Loading...
HomeMy WebLinkAbout0044 YARMOUTH ROAD - Health �44 Yarm' oath Road �j Hyannis - A = 327 169 - r 1 4 ti I I� 146 'I a V I� f t, i ,, j r A i93 Waltham Services Integrated Pest Management. in Suite 200 Ina Prkway Detailed service Report#2128635 Weymouth,MA 02189 Pwr.xer. {o,.nolSwcsldp3 800-542-2079 Waltham ServlGu 8i7 Moody Sheet tvakham, MA 02453 761-M!1B10 client: 1b5B16 Service Locirtlon. 165816 BASS RIVER PROPERTIES SASS RIVER PROPERTIES JODIMCDONALD 30DIMCDONALD 150 KAIN Tr 444YARMOUTH RD , WEST DENNIS,MA 02670 HYANNIS,MA 02601 Customer Signature: Teamicibn SignaturC L'iceuwies/Certifications MA-C-26175 lld; KEVIN BROWN Time In: 11/11/11:0;12 AM Tams DUE UPON RECEIPT Tome Out. 11/11/11 03!32 PM PO# Order# Service Data Service Description 2126635 ti/11/2on CSA IrdfA General Comments TeCh Comment, reate apartmentg fo.roadws Materials Summary EPA# Acbw Ingredient Finished Qty ApplMon Equlpment SR1CU Ft ADPIled Material Applied Lot# Ditubun Factor Undiluted OLy Applleation Method weather AoVan.fnckroach Gel Bait 352-552 Indoxacarb 330.000 Gram n/a n/a 0A0155> See Material D¢Wils 330.000 Gram CRACK ti CREVICE n/a Targel.Pests,ROacho prmAppBed#3,#4,#1,#2 ' Nuvan Prog ips SQI-553 Oidrlorvos,vapona 48.000 Gram n/a n/a - n/a See Material Details 768.000 Gram PLACEMENT Cl RAPS) Na rprgat Pests-Roaches 4wsAPPbed•#3,#4 PHANTOM TERM aDE-INSECTICIDE 241-392 Chlorfenapyr 0.580 Gallon n/a Ma n1a See Material Details 0.860 Fluid ounce SPOT Ma Target Pests;Roaches Areas Applied W3,ir2 Open Conditions Severity Responsibility Created None Noted Conditions Resolved This Visit Severity Rmonsiblilty Created None Noted With Without Total Device Exceptions Pest Sumrt>lary Qu y Device Summary Activity Aannty Inspected Replaced Removed Skipped None Nd.d None Notegf Aecftionat pest findbtgs may have been observed,Plebse see Con0goes sner eonB»9rtts 10r snore details, Area Inspections Area Pest Findings Time Xnterior. 3:31:14 PM Interior ->ADartrnents 3:31:14 PM Printed: IL114/2031 Pager 1/3 9T/11 39tid SdOdd 83AId SSVE 618VVBE809 Eti tST TTOZ/bT/TT Wahh%^r, Waltham Services Integrated Pest Management sLd�00 Ind Prlcway Detailed Service Report*2128635 Weymouth,MA 021139 mar .zo�tsr +s 8M-542-2079 Area Inspections Ama Pest Findings Time Interior =?Apartments >#1 11:06:41 AM Interior->Apartments >82 3:31:14 PM Ccnvnerit:Vacant unit-heavily infested with reaches Interior->Apartments->*3 1024:01 AM Interior->Apartments->#4 1056:58 AM Device Inspection Details Device Name Device rym Activity Pest Findings Time None Noted - Material Application Details EPA.9• Material Applied Lot No. Rate Or icaticn Dilution Factor QUantity 5481-553 Nuvan Prostrips 20,0000 16,0000 32.0000 Gram A,ppllcation:PLACEMENT{TRAPS) Target Pests:Roaches Comment Placed in wall voids in�Ichen and bathroom Areas Applied:Interior->Apartments->#3; Technician:KEVIN BROWN 352-652 Advion Codm%ch CAJ Bait DA015SE 0.6003 1.0000 60,0000 Gram Application:CRACK&CREVICE Target Pests:Roaches eamment:Baited kitchen wd bathroom ..yeas Applied:Interior ->Apartments-n 43; Technician:KEVIN BROWN 241.392 " PHANTOM TERNmaDE-INSECTICIDE 21,4500 0.2500 0.250oGallon Application;SPOT Target Pests:Roaches Comment:Treated perimeters of each roam Areas Applied:Interior ->Apartrrents->#3; TO cian:KEVIN BROWN 5481.553'. Nuvan Pmstrips 20-0000 16,0000 16.0000 Gram Application:PLACEMENT(TRAPS target Pests:Roadies "ment Placed in bathroom no void Areas Appled:Interior ->Apartments->94; Tomician:KEVIN BROWN 352-652 Advion Cockroach Gel Bait OAOISSE 0.6000 1.0000 75.0000 Gram Application:CRACK&CREVICE famet Pests:Roaches OTmepv Bolted kitchen and bathroom Areas Applied:Interior ->AparMw s->#4; Technician;KEVIN BROWN 352•E52 Advion Codonath Gel Bait OA015SE 0.6000 -.0000 75.0000 Gram Application:CRACK&CREVICE Target Pests:Roaches Comment!Baited kitchen and bathrooms Areas Applied:Interior ->Apartments->#1; Technician;KEVIN BROWN 352-652 Advion Cockroach Gel Bart OA015SE 0.6000 1.0000 120.0000 Gram Application,CRACK&CRMCE Target Rests:Roaches Co.Ament:Baited kitchen and bathroom Ar4s Apoled:Interior ->Apartments->#2; Technician:KEVIN BROWN 241.392 PHANTOM TERMITICIDEINSECTICIDE 21,4500 0.2500 Q3300 Gallon Application:SPOT PrJt>tied: iX/x4fR077 Page: Z/3 9T/3T 39Vd Sdodd 63AId SSbE 61Bb06EB95 Eb:9T TTBZ/bT/TT r 4) Waltham Services integrated Pest Management Suite 2�y Ind lirkway Detailed Service Report#212$635 Wall, Id, Weymouth,MA 02189 "40d'a r'w"a" '"°r sr�°"a 800-542-2079 Material Application Details EPA Material 40ed Lot No. Rate of APDOcation Ulution F"wr 4uandty Target Pests:Roaches Comment:Treated perimeters of each morn Aseas Applied;Interior-a Apartments-a*2; Technician:KEVIN BROWN Printed: 11/14/1011 Page: 3/3 9T/E1 39ad ScIMH 63AId SSV9 618VPBE809 Eb:ST TIOZ/PT/11 TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 10 _3- 11 Time: In Out Owner l`J ""'^^'l Tenant rye Address i S O P\� � Address Li L' ' I`e � Iy` Complia ce Remarks or Regulation# Yes . NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities Pnmvea: f 6 6. Heating Facilities &DOOM 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 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 ` h. _K v TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date rG 3` I Time: In Out Owner Address Address Li L' Complia ce Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities roved; to 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 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 i � TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date f G —3-- 1 1 Time: in Out Owner I`JL"OV)� '&k"+Teriant Address Address Li cj YJ Complia ce Remarks or Regulation# Yes XNO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities P _( 4. Water Supply Approved. 