34-003 (17) 267 TURKEY HILL RD BP-2016-1433
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:34-003 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: shed BUILDING PERMIT
Permit# BP-2016-1433
Project# JS-2016-002466
Est.Cost:$24500.00
Fee: $86.40 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: HOMETOWN STRUCTURES 98186
Lot Size(sq. ft.): 178247.52 Owner: PINNEY JAMES
Zoning: Applicant: HOMETOWN STRUCTURES
AT: 267 TURKEY HILL RD
Applicant Address: Phone: Insurance:
627 SOUTHAMPTON RD (413) 562-7171 WC
WESTFIELDMA01085 ISSUED ON:6/9/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:12 X 36 PREASSEMBLED SHED
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: 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 6/9/2016 0:00:00 $86.40
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1433
APPLICANT/CONTACT PERSON HOMETOWN STRUCTURES
ADDRESS/PHONE 627 SOUTHAMPTON RD WESTFIELD (413)562-7171
PROPERTY LOCATION 267 TURKEY HILL RD
MAP 34 PARCEL 003 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /� �0
Fee Paid CIAA' 154'7! Cit .
Building Permit Filled out
Fee Paid
Tvpeof Construction: 12 X 36 PREASSEMBLED SHED
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 98186
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF RMATION PRESENTED:
, Approved 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
Dei'•lit'.n Delay
/ /� 74b
Sign. of.;i i ding 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.
The Commonwealth of Massachusetts
i Ig` Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
kidUSE
Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
...--.....1One-or Two-Family Dwelling
CI cr. $ This Section For Official Use Only
W a Wo
c‘i Ittiliiing Permit Number: 1. e A.+ 'ed:
W wilding Official(Print Name) 40011141°11:016-e Date
C L
W SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
---167 -fur 47 J-J lI iScl, r/w'c".. , /LIQ buuk l i'lo, Oa3t '71
1.1a Is this an accepted street?yes k no Map Number Parcel Number '
13 Zoning Information: 1.4 Property Dimensions:
I'c s ,d.e, m I 11g. / ton iv- Oyo
Zoning District Proposed Use Lot Area(sq fi) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provi ed Required Provided
t/001 f/- !'130' R: .231. 1O0' #1-
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public Ila Private 0
1/w Municipal 0 On site disposal if yes❑ s ystem 11r
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
..jCl/►- 5 P;r1n el e. 6<-04-47 Aqylio r/0 rc,.ce , (V7 A O i o()
Name(Print) City,State,ZIP
I?to-7 Turk./ N;// R , S-)U -59-0
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.t3' Number of Units Other 0 Specify:
Brief Description of Proposed Work': dt 1;,s,7 U f /i�'ta a se.,-,(1 le J 4 c c e.ss e'-r 6/vi,,.
(i 3a Si f+) id' .' 3e'
+0 he rc c-e_a on t SenulLbcs
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ a t,c p 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ ❑ Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ — 2. Other Fees: $
4.Mechanical (HVAC) $ — List:
5. Mechanical (Fire $ _ Q/ "10Suppression) Total All Fees: $ U l.�
• Check No16 4 r1% Check Amount: Cash Amount:
6.Total Project Cost: $ p y ..51)L 0 Paid in Full ❑Outstanding Balance Due:
I.
f
1 :ar ~1f
.s.
u
i.
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Css,p/eb 8-- 3-/7
An8 rc.c-) F,,/t-Z License Number Expiration Date
Name of CSL Holder U
Q p., List CSL Type(see below)
029 S 15 fly,. /_7 R 4,
No.and Street Type Description
U Unrestricted(Buildings up to 35,000 cu.ft.)
Hv' i' 'r", (M 0 6 iV .cti R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
S to 9-'11-7) I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC)
u� ) 5-497-2a .5-.22-i t.
H H" -k.-,, Stet,c ii.,/-c f HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
to a7 S v.riAno/..n /id-.
No.and Street ^ Email address
ltiee3frcM MA Cl/vSS 5(,,- 71"7 )
City/Town,State,ZIP Telephone
SECTION 6: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 Or No 0
SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize /7.,.r.c -.-1 S c.1 n 1
to act on my behalf,in all matters relative to work authorized by this building permit application.
