22B-032 (8) Town of Northampton
Inspectional Services Department
210 Main Street Northampton,MA 01060
FIRE ESCAPE AND FIRE BALCONY AFFIDAVIT
Date: 12/8/2023
To: Inspectional Services Department Commissioner
I certify that I have inspected the(please check one of the following):
Fire Escape Exterior Bridge Egress ]Connecting Balconies nWooden Stairways
Located at:(Check One) Side Front ❑or Rear of: Brick Building
LJ
Building located at: 159 Pine St, Florence, MA 01062 Ward:
Property Owner: Durai Rajasekar/ River Valley Healthcare Phone#:
Owner's Address: 159 Pine Street
City: Florence State: MA Lip: 01062
To the best of my knowledge,information and belief,this egress component is in conformity with provisions of the
Massachusetts State Building Code,Chapter 1001.3.2
Certification is required every five(5)years by a Massachusetts Registered Professional Engineer,Licensed Fire Escape
Installer or other qualified individual acceptable to the Building Official.
Registered Professional Engineer Registration Number
Edgar Hernandez G=3 B34503
Licensed Fire Escape.Installer License Number and Type
(or other Approved by Building Official)
101 Paris street Everett MA 02149 617-461-9289
Address Phone Number
Commonwealth of Massachusetts Hampshire County,
Then personally appeared the above named: /
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My commission expires on: Flo . : Mseptem��
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101 Paris Street, E, - ett MA 02149 (617)461-9289
Eddie's Iron Works Inc at Eddiesironworks.net