1 Complaint Records & Orders to Correct IOARD OF HEALTH
MEMBERS
lHN T.JOYCE,Chairman
ANNE BURES,M.D.
THIA DOURMASHKIN,R.N.
J.McERLAIN,Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET
01060
(413)586-6950 Ext 213
IER TO CORRECT VIOLATIONS OF CHAPTER II OF THE STATE SANITARY CODE I
"MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AT:
1 Brewster Court, Apt. #3, Northampton, MA 01060
DATE: December 18, 1996
ORDER ADDRESSED TO: Nana Corporation
c/o Chris Boulger
1 Brewster Court, Apt. #1
Northampton, MA 01060
COPIES OF REPORT TO: Chie Nakatani
1 Brewster Court, Apt. #3
Northampton, MA 01060
This is an important legal document. It may effect your rights You may
obtain a translation of this form at:
Isto � um documento legal muito importante que podera afectar os seus
direitos. Podem adquirir uma tradgao deste documento de:
Le suivante est un important document legal. II pourrait affectar vos
droits. Vous pouvez obtenir une traduction de cette forme a:
Questo a un documento legale importante. Potrebbe avere effectto sui
suoi diritti. Lei pu6 ottenere una traduzione di questo modulo a:
Este es un documento legal importante. Puede que afecte sus direchos.
Ud. Puede adquirir una tradcci8n de esta forma en:
To jest wazne legalny dokument. To maze miec wplyw na twoje
uprawnienia. Mozesz uzyskac tlumaczenie teo dokumentu w ofisie:
NORTHAMPTON BOARD OF HEALTH
City Hall, 210 Main Street
Northampton, MA 01060
Tel #: (413) 586 -6950 x217
The Northampton Board of Health has inspected the premises at
1 Brewster Court, Northampton, MA (assessor's map 32C parcel 31 .),
for compliance with Chapter II of the State Sanitary Code.
This letter will certify that the inspections revealed violations listed below,
which are serious enough as to endanger or materially impair the
health, safety, and well-being of the occupants.
Under authority of Chapter III, Section 127 of the Massachusetts General
Laws, and Chapter II of the State Sanitary Code, you are hereby ordered to
make a good faith effort to correct the following violations
within FOURTEEN DAYS of the receipt of this order.
\TION
VIOLATION
Apt. #3 mailbox locking mechanism
defective.
(1) Main exterior entry door to the
dwelling is not properly
equippedllockable.
3,
1
REMEDY
Repair/replace mailbox locking
mechanism.
(2) Main interior entry door to Apt. #3
will not lock properly.
(1) Both living room prime windows
are ill-fitted, not weathertight, and will
not lock properly.
Bedroom#1(Left)
(2) Ceiling repair has not been
completed requires finishing paint
over drywall surfaces.
(3) Bedroom wall near left window wl
peeling &bulging surfaces.
(4) Bedroom wall near right window
wl cracking surfaces.
(1) Door must close and lock
automatically and be equipped with an
electrically-operated striker
mechanism, and associated
equipment. SEE ATTACHED
REGULATION
Repair/replace locking mechanism in
an approved manner.
(1) Repair windows in an approved
manner.
(2) Finish bedroom ceiling in an
approved manner. ,
(3) Repair bedroom wall in an
approved manner.
(4) Repair bedroom wall in an
approved manner.
Bathroom
(5) Signs of moisture seepage from
above. (Bathroom above?). Ceiling
needs refinishin•.
Locate and repair source of moisture
infiltration. Repair bathroom ceiling in
an a• .roved manner.
nspection of premises was made on December 16, 1996 at approximately
?:15 pm.
If you have any questions regarding this abatement order contact the Board
of Health office.
Very truly you
dl
David E. Kochan
Sanitary inspector
Northampton Board of Health
This inspection report is signed and certified under the pains and penalties
of perjury.
CERTIFIED MAIL# P 061 775 824
F HEALTH
X.Chairman
RAY.MLD.