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 T 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 P rY 9 18. Driveway Width �j 6 S -rc._ 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms. Number of Vehicles Allowed (max) Number of Persons Allowed (max) 3 �17 Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here f � -- TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date �� 3— I Time: In Out jig Owner 1IJ LA)� '&""""�Tenant Address o Mom-"' Address LI Ll Complia ce Remarks or Regulation # Yes ZNO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply WDCelt 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 p���--@ l - 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) f I1 Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here } TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 12- I�Z 120 I Time: In Out Owner RON& - r=-®TZOO E I n TenantGO--ram Address Address 1` ym mt&n p 41� 2 tA)- r!s I r� rr y,��tj 9S Mrs Compliance Remarks or Regulation # Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 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 41 U 16. Sewage Disposal 17.Temporary Housing axe 18. Driveway Width 19. Number of Tenants Observed 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 O r v TOWN OF BARNSTABLE BOARD OF HEALTH ` ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 2 ,Z 20 1 Time: In Out Owner A.)& �`►, -'��A - n i , Tenant Address C � .J. /� n� Address —I H A W 0%l`rj4 ft N)tj NYA t,3 tJ I S M Compliance Remarks or Regulation # Yes.j NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 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 - r .- 14. Insects and Rodents DtA�d gZAC)� G5 E"ENT 15. Garbage and Rubbish Storage and Disposal ) 16. Sewage Disposal ~ - -- ----- -- Jff� } 17. Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) a Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here a 150 Wain Street'Wk t Oennh% Wt 02670 509-394-4446 Q7'aXS08-$94-4919 zvsv�v.�ass�yv�'ropee�ies com Cape Cod's TzarSeP"Flue&aay Company" a e t To: Jim �7a Barnstable BOH From: Bass River Properties Fax: (508) 790-6304 Pages: (including cover) Phone: Date: Re: CC: �. ,, h�:RsS 1{ � r }cr:,e�,���1���!^tt`,F:!^�;lt�.vi'•I'�JL'tP;Y't��1n I'i1C. LOBO 3Jad sdO�ld d3AId SSV9 6L8hti6E8e5 sZ:OT TIOZ/6ZIZL Waltham Services 317 Ebbey Ind Prkway Integrated Pest Management Suite 200 9 Weyrnouth,MA 021B9 Detailed Service Report#2139923 800-542-2079 Waltham Services 817 Moody Street Waltham, MA 02453 781-893.1810 Client: 165816 Service Location: 165816 [508-394.44461 BASS RIVER PROPERTIES BASS RIVER PROPERTIES RONALD BOURGEOIS r-90[)FMC-9ONALD, 150 MAIN ST 44 YARMOUTH RD WEST DENNIS, MA 02670 HYANNIS, MA 02601 CustomerWgnature: Technician Rnature: LicensesJCerditcatiohs _ MA-C-29082 Time In: 12/22/2011 02:2e.36 PM Terms: DUE UPON RECOPY TimeOot: 12f2212011 02:42:27 PM PO KEY ACCOUNT THOMAS PERKM Order Service Description Qty RIM23 Commercial Service Agreement 1 Service Comments Tech Comment, INSPECTED 4 UNITS,BAITED AS NEEDED FOR COCKROACH CONTROL,NO CURRENT VISIBLE ACTIVITY NOTED Material Summary EPA Active Ingredient Finished Quantity Application Equipment Application Area Material Applied Lot# Al Concentration Undiluted Qty Application Method Weather Advion Cockroach Gel Bait 352-65Z Indoxararb 6.000 Gram ND012SE 1 6.000 Gram CRACK b.CREVICE Target A w&,-Roadies Arem Applled.02,A3 Open Conditions Saveyity created Area Responsibility Last Inspected Alone Naied. Corudldons Resolved This Visit Severity created Area Rmponcibi!ity last Inspected None Natad. Pest Summary De:viCe Summary With Without Total Device Exceptions Pest Aetivity Quantity Device Type Activity Activity Inspected Replaced Removed Skipped None Nowdd, None Now Addibbnal pest bndings may have been observed.Please see'wndrdans avid comments farm re de&lils. Area Inspections Area Pest Findings Time Interior -?Apartments-a#1 02:34:00 PM Interior -5 Apa"nts-}#2 02:32:26 PM Comment BAITED 93TCHEN PERIMETERS FOR COCKROACH CONTROL NO ACTIVITY NOTED Interior ->Apartments->*3 02:41:07 PM Comment: BAITED KITCHEN CABINETS FOR COCKROACH CONTROL,NO ACTIVITY NOTED. Interior ->Apartments->#4 C2:37:09 PM Comment:INSPECTED KITCHEN PERIMETERS NO ACTIVITY NOTED r Printed:l2/22/2o11 i IIVM7n-MCwiM7nr 1I0.1 t0/Z0 39Vd SdONd 613AId SSVE[ 618ttSE809 SZ:OT IIOZ/6Z/ZT Wattimm services 317 abbey Ind Prkway Integrated Pest Management Snkte 200 Weymouth,MA 0209 Detailed Service Report #2139923 800-542-2079 1{y,rr.d l:rw.