31B-185 (7) r i
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 IXAVIg Time p:oo r&/pm #Occupants 3 #Children<6 Years
Occupa t,N me k v ' Phone#
Address (o 3 S*a+.e s.{-. 0^14- �� City/Town A/0, yj4,A,,4. -,n Apt# 3,
Owner Name Phone#
Owner Address City/Town Zip Code
Inspector pA. - 6��j� Title tc .~hof c yr
Arca or Type of Violatl'on possible Code ✓If Violation —
Glenient Sections Observed
Exterior, Locks,striker mechanism(4 or more units) 480 •Z� ��, 1" ��
Yard& �,/ �I✓
Porch •)Uy y�• V t �I t i
Posting,ID,Exit signs/emergency lights 48:1,483,484 ) (�
Handrails,steps,doors,windows,roof-maintenance 500,sw 00 ; $ "t/1 •GO�II) �J ��
Weather tight elements 507: ; 1 '
Rubbish-storage and collection fif10,Ei07
Yard maintenance-trash,debris,vegetation 602 Iw s.) ur T'
Common Maintenance of area 500 1�jjjl.r}bill
Areas& v U
Entry Doors,lights,windows—weather tight,maintenance 507,,s0U
Egress—means,obstructed,safe 450,4S7„452
Handrails—provided,maintenance 503,SM)
Interior Lights 254
Halls& _
Stairs Floor,walls,ceiling-maintenance UX)
Railings,stairs 503,500 -
Doors,windows—weather tight,maintenance 501.,500 r
Kitchen
07.,500
Kitchen Location(circle): Front Rear Middle Floor Level of Unit
Refrigerator,sink,stove,oven-good repair,impervious 7.00
and smooth
Floor,walls,ceiling-maintenance 500
Outlets,lights 257
Windows,screens—weathertight,lock,maintenance, r501,480,5001
provided 551
Non-absorbent floor 504
Living room Floor,walls,ceilings Soo
Outlets,lights 250
Windows,screens-lock,weather tight,maintenance, 507.,480,500,
�� provided 551,
Area or Type of violation PossibleCodq If Violation Responsible Description
F.;loment• Section(s) Observed Party
Owner Occupant
Bedroom Floors,walls,ceiling 500 _
alt
Outlets,lights 250
Windows,screens—weathertight,locks,maintenance, 501,480, 500, � +
rovided 551
_Bedroom Floors,walls,ceiling 50C),
U2 —
Outlets,lights 250
Windows,screens—weather tight,locks,maintenance, 509.,480, 500,
_ provided 559.
Bedroom Floors,walls,ceiling SQ0
83
Outlets,lights 7.50
Windows,screens—weather tight,locks,maintenance, 501,480, 500,
provided 551
Bathroom Sink,shower,tub—impervious,maintenance 150,Soo
Lights;outlets 2.50
Ventilation—natural,mechanical 280
Floors,walls,ceiling—maintenance 500,504
Basement Maintenance,weathertight 500,509.
Lighting 2.53
Water Fuel Type(circle): Public Private
Potable,quantity,pressure 180,354
Responsible for paying MGL ch 186 s 22,metering
Slot Water Fuel Type(circle): Natural Gas 011 Electric Other
Temp.: Of Location taken: Ism
*110 Of min-130 max Of --
Hooting 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. Of
tub" Living Room °f
• Min 68 Of 7:00am-10:59pm Bedroom 1 Of
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 250,2%,256,354
Smoke& Required&operational .482
CO
Detectors Note:CO detector not needed for all electricl
Pasts Free of pests/harborage '550
Bedbugs/cockroaches/rodents-evidence 550
31 Me
Referral: ❑ Electric ❑ Fire , plumbing ❑ Building ❑ Other
This inspection report is si ned g9d certified under the pains and penalties of perjury.
Inspector Signature
Occupant or Occupant's epresentative 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
A.; "L o s c 'c.,
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