-.... -c -- f%it d- j e.g. -5r 8�S/•., S-/b - I t ,
Print Owner's Name(Electronid Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
Cie...," f'le,-l/i-n S-/ (o^ /(o
Print Owne sr or Authorized Agent's Name(Electronic Signature) Date 6_
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.Qov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) L/3? (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) - Habitable room count -
Number of fireplaces - Number of bedrooms -
Number of bathrooms - Number of half/baths -
Type of heating system - Number of decks!porches
Type of cooling system - Enclosed - Open -
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License. CS-098186 -
Construction Supervisor (T
ANDREW D KURTZ .
295 BROMLEY RD �r
HUNTINGTON MA 01050
Expiration
Commissioner 08/03/2017
fe rQm.ino 1Cloeal//l o-.:2C./��t-z:�juci u ei,
it . _ Office of Consumer Affairs and Business Regulation
,, 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 159772
Type: Ltd Liability Corporation
Expiration: 5/27/2016 Tr# 250405
HOMETOWN STRUCTURES
ANDREW KURTZ
627 SOUTHAMPTON RD
WESTFIELD, MA 01085
Update Address and return card.Mark reason for change.
SCA 1 is 20m.0911 Address Renewal Employment ' Lost Card
'"1.-4,Y r.irrnrriewer,///ri../(,.:,.a•/,.:r//.:
Mice atConsumer Affairs&Business Regulation License or registration valid for individul use only
1::,V:Ii1OME IMPROVEMENT CONTRACTOR before the expiration dale. If found return to:
• Registration: 159772 Type: Office of Consumer Affairs and Business Regulation
pv 10 Park Plaza-Suite 5170f: 47-Expiration: Ltd Liability Corpo'36
' Boston,MA 02116
HOMETOWN STRUCTURES
ANDREW KURTZ
627 SOUTHAMPTON RD _
WESTFIELD,MA 01085
t ndersecrelary Not valid without signature
THE COMMONWEALTH OF MASSACHUSETTS Registration: 159772
Office of Consumer Affairs and Business Regulation
�
( Home Improvement Contractor Registration Program Expiration: 5/27/2016
)I / P. O. Box 419291 Received:
Boston, MA 02241-9291
APPLICATION FOR RENEWAL OF REGISTRATION
Home Improvement Contractor or Subcontractor
''�■+� MGL Chapter 142A,201 CMR 18
HOMETOWN STRUCTURES New Mailing Address (if different)
ANDREW KURTZ
627 SOUTHAMPTON RD
WESTFIELD, MA 01085
REnUIRED RENEWAL FEE: ONLY CERTIFIED CHECKS OR MONEY ORDERS CAN BE ACCEPTED
ANY OTHER FORM OF PAYMENT, INCLUDING BUT NOT
$100 LIMITED TO PERSONAL OR BUSINESS CHECKS, WILL BE
RETURNED AS INELIGIBLE.
BERKSFfiBANK MONEY ORDER 2116-7169
America's Most Exciting Bank CHECK NO. 1311015046
P.O.Box 1308,Pittsfield,MA 01202-1308
QQ DATE May 19,2016
ONLY ••� �� ���i�Ts AMOUNT *****$100.00
• ONE HUNDRED DOLLARS AND ZERO CENTS DOLLARS
Pay to the Commonwealth Of Massachusetts
Order of:
CUSTOMER COPY
NON-NEGOTIABLE
Peter A Fedora
UNICIA4.1 x 1'(,u- Geiee/a/ ,/ffai&z r- _5//7/l CO
Signature of Applicata Title held if applicable Date
A FALSE ANSWER TO ANY QUESTION IN THIS APPLICATION CONSTITUTES GROUNDS FOR SUSPENSION OR
REVOCATION OF THE APPLICANT'S REGISTRATION.
