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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSEfiS 02664.4451
Telephone (508) 398-2231, Ert.1240
18 S Ra,,-'r<- 79
Name and Address of Owner
Floor-Apartment No ax. Occupants
No. Sleeping Rooms 2 tto. O*elling or Rooming Uni
No. of Habilable Roor" -3
- Fax (508) 398-2365
Address -
Type: E Annual E Seas
lnspection: E Scheduled
, Unit
-No.
Stories
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onal
Electric E Gas
Prior to Occupancy ! Complaint
Basement: ! Finished B{nfinished
Detectors: E Smoke(s
als/Floor Ce lng
Not Present ! Carbon Monoxide Not Present diu"nt
Gas, Oil, Electric, Propane
Q"-triclrical tr Panel Not Labeled B/Pat\el Labeled
E-S-afety Concerns
QX-rtchen Stove
Qdppearance of Mold
Bf6i"s"tion ! Rals, Mice, Roaches or Olher Efone Observed
Rubbish ntainers/Covers 5 Area Clean
Exterior of House
!-E-ocks on Doors B€-gress
E6tormlscreen Door [Eoor Closure El-Wrndows
Ll-t(itchen
! Remove/Reseal Sealant Base o, Shower ! Top o, Tub
Q-ffialAppearance
Bedroom !1 tr2 D3 D4 D5 !6
! Base of Tub (Floor)
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! A Copy ol "Tenants Rights' Has Been lssued to Tenanl.
One or more of the violations checked above is a condilion which may materially impair the health or safety and well-being of the occupant as
determined by 105CMR 410.750 of the code or lhe authorized inspector (see over).
This inspection is Si Certifi [Jnder the Pains and Penalties ol Perjury.
J4?€--<-r.1<-lnspector T tle
Date 3 -zq-z-s tt:.30 @
The next scheduled reinspection
a
k,*<a7vD Time
4
PM
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