✓•"I'Frii rr.l!;irtar lA'll Waltham Services 817 Moody Street Waltham, MA02453 791-893-1810 Device Inspection Details Device Hama Device Type k6vity Pest Findings None Noted Total Devices:0 Skipped:o No Acdvityt 0 ACUVILY:0 Material Application Details EPA# Active Ingredient Application Equipment Material Applied Lot# AI Concentration Appliration Method Advlon Codd'oath Gei Bait 352-652 Indoxacarb NDOME 0.6000 CRACK&CREVICE Target Past;Roaches Device Name Quantity Time of A licabon Technician Name Interior -}Apartments >#2 4.000 Gram 02131:56 PM THOMA5 PERKINS Interior -}Apartments•>#3 2.000 Gram 02:40:21 PM THOMAS PERKINS r lAintodc 12122/2011 Page 2 Walt"'x LOICO 3E)Vd SdOad 63AId SSbS 61817ti6E809 9Z:0T TT3Z/6Z/ZT . Waltham Services 317 tabbey Ind Prinvay Integrated Pest Management Suite 200 g 9 $ . Weymouth,MA M189 Detailed Service Report #213992S MOSWRINMW 800-542-2079 r'r,lntid.riYkri�r 6':aemcl Jicr,!8.'1;1 - �. Waltham Services 817 Mandy Street YValdwm, MA02453 781-893-1M Client: 165813 Service Location: 165813 [508-394-4446] BASS RIVER.PROPERTIES BASSRJVER PROPERTIES RONALD BOURGEOIS r--JODI-MCD,- 150 MAIN ST I 156 MAIN ST - WEST DENNIS, MA 02670 \. HYANNIS,MA 02061 CuseemerStgnature, Techsticlan Signature: Lkensos/CerRrtkatlans MA-C-29092 'T� ._(x �►� Time A+: t2/2V2011 01:57:03 PM Term: DUE UPON RECEIPT Time out: 12/22/2011 02:=Do PM PO#: KEY ACCOUNT THOMAS PERKINS Order Service Description Qty 2139925 Commensal Service Agreement i Service Comments Tech Comment:INSPECTED UNITS FOR COCKROACH CONTROL,MINOR ACTN17 NOTED AND REPORTED IN SOME UNITS.BAITED UNIr5 AS NEEDED, um EPA# Active Ingr t Finished Quantity Application Equipment Application Alva Material lied i�t# Al Concentratia Undiluted lication Method Weather Advion Cackroaah Gel Bait 52-652 Indoxacarb 24.000 Gram ND012SE 1 24.000 Gram CRACK&CREVICE ' Nqm Cbs Raacbes Arsat App%red.• A,3,5,C Open Conditions severity Created Area RWrysibility Last Inspected None Noted, Conditions Resolved This Visit severity Created Area Responsibility Last Inspected None Naied. Pest Summary Device Summary With Wlthout Total Device Excepdons Pest Activity - Quantity I Device Type Activity Ad vity inspected Replaced Removes Slopped None Noted, A04m Nosed. Aabribonal pest frndings rm/have been observed.Please see co.7dnione and coAmr„enis for more details. Area Inspections Area Pest Findings Time Inteior->Main Building -> A 02:03:30 PM Comment: BAITED KITCHEN PERIMETERS FOR REPORTED MINOR ROACH ACTIVITY,NONE NOTED TODAY. Intelor-> Main Building -}2 02:10:44 PM Inmior >Main Building ->3 02:16:49 PM Comment: BAITED ROOM PERIMETERS FOR COCKROACH CONTROL Inteior-a Main Building -:,5 02:13:52 PM Comment: BAITED ROOM INTERIOR FOR COCKROACH CONTROL.TRASH NEEDS TO BE DISPOSED, INSECT HARBORAGE. Printed:12/22/2011 Page 1 t�I'a L01VO 39tid SdOdd 63AId SSVE 618006E805 SZ :01 TTOZ/6Z/ZT Waltham Services a 337 Libhey Ind prkway Integrated Pest Management Suite 200 Weymouth,NA OnS9 Detailed Service Report #2139925 SM-542-2079 r,.f.•;�1iws,d,f:annrl,ir,ha!b!tf Waltham Services 817 Moody$treet Waltham, MA C2453 781-893-1810 Area Inspections Pest est Fndi Time Intei -or->Main Building C 02.0$.03 PM Comment: BAITED KITCHEN PERIMETERS FOR MINOR COCKROACH ACTIVITY Inteior-Main Building -} E 02;18:90 PM Comment: NO KEY FOR ACCESS pevice Inspection Retails Device Name Device Type Activity Pest Rndin s Time None!doled. Total Devices:0 Sicipped:0 No Activity:0 Activity:0 Material Application Details EPA 9 Active Ingredient Application Equipment Material Applied Lot* Al Concentration Application Method Advion Codweach Gel Salt 352452 Indoxacarb CRACK&CREVICE ND02SE 0.6000 Ta et Pest: Roaches Area/Device Name guantity Time of Application Technician Name Inteior-} Main Building A 6,000 Gram 02:01:31 PM THOMAS PERCNS Inteior-!A Main Building •3 C 6.000 Gram 02:07:34 PM THOMAS PERKINS Inteior->Main Building -�5 6,000 Gram 02:12:50 PM TPIOMAS PERKINS Inteior Main Building >3 6.000 Gram 02;16:23 PM THOMAS PERKINS Printed:12/22/2011 Page 2 �t L0150 39Vd S6108d d3AId SSVS 618PPSE809 5Z:0T ZLOZ/6Z/ZL i � I Waltham Services 317 Libbey Ind Prkwby Integrated Pest Management suite 200 Weymouth,MA 02159 Detailed Service Report #2139924 800-542-2079 1'!yp irx>1�Cf}kru F'{.LlA3fJ 1?1.•r/X;Ti Waltham Seryices 817 Moody Sbvet Waltham, MA 024S3 751-893-1810 Client, 165814 Service Location: 165B14 1508-394-44461 OASS RIVER PROPERTIES BASS RIVER PROPERTIES RONALD BOURGEOIS . .... JODI MC.DPMD 150 164 MAIN STD WEST DIENNIS, MA 02670 HYANNIS, MA 026 y _• _7� Custarner Signature: Tethniclan signature' Lteeaiipycemfi cattora MA-C-Z90M � � i ~� V Tlmaln: 17hoti 0125;50 PM TerrttG: DUE UPON RECEIPT Ylme Out: tz/22/201I o1:55:ot PM PO#: KEY ACCOUNT THOMAS PEWIN5 Order S Service Description Qty 2139924 Commercial Service Agreement 1 Service Comments Tech Comrrent INSPECTED ALL UNITS,NO ACTIVITY NOTED Material Summary EPA# Active Ingredient Finished Quantity Application Equipment Application Area Material kPlied tot# Al Concentration Undiluted Qty Application Method Weather None Noted Open Conditions Severity Created Area Pesponsibilil Last Inspected None Nocad Conditions Resolved This Visit Severity creased Any _ Responsibility Last I wd None Notes! , Peat Summary Device Summary With Without Total Device Exceptions Fit Activity Quantity. Device TYP Activity Activity Inspected Replaced Removed .Skipped None Noted. None Noted. Additional pest findings may hare been observed.Please see conzt0ions and comments&r more deep& Area Inspections Pest Pindin s Time Area Interior->Apartments ->A 01:5100 PM Comment: NO ONE HOME,INSPECTED KITCHEN NO ACTIVITY NOTED 01:50;07 PM Interior->Apartments ->8 Comment;TENANTS 5LEEPING,NO REPORTED ACTIVITY 01-46:01 PM Interior->Apartments -}L Comment INSPECTED ALL AREAS NO ACTIVITY Interior->Apartments ->R 01tA5:44 PM Comment INSPECTED ALL AREAS NO ACTIVITY NOTED Printed;1212212011 �WPrre a iAm . ;f 10/90 3E)Vd SdOdd d3AId SSVS 618VPSE809 5Z:OT TTOZ/6Z/ZT Waltliain 58rvrce5 . . 