The Commonwealth of Massachusetts Print Form J
Department of Industrial Accidents
_ — t Office of Investigations
= i 1_4 1 Congress Street, Suite 100
• Boston, MA 02114-2017
"t..•
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business,Organizationilndividual): Hometown Structures
Address:627 Southampton Road
City/State/Zip:Westfield, MA 01085 Phone #:(413) 562-7171
Are you an employer? Check the appropriate box: Type of project(required):
1. ✓❑ I am a employer with 15 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in anycapacity. employees and have workers'
P 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 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 accesso buildin
employees. [No workers' 13.S Other rY 9
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the 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'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: Berkshire Insurance Group
Policy#or Self-ins. Lic.#:AWC-400-7028459-2015A Expiration Date:11/27/2016
Job Site Address:267 Turkey Hill Road City/State/Zip:Florence, MA 01062
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 S1,500.00 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 insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: 14•"N' ",.L. Date:I5/16/2016 I
Phone#:413-562-7171
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#:
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY
INFORMATION PAGE
A.I.M. Mutual Insurance Company
54 Third Avenue, Burlington, Massachusetts 01803-0970
(800)876-2765 NCCI NO 26158
POLICY NO. FAWG400-7028459_2015A'
PRIOR NO. i AWC-400-7028459_2014A1
ITEM
1. The Insured: Hometown Stuctures LLC
DBA:
Mailing address: 627 Southampton Road FEIN: **6332
Westfield,MA 01085
Legal Entity Type: Limited Liability Corporation
Other workplaces not shown above: See Location
2. The policy period is from 11/27/2015 to 11/27/2016 12:01 a.m.standard time at the insured's mailing address.
3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the
states listed here: MA
B. Employers'Liability Insurance:Part Two of the policy applies to work in each state listed in item 3.A.
The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident
Bodily Injury by Disease $ 500,000 policy limit
Bodily Injury by Disease $ 100,000 each employee
C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B
D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE
4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans.
Alt information required below is subject to verification and change by audit.
--- --- --- ----------
Classifications Premium Basis Rates
Code Estimated ( Per$100 i Estimated
No. Total Annual I Of i Annual
Remuneration Remuneration i Premium
INTRA 337067
INTER SE CLASS CODE SCHEDUF.E
1
Minimum Premium $500 Total Estimated Annual Premium $18,423
GOV GOV—1
Deposit Premium $19,379
STATE 4CLASS!
MA ' 28027 State Assessments/Surcharges
$16,627.00 x 5.7500% $956
�J
This policy,including al endorsements,is hereby countersigned by � at- 12/01/20.15 _.
Authorized Signature Date '^
Service Office: Berkshire Insurance Group Inc
54 Third Avenue P O Box 4889
Burlington MA 01803 Pittsfield,MA 01202
WC 000001A(7-11)
Includes copyrighted material of the National Council on Compensation Insurance,
used with its permission.
-NOTE—
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
?.;f6,76. \\.
tsi
coti
shed
(.'��
� cS
O
Jr.
a A PORTION OF:
BOOK 2713, PAGE 58
CP SEE:
O. PLAN BK. 186, PG. 71
LOT #1
(o
NOTE:
SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD. .shed cottoge
SEE: BOOK 5842, PAGE 161
rn
� J
W (D
C'4
180.15'
60.00'
TURKEY HILL ROAD
TO:
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTAT1ON ALL VISIBLE EASEMENTS, ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
=ass ww��wC THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
-; "tiss. —MORTGAGE LOAN INSPECTION PLAT—
NORTHAMPTON, MASSACHUSETTS
RAN "
E. : PREPARED FOR
o
035
izo32 " JAMES C. PINNEY & BEVERLY BAGLIO
SCALE: 1"=80' JULY 17, 2015
`'4 0 HAROLD L. EATON AND ASSOCIATES, INC.
REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS
f
HOMETOWN STRUCTURES I N VO I C E
-_ 627 Southampton Road
Westfield, MA 01085-1329
' (413)562-7171
'� Order Date S /(o - / (a
1.--:, --1:-.f-z www.HometownStructures.com Estimated Completion Date 1-04-4ke ,t/...
be.4e;17 8.43 i..o He -.1l
Bill To Erii�. Fc-tlanc�cZ.. Notes.— Plc*" Pc.Sn4. Pgrl�s,de Ptel
Address 9l 7 TV' e l / Rd
F1u^<n mA 6 /0 to — .Sker,,,.;;,et l,i,,l;,,..,s kG 5 crass-rer.
