HomeMy WebLinkAboutfire and safety inspection Jul 2024YARMOUTH FIRE DEPARTMENT
96 OLD MAIN STREET
SOUTH YARMOUTH, MA 02664
PH.: 508-398-22 1 2 / F AX: 508-7 60-4861
FIRE AND SAFETY INSPECTION REPORT
ADDRESS OF INSPECTION:
E SOUTH YARMOUTH E WEST YARMOUTH
! OWNER E MANAGER n TENANT OTHER (explain):
DATE TIME:PHONE:
NAME:PHONE
OWNERS MAILING ADDRESS:
An inspection of the above captioned property was conducted by the undersigned during which the following
fire or safety deficiencies (D) or violations (v) were observed and noted for correction:
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You are hereby ordered to abate or correct the deficiencies or violations within
so may result in civil and / or criminal complaints being filed.
days. Failure to do
Signed:
Original- Owner/Tenant Yellow Copy - Flre Department
Title:
! YARMoUTH PoRT
NAME:
Copy Received By:
FBP 99.I
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DEPARTMENT OF PI,JBLIC HEALTH
DIVISIOI{ OF HEALTH CARC FACILITY
TICET{sURE & CERTIFICATION
57 Forest Street
Ma MA 01752
lnstructions: Facilities and programs are to provide a copy of this form to their local Fire Department when
requesting a fire inspection for licensure purposes. Facilities and programs must return this form completed, or
the inspection certificate issued by the head of their local Fire Department, when applying for or renewint a
license. Nursing homes and rest homes must maintain on file with the facility proof of quarterly fire inspections
as required under 105 CMR 150.015(D).
FACILIryPROGRAM INFORMATION
Facility/Program Name Sn f\owor )C 1ad \
?\Y^ctrFacility/Program Address
Reason for lnspection:
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Licensure Renewal Facility/Program Renovations
Nursing Home or Rest Home Quarterly lnspection (105 CMR 150.015(D))
This is to document that the above facility/program was inspected on:
and determined to be:
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,\ ln compliance with localordinances regarding fire prevention and safety
_ Not to be in compliance with local ordinances regarding fire prevention and safety. The following
violations were observed (list violations, or indicate if a list of violations is attached):
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ot Local Fire pa rtme nt Official
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Rev. 06/25/15
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Typ€d or Printed Name of Local Fire Oepanment official
CERTIFICATION OF
LOCAL FIRE INSPECT]ON
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INSPECTION INFORMATION
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