317I.ibbeyInd Prlcway Integrated Pest Management Suite 2" ; � 1 Weymouth,MA 02109 Detailed Service Report #2139924 800.542-2079 f4sl,red,1r*.Ja-f:eHnn!Mo:r:R2.e . Waltham Services 817 Moody Street Waltham, MA 02453 781-M3.1810 Device Inspectlon Details Device Name Device Type Activity Pest Findings Time None Ab&t Total Devices;0 Skipped:0 No Activity:0 Activity:0 Material Application Details EPA Active Ingredient Application Equipment Material Applied Lot Al Concentration Application Method _ Nate Nobd Printed.12/2212011 Page 2 a fiIM M.{I�v NAf LOIL0 . 3Jad ' SdOdd 83AIa SSV9 618bb66809 9Z:0L T13z/6Z/ZL `gyp THE "J'T4 Town of Barnstable Public Healthealltth Division 200 PITNEY 5 ze�q .0 02 1A 5-320 Hyannis, MA 02601 7006 2150 0002 1042 1283 0004606238 24 2008 MAI+D FROM ZIPCODLr-..02601 c\a Yarmout Road Realty Trust Attention: on Bourgeois �l _ 150 Main treet 4I NOTW West Denn s, MA z J 02670 _3 fl A rn/1 ED^ RIe1'13RE US SENDER SF UNABLE TO FORWARD SC: 02601400200 *098 9-028 54-24-39 02603. �100 xA— , I � SENDER:COMPLETE THIS:SECTION THIS,'SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat6re � * ( item 4 if.Restricted Delivery is desired. _ ❑Agent ® Print your name and address on the reverse X tt�.'� ❑Addressee I so that we can return the card to you..0 Attach this card to the back of the mailpiece, B. Receives oy(Printed Name) C. Date of Delivery I or on.the front if space permits. - D. Is delivery address different from item 1? ❑Yes I 1. Article Addressed to: If YES,enter delivery address below: ❑ No 3. Se ce Type ertified Mail ❑Express Mail e ( � ❑Registered ❑Return Receipt for Merchandise S� pe I13 Insured Mail C.O.D. I \ D 4.I Restricte d Delivery? Fee (bra ) ❑Yes I I 2. Article Number [�: I (rransfer from service label) 7006 2150 0002 1042 1283 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-15401 _T—r-I..T.-.i_.. 1" w 11 - jes P%. F� '°kti Town of Barnstable `� PITNEY BOWES .� 20001Main aSlttric Hh Division , 1�42 1276 16004696238 JUL 24 2008 Hyannis, MA 02601 (��6 2150 oaa2 V ., AILED.FROM ZIP CODE 02601 e , Yarmouth oad RealtyTrust �� Ronald B urgeois 150 Main Street West De nis, MA = 02670 - _ 0 l+bT7CIE t7��9 3E i �^OTC t��✓��4,fBS RETURN TO SENDER c REFUSED CON UNABLE TO PORWARO IRtO: 02601400200 *0969-026E0-24-39 i akin F I� .®— ��/�]� : ®� 111,,,,,1,1,11„ll„>,,,11,1„III)I 11,,,,,),111,,,11,>„1,1,1 L SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY i ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. El a Print your name and address on the reverse X ❑Addressee I so that we can return the cans to you. I B. Received by(Printed Name) C. Date of Delivery I M Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from Item 17 ❑Yes _ _ If YES,enter delivery address below: ❑ No � � I I ����I'ID✓1: �r�aid ��ra��is I 1.61(✓1 5*-Ct {{{ I w 3. rvice Type e) yin S Y � Certified Mail ❑Express Mail i a x ❑Registered ❑Retum Receipt for Merchandise I I Zfo ❑Insured Mail ❑C.O.D. 4. Restricted Delivery? Extra Fee) ❑Yes 2. Article Number J 1 7006 2150 0002 1,042 1276 I (Transfer from seMce labeq } ## I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 4 I t i t- TC—i i T--i-T i r r i i i—► t i i Certified Mail#70062150000210421276 Town of Barnstable r Regulatory Services r • BARNS-FABLE,MASS. � • Thomas F. Geiler,Director M $ 'plfo;a. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Yarmouth Realty Trust July 18,2008 _ .Ron-Bourgeois _ 150 Main Street West Dennis,MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 44 Yarmouth Road Unit 4,Hyannis was inspected on 07/17/2008 by Tim O'Connell,Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.482—Smoke Detectors/Carbon Monoxide Detectors Carbon monoxide detector not working at the time of inspection You are directed to correct the violations listed above within 24 hours of your receipt of this notice by replacing carbon monoxide detector You may request a hearing before the Board of Health if written petition requesting same is received within ten(10)days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. i ;cean, TRS., OARD OF HEALTH CHO Q:\Order letters\Housing violations\Rental ordinance\Address.doc a Town of Barnstable Public Healthy ivision mnmmmmw P1TNAEYrOWES HARNSTABLK A p ' 200 Main Stre = 0004so6236 �LJ4 20 s `Hyannis, MA 2601 MAILED FROM ZIP CODE 02601 7006 150 0002 1042 1269 DA 4.1 ;1 Yarmo h Road Realty Trust Attentio : Ron Bourgeois 150 Mai Street _ _ -? r West D nnis, MA ` s��l�[ 02670 TJ27CTE 0.29 SC 3 02 0€114��Js3' Ilr 1 '%,�tJ' ; �A�ry� '/ j�-f raErut�rd T0 SENDER R� 1/1 �IV 10 . LE TO TOFF ORWARD / BC: 02601400200 *0 969--02^649--24-39 0260104002 ` ,,, .,six,;+�•a.:_..