PARSONS
TRAIN.Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS 01060
DEFILE OF THE
BOARD OF HEALTH
210 MAIN STREET
01090
1412)5908090 En.213
)DER"MOINIMUME STANDARDS OF FITNESS FOR HUMAN HABITATION SANITARY
AT
\partment a 1 , 1 Brewster Court, Northampton, MA 01060
ATE: November 8 1989
RDER ADDRESSED TO: Anthon R Williams
9 Hillcrest Drive
Florence , MA 01060
OPIES OF REPORT TO Shari Drew
Apt. # 1 , 1 Brewster Court
Northam ton MA 01060
(ous may obtain document . It
ofmthis form at:
affect your rights.
at;
Isto a um documento legal muito importante que podera afectar os
seus direitos. Podem adquirir uma tradcao deste documento de:
Le suivante est un important document legal. 11 pourrait
affecter vos droits. Vous pouvez obtenir une traduction de cette
forme a:
ssuis suoi u diritti . Leig importante.puo ottenere una avere to
di questo
modulo a:
Este es un documento legal importante Puede que afecte sus
direchos. Ud. Puede adquirir una traduction de esta forma en:
To jest wazne legalny dokument. To moze miec wplyw na twoje
uprawnienia. Mozesz uzyskac tlumaczenie teo dokumentu w ofisie:
Northampton Board of Health
City Hall, 210 Main Street
Northampton, MA 01060
e Northampton Board of Health has inspected the premises at
32C
of 1 1 Br for Northampton
Chapter II of' sThepState
.r cel 31 •• )) ,,
unitary Code.
kis letter will certify that the inspections revealed violations
.sted below, which are serious enough to-endanger orhe
iterially impair the health, safety,
:cupants.
)der authority of Chapter III , Section 127 of the Massachusetts
eneral Laws , and Chapter II of the State Sanitary Code, you are
ereby ordered to make a good faith effort to correct the
ollowing violations within TWENTY-FOUR HOURS of the receipt
f this order:
TION . VIOLATION
1 ( 1 ) Living room baseboard out- ( 1 ) and ( 2) Repair both out-
let ( Living room/kitchen wall) lets in an approved manner.
(2) Bedroom baseboard outlet
(left wall) :
Both outlets show sparks and
current is intermittent when
appliance is plugged into
them.
Replace shattered window
)0 & Left side bedroom with right Rane.
)1 upper prime window pane pane.
not-weathertight.
u should have any questions regarding this abatement order contact the
of Health office.
REMEDY
tru%y yours,%/
E. Kochan
.ary Inspector
Lampton Board of Health
:nED MAIL # p 890 362 432
D OF HEALTH
=E.Chairman
KENNY, M.D.
R. Parsons
AlcERLAIN, Hcalth A6cnt
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE OF THE
BOARD OF HEALTH
110 MAIN STREET
Oloog
Tel. 1c13)X${' 2 X
586-6950 Ext. 214
CORRECT VIOLATIONS OF CHAPTER Ii OF THE STATE SANITARY CODE "MINIiUM STANDARDS OF
FOR HUMAN HABITATION" AT
DRESSED TO:
1 Brewster Court, Northampton, MA
Anthony R. Williams
9 Hillcrest Drive
Florence, MA 01060
3F INSPECTION REPORTS ISSUED TO:
DATE February 12, 1987
Donald LaCourse
Apt. 44, 1 Brewster Court
Northampton, MA 01060
an important legal document. It may affect your rights. You may obtain a translation
s form at:
um documento legal muito importante que podera afectar os seus direitos. Podem adquirir
adupao deste documento de:
vante est un important document legal. I1 pourrait effecter vas droits. Vous pouvez
.r une traduction de cette forme a:
) e un documento legale importante. Potreb'oe avere effetto sui suoi diricti. Lei pub
:re una traduzione di questo modulo a:
as un documento legal importance. Puede que afecte sus derechos. Pd. Puede adquirir
raduccion de esta forma en:
e uprawnienia. Mozesz uzyskac
s[ waive legalny dokument. To moie miec wply w na two J
czenie tego documentu w ofisie:
Board of Health
210 Main Street
Northampton, Mass.
Tel. No. (413) 586-6950 Ext. 214
The Northampton Board of Health has inspected the premises at 32C
Northampton (assessor's map
:el 31 for compliance with Chapter II of The State Sanitary Code.
This letter will certify that the inspections revealed violations, listed
ow, which are serious enough as to endanger or materially impair the health,
ety, and well-being of the occupants.
