HomeMy WebLinkAbout0008 PRISCILLA WAY - Health 8 PRISCILLA WAY;
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HOBS&WARREN TM THE COMMONWEALTH.OFMASSACHUSETTS
FORM 30C&
BOAR OFF TH
CITY/TOW N
W
DEPARTMENT
c ADDRESS
GSM gvey`0
T LEPHONE
I
Address Occupan
Floor Apartment No. N' .of Occupants
No.of Habitable Rooms No.Sleeping Rooms
No. dwelling or rooming units No.Stories
Name and address of owner
Z Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers.-
Drainage
Infestation Rats or other: 0 -/
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:Chimney:
BASEMENT Gen.Sanitation:
Dam ness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2 f
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
ks, Flues,Ven ,Safeties:
Kitchen Facilities Sin 0
ve
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n: 00
General Building Posted
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 RT IS SIGNED AND CERTIFIED UNDER HE PAINS AND/
PENALTIES OF PE JU Y" l
INSPECTOR TITLE
r r I M.
DATE I TIME ` P•M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
- - ",�xx�`
`
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, 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 ko endanger m materially impair the health m safety, and well-being ofthe
� occupants or the public. Because Chapter ||. 105CIVIR41O.1UO through 410.O20 state minimum requirements of fitness for
� human habitg|on, any other violation has the potential to fall within this category in any given specific situation but may not doxo
�
in every case and therefore is not included in this listing. Failure to include shall in noway be construed uoa determination that
other violations orconditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
haa|Un official to order repair orcorrection of such violation(s) pursuant to 105 CIVIR 410.830thmugh 410.833 nor shall failure 10
� include affect the legal obligation of the person to whom the order is issued to comply with such order.
� (\) Failure to provide a supply cd water sufficient in quantity, pressure and 1emporature, both hot and cold, to meet the ordinary
� needs of the occupant in accordance with 105 CIVIR 410.180 and 410.190 for a period of 24 hours or longer.
�
(B) Failure to provide heat as required by 105 CIVIR 410.201 or improper venting or use ofaspace heater uvwater heater as
prohibited hy105CIVIR41O.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity orgas. ^
(D) Failure tn provide the electrical facilities required by105CIVIR410.250(B). 41O.251</V. 410.253 and the lighting in com-
mon amarequired by 105 CIVIR 410.254.
� (E) Failure to provide a safe supply cdwater.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105CMR
� 41U.15O(A)(1)and 41U.3OU.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage ortrash,which,pmvontsogreoo in case ofun emergency 105CIVIR 410.450. 410.451 and 410.452.
(H) Failure ho comply with the security requirements of1O5CIVIR41O.4D0(D).
(|) Failure to comply with any provisions of 105 CIVIR 410.600. 410.001 or41U.6O2which results in any accumulation ofgar-
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 10 accidents or0zthe o»oukion or spread of disease.
(J) The presence of|oadbunod paint on adweUing or dwelling unit in violation of the Maa000huuo8o Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105CIVIR400.000. (See M.G.L. o. 111 @@ 1SU through 1QQj
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else 10 fire, burns, shock, accident or
other dangers or impairment to health orsafety.
(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 CIVIR 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 urcovering on a pipe, boiler or furnace which may result inthe e|ouoo
of asbestos dust orwhich may result in the release of powdemd, crumbled o/pulverized asbestos material in violation of 185
CIVIR41O.353.
(N) Failure 10 provide a smoke detector required by1O5CIVIR41U.482.
(D) 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 orconditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
o/any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub ao required in1O5CIVIR410.15O(A)(2) and 41O.15U(A)(3)orany
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 p|umbing, hoaAing, gaaU8ing, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain uoafe handrail or protective railing for every stairway, porch ha|uony, roof orsimilar place as
required by 1O5CIVIR41O.5O3KV and 41O.503(B).
(5) Failure tneliminate mdents, 000knoaoheu, insect infestations and c4hm pests as required by 105 CMR 410.550.
(P) Any other violation of 105CIVIR 410.000 not enumerated in 105 CIVIR410750(A)through (0)shall be deemed to bou con-
dition whiohmayondangorormateriuUyimpairthahoa|thoruafetyandweU'boingofan000upantuponthefai|ureofthemwner
to remedy said condition within the time 000rdered by the Board of Health.
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1 � � �.�n �-�, �
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Date Z/0 S.42
voluntarily grant permission to the Town
(Occupants name)
of Barnstable Board of Health (Agent or Health Inspector) to inspect my dwelling unit
located at ( (_nn 1. in accordance
(House#, [Apt\Unit#if applica e],street,village)
with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code
(105 CMR 410.000) on ft:r(n 11, I hereby authorize and name
(Date of inspection)
1. to be my tenant representative for the
(Occupant representativey
purpose of this inspection. 01cad 1✓l�J(�I S is an adult person
(Occupant representative)
designated and duly authorized to act on my behalf and will be accompanying the Town
of Barnstable Board of Health for the inspection, granting access to any and all locations
(including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and
answering questions. This authorization is only valid for the inspection date specified
above, and must be renewed for any future inspection(s.)
\ 10, 0
Occupants Signature \ D to
Occupants Representative Signature \ Date
Q:\Rental Ord inance\inspection permission 2.doc
e-
HOBBSBWARREN'M THE COMMONWEALTH OF MASSACHUSETTS
FORM 30G�,_�)
BOA43D�OF HbqTH
CITY/TOWN
F 2)'V
r ` DEPA T EN
o N V �*
ADDRESS � —��
�'//pp//ppp\
G„M ey`e� (9
TELEPHONE
Address rl j� _ _ a�15 Occupa U�I�G'1 TSo l yg0 rd—
Floor A artment No No.of Occu ism � l,l
p — p
No. of Habitable Rooms No.Sleeping Rooms_ Yie—
No. dwelling or rooming units —.—,No.Stories.-- R766 ho
Name and address of owner /)/1 V 1 S _
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains.-
Walls:
Foundation:
Chimney:-
BASEMENT Gen. Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n..-
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect..-
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink l
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin, Shower or Tub.-
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
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 INS EC ION ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI S I
INSPECTOR TITLE
A.M.
DATE I Z TIME ' 00
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, 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.
Check list for unconnected parcels:
Name: David M. Patulak
Map/Parcel: 307-263 (508) 771-4229
Prop location: 8 Priscilla Way
Mailing address: 8 Priscilla Way
Hyannis, MA 02601
Visually check property location
check for any past pumping records As of 11/7/200 no pumping records since 1985
check water company for water use 40 ccf per year
check with engineering for permits and if they are within the bounds of connecting
As of May 17, 2000 no record of any permits taken out.
Notify Board of Health to send letter to connect
Date BOH notified: Nov. 5, 1999
Date BOH copy received: ?
Date BOH letter sent: Nov. 16, 1999
Date BOH letter expires: May 16, 2000
Sent to Tom McKeon for next step November 7, 2000
Connected May 10, 2001
CHKLIST.DOC
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