HomeMy WebLinkAbout0025 GUY LANE - Health 25 A= GUY LANE, HYIEW E H
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MRVP #
Assessors office (1st Floor)
Assessors Map and Parcel #
Building De artment (4th Floor)
Zoning C - 4f
INSPECTION FEE 69 0,0 O
RE-INSPECTION FEE $15.00
Request For .A Housing Inspection For Certification Under the
MA Rental nVoucher Program
Your NameY�n
Affiliation (Circle One) Owner Real Estate Agent en
Your Address a 6-0 MA g�tQ Q
Telephone Number (Day) '� � tq (Night) M00Da-3a—
Address of Property Where Inspection Requested
Unit/Apt.# (PJ t_-
Name of Owner n �►VQ�(IVonr)Q,
Address 1AllD mA • V�- q0
Mailing Address (if different)
Telephone Number (Day) 'f(0(7 g qq R (Night)
�^
Will there be any children under the age of six (6) who 11
be occupying the rental unit? (circle one) Yes No111
Was the dwelling constructed prior to 1979? Yes No
------------------------------------------------------------
FOR OFFICE USE ONLY:
Certification
The dwelling, dwelling unit, or rooming unit located at
ZSk4x&m w,%® was inspected on
11 /j- ?4v0 by Health
Inspector for the Town of Barnstable and was found to be in
compliance with the provisions contained within 105 CMR
410.00, State Sanitary Code II: Minimum Standards of Fitness
for Human Habitation. However, this certification does not
include a determination as to whether this unit contains any
lead paint because under 760 CMR 49.02 Massachusetts Rental
Voucher Program, a separate lead paint inspection must be
conducted.
Inspector's Signature
Date I/ / , �
FORM30 Caw HOBBSSWARRENTM THE COMMONWEALTH OF MASSACHUSETTS
BO RD OF HEALTH tic
CITY/TOWN w� '�v►�J�
0
DEPARTMENT
ADDRESS
�M SVBy`e J
TELEPHONE- r
Address v� Ll�� !d'Vwt�Wo _ Occupant_. ��"�
Floor Apartment No. No.of Occupants-3—
No.of Habitable Rooms 7 No.Sleeping Rooms -s_ `�60_15,17
No.dwelling or rooming units_ No.Stories —Z — I J�
Name and address of owner__/ytzd o��r��j + o
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish ,'44 U.c
Containers: Z, 4z oW Ir44 s
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.: Al — OGC
❑ B ❑ F ❑ M Doors,Windows: _o k tvt rulvviA d6 Lu ZZWd !/
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling: i b4 40 the Lv /a
Hall Lighting: f.f
Hall Windows:
HEATING Chimneys:
Central ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Su ply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks S6fety and Vent(s)
ELECTRICAL Panels, Meters,Cir.: —0
RR-f'10 U,9'20 Fusing,Grnd.:
AMP: 14b Gen.Cond. Distrib. Box.-
Gen. Basement Wiring:
DWELLING UNIT "
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen C} dC
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten. , Oil, Elect.: i d
Stacks, FI s,Vents,Safeties:
Kitchen Facilities Sink 1
Stove ,k^ S 13 v-r Ka, T v,-f y -
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Le 1tiQ4v-1 ^u e0:WN L 10 74V
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Buildin Posted �f
Locks on Doors:
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
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPO T IS IGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI FIDE
INSPECT � TITLE
�t » .swo
DATE TIME �} //'' P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
,. ..:{,;2fSA.-"i6hY4+�'+-"f'ht 1� +e . . .:`. . :i},+as ..y, s r nr',_.•>Y+.r^.s..,:n:a:e•+•. ,s
4W.s; �'$ ' eJ��. ',.r i; s X ,�e.�„�., .�ti,. �h0-..�•li,'�" ' '�tsgr-
a .
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or
impair the heaith, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity,'pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit;passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents,-cockroaches, insect infestations and other pests as required by 105_CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy,said condition within the time so ordered by the Board of Health.
• 1
THE COMMONWEALTH OF MASSACHUSETTS
FORM 30-, C,W.. HOBBS&WARREN'"
BOARD OF HEALTH QkOaw "5-f OL/a
CITY/TOWN V v ✓� Ili
DEPARTMENT
10
7 S 4
ADDRESS [ y
TELEPHONE
Address _L f��r#V&"W- wo______ Occupant_ Lowa _.
Floor Apartment No.—__ ._ No.of Occupants .3_
No. of Habitable Rooms___No.Sleeping Rooms-_-7
No.dwelling or rooming units /_____ No.Stories .Z--
Name and address of owner�4rr� Lp��j_o 1�1ti�j�[1 ��w� -s'�: (4..), k ..o G Z 6 a
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish (p ) (f ti 4,w ►a+l
Containers: ti �o Dta+1�S gi, 'N4 _ ,
Drainage If
Infestation Rats or other:
STRUCTURE EX Stops,Stairs, Porches:
Dual Egress:and Obst'n.: Ok
❑ B ❑ F ❑ M Doors,Windows: . O k kA Qlan v-C dvry d6 11P el /c/ M
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling: S U tA lip tv Zovv -,da 1/ v 3S
Hall Lighting: - o
Hall Windows:
HEATING Chimneys:
Central ❑ N Equip. Repair
TYPE: } A Stacks, Flues,Vents:
PLUMBING: Supply Line: V,a44-
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.: ✓0,0.(4W _
5?110 [A220 Fusing,Grnd.:
AMP: 1 Gen.Cond. Distrib. Box:
I Gen. Basement Wiring:
DWELLING UNIT Stk�C�P
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks ?G43
Kitchen \ Q K
Bathroom
Pantry
Den
L'ivin`'Room
Bedroom(1)
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Su .Ten. G -,Oil, Elect.: / U °F
Stacks, FI s,Vents,Safeties:
Kitchen Facilities Sink
Stove t i" t f3 v " T., car Q,vr
Bathing,Toilet Facil. Vent.,.Plumb.,Sanit'n' Lo thy- ,{ " -r, 1116c r 5ed w. L//D Z,Ty
Wash Basin,Shower or Tub: n_o(X S
Infestation Rats, Mice, Roaches or Other:
i Egress Dual and Obst'n: 6 K
' General Building Posted IV lAa- 9
Locks on Doors:
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
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPO T IS IGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI S IF PE
INSPECTO ` TITLE '��^� 'e •-
DATE �f 17/ TIME /f h" P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION'"' 2 '' P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or
impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical-wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.