`_,.�" _.__._..-�.n►!�"�--- _ t ,•air""""'"°" -- �,. _ 1 _ I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent I i ■ Print your name and address on the reverse ❑Addressee I �I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I E Attach this card to the back of the mailpiece, I or on the front If space permits. D. Is delivery address different from Item 1? ❑Yes I 1 ArtlltLll�Wino Addressed to. e d�, u('+ If YES,enter delivery address below: ❑NoV-eaI�� , l2ov� Urn 0 o I S Y I I S J W rV l /� 3. S rvice Type�IE3 Certified Mail 13 Express Mail I ❑Registered f3 Return Receipt for Merchandise pZ,(o7 O ❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes I I i 2. Article Number(1iansfer from service la4e 7006 2150 0002 1042 1269 I Q I \, I PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M=1540 f— iT iT T-Ci l"i T F r iI{I FT F 1 Certified Mail#70062150000210421269 Town of Barnstable Regulatory Services r ' sa S MASS. ' Thomas F. Geiler�Director MA g E16 9. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 t Office: 508-862-4644 Fax: 508-790-6304 Yarmouth Realty Trust July 18, 2008 Ron Bourgeois w 150'Main Street - West Dennis,MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 44 Yarmouth Road Unit 6,Hyannis was inspected on 07/17/2008 by Tim O'Connell,Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.482-Smoke Detectors/Carbon Monoxide Detectors No smoke or carbon monoxide detectors present at the time of inspection You are directed to correct the violations listed above within 24 hours of your receipt of this notice by installing smoke and carbon monoxide detectors Yo��-may re �aPst-a hearing-beferetthP )3e?rd,_of Health, written wpetitisn-rein—sting Same is received within ten(10)days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER 01 THE BOARD OF HEALTH Thomas A. McKean,R.S., CHO Q:\Order letters\Housing violations\Rental.ordinance\Address.doc Certified Mail#70062150000210421283 Town of Barnstable Regulatory Services r ti 9BA NSrAABLE.� Thomas F.Geiler,Director 1639. n3. p'`0 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Yarmouth Realty Trust July 18, 2008 Ron Bourgeois _ 150 Main Street West Dennis,MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 44 Yarmouth Road Unit 3,Hyannis was inspected on 07/17/2008 by Tim O'Connell, Health Inspector.for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.482—Smoke Detectors/Carbon Monoxide Detectors Missing Smoke and Carbon monoxide detector near bedroom off kitchen 105 CMR 410.500—Maintain Structural Elements Molding tile on kitchen floor - —105 Ci91R 410.500�—Ma ntain-Structural Elements �- - Kitchen cabinet needs repair You are directed to correct the violations listed above within (24) hours of your receipt of this notice by installing smoke and carbon monoxide detector and carbon monoxide detectors and (30) days to replace molded tile and repair kitchen cabinet. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10)days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAOrder letterAHousing violations\Rental ordinance\Address.doc f Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE . RD OF HEALTH T omasMn,R.S., CHO Q:\Order letters\Housing violations\Rental ordinance\Address.doc YOU WISH TO OPEN A BUSINESS? 7ForYour Information: Business Certificates cost $30.00 for 4 years. A Business Certificate. ONLY REGISTERS YOUR NAME in the Town ICH YOU .MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" Fl., 367 ,Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. y DATE Fill in please: F APPLICANT'S YOUR NAME/CORPORATE NAME SoL F30SINE5S YOUR HOME ADDRESS: y/ D . 7 TELE—F HONE # Home Telephone Number me--,3lad -oek-` NAME OF NEW BUSINESS 14-&���q V ,- f//u TYPE OF BUSINESS /�11a77f.�„Eli�,t�/ P /�r:�c�yG,ei9�/t�✓ IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO _l..... - ADDRESS OF BUSINESS D. MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 290 Main St. — (corner of Yarmouth Rd.. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO R'S OF CE MUST COMPLY WITH HOME OCCUPATION individual ha b ipfor e an per it requirements that pertain to this type of business. d �J RULES AND REGULATIONS. FAILURETA Aut orize n ** COM l.Y mAY RESULT IN FINE. COMMENTS: ( _. �e 2. BOARD OF HEALTH This individual.ha ee informed of �mni u• e rtain to this type of business. Authorized Signa e** MUSTCOfUIPLYWITHALL COMMENTS: HAZARDOUS MATERIALS REGULA1I0N14 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has e n inf rn ed f the licensing requirements that pertain to this type of business. Authorised ignature** COMMENTS: 6 ... FORM3O H,w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH CITY/TOWNLj _ DEPARTM51T ADDRESS I �M D TELEPHONE Address i• — P Occu an Floor Apartment No. No.of Occupants No.of Habitable Rooms o.Sleeping Rooms No.dwelling or rooming units N Stories Name and address of owner 50- Remarks Reg. Vio. YARD Out Bld s.: Fences: D.1 67e) 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 Livina Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink 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 INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES P Y." INSPECTOR TITLE A. DATE �0 TIME - P.M. A.M. THE NEXT SCHEDULED REINSPECTION 72�D P.M. -� I 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. f +� &W HORRSBWARREN TM THE COMMONWEALTH OFMASSACHUSETTS FORM30 C BOARD OF HE LTH C411T.DW" 4 W V L „ _ l fl DEPARTME�T h �v .w�, QF 4�M SVey`0w ADDRESS T EPHO Address — Occupant_. Floor Apartment No.