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HomeMy WebLinkAbout0053 SPRING STREET - Health 53 SPRING ST., HYANNIS A= .A5 / I� FORM30 C&w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN DEOARTMENT Ai-k iA IS��; � sue. �►� ADDRESS �3 �+ PPI,.,�, S�. TELEPHONE �f/ Address NA`IA*A t4 1 S 1-01A 0 Occupant 9 7-00 N Floor Apartment No. No.of Occupants ,No.of Habitable Rooms No.Sleeping Rooms t� No.dwelling or rooming units �- No.Stories Name and address of owner 4F YZ�v V- Sg� ®(Z-C Remarks Rego Vlo. YARD Out Bld s.: Fences: -ra4.w ./ Garba e and Rubbish - *x eeGS D t/&4- / 41/v &a Containers: -T2 A S Gf f ti Drainage ZA,AFL. Infestation Rats or other: 'CC�LM i2 STRUCTURE EXT. Steps,Stairs, Porches: t C S i,XA �vvO L to Dual Egress:and Obst'n.: ❑ B ❑ F _ ❑ M Doors,Windows: Roof U Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: S Obst'n.: p, LOD uc- Hall, Floor,Wall,Cei P-o t -1 �'5 R a2� Hall Li htin : l a.�ct2 hL �"t-C Af N3 Hall Windows: HEATING Chimneys: Central ❑ Y ElN Equip. Repair "C f , 6 Sy co---LO PP TYPE: Stacks, Flues,Vents: 0$j 1 AA;=t VL-6o ,of PLUMBING: Supply Line: A 12 Ar O AJ �N ElMS ElST El Waste Line: C.p( 1.10 1 H.W.Tanks Safety and Vent(s)- ELECTRICAL Panels, Meters,Cir.: �U -( I rP ❑ 110 ❑ 220 Fusing,Grnd.: f?,j Ns 'NL�- „ AMP: Gen.Cond. Distrib. Box: la Z Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks (�1 Kitchen A 1'Up Bathroom Pantry Den Living Room Lxz)if 2 r�� (- Bedroom 1 5 P -- f-0 0�1. Bedroom 2 ,) Bedroom 3 to) Bedroom 4 N © Hot Water Facil. Sup.Ten.,Gas, Oil, E ct.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink / o K 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 Buildin Posted Locks on Doors: t 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTI OF PWIV " .� S C-C,-C 0INSPECTORTITLE R A.M DATE � 12/0 TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION � � P.M. --- 410.750: Conditions Deemed to Endanger or Impair Health cr 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 endarger 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 tris 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 10E 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 nfestations 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. y_ .:yf^..wsAg7r�'n„tiy�,er.Ytl.cxe:cc.-.�.1..n»..Y,mow,....,,,..-..i....rt'"�`J.j l � i j TM THE , MMONWEALTH OF MASSACHUSETTS '10-FORm 30 &W HOBBS&WARREN {, '� 'a .. �. BOARD OF HEALTH CITY/TOWN it,n4--t14 DEPARTMENT a i ', •y ADDRESS. ".A4/� ,M TELEPHONE �/!YJ �• Address YkI.0A14 %4 1 S 1'0 A 0 Occupant_47_1"L� .>_71,0/A/ ; w Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms t _ No.dwelling or rooming units A.r No.Stories Name and address of owner6A Rat 1 V k v.► ! G. S l AS CO j c,. E-( VQ, &01e,,,1,A D1 -C SrA►c N Remarks Reg. Vio.— ti YARD Out Bld s.: Fences: 144mv Garbage and Rubbish &AxAecs &a Containers: -pry 0S if ►,y � . Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: t S 0 L P_ 1:4 to ,c Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: /( } Roof Gutters, Drains: ]f t. Walls: 4 .----~- Foundation: ,,,, Chimney: BASEMENT Gen.Sanitation: `• +/ ---- Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: v S i tV S,r d " Obst'n.: ,•P Hall, Floor,Wall,Ceflin : / Cori r 44b,,z,, Hall Lighting: �`� t t.,IGc�.jG i�2 �"t C t�J ' / , ✓' Hall Windows: HEATING Chimneys: �A 0'ta'� l� Central, ❑ ❑ N. , EquIp. Repair., � - ."C. v�+ld• fz_ v2 . fa.:. TYPE: Stacks, Flues,Vents. PLUMBING: Supply Line: , b "i` f a A-4 N L") ❑ MS ❑ ST ❑ P Waste Line: t„ G 10 ,-)t H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 1 ( ; 4 &i- ❑ 110 ❑ 220 Fusing,Grnd.: { °9 • ± 4 if-OS, k_ l AMP: Geri.Cond. Distrib. Box: t /v1 ,I / 110 2S3 Gen. Basement Wiring: DWELLING UNIT Ventil. `L to . Outlets Walls . Ceils. Wind. Doors I Floors) Locks l d V Kitchen �p Bathroom (/ Pantry Den Living Room S"( "(&) Bedroom 1 , V 01 55- Bedroom 2 Bedroom 3 ((� ) Bedroom 4 ` 0 Sf -1 Hot Water Facil. Sup.Ten.,Gas, Oil, EI ct.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink i L4 60 F /41.0 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 µ Buildin Posted .�.,..A s w t3- -�4•w 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF.PER UR 71 INSPECTOR �•S TITLE la SPE c-t 0� A r DATE 9 t Z(�I d TIME t �' P.M. A.W 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 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 caoacity 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. FORM30 HOBBSB WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH CIT /TOWN 4 W f ^ ' o �✓� � � DEPARTMENT ADDRESS M sey`0 (?�!� T,E}�L,EPAIONNE t Address f f `J ---Occupant----�" —----------- _. Floor Apartmen o.— _ No.of Occupants .�`? No. of Habitable Rooms No.Sleeping Rooms__P__ n Q No. dwelling or rooming units _ No.St ries_ _ $L �z�,�� Name and address of owner s 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: I 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 E ui . 