23A-134 (15) § �
^ @ /
\ ! _ 13
—
` to
:
\
§ } 2F4 gopoll §
J � _ a S
/ \ \ ~ PI
* � 2 §
\ \ 2 ` t m ƒ tm
� \ #
� \ \ k ! \ ( fI ) � Oil k /
/
\ ( � w � \ ) \ � \ \ /
\ \ ) ] ) } r 2
ƒ § § � : q
k
\ \ 9 /
�
} ®
/
7 §
I
9Ao/1D
City of Northampton
rdsssachnsetts Cka e0q$'
f
s
v ur w . g or a. .—eiut marscdidite s�c
XacNupten 01060 1
L � G PE-+.IL]IC IHSP6C^.IGNS
E: HILL INSTITUTE
PR RESS:83 PINE ST
OWNER(S)OF RECORD.
OWNERS
ADDRESS-ST: 83 Fine Slh`Ct
TELEPHONE NO:(gl31 524-172$
NAME ON CERTIFICATE: Nill Insfiju¢e
TYPE OF SUNESS
ec o0 o er nci 000-arh(;13't in,Mucti anal elassts in arty ioallS 9 end olden (adalfs)
USE GROUP:
Please wmplete 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. It this information is
not correct,or H you no longer own this property..please note any changes at the bottom or on the back of this
form and return 0 to the building department. Feel free to contact us R you have any questions.We can be
reached at(413)587-1240.Thank you.
Applicant name:
Chris !{ammel
Applicant Title:
Owl AGlmnlsLeier
Telephone
(4iq) ;g4-I-T25
Preferred inspection timaldete
Vnar 0� l; work.nj wf a Possible Uate 4nd 4ime.
Comments't
ek rgi Gar' _i'<gte LX�e��f�atli�- h rccer e i l h0.'ol, nc n DlYMi0nq sears.) 1 4pe�cGiLt Tkn wit4nt 2 _
hit
Basic Periodic Inspection Checklist
st,aemetl tmma
All svuctural and asociuted component,(roundauon,rmf,wull,nuppon member.,stairs. ,,dewalk,Ern.)am
amtamed ins safe and wund condition.
Buildings arc maintained in compliance with the Maeaechuaetn Road of Fire Prevention Regulations and the Masmchusess
State Bnildine Code-
Required neopene,separations arc provided and maintained.Example.arc dwelling univ<arrider,umviini4
enmmereiapenmmemlal or reudentiaVmmmeroial scp:vazimts.
4095
HILL INSTITUTE
M NNE dma£ 53416B/SIIB
RaRENCE,Atnotoez aws
ppyc'/ DOLLARS
tentendids
._.,.... nr00L0q Sd- t: 211e716SEW 01 23 647209d-