— No.of Occupants_ No. of Habitable Rooms 5 No.Sleeping Rooms___ No. dwelling or rooming units_ No Stories_ Name and address of owner 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: Lighting: 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 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 INSPECTION REPO IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURV ' INSPECTOR ' TITLE J') DATE TIME �/ T` P.M. 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 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 Ieadbased 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. r Citizen Web Request Page 1 of 1 Citizen Request Management Request ID: 21447 Created: Pi/26/2007 12:06:52 PM + Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Category: Chapter II : Housing Substandard E.C. Date: 11/28/2007 I Created By: Barrett, Caitlin Citations: Health Office Time Worked: 0.45 Response Time: 8.00 + Request Location: 44 YARMOUTH ROAD 2 Hyannis, Ma 02601 Parcel Number: Map: 327 Block: 169 Lot: 000 Request: Caller states refrigerator has not worked since August 1. Also, part of stove isnt working. Tenant states owner is aware of these issues, but has yet to fix. Request Work History: Entered on 11/27/2007 11:15:15 AM On 11-27-07 went to said property and met with tenants daughter. I then open fridge and pu thermometer into fridge and left it there for ten minutes. When I checked it the instrument read 60 degrees F. They are also missing door knob on front door and they have a bathroom sink that leaks. Will send out order letter. http://issgl2/intemalWRS/WRequestPrintPub.aspx?ID=21447 12/13/2007 F Jo Certified Mail#7006 0810 0000 3525 3244 �oF1HE rows Town of Barnstable P Regulatory Services BARNS"CA©LE, - 9 MASS. m Thomas F. Geiler, Director ArFa MAC Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 27, 2007 Ron Bourgeois 150 Main Street West Dennis, MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 44 Yarmouth Road Unit 2, Hyannis was inspected on November 27, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed missing door knob on the inside of said unit. Observed leaking faucet in bathroom. 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Refrigerator temperature at 60 degree's F. 105 CMR 410.100 - Kitchen Facilities. Observed front right burner on stove top not working. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by fixing burner on stove; by installing door knob on door. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by fixing or replacing refrigerator so that it works properly; and by fixing leak in bathroom Fawcett. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. QAOrder letters\Housing violations\Rental ordinance\44 Yarmouth Road Unit 2.doc Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF HE BOARD OF HEALTH mas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Cc: Latonia Cennady Q:\Order letters\Housing violations\Rental ordinance\34 Yarmouth Road Unit Ldoc Citizen Web Request Page 1 of 3 �/ Logged In As: Citizen Request Management Wednesday, Novemb TOWN\ba rrettc Route to Users Search Requests Create Requests Request Information Request ID: 21447 Created: 11/26/2007 12:06:52 PM Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard edit Estimated 11/28/2007 Change Estimated Oct November 2007 Dec Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 1 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 Created By: Barrett, Caitlin Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number Caller states refrigerator has not Map: 327 Block: 169 Lot: 000 worked since August 1. Also, part of stove isnt working. Tenant states Parcel Lookup owner is aware of these issues, but has yet to fix. http://issgl2/intemalWRS/WRequest.aspx?ID=21447 11/28/2007 Citizen Web Request Page 2 of 3 Email: Edit Re uestor Information Track Request Progress Request Work History: ► Internal Note History: Entered on 11/27/2007 11:15:15 AM by O'Connell, Timothy On 11-27-07 went to said property and met with tenants daughter. I then open fridge and put thermometer into fridge and left it there for ten minutes. When I checked it the instrument read 60 degrees F. They are also missing door knob on front door and they have a bathroom sink that leaks. Will send out order letter. Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) II Spell Check Spell Check Add document or image link: Browse... * You can also type in a folder name to see everything in the folder Current Links: q p 8 - , Time worked on request: 0.45 ' Response time. _ - __ * Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. http://issgl2/intemalWRS/WRequest.aspx?ID=21447 11/28/2007 Citizen Web Request Page 3 of 3 Save changes f Check to notify town employee below Save changes and notify to review this request. Health office citizen* - — - - - --- - c' Close request and notify citizen* Agostinelli, Joan - Brief message to reviewer: *notify works if email address was given Update - Spell Check Public Use: Printer Friendly Version. Internal Use: Printer Friendly Version http://issgl2/intemalWRS/WRequest.aspx?ID=21447 11/28/2007 11/28/2007 14:26 15083944819 B.R. PROPERTIES PAGE 02 Ilk ravertteo 150?Kann Street Wea g3enp14 WA O<.'670 508-394-4446` &Z S08-394-4819 w�vw.