REFERRAL OF COMPLAINT
Your signature to this form,or a photocopy thereof,authorizes the Division of Registration to:
(I)receive copies of all medical,dental and mental health records relating to your complaint,(2)refer your
complaint to appropriate law enforcement authorities to investigate or prosecute your complaint,and(3)conduct a
preliminary investigation,
Please note that all complaints are investigated to determine their factual basis. The act of filing a complaint does
not assure or imply that disciplinary action will necessarily be taken against the licensee.
The above information is true, and complete to the best of my lmowledge.
//,.//, O// r/4�
Yomur tore // > Date
.4/4 azz-m5Sigyba5(
GTy of.nwf7//A5nO2°"". Mail this form to:
Office of Investigations,Division of Registration
ti 100 Cambridge Street,15th Floor
Boston,MA 02202