Under authority of Chapter 111, Section 127 of the Mass. General Laws ,
I Chapter II of The State Sanitary Code, you are hereby ordered to make a good
ith effort to correct the following violations within twenty-four (24) hours
om the date of receipt of this order.
VIOLATION REMEDY
GULATION
0. 02 Back interior stairwells and
0.500 corridors with heavy water
0.501 seepage which has caused ex-
tensive structural damage to
the ceilings and wells (peel-
ing paint and falling nlaster) .
This excessive water seepage
has iced up along walls, steps,
and flooring, creating a safety
hazard to all occupants.
Stairwell exterior window
glass missing.
f you have any ouestions concerning this notice, please call our office.
Locate and repair
source(s) of water
seepage: remove all
accumulated ice
buildup; repair all
walls and ceilings
so as to he struct-
urally sound and
intact.
Repair window.
'ours v truly,
'David E. Kocha
Sanitary Inspector
DEK/ec
Fuels.
Certified mail P 525 163 104
D OF HEALTH
OYCE,Chairman
KENNY, MD.
R. Parsons
McERLAIN, Health Agent
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE OF THE
BOARD OF HEALTH
310 MAIN STREET
01060
Tel. (413)tS X
586-6950 Ext. 214
CORRECT VIOLATIONS OF CHAPTER II OF THE STATE SANITARY CODE "MINIMUM STANDARDS OF
FOR HUMAN HABITATION" AT
)DRESSED TO:
1 Prewster Court Northampton , MA
Mr . Mark Momeio
231 71m St
Northampton , MA 01060
OF INSPECTION REPORTS ISSUED TO:
DATE January 28 , 1987
Donald LaCourse
Apt . 04 , 1 Brewster Court
Northampton , MA 01060
s an important legal document. It may affect your rights. You may obtain a translation
s form at:
: um documento legal muito importante que podera afectar os seus direitos. Podem adquiri
:adupro deste documento de:
ivante est un important document legal. I1 pourrait affecter vos droits. Vous pouve
it une traduction de cette forme a:
o b un documento legale importance. Potrebbe avere effetto sui suoi diritti. Lei pub
ere una traduzione di questo modulo a:
es un documento legal importante. Puede que afecte sus derechos. Ud. Puede adquirir
'.raduccion de esta forma en:
>st waine legalny dokumenc. To mole miec wplyw na twoje uprawnienia. Mozesz uzyskac
aczenie tego dokumentu w ofisie:
Board of Health
210 Main Street
Northampton, Mass.
Tel. No. (413) 586-6950 Ext. 214
The Northampton Board of Health has inspected the premises at
Northampton (assessor's map q2C
ewster Court
Sanitary Code.
for compliance with Chapter II of The State
This letter will certify that the inspections revealed violations, listed
, which are serious enough as to endanger or materially impair the health,
and well-being of the occupants.
Under authority of Chapter Ill, Section 127 of the Mass. General Laws,
:hapter II of The State Sanitary Code, you are hereby ordered to make a good
i effort to correct the following violations within twenty-four (24) hours
the date of receipt of this order.
VIOLATION
y,
LATION
152 Back interior stairwells and
509 corridors with heavy water
301 seepage which has caused ex-
tensive structural damage to
the ceilings and walls (peel-
ing paint and falling plaster) .
This excessive water seepage
has iced up along walls , steps ,
and flooring, creating a safety
hazard to all occupants .,--A. ./
you have any questions concerning this notice , please
REMEDY
Locate and repair
source(s) of water
seepage ; remove all
accumulated ice
buildup; repair all
walls and ceilings
so as to be struct-
urally sound and
intact . -
's v y truly ,/i%%9�
id E . Koe. a
itary Inspector
/ec
ls .
!tified mail 1/P525 163 091
call our office .
D OF HEALTH
rICE,Chairman
CENNY MD
R. Parsons
rtcERLAIN, HcaIt Agcnt
CITY OF NORTHAMPTON
MASSACHUSETTS
CORRECT VIOLATIONS OF CHAP
FOR HUMAN HABITATION" AT
DRESSED TO:
Mark Moggio
OFFICE OF THE
BOARD OF HEALTH
110 MAIN STREET
01060
Tct.
