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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF YARMOUTH
1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664.4451
Telephone (508) 398-2231 , Ext. 124A - Fax (508) 398-2365
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lnspection eduled rior to Occupancy E Complaint
Basement: I F n shed y'u"finished
anel Labeled
Aipearance of Mold
Max. OccL.rpants ( f.lo. ot Hab,tabre Rooms
No. Dwelling or Rooming Units_No. Stories
RvFnding
Present
Address'.J.-?
Flo Apartmenl No
No. Sleeping Rooms
Name and Address of Owner
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Type: ! An I Seasonal
Deteclors: ! SmokgF) Not Presenl E Carbon Monox,de Not Present
Q,Yu?lls/Ftoot dceitino
ZPlumbing
6y*rical ! Panel Nor Labeled
Z-S"1ety concer.ns,//
G/K;tchen Stove tr Electric B/Gas
-A-lntestdtion E Rats,
.8 Garbage and Rubbish
s or Other
Containers/Covers
a- iloi" 9u."."0
rtrea,clean
Mice,
,l Exterior Yard Exterior ol House
,4 Lo_cks on ooors Aig">
; SlorF/Screen Door ,/Door Closure
Wkttchen
E Remove/Reseal Sealant Base of Shower
HVindows
! Top ofTub ! BaseofTub(Floor)
eneral Appearance
Bedroom !1 a2 a3 !4 !5 tr6
COMMENTS
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I A Copy of "Tenants Rights' Has Been lssued to Tenant.
One or more of the violations checked above is a condition which may materjally impair the health or safety and well-being of the occupant asdelermined by 105CMR 410.750 of the code or the authorized jnspector (see over).
ection porr is Signgl itied Under the Pains and Penalties of Pe.jury
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This insp
lnspector
Dale b-22-23 Time a
PM
PM
The next scheduled reinspection
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