HomeMy WebLinkAbout2000 Aug 03 - Rental Inspection �
' THE COMMONWEALTH OF MASSACHUSETTS
° BO�eRD OF` HEALTH
�-\ __ __ _------- --- -_ TO.VJN OF_YARbiOU_TH_----- — ' �,,
cinrirowN �
u ` W BOA_RD OF HEALTH ;' '
�T ;���/��� / � DEPARTMENT-- .
.
' �� %b .1•,�'�t __ � ___ _1146 ROUTE 28,_SOUTH YARPr10UTH,_1'dA
, _ - — ---
� W
ADDRESS
: '
�,M , •" �2-���ex�:35
r LEP
Address �-�_ C___'t_. ___ _ _ _— --- Occupant __L�C���i_:- ---
Floor �--�__ ,�partment No ��- - No. Occupants _. _ �"
No. of Habitable Rooms ""' No. Sleeping Rooms _�-Q__�'�-C� F
No. dwelling or rooming units _^---_ No. Stories __�____
Name and address of owner----__— ----_--------- ---_____---------- --
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 res nd ObsYn.:
❑ B ❑ F ❑ M r ndows.
��,�..� Gutters, Drains
���L� Walis:
/����� Foundation:
���
Chimne :
BASEMENT Gen. Sanitation:
Dampness �
Stairs
Lightin :
STRUCTURE INT. Hall, Stairway:
-��
Hall, Floor,Wall, Ceiling: �-,.,,., -- �
Hall Lighting: "
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PL�U ��NG: Su ly Line:
.0'MS ❑ ST ❑ P Waste Lin �.
.Tank(s afet and Vent(s)
E�ECTRICAL Panels, Meters, Cir.: � - —
❑ 110 ❑ 220 Fusin , Grnd.:
AMP: Gen.Cond. Distrib. Box: � p (
Gen. Basement Wiring:
DWELLING UNIT
Ventil. Lgtng. Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen �
Bathroom
Pantry
Den
Room f �
Bedroom 1
Bedroom (2)
Bedroom (3)
Bedroom (4)
Hot Water Facil. Su .Ten., Gas, Oil, Elect.:
Stacks Flues Vents S feti s:
Kitchen Facilities Sink ,.
Stove
Bathing, Toilet Facil. Vent., Plumb., Sanit'n.:
Wash Basin, Shower or Tub:
Infestation Rats, Mice, Roaches or Other.
Egress Dual and ObsYn:
General Building Posted:
Locks on doors:
A Copy of 'Tenants Rights' �as Been Issued to Tenant.
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
4UTHORIZ D INSPECTOR (See Over) This Inspection Report is 3igned
an ified e Pa s and Penalties f Perjury.
IMSPECTOR _ �1�� TITL _ ��
-- A.M.
aU � P.M.
DATE _- "` - TIME - --
._ `� --/(ra--- _ _
t:�,�
G�----- A.M.
THE NEXT SCHEDULED REINSPECTION P•M•