284 Complaints ' BOARD OF HEALTH
' CITY HALL
COMPLAINT RECORD
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Date:1 11 )( Time: ((J J Map: [Parcel:
Name of •mplainant: /Jinn On/ <, 4 (5
Address: ()bAktae WI\d\ Tel: 9'7S
pp NATURE OF COMPLAINT: <<��
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Location: g g L S L,. 4.y A l-VICC\C
Owner:
Address: Tel:
Take •Tii Ai Date of Inspection: Time:[ j
INSPECTOR'S REPCRT:
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Action Taken: i - G L.O- /E.'>
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Inspection Form
Northampton Board of Health, 212 Main St., Northampton, MA 01060, 413.587.1214
SSC 105 CMR 410.000: Chapter II, Minimum Standards of Fitness for Human Habitation
Date: '7 II .o-t't Time: liti-a #Occupants:3#Children<6 Years Z
/it-
Address. 1Jc % S' -11.34, Sr Unit# 2, City/Town: Nerthamphm 3r--fi r./
Occupant Name: (_`/t-3t 1>r4K-t5 Phone# if(3 -ti9
3790
Owner Name: Phone#
Responsible
Party
Owner Address: City(Town: Zip Code:
#Dwelling! Rooming Units in Dwelling: Z #Stories:
Unit:
-7
Floor Level of
#Sleeping Rooms: 'Z #Habitable Rooms:
Locks
480
Inspector Title:
Posting, ID, Exit signs/emergency lights
481,483.484
If violations are observed and checked,describe them fully on Page 3.
a or
nent
Type of Violation
Use blank boxes for ones not listed
Possible
Code
Section(s)
'if
Violation
Observed
Responsible
Party
Owner
Occupa
nt
srior,
rd &
rch
Locks
480
Posting, ID, Exit signs/emergency lights
481,483.484
Handrails, steps, doors windows, roof
500,501.503
Rubbish—storage and collection
600,601
Maintenance of Area
602
lmon
as&
dry
Light, windows
253,254,501
Egress
450,451,452
Handrails
503
Door
501
,r Halls
lairs
Floors, walls ceilings
500
Hallways, railings, stairs
503
Light, windows
253,254,501
oom 1
Location (circle): Front Rear Middle Left Middle Right Floor
Unit
Level
of
Ventilation
280
Ceiling height
401,402
Windows, screen
501,551
Wall
500
'oom 2
Location (circle): Front Rear Middle Left Middle Right
of Unit
F
oor Level
Ventilation
280
height
x01,402
Windows, screen
Windows,s,
501,551
troom
Toilet, sink, shower, tub, door
150
Smooth, impervious surfaces
150
a or
tent
Type of Violation
Use blank boxes for ones not listed
Possible
Code
Section(s)
/if
Violation
Observed
Responsible Party
Owner
Occupa
nt
Lights, outlets, ventilations
251,280
Floors/walls
504
.hen
hen,
nt
Sink, stove, oven; good repair, impervious and
smooth space refriq
loo
Lights, outlets, ventilation, windows, screens
251,280,501,
551
Ceiling height
401,402
Floor
504
Floors/Walls
500
I room
)fining
om
Lights, outlets, ventilation
250,280
Ceiling height
401,402
Windows/screens
501.551
Ceiling condition
Sink
.ment
Maintenance
500
Watertight
500
Lighting
253
der
Source(circle): Public Private
Must be potable
180
Quantity, pressure
180
Responsible for paying MGL ch 186 s 22, metering
354
Nater
Fuel Type(circle): Natural Gas Oil Electric Other Temp.: 56 °f Location
taken: Kitchen
Quantity, pressure, 110 F min, 130 max
190
Venting
202
)ling
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
:trice!
Type(circle): 110 220 Amp:
Amperage,temporary wiring, metering
250,255.256,
354
nage,
nbing
Type(circle): Public Private
Sanitary drainage required and maintained
300.351
:e &CO
actors
Required &operational
482
Emergency lights
i or
lent
Type of Violation
Use blank boxes for ones not listed
Possible
Code
Section(s)
✓if
Violation
Observed
Responsible Party
Owner
Occupa
nt
:ts
Free of pests(rodents, skunks, cockroaches, insects)
550
Structural maintenance and elimination of harborage
550
:OS Or
aint
353.502
ment
620
810
Referral:
❑ Electric ❑ Fire ❑ Plumbing ❑ Building ❑ Other
This inspection report is signed and certified under the pains and penalties of perjury.
Inspector Signature:
Occupant or Occupant's Representative Signature:
Reinspection Date: Time:
Date. 4:2242
I Time: 71
I Map::
Parcel.
Name of Complainant /
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(41 3)
Address: 9' yr.5SF C% l-r ft
Tel: 9,9-171
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NATURE OF COMPLAINT:
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Location: arN dJo"^+-% Sf
Owner:
Address-
Tel:
Taken by: I
Date of Inspection:
Time:
L INSP0ECTOR'SREPORT:
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Action Taken: fit- L ;
Inspector Signature
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BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Name of
Complainant G/SA SHINN
_ Fie -
Address z�y S7/2///6 S7/CEt>E'r Tel
Nature of Complaint ONE/9SAr/N6 oar/7— /N en"AM Enr
Location of Premises 2 FANYL/ f10US'E
7 an maxi/ d7.
Owner C»N/<cuE -f Sid,41 G/9,P,: 4n-sss )
Address ,5'/aePEsr"rJ/P/OE
Occupant
Taken by Referred to
E-,uetMD
Date of inspection 1015l%/t// Time re" 8:3o a,-.
INSPECTOR'S REPORT TEEM.-6FFr
s/IF WAS /h/S r7 AI- -' /�i=rWMf
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Action Taken y6 FICNt4.9cz/nn/ "IVehi'T+2
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