31B-145 (9) City of Northampton
~- - Massachusetts
DEPAR2WNT OF BUIZDING INSPECTIONS yY
.. , 212 Main Street • Municipal Building ,rte
r, ' ( PNorthampton, MA 01060
PERIODIC INSPECTIONS
3
Application Sent on April 7, 2016
PREMISE NAME:
PREMISE ADDRESS: 114 KING ST
OWNER(S) OF RECORD:
OWNERS: ADDRESS:
NORTHAMPTON, MA 01060
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TELEPHONE NO:
NAME ON CERTIFICATE:
TYPE OF BUSINESS
USE GROUP:
INSPECTION FEE $185
Please complete and return this application to the Depattment 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:
Ve
Applicant Title: Cow
Telephone
�M ` 7Z7- 3�`fib
Preferred inspection time/date
Comments: