39 Housing Inspection 2003 CHAPTER H HOUSING CODE CERTIFICATION FORM
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HOUSING CODE INSPECTION REPORT
This is to certify that P/?-/ i'ING S//rli//i'LT /alt 4//ii'6
(Name of Facility)
located at 3 9 Pi-//y(E Sim
(Street)
/YOPT,,/2>/W/-(i#/)24 O/OG O
(City) (Zip)
was inspected on r9/767./ /ij, Zoo's by David E. Kochan
' (Date) (Name of Inspector)
of Northampton Board of Health, City Hall, 210 Main Street, Northampton, MA 01060
(Inspecting Board,Agency or Department)
Zsne%„nrl KFQv ; > &Y H»2IG AY-,NEON orfr7 //..>NC
The above facility complies with Chapter II of the State Sanitary Code and other regulations pertinent to the
following areas'
Kitchen Facilities Yes ✓ No
Food Storage and Preparation Yes ✓ No
Water Supply Yes ✓ No
Hot Water Temperature Yes ✓ No
Bathroom Areas " "" - " Yes ✓ No
Sewage System Yes � No
Lighting and Electrical Operations Yes ✓ No
Heat Yes ✓ No
Ventilation Yes ✓ No
s. a,
Smoke Detectors Yes No
w//.
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Exits
Asbestos NSA
Garbage and Rubbish Disposal & Storage
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Control of Insects, Rodents &Skunks
Yes ✓
Yes ✓
Yes ✓
Yes ✓
No
No
No
No
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CHAPTER II HOUSING CODE CERTIFICATION FORM
Location: 37 P4241Ci " s-iiffit7 4JDfiT14,717e/✓/mA O/OGo
Approved: Yes ✓ No *Conditionally
Recommendations: fthit//fl/iP7/1/ Pi/PE DE/7 51100.0.6).E- Cca-r29rTE„D AND AN .TNsPECi/cN
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David E. Ko an (413 -587- 1217)
Signed(Inspector or epresentative of Inspecting Authority)
* Conditional approval may be given only when, in the opinion of the inspecting authority, the occupant(s)
health would not be endangered in the dwelling prior to the correction of the noted non-compliance items.
Conditional approval will satisfy occupancy requirements, but violations noted must be corrected by the
specified time and a re-inspection made to insure compliance.
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