0131 y$'.°.e4Y.
586-6950 Ext. 214
TER II OF THE STATE SANITARY CODE "MINIMUM STANDARDS OF
Apt. #4, 1 Brewster Court
DATE December 18, 1986
231 Elm Street
Northampton, MA 01060
)F INSPECTION REPORTS ISSUED TO:
Donald LaCou The
Apt. #4, 1 Brewster Court
Northampton, MA 01060
an important legal document. It may affect your rights. You may obtain a translatio
form at:
um documento legal muito importante que podera afectar os seus direitos. Podem adquir
adu2ao deste documento de:
vante est un important document legal. II pourrait affecter vas droits. Vous pouvez
r une traduction de cette forme a:
e un documento legale importante. Potreboe avere effecto sui suoi diritti Lei pub
re una traduzione di questo modulo a:
is un documento legal importante. Puede que afecte sus derechos. lid. Puede adquirir
:eduction de esta forma en:
st wazne legalny dokumen t. To mole miec wplyw na
czenie tego dokumentu w ofisie:
twoje upra
enia. Mozesz uzyskac
Board of Health
210 Main Street
Northampton, Mass. -
. Tel. No. (413) 586-6950 Ext. 214
The Northampton Board of Health has inspected the premises at
#4, 1 Brewster Court , Northampton (assessor's map
31 ), for compliance with chapter II of The State Sanitary Code.
This letter will certify that the inspections revealed violations, listed
which are serious enough as to endanger or materially impair the health,
and well-being of the occupants.
Under authority of Chapter 111, Section 127 of the Mass. General Laws,
iapter II of The State Sanitary Code, you are hereby ordered to make a good
effort to correct the following violations within twenty-four (24) hours
the date of receipt of this order.
VIOLATION REMEDY
ATION
51 malfunction of kitchen stove,
repair the stove
control knob is broken,
burners do not heat up
a have any questions concerning this notice, please contact our office.
very truly,
32C
r J. McErlain
:h Agent
lee
if ied mail 4P525 163 071
LA,id D.
,N,N ELL,RN.
LAN, ReaIlh 4ccar
I.1 OF NORTHAMPTON
't?ASSaC11i;SEi'1'S
OFFICE OF THE
BOARD OF HEALTH
210 MAIN STREET
01060
TEL-(913)589-9091
'.CERECT VICLJTO'i5 OF ARTICLE II OF THE STATE SANITARY CODE " KINIMUI4 STANDARDS
i FOR HOMAN HABITATION" AT
2E:SED TO:
p.-• & yrs. Wi11ian Wood
26 Denise Court
n
IA
' TNSFECTION REPORTS ISSIIED T0:
1 Br
m n.n
DATE •7
This is an important legal documept. It may affect your rights. You may
obtain a translation of this form at:
Into a um documento legal muito importante que podera afectar os seus
direitos. Podem adquirir uma traduczo deste documento de:
Le suivante est un important document legal. II pourrait effecter vos
droits. Vous pouvez obtenir une traduction de cette forme a:
Questo a un documento legate importante. Potrebbe avere effetto sui
suoi diritti. Lei pub ottenere una traduzione di questo modulo a:
Este es un documento legal importante. Puede que afecte sus derechos.
Ud. Puede adquirir una taduccidn de este forma en:
I Y 0.VtLRO VO}1L'' O ET YPa(Do. RnooEL Va
AUTO ELV0.L EVC aT1U r
EnT)PE0.0EL TO. VO}LL80. OQS CJLHQLWlROta• AffiOPELTE V4
' . , TO
TCPETE UETCDPOOiI CVTOU toll EYYP V
'( f0 7 • i '4 -' fr,' r
!L :fit \--g- ,,,, } f'_
ir 3I_ y f , i A ii� Vim:
JJ � T� r� ��, a
h ) fy Board of 'r.'ealtht Nortyee of on r Vass•
4 4,Z 19T J -f 210 Pain Street -- Tel:-1-46.-53,e4071
•
The - _ a d of Fsslth has = ed the _____es at
?;ortha^ (asses( ssrr s rap 9 C
1 31 .), for compliance with Article II of the State Sanitary Code.
