32C-169 (16) City of Northampton
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TNYENT OF BUXLDING INSPECTIONS
1 in Street • Municipal Buildingti
- "----7 Northampton, MA 01060
SEP p PERIODIC INSPECTIONS
Q 2015 rU
^0 Application Sent on August 5, 2015
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PREMISE NAME: HAMPSHIRE E ZONAL COLLABORATIVE -�0jiLlbffaflX
PREMISE ADDRESS: 228 PLEASANT ST semes
. OWNER(S) OF RECORD:
OWNERS: ADDRESS:
NORTHAMPTON, MA 01060
TELEPHONE NO: ,
NAME ON CERTIFICATE: HAMPSHIRE EDUCATIONAL COLLABORATIVE
TYPE OF BUSINESS '
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USE GROUP:
INSPECTION FEE: 150 764
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.
Applicant name.
Applic t Title:
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Telephone
Preferred inspection time/date
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