31B-141 City of Northampton
assachusetts
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31 .
DEPARTWENT OF BUILDING INSPEC . TIONS -:; ..
212 Math Street 0 Muntclpal Betiding
Northampton, MA 010
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Property Address: ..,,..,-, , .:,, i "::7 t- --: ,..‘ /, - i..„)/ .4--
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Contractor „” „,--
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(contractor) attest and affirm that the building I intend to
insulate does not have any open air (knob and tube) wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature
Date