Phone# S iO-S iS9 Cell Phone#
E-mail Address -j4 ?l(o 1 @r'1.c; L CC""' Sgfyq 1'3Gc�);oria;1- L,c) -'-
.11 F
DuraTemp T1-11 ❑ ❑ yim
❑ In-stock Display Shed
To Be Custom Built Body Color Body Color
Trim Color WA S'k. Trim Color. White
O Delivered Fully Assembled (Includes fascia&vim around doors and windows) 41'7cwdesfascia&vim arounddoors and windows)
Z Modular ❑ Modular B Door Color w h'at.. Door Color
O Built On-site iSperNiftrim onciao,isadifferent calor/ Corners
Corners LA%r*.,6 SOFFIT CHOICE(For New England Style Only)
Size )T? ' X 3 b ' SOFFIT CHOICE(For New England Style Only) 0 Venting Vinyl wane
0 Solid DuraTemp T1-11 Bodycoio, ❑ Venting Vinyl BrBrowo
A New England Series
O Keystone Series 0 Econoline Series ❑ Exposed Rafter Tails Body coo
❑ Aluminum Strip Vent Bury colo' Base Price $ I?, VOo
Style 11) 3b( 5£..-f4-s C.halo-f-
(` Door Adjustment $ 1, / Sb
LI4?-14) 4?-14f4:.:,- ac,r,.w-
. Window Adjustment $ 02, yu j
Shingles Windows Ramp ❑ 6'x 4' 3 5'x 4' ❑ 54"x 4' ❑ 00 $
❑ Dual Black 3 18'x 36"
❑ Earthtone Cedar ",11 24'x 36"
❑ Dual Gray 0 30"x 36" Loft ❑ 4'x 8' ❑ 4'x 10' ❑ 6'x 12' �1 ' r$
❑ Dual Brown _❑ 36'x 36" Window Boxes ❑ Wood ❑ 18" ❑ 30' $
❑ Weatherwood 0 NI 36"x 40"
❑ Harvard Slate A 11 ;'ns k k1 ❑ Vinyl LI 24" CI 36"
❑ Charcoal Gray mild,"'-"i Color
X. 8 ® ,o.X 3k,'
Shutters Ai Wood Color/Detail $ + ) toll
Drip Edge:,15(W 0 B Grids:)100/ 0 B
❑ Vinyl
Single Door Double Door g,!► 5-}-c, <«,5c $ 30a
Width 3'x :" Width IP:k'O aka seas Sfts
Type F": Type F-1 i-"si,kleci 64,,-- $ 8aS
co.'s
Transom t e��" p^� Transom rpt�""S �'",;u ^`�,�r $ bSv n.r
Grids: ❑W ❑B Grids: ❑W ❑B r..*d,,, t 4 5„, gl Yo ^vT
Hinges 0 SW. ❑Strap Hinges: 0 Std. 0 Strap Site Preparation-pad size I S x 39 J as 5 N
p (subject to site evaluation) $ � _
Uf Overwidth Road Permit Fee $ tpy
2?.t'f .±.r N
Loading Illustration 1 Sano bes Codes 3 vas N.
P�m0 --
Subtotal $ ab,9"1S
Trailer > Truck Sales Tax $ 1, a 5Q
/ TOTAL $ ?Si._ 2 a -
S e_Q- i```)(c Deposit $ ) 6 .Ull v
Oi Balance $ I$, .? ?.5
Customer Signature
Salesperson Signature
i-e\ro
3L '
'dy 31,xyo
14 3bxvc
6
t 36 / d `
.. J
2,,"310 a yx3L1 aYR3b 94„3b
i
U ? c)Q‘
-c,, S
F==i====,:= 7.
...„....,__ __ ........_._____
111
I
Al1 sks%
1
NY,z4
. . .
.,.
(• /
,...,'N.. . , ... • ., ..., ' ...,A-.0*- 4 -
--)\-
I
' •
...$,
...... . .„, , .
, ...._,....-
'1;
5),6 k-•-'(\ . •
I a
ni 1 i
_ .
i
I ...
\.
' ..........momm""'•"'". '
11.
al i
11
0 . .
' If
.;
J..
, • c
. _
, .
- .. . .
...mam1 .
.- • `....
,
g ....
101111111MIMP
10,
.. ,
.....____ .
' .1 111111
LIIIulii Li u a
1
.
II .,
N
Il
. ,
___
Son G ; �es
0 0 • . :I "1 -
z
L
,a ' 0 0
C 0
z
-74 0- 0 0 _______Q__
4- 1\' iii 1 ?' ,,F 1)' /I'
c 'kf---• -- �;- �-emsOrIssk
s�,r n t S
/
t
(
%
§
\
/
/
/
/
C
ƒ
\
(
t
y
ƒ�
1.«
/«
4