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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., bvft'�� rt�j kt` Y t! rS r