HomeMy WebLinkAbout2000 Jan 25 - Rental Inspection THE COMMONWEALTH OF MASSACHUSETTS
�. BO�eRD OF HEALTH
�� `���_ _ _TOWN_OF YAR2�i0UTH__ __ __ __
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CITY/TOWN
�N W BOARD OF HEALTH
�� o DEPARTMENT
' � _ ��r' �ti/l� 1146 ROUTE 28,_SOUTH YARMOUTH, 2�fA
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� � ; ADDRESS
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��M 5�.� �2��1—ext:35
TELEP
Address _ � '
( > � __ "����`'�---'�----Occupant _�'�,���1,� �u�� 1 11.s{
Floor � _{-� ,Apartment Na __--> ____ No. Occupants t�= � S {'�� �
\ No. of Habitable Rooms __ I� __ No. Sleeping Rooms- �
No. dwelling or rooming units _� �� No. Stories _ � __
� Name and address of owner _ _ ___ __ _
�Q�'-I� ----
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garba e and Rubbish:
Containers:
� Drainage �/
Infestation Rats or other: ,�
� STRUCTURE EXT. Steps, Stairs, Porches:
� -- / Dual E ress: and ObsYn.:
❑ B IWF ❑ M Doors, Windows
� Roof
Gutters, Drains:
Walls: ( `
� Foundation. �
Chimne : ✓
� BASEMENT Gen. Sanitation: a � -�''
Dampness: �
` p Stairs: 1 '
��� Lightin :
'�' STRUCTURE INT. Hall, Stairway:
Obst'n.:
Hall, Floor,Wall, Ceiling:
Hall Lighting:
Hall Windows
HEATING� /� Chimneys
Central �'Y O N Equip. Repair
� TYPE: ��,,� Stacks, Flues,Vents:
PLUMBING: Supply Line: _
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tank(s) Safet and Vent(s) _
ELECTRICAL Panels, Meters, Cir.:
❑ 110 ❑ 220 Fusin , Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
� DWELLING UNIT
Ventil. Lgtng. Outlets Walls Ceils. Wind. Doors Floors Locks
� � Kitchen �/' fo'' �A ��
Bathroom
V Pantry
Den
Living Room l/' �'
Bedroom
Bedroom -� � ,�
/� � Bedroom �� � ,� �
� Bedroom �
� y
� Hot Water FaciL 5u .Ten., Gas il lect.: �
Stacks Flues Vents Safeties:
Kitchen Facilities Sink `/' �rN �
Stove
Bathing, Toilet Facil. Vent., Plumb., Sanit'n.: ¢� �
Wash Basin, Shower or Tub: `. � _
� Infestation Rats, Mice, Roaches or Other. _
, n Egress Dua� and ObsYn:
V,� General Building Posted: � ,{-� �` � -�,.� .t-
Locks on doors: !/
,�f/�- A Copy of 'Tenants Rights' Has Iieen Issued to Tenant.
Y7�� ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
4UTHORIZED INSPECTOR. (See Over) This Inspection Report is 3igned
and Cer ' ied Under he Pains and Penalties f Perjury.
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INSPECTOR __i _ — TITLE _
A.M.
DATE — -- � � _- ----. .
�- "� � �} ____ TIME _��a �
e'�� - -�--
THE NEXT SCHEDULED REINSPECTION�__���k�,� P.M.