Th-3s letter will certify that the inspections revealed violations, listed
or materially impair the
r, which are serious enough as to ;raterially endanger
th safety, _.,d tall-being of the occupants.
r
Under authority of Chapter 111, Section 127L of
Article II of the State Sanitary Code, you are hereby
ssary repairs or contract with a third party within five (5) days
t of this order and to make a good faith effort to substantially complete
ection, within fourteen (14) days of the receipt of this order, the following
.ations:
Remed
elation Violation —�
Deteriorated p Repair plaster or replace
Clean stairs of loose
plaster.
the Mass. General Laws,
ordered to begin the
of the re-
3.1
3.1
Laster in rear stairwell
walls and ceilings. Plaster fallen on
stairs.
Facia system rotted in several places.
(This could be the cause of the
Interior water damage to the plaster and
other areas.)
erior porches are in hazardous
_ondition. The Third floor porch is
pulling away from the house.
3.1 Foundation mortar is deteriorated.
Many loose foundation bricks.
Northampton Building Inspector Cecil Clark, to insure the
Please
Repair facia system.
Repair according to
Massachusetts State
Building Code.*
Re-mortar the foundation
in necessary areas.
check with the meeththe on u
intended repairs will meet the standards of the Massachusetts State Building Code.
If you have any questions, please feel free to call me at this office.
Thank you, in advance, for your cooperation.
Very truly yours,
P 9-k
Peter J. MrErlain
Health Agent
Certified Mail # 234433
cc: Cecil Clark, Building Inspector
ativn of an order. To
have the right to e i n writing a Petition
dish
he rin modification,th person .; - filed on
'nearing before the Pt=rd of t -L
ctltlol "a"� be
n accordance with the regulations be�on:
iy person or persons upon whom
any Y order has oeServprs
pursuant
r :any regulation of this code 3 e r s enredduu
requirements of Regulation 33 . 2 have been satisfied) ; provided ,
tc h retition must be filed vithin ven days after the day the
rder .,.as served;
ny person aggrieved by the failure of any inspector (s) or other
erspnnel of the board recuired under this
i) to inspect upon renuest any premises as
code; provided, such petition must be filed within thirty days
after such inspection was requested ; or
p) to issue a report on an inspection as required by this code;
provided , such petition must be filed within thirty days after
the inspection; or .
upon an inspeion to find such. violation violations t are claimed to exist or to certify that aere
violation or combination of vidlatioand oylendangeroortmamate-
rially impair the health or safety, well—being of be
occupants of the Premises; provided, such
filed within thirty days after receipt of the inspection
report; or
(4)
to issue an order as required by Regulation 33 .1; provided,
that such petition must be filed within thirty days after
receipt of the inspection report.
Any person upon whom this order has been served or any person
ieved by the l ore r to perform
e has the right to at a hearing any adverse
y has a right to appear at said hearing.
Public Documents
All relevant inspection natroin insthea poossessiont of
other documentary be copied for a
Lth are open for inspection and may
Remedies aria ties
Part of the Inspection Report contains a brief sure ary of some me
al remedies tenants may use in order to get Housing Code violations
dollars, nor
rected. Failure to comply with this order also subjects the person
ered than a criminal fine 500) dollars for eachnday'ss 0ailure to comply
�e than five hundred ($5 )
.h this order.
(3 )
orders, notices
the Board of
fee .
Date:
BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Name of Complainant 6/1/5
Address: / S,rn&e
Nature of Complaint
Location:
Owner.