�essgpe�tr�s.com `Cape CO-Cs T-UffSeniee malty Compciny" November 5, 2007 I-atonya Cannady 44 Yarmouth Road, Unit 2 Hyannis, MA 02601 Dear Latonya, We would like to gain acc s YQ nit S6t ay, Recember 1, 2007 at apprc x'mately 10:15 am to replaceyour:.r �e =„p ry for nche o erxis+l:ues that need attention. �,. gym. Y t, Due to dire hazards an ,ilitis�u ,; ease remoe the couch from the staircase as soon as possible. `� As always, please do.,�lif h ., call if You have any questions. Sincerely, Ronald D. Bourgeois Bass River Properties r } (506) 394-4446 Co ` r: partment c-c. Town of Barnstable Health De �r3 111218I2007 14.26 15083944819 B.R. PROPERTIES PAGE 01 %)0 S,W yin Street'EJdJest venn4 XX 02670 508-39.4--4446 Tad 508-3.94-481.5 �� 3operties tort "Cape Cod's TwT semice xeaay co nvarry» q f To Tim O'Connell From Bass River Pro perties ram 509-790-6304 Pages: (including cover page) �r Date. Rea CC: FORM30 C'w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARDC EA, CITY/TOWN �� r PARTMENT r V ADDRESS GSM svey`0 LET2NE Address — Occupant_. ✓ �� " Floor Apartment No. No.of Occupants 7 -- No.of Habitable Rooms No.Sleeping Rooms r No. dwelling or rooming units No. ries _ Name and address of owner 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 0bst'n.: ❑ B ❑ F ❑ M Doors,Windows: t Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: O bst'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 t Outlets Its 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 Si i ove �"L Bathing,Toilet Facil. en ., 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 I OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECT .(See Over) THIS INSPECTION 0 T IS S NED AND CERTIFIED UNDE HE PAINS AND PENALTIES PE Y. ' INSPECTOR r TITLE DATE 1 t>` TIME 1" M• A.M. THE NEXT SCHEDULED REINSPECTION CTB P.M. • n 410.750: Conditions Deemed to Endanger or Impair Health or Safety 4 ' 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. i (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). r .(5) Failure to eliminate rod ents,'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. TM THE COMMONWEALTH OF MASSACHUSETTS FORM'30 Caw) aw HOBBS&WARREN - � - BOARD OF HE A T CITY/TOW N k dEPARTMENT ADDRESS U1M sey`0 TELEPHONE r Address — Occupant_< �-�S Floor Apartment No. No. of Occupants �-�- No. of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units No. -tz ries Name and address of owner 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: Lighting: STRUCTURE INT. Hall,Stairway: 0 bst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central, .❑Y_r❑ 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 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: �. DWELLING UNIT Vrentil. L tra Outlets lls Ceils. QWiro. Doors Floors Locks r ' Kitchen Bathroom �,,.,_ e Pantry Den 'f 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.,. Move) u t. a Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: `, e -- Wash-Basin,_Shower orTub: 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 INSPECTJJ. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES PER RY. ' L. INSPECTOR TITLE �. i A. DATE v` . TIME P.M. j 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 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 standard's 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. y (N) Failure to provide a smoke detector required by 105 CMR 410.482. 0 An of the following conditions which remain uncorrected for period of five or more days following the notice to or ( ) Y 9 P Y 9 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. C 1 W Hoess&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS FORM30 Cx BOARD OF H T14 H CITY/TOWN W DEPARTMENT tl i 6- r-). f l ADDRESS 4�M yv 9 y`0 I � p T E HONE f j L1 _t�\ Address — Occupant_. Floor Apartment No. No. of Occupants___ No. of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units No.Stories 01 Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: c ev 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: 1 ­9E 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.: ks, Flues V ,Safeties: Kitchen Facilities in S ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other.