21.245 Electric Eye Records PetitionIr-1HNK You+
CITY CLERK
NORTHAMPTON
210 MAC -ROOM 4
(413) 587-1224
04-01-2021
REG 14:41
000025
SECOND HAND
CHECK $ 2 5 $2o O
City of Northampton
Application for Annual License
NORTHAMPTON, MASS.,
To the Honorable City Council of the City of Northampton:
The undersigned respectfully petitions your honorable body for a License as follows:
Name of Business: Electric Eve Records
Type of License: Secondhand Dealer
Location of Business: 52 Main St.. #6
Print Name of Applicant: (V) A 6 wj C P�f�f
Signature of Applicant: (V) a1z_
Address of Applicant: (v) No. 52 Street /" � n S t ' _�e'b
In City Council,
Referred to Committee on Licenses.
ATTEST:
City Clerk
In Committee on Licenses,
Voted to recommend that Petition _be
granted, not granted
ATTEST:
Clerk
In City Council, (date) Voted that Petition be
not granted
Attest: Clerk to City Council
granted
City of Northampton
STATEMENT OF ALL TAXES FILED AND PAID
Name of Business:
Location of Business:
Electric Eve Records
52 Main St.. #6
The license (as a/for a) Secondhand Dealer will not be issued unless this certification clause
is signed by the applicant listed on the license.
1, CV) A r'� � � cig'es (print name of owner or authorized agent of the
business) certify under the penalties of perjury that I, to my best knowledge and belief, have
field all state tax returns and paid all state taxes as required under law.
Signature of Owner or Agent
(1/) or
Social Security Number
Federal Identification Number
Your social security number will be furnished to the Massachusetts Department of Revenue
to determine whether you have met tax filing or tax payment obligations. Licenses who fail
to correct their non -filing or delinquency will be subject to license suspension or revocation.
This request is made under the authority of Massachusetts General Law, chapter 62C, section
49A.
City of Northampton
AFFADAVIT OF WAGE COMPLIANCE
Name of Business: Electric Eye Records
Location of Business: 52 Main St.. #6
The Northampton City Council, in determining whether to issue, re -issue, modify, suspend orrevoke a
license. under G.L. c. 140,shall require that a potential or current licensee certify that they are not
subject to a federal or state criminal or civil judgment, administrative citation, order or final
administrative determination resulting from a violation of G.L. c. 149, c. 151, or the Fair Labor Standards
Act The City Council may require a wage bond or insurance be posted by any potential licensee who
does not certify that they are not subject to a federal or state criminal or civil judgment, administrative
citation, order or final administrative determination resulting from a violation of G.L. c. 149, c. 151, or
the Fair Labor Standards Act. Licensees that are subject to a state or federal debarment for violation of
the above laws, either voluntarily or involuntarily, or that have been prohibited from contracting with
the Commonwealth or any of its agencies or subdivisions shall be prohibited from holding, or continuing
to hold, licenses issued under G.L. c. 140, for the entire period of debarment or other stated time
period.
Applicants must check box 1 or box 2 as applicable and must sign this Form, certifying compliance
with the requirements set out in this Form. This Form must be included with the application.
AFFADAVI (V) (Choose 1 below)
This License applicant is not subject to a federal or state criminal or civil judgment,
administrative citation, order or final administrative determination resulting from a violation of
G.L. c. 149, c. 151, or the Fair Labor Standards Act within the last three years.
❑ This License applicant is subject to a federal or state criminal or civil judgment, administrative
citation, order or final administrative determination resulting from a violation of G.L. c. 149, c.
151, or the Fair Labor Standards Act within the last three years. This applicant will provide a
wage bond or wage insurance for the period of the license.
(V) A >4--�w CSAZ�QSf o N)
(Typed or printed name of applicant) (Signature)
City of Northampton
Treasurer/Collector's Office
Permit Denial Form
Revised 11-30-2018
REQUESTED BY: Pamela L. Powers, City Clerk
Name of Person, Corporation or Business: Electric Eye Records Andrew Crespo
Location of Property, Service or Address: 52 Main St., #6, Florence, MA 01062
All permits denied for outstanding amounts must receive confirmation of good standing
from the Treasurer/Collector's Office PRIOR to issuance of the permit
For Tax Collector's/Treasurer's Office Use Only
Please list below any tax, assessed to your office that is unpaid for twelve (12) months or
more after its due date, unless there is a pending abatement or appeal before the Appellate
Tax Board, for the person, corporation, or business entity noted above.
Tax accounts are current.
Signed:
Adopted 5-21 1992 [Ch14 S.14-21 of the 1977 Code]
Denial/Revocation of License
Dated: April 5, 2021
City of Northampton