n Co(/ —
3
. /w7Ck ()Eft(%/✓?_
S QOy/LGER
Address: w$Nft coal:W*004
I Bete/Alta coati-, AtrtJ
%N stPivnlsi
Taken by:
Date of Inspection: /2 -i3-9G
INSPECTOR'S REPORT:
(r) E>rfy ring
(t) t+irtf Dole
(3) 5250g WO) 4)
wcK Celrel✓G
Ia5/)
(±)3r-;If Liot aE <oorn Ohm, ✓
im Or✓iz IZcf i1tO/ (✓'41- VCO
Not 6o'K 9n0PEK)7 • (Se,ai58e)
Parcel: 3/
Te1s6KO 6
Tel:586-7770
st'(-Torn 64)
Time:P."/S/no
(tyro) No i Ep JIP%%D QRGPffe41 yid
fc 11/71. Cr3(CofK OEnC'Ariy
(4) CEl6/t.t5 Azfn ?,NS11 •40/9
(pt/,. ct
«) Lc/AIL 4,VAZ a RDO (u - (co,"
es" petwiet
el M c. rv�¢ wi ooa•..1/Af /S o0
v'(
wrJH CO4c4 $crtPACtS /
//Rib - me al-vrk 56e746.e. ✓
Action Taken:
5rcni)/-"yet
iy
eCpn .c7 'Arcc¢ Sna-�
SENT /L_/F- 9ti
Inspector Sig r ttire
(441;
Date: 1 a--8-c?C
Name of Complainant: 'non%c.c- L9 hin•
} c A.0-3 Tel:
.4A
Address $ ra ec Cpa?bi
Nature of Complaint OQ icC, 5
mo o'It. .524"6 SOS
1, C/ wci Co ``a�aS -
2 , Re 1e Wi . (IL
BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Location:
Owner. C,(A_
Address:
S t3
cm
(=i.lo
SR4 -7o7a
ad'as-
Taken by:tP I Da�af�nePeeSen: /2 -u-ft,
bane: 7(20❑M
INSPECTOR'S REPORT:
•te6w cvOR,NNt cN R EPA EPjq4vs ATTNns
b2-41-1 /Pm) cowed",kapn OAeetD A 6AnM - A70se<M Ano.ct
REGHROING PNMAots CAUSER BY cNFt6A SEEPAGE
CEUME REPA/7s oN6efNG•
ilnlE
Action Taken:
c
BOARD OF REALM azc
inAP CITY HALL.
COMPLAINT RECORD
Name of 51/AP/ Ara
Complainant ._
Address AFi
Nature of Complaint
tcarC avnsrs,e4; bro,tcoY,
s.,oks Crefecreft PA cal Y cti
Date gi7 Time/'yS�
Tel. 1-997/
AT/P/YS' FA//t u�/R Pa SPARKS
G cut titrivs.c, /(✓Ar'Z ce -
Location of Premises
Owner "raft j/l42/AA1.5
Address r H/'tatsr oyYF rho No -
Occupant
Taken by ,aft
Taken to
Date of inspection ///er Time
INSPECTOR'S REPORT goo"IC Y,o sA
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BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Date
Name of
Address ..
� T�...✓r
Nature of Complaint 6pAa
L 0/1444-"--k
/-12]VTime `f.._'....
Location of Premises
2J2.
Owner
Address
Occupant
Referred to
Taken by G' OZ)
A++'s
Date of inspection /..4-77" Time /
INSPECTOR'S REPORT ..._—tteset2
Action Taken
Inspector
BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Date u P8 Time
teller «cased from
Name of .�y�� BA.e+
Complainant B S-44" CcY/
7- 5 E f/a
Address #Z
Nature of Complain
Location of Premises / B//
Owner R CoX spy (58G-3607
Address fLO 61060
Occupant
LeT rr
Taken by
Date of inspection
INSPECTOR'S REPORT 5'�-
LE7T#
/ 3
Tel. s S4�
Action Taken
Tyr rHrs T/PAt,A= mnr rid
BE VERiAG/'
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p�
7 Nr rodtp• Nn7
•
Insp"
Name of
omplainant
ddre
Nature of Complaint
BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Date
m? Sic
mire 3/
Time
�� ' .
Tel. =r—�`—
Location of Premises .
MARK
Owner
Address
Occupant
Taken by
(nose)0
Date of inspection
INSPECTOR'S[ E REPORT
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8!hG
/tyro i WKAceNC �R K STpiRNt<c ;
AceNa l/ len/ itr s My Facie vc FuM rive
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Action Taken
2
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ct.r
Sir
Name of
Co pl in
ress
Nature of Complaint 2
BOARD OF HEALTH
CITY HALL
COMPLAINT RECORD
Date
Itree-rci—oC
Tel. SQo- 'f%O
/aw
Location of Premises
caner
Address
Occupant
Taken by
Date of inspection
INSPECTOR'S REPORT
:II A
-), I--. S1$ is/As-
Action Taken
Referred to
WA 6, as c --P "3
Time
Inspector