32A-088 (8) _ City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS
Street • Municipal Building JyX ^Jpb
L— "-`! I rthampton, MA 01060
�f PERIODIC INSPECTIONS
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„� Application Sent on March 19, 2015
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PREMISE NAME. TH CENTER INC t t o
PREMISE ADDRESS: 25 GRAVES AVE
OWNER(S) OF RECORD: I I --''
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OWNERS: ADDRESS:
NORTHAMPTON, MA 01060
TELEPHONE NO: ��—
NAME ON CERTIFICATE- HARISTON HOUSE — GANDARA MENTAL HEALTH CENTER INC
TYPE OF BUSINESS
USE GROUP: 60411x6
INSPECTION FEE:_ $ 150.00 9�
Please complete and return this application to the Department of Building Inspections, 212 Main Street,
Northampton, MA 01060. We will contact you to arrange a time to inspect your property. If this information is
not correct, or if you no longer own this property, please note any changes at the bottom or on the back of this
form and return it to the building department. Feel free to contact us if you have any questions. We can be
reached at (413) 587-1240. Thank you.
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Applicant name:
196
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Applicant Title: r
Telephone
Preferred inspection time/date j
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Comments:
Commonwealth OfMassachusetts
City of Northampton Map: Block: Lot:
32A 088 001
In Accordance With The Massachusetts State Building Code, Section 110, This
CERTIFICATE OF INSPECTION
is issued to Hairston House
I Certify that I have Inspected the R3 Group Residence known as Hairston House
located at 25 GRAVES AVE, in the City of Northampton
The Means OfEgress Are Sufficient For The Following Number Of Persons:
BY STORY
Story Capacity Story Capacity
First Floor 3 Second Floor 16
BY PLACE OF ASSEMBLY OR STRUCTURE
Place of Assembly or Structure Capacity Location Place of Assembly or Structure Capacity Location
CI-2015-0091 04/16/2015 04/16/2016
Certificate Number Date Certificate Issued Date Certificate Expires I3uildi fic' Kyle J. Scott
**A COP)'OF THIS CERTIFICATE. MUST BE POSTED IN CLEAR 17EIi%NEAR AII, EA[TRANCES
212 Main Street-Rm 100*NORTHAMPTON,MA*Phone:(413)587-1240*Fax:(413)587-1272