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 11220 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 10 0 Bedroom 2 70 t 7 Bedroom 3 D Bedroom 4 Hot Water Facil. Sup.Ten., Gas, Oil, Elect.: S ks, Flues,Vents afeties: Kitchen Facilities ink e 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 C ECKED 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJ R INSPECTOR TITLE A.M. DATE _ TIME v v _ P.M. ,r / A.M. �/J ITHE NEXT SCHEDULED REINSPECTION P.M. t 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 heaith, or safety and well-being of a person or oersons occupying the premises. This listing is composed of those items which are deemed to always have the potential tc 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'o-all 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 oy 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 o-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, inset 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 hea th 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. - I X)G Date �U To Whom It May Concern: I voluntarily grant permission to the Town (Occ ants name) R of Barnstable Board of Health (Agent or Health Inspector)to inspect my dwelling unit _ £p located at / V1 6� in accordance (House#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code(Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on /A t/ I hereby authorize and name I (Date of inspection) to be'my tenant representative for the (Occupant representative) purpose of this inspection. is an adult person panf representa i ) 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.) 4 41, ld ccupants Sign ture \ Date Occupants Representative Signature \ Date Q:\Rental Ord inance\inspection permission 2.doc vJ3 J 3 Date To Whom It May Concern: I, , voluntarily grant permission to the Town (Occupants n o arnstable Board of Health (Agent or Health Inspector) to inspect my dwelling unit located at d 1?]-� in accordance (House#, [Ap nit#if applicable];street,village) with the Town of Barnstable Code(Chapters 59 and 170) and the State Sanitary Code (105-CMR 410.000) on' — , a I hereby authorize and name / (Date o ins�n) to bey/my tenant representative for the cupant representative)purpose of this inspection. f is an adult person iP p ron pant-representative) designated and duly authorized to act 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.) Occupants Date \ Date Occupants Representative Signature \ Date Q:\Rental Ordinance\inspection permission 2.doc 53 , Date j o� To Whom It May Concern: I, (�pT�p,SjN/�� , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health(Agent or Health Inspector)to inspect my dwelling unit located at ' vl�'l rS 'in accordance (Muse#, ( Unit#if appl able],street,village) with the Town of Barnstable Code(Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on 6�L Lf I hereby authorize and name D e of inspection) 'o e my tenant representative for the (Occupant representative) purpo of this inspection. is an adult person cup antrepresentative) designated and duly authorized to act n 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.) oe Occupants Signature \ ate Occupants Representative Signature \ Date Q:\Rental Ordinance\inspection permission 2.doc Date U To Whom It May Concern: I, ejj voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health (Agent or Health Inspector)to inspect my dwelling unit located at - 5-3 in accordance (House#, [ Unit#if applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on el I hereby authorize and name (Date inspection) t be my ant representative for the (O c pant representative) pure•se is inspection. is an adult person ( ccup t repr entative) designated and duly authorized to act on y 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.) Occupants Signa re \ Date Occupants Representative Signature \ Date QARen-tal Ordinance\inspection pemiission2.doc InqDate 6 To Whom It May Concern: t - r I, al "O luntarily grant permission to the Town (Occupant name) ` of Barnstable Board of Health (Agent or Ijealth Inspector) to inspect my dwelling unit J located at `� in accordance ( p 'cable], street,vil ag with the Town of Barnstable Code (Chapters 59-and 170) and the State Sanitary Code (105 CMR 410.000) on I hereby authorize and name (Date of inspection) r r,�, to�be my tena;,nt representative fo: the'01, ; r, pant epresentai vej purpose of this inspection. is an adult person cupant represen tive) 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.) % 4 Oocupantssigkature \ Date ` Occupants Representative Signature \ Date t Q:\Rental Ordinance\inspection pennission 2.doe f y TOWN OF BARNSTABLE BOARD OF HEALTH ;'` .�✓� ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date Time: In Out Owner. Cn lorriw`Yv Tenant Address 3?) ���OYJ�'-G` `'� `� Address `7 3 �(�R R VM Pomplignce Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities IaRProvel -,_.- -j(�t 3. Bathroom Facilities 4. Water Supply f 5. Hot Water Facilities 6. Heating Facilities , 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal. . 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed (lo PART II `` 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector. If Public Building such as Store or Hotel/Motel specify here Date G b To Whom It May Concern: I, 7 , voluntarily grant permission to the Town ccupants name), of Barnsta (� rd of Healthr(Agent or Health Inspector) to inspect my dwelling unit located at 'ate 52 in accordance Y , House#, A t\Unit#if applicable],street,village) With the:Town of Ba stable?Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) o I hereby authorize and name - (Date jf'inspection) to be:my tenant representative for the Occupant representative) purpose of this inspection. f3 — L is an adult person ccupant representative) designated and duly authorized to act on my behalf and will be accompanying the Town of Barnstable Board of Health for the inspection, grdnting access to any and all locations (including bedrooms,,bathrooms, closets, etc.,).allo ing the use-of photographs and answering questions. This authorization,is only valid for,the inspection date specified above, and must be renewed for any�ftiture inspect on(s.) t �' V y': 1 Occup n s i ure A Date Out enfaive Si nature DPan t �. ----- -Q:\Rental Ordinance\inspection-permission-2.doc---=-------, - -'' FORM 30 C&W HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH CITY/TOWN W A a DEPAqTMENT tj ADDRESS S7o 4„M SVBy`0W O / c 2 TE�LE HONE Address J `� _ Occupant-- Floor— Apartment N No. of Occupants S G No.of Habitable Rooms_No.Sleeping Rooms----G No. dwelling or rooming units No.Stogies Name and address of owner Remarks eg. 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: AA 4 Chimney: U ' 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: Su ply 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 G 0 Bedroom 3 Bedroom 4 2 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:, S s,Flues,Ve ,Safeties: V Kitchen Facilities in ove 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 &FCKFD 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 REPORT I IGNED AND CERTIFIED UNDER E PAINS AND PENALTIES OF PERJURY.' INSPECTOR TITLE r DATE P.M. A.M. TIM . THE NEXT SCHEDULED REINSPECTION P.M. 9 410.750: 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 encanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 41C.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 withir 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 healt)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. Date 0 I, — �� , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health(Agent or Health Inspector) to inspect my dwelling unit located at in accordance (Muse#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on y b d 6r-; . I hereby authorize and name ate of inspection) to be my:tenant representative for the cc pant representative) purpose of this inspection. ;-J 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 irispection(s.) Occupants Signatu \ Date dW� cupants�e Signature \ ate I. Q:\Rental Ordinance\inspection permission 2.doc PP7 ? Date !� "t 0 I, R 6 Z-A , voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health(Agent or Health Inspector)to inspect my dwelling unit located at S 3 9 " �S in accordance Au, #, [Apt\Unit#if a able],street,village) with the Town of Barnstable Code(Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on Y126 d I hereby authorize and name (Date of i spe ion) f to be my tenant representative for the Occupant representative) ` purpose of this inspection. is an adult person 11� (O upant 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 mspection(s.) cupants ignature \ Date v7 ccupants Representative Signature \ Date Q:\Rental Ordinance\inspection permission 2.doc r i 3 , , t Date voluntarily grant permission to the Town (Occupants name) of Barnstable Board of Health(Agent or Health Inspector)to inspect my dwelling unit located at 5 3 S RQ M G S�}-��/ GUI in accordance (House#, [Apt\Unit#if applWable],street,village) with the Town of Barnstable Code(Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on �/ .2 6 7 I hereby authorize and name (Date of it spection) k to be my tenant representative for the (Occupant representative) o purpose of this inspection. �� 2 %Q 1v 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.) t f \ ccupan Signature Date ccupants resentative Signature \ ate QARental Ordinance\inspection permission 2.doc f Date �l . voluntarily grant permission to the Town (OccupaAs name) of Barnstable Board of Health (Agent or Health Inspector)to inspect my dwelling unit located at S S I in accordance >�b - (14ause#, [Apt\Unit#if applicable],street,village) with the Town of Barnstable Code(Chapters 59 and 170) and the State Sanitary Code (105'CMR 410.000) on 61 d'i 0 - I hereby authorize and name '(Datelof inspection) _ to be my tenant representative for the ( ccupant representative) purpme of this inspection. CA 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.) ccup is Signat e \ b4te \ / O ccupant resentative Signature \ Da e Q:\Rental Ordinance\inspection permission 2.doc Date I, A S G tJ So F/ E LAO , voluntarily grant permission to the Town (Occupants name) 4 of Barnstable Board of Health(Agent or Health Inspector)to inspect my dwelling unit 11 located at 5 3 s�,2 J i'lJ t� I � 1��j kl 15 in accordance (Ho se#, [Apt\Unit#if appli le],street,village) with the Town of Barnstable.Code(Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on Li b /0:Z I hereby authorize and name Date of i spection) � to be my tenant representative for the Occupant represent tive) purpose of this inspection. /LLl 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.) 5-0 r 1 Occup is Ski nature \ Date \ /al upa epresentative Signature \ ate Q:\Rental Ordinance\inspection permission 2.doc JfrsaJ 53