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160 Complaint Record & Inspection Form 2012 Date: f .II ,t1Ellr � , trlc�nf Name or Complainant: pp Address: ( UE LOCrtpo;n< tj SI Cm,_ C€S r-Afl NATURE OF COMPLAINT: C rE,,:L Va,L p.,:ss fur,: h clbf c ' ski ` 'elp el q-1/4 rv+F..=T Location: Owner: Address: etiry/zc ,-. Taken by: INSPECTOR'S REPORT: Action Taken: t: I Inspector Signature. Inspection Form Northampton Board of Health, 212 Main St., Northampton, MA 01060,413.587.1214 SSC 105 CM?410.000: Chapter II, Minimum Standards of Fitness for Human Habitation q'. Date:li fin ,yyt Time: #Occupants: #Children <6 Years Type of Violation Use blank boxes for ones not listed Address: t(p0dpc6'y f4obS Unit# (,ol(DA9JSir— City/Town: Northampton lif Violation Observed Occupant Name:t'rtll fMty uhk. u100DIDki$ Phone# 31D.`4D. 36I'( Owner Name Nil tdhonne 6.eg44- le31- 2-b -61r0 Owner Address: City/Town: Zip Code:4 J rileCiiLp so hfAl»O% rl t/ /f%3 # Dwelling/Rooming Units in Dwelling: #Stories: Floor Level of Unit: #Sleeping Rooms: �j #Habitable Rooms: Locks Inspector: t2.+4.04 Sut-rtt Title: , tkryn4 1,046lieDX- If violations are observed and checked, describe them fully on Page 3. Area or Element Type of Violation Use blank boxes for ones not listed Possible Code Section(s) lif Violation Observed Responsible Party Owner Occupa nt Exterior, Yard & Porch Locks 480 Posting, ID, Exit signs/emergency lights 481,483,484 Handrails, steps, doors windows, roof 500,501,503 Rubbish 600,601 —storage and collection Maintenance of Area 602 Common Areas & Entry Light, windows 253,254,501 Egress 450.451,452 Handrails 503 Door 501 Interior Halls &Stairs Floors, walls ceilings 500 Hallways, railings, stairs 503 Light, windows 253,254,501 Bedroom 1 Location (circle): Front Rear Middle Left Middle Right Floor Level of Unit Ventilation 280 Ceiling height 401,402 Windows, screen 501, 551 Wall 500 Bedroom 2 Location(circle): Front Rear Middle Left Middle Right Floor Level of Unit Ventilation 280 Ceiling height 401,402 Windows, screen 501,551 Bathroom Toilet, sink, shower, tub, door 150 Smooth, impervious surfaces 150 Lights, outlets, ventilations 251,280 Floors/walls 504 Kitchen Sink, stove, oven; good repair, impervious and smooth, space refriq 100 Lights, outlets, ventilation, windows, screens 251, 280,501, 551 Area or Element Type of Violation Use blank boxes for ones not listed Possible Code Section(s) if Violation Observed Responsible Party Owner Occupa nt Kitchen, cont. Ceiling height 401,402 Floor 504 Floors/Walls 500 Living room and Dining Room Lights, outlets, ventilation 250,280 Ceiling height 401,402 Windows/screens 501, 551 Ceiling condition Sink Basement Maintenance 17141iei f,D imAL, u')(ryt/ 500 Watertight 51k4tati c 041k// 500 Lighting 253 Water Source(circle): Public Private Must be potable 180 Quantity, pressure 180 Responsible for paying MGL ch 186 s 22, metering 354 Hot Water Fuel Type(circle): Natural Gas Oil Electric Other Kitchen Temp.: °f Location taken: Quantity, pressure, 110 F min, 130 max 190 Venting 202 Heating Type(circle) Forced Hot Water Forced Hot Air Steam Electric No portable units 200 "Habitable room and every room with toilet, shower, tub" 201 • 68F7 am toll pm, 64F 11:01 pm to 6:59 am, except 6/15-9/15 • 78 F max in heating season/measure 5 feet wall, 5 feet floor Venting, metering 202,354, 355 Electrical Type(circle): 110 220 Amp: Amperage, temporary wiring, metering 250.255, 354 256, Drainage, Plumbing Type(circle): Public Private Sanitary drainage required and maintained 300,351 Smoke&CO Detectors Required &operational 482 Emergency lights Pests Free of pests (rodents, skunks, cockroaches, insects) 550 550 Structural maintenance and elimination of harborage Asbestos or Lead Paint 353, 502 Curtailment 620 Access 810 Other Referral: ❑ Electric ❑ Fire ❑ Plumbing ❑ Building ❑ This inspection report is signed and certified under the ins and/p/epe!(ies of perjury. Inspector Signature: (,4a4,,t..„.02.` '`tfita_- Occupant or Occupant§ Representative Signature: Reinspection Date: Time: Written description of any violation(s) checked above Include Area or Element, code citation and a description of the condition(s)that constitute the violation. You may include remedies that would be an acceptable means of achieving compliance with 105 CMR 410.000. NOTE: *indicates that this housing inspection has revealed conditions which may endanger or materially impair the health, safety, and well-being of any person(s)occupying the premises Area/Element, Code Citation and Description of Violation Acceptable Remedies cv' jilt" E'm.-s+i/FEE tc)/ itczi SeD-4-_ Pic) c 3 ftuS iz /t'.0 h 2c,E�-.-'* Sa+� •"'� rV�"', c f" t"-••-•- rre Pe-1i/ Qr'atinn I,-i- car— ic1 ) ,i I er e a -) , h o d yt eiluref C:/e CLS p iiciTh cite 4 /ylce arc 4410 ,'//✓s Hr- /IL`