96 Inspection 2017 Northampton Health Department
212 Main Street
Northampton, MA 01060
(413)597-1214
Inspection Form
State Sanitary Code 105 CMR 410.000:
Chapter II, Minimum Standards of Fitness for Human Habitation
Date j Y /7 Time t '3oAi/pm #Occupants f #Children<6 Years
Occup nt ame /uG J r'kt"e Phone#
Addresser(D
. jj City/Town Apt#
Owner Name Phone#
Owner Address City/Town Zip Code
Inspector C i C 5 Title - tie J1 Ts&5Pei r
Area or Type of Violation Possible Code ✓if Violation Responsible Description
Element Section(s) Observed Party
Owner Occupant
Exterior, Locks,striker mechanism(4 or more units) 4• 80
Yard&
Porch
Posting,ID,Exit signs/emergency lights 4• 81,483,484
Handrails,steps,doors,windows,roof-maintenance 500,503
Weather tight elements 501
Rubbish-storage and collection 600,601
Yard maintenance-trash,debris,vegetation 602
Common Maintenance of area 500
Areas&
Entry Doors,lights,windows—weather tight,maintenance 501,500
Egress—means,obstructed,safe 450,451,452
Handrails—provided,maintenance 503,500
Interior Lights 254
Halls&
Stairs Floor,walls,ceiling-maintenance 500
Railings,stairs 5• 03,500
Doors,windows—weather tight,maintenance 501,500
Kitchen Location(circle): Front Rear Middle Floor Level of Unit
Refrigerator,sink,stove,oven-good repair,impervious 100
and smooth
Floor,walls,ceiling-maintenance 500
Outlets,lights 251
Windows,screens—weather tight,lock,maintenance, 501,480,500,
provided 551
Non-absorbent floor 504
wing room Floor,walls,ceilings S00
Outlets,lights 250
Windows,screens-lock,weather tight,maintenance, 501,480,S00,
provided 551
Area or Type of Violation Possible Code +cif Violation Responsible Description
Element Section(s) Observed Party
Owner Occupant
Bedroom Floors,walls,ceiling 500
#1
Outlets,lights 250
Windows,screens—weather tight,locks,maintenance, 501,480, 500,
provided 551
Bedroom Floors,walls,ceiling 500
#2
Outlets,lights 250
Windows,screens—weathertight,locks,maintenance, 501,480, 500,
provided 551
Bedroom Floors,walls,ceiling 500
113
Outlets,lights 250
Windows,screens—weathertight,locks,maintenance, 501,480, 500,
provided 551
Bathroom Sink,shower,tub—impervious,maintenance 150,500
Lights,outlets 250
Ventilation—natural,mechanical 280
Floors,walls,ceiling—maintenance 500,504
asement Maintenance,weathertight 500,501
Lighting 253
Water Fuel Type(circle): Public Private
Potable,quantity,pressure 180,354
Responsible for paying MGL ch 186 s 22,metering
Hot Water Fuel Type(circle): Natural Gas Oil Electric Other
Temp.: °f Location taken: 190
*1101 min-130 max°f
Heating Type(circle): Forced Hot Water Forced Hot Air 200,201
Steam Electric
No portable units Bathroom °f
"Habitable room and every room with toilet,shower, Kitchen °f
tub" Living Room °f
• Min 68°f 7:OOam-10:S9pm Bedroom 1 °f
Min 64°f 11:00-6:59am
Bedroom 2 °f
• 78 F max in heating season/measure 5 feet wall,5
feet floor
Cooper TM99A-UL Digital Thermometer used to
take temperature readings
Electrical Type(circle): 110 220 Amp:
Amperage,temporary wiring,metering 250,255,256,354
Smoke& Required&operational 482
CO
Detectors Note:CO detector not needed for all electric!
Pests Free of pests/harborage 550
Bedbugs/cockroaches/rodents-evidence 550
Other
Referral: 0 Electric ❑ Fire 0 Plumbing 0 Building ❑ Other
This inspection report is signed and certified under the pains and penalties of perjury.
Inspector Signature
Occupant or Occupant's Representative Signature
Re-inspection Date Time
NOTE: *indicates that this housing inspection has revealed conditions which may endanger or materially impair
the health, safety, and well-being of any person(s) occupying the premises
Area/Element Code Citation and Description of Violation
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