- Egress Dual and Obst'n: on 4 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR �P TITLE DATE_—A S ® TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. f- / •a 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 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. Date 7 Co voluntartlYgrant permissionn to the Town (Occupants name) ' of Barnstable Board of Health(Ag44ent or Health Inspector) to inspect my dwelling unit located at I'� ) Zkntl'(3 1-in accordance (House#, [Apt\Unit#if applicable],street,Village) with the Town of Barnstable Code (Chapters 59 and 170 and the State Sanitary ( p ) Code (105 CMR 410.000) on kD�Mb& ,� I 1)r)� - . I hereby authorize and name (Date of inspection) to be my tenant representative for the (Occupresentative an ep purpose of this inspection. is an adult person (Occupant repres ntative) 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 p and all locations (including bedrooms, bathrooms, closets, etc.,) allowing the use of photographs and answering questions. This authorization is only valid for.the inspection dat specified above, and must be renewed for any future inspection(s.) Occupants Signature' v Date \ I Occupants Representative Signature `, Date Q:\Rental Ordinance\inspection permission 2.doc ` � ' ' D� • {r 1 + � �J \ �� FORM30 C&W HOBBS&WARREN TM THE COMMONWEALTH OFMASSACHUSETTS � R BOARD OF=HLTH CITY/TOW ' � W DEPART E T ``,, a A- V;L ADDRESS GSM SVO� TEL PHONE Address Occupan Floor Apartment No. No. of Occupan s No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No. tories Name and address of owner 9 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 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 ❑ 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.: St s, lue ,V afeties: Kitchen Facilities in ve 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 INSPECTION REPOR IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE DATE_ �-� TIME �__ A.M. THE NEXT SCHEDULED REINSPECTION P.M. A 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 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 An other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750 A through O shall be deemed to be a con- dition Y ( ) 9 ( ) 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. I try .t r � �� P � � � '� ----J FORM30 &w HOBBs&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH DEPARTMENT � ,.^ 'l/JYL ADDRESS ^M sey`0 y TE PHONE Address Ll )1`)y'/11 Occupant Floor Apartment No.�_No.of Occupants No.of Habitable Rooms_—No.Sleeping Rooms No. dwelling or rooming units No.Storie Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: 14 Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof rcV Gutters, Drains: yw 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: 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). U- Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: S_tW,ks, Flues,Ve is S ies: Kitchen Facilities in ve 11 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 VIOLATION 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 SI NED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUFI INSPECTOR TITLE _ A.M. DATE ® + TIME P.M. fu /�, A.M. THE NEXT SCHEDULED REINSPECTION P.M. r 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. I (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 Ieadbased 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. r ' I �f P 3L --- i �� HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS FORM30 C BOARD OF HE TH CITY/TOWN W , O � DEPA TMENT ADDRES Ll G„M Sve y`0w TELEPHO Address Occupan Floor Apartment No. No.of Occupants No.of Habitable Rooms- —No.Sleeping Rooms �_ No.dwelling orrooming units No.StoriesA � � Name and address ress of owner 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 IV V Gutters, Drains: Walls: on 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 Vents ELECTRICAL Panels, Meters,Cir.: E1 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.: S s, Flues,Vents,S feties: Kitchen Facilities ink 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 In Locks on Doors: ONE OR MORE OF THE VIOLATI NS 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 PERJURY." ~� v .—� " TITLE 1� INSPECTOR DATE TIME _ P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. s' • � II 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 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. r 3 co vs FORM 30 HOBBS 8 WARREN M THE COMMONWEALTH OF MASSACHUSETTS BOARD H ALTH CITY/TOW A W DEPAR ENT ,4 0-)- S I 'p ADDRESS Cj GSM sva'�W Cs S TELEPHON Address-- _ _ Occupant . Floor -Apartment No. 3 __ No. of Occupants No.of Habitable Rooms No.Sleeping Rooms-1►., _ No. dwelling or rooming units— o.StQg es Name and address P S// fof owner!—� - � --- b -- ' �IL60v Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Ity Dual Egress:and Obst'n.: , ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen. Sanitation: Dampness: Stairs: Lighting: 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.: Stqr,ks, Flu s,Vents,Safeties.- Kitchen Facilities ink ve 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 INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." 6 INSPECTOR s d TITLE DATE TIME P.M. A.M. THE NEXT SCHEDULED REINSP_ECTION P.M. I 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. f 4,,,.� ��CC..���� �� ������y� ���� I �. ���.��� � 1 �� ���� �;� - . Parcel Detail Page 1 of 3 {. ¢°•� o A ell, ( a��S�. @,b�u�A�4. �'+% �td�*� maw• Logged in As: Parcel Detail Wednesday, Februa Parcel Lookup Parcel Info 1 Developer j Parcel ID 1327-169 Lot 1 Location 144 YARMOUTH ROAD Pri Frontage 175 Sec Sec Road i Frontage Village!HYANNIS Fire District HYANNIS Sewer Acct j2631 Road Index 11890 Interactive ,. ` Ail Ma t -- Owner Info Owner;ARENSTRUP, RICHARD D TRS Co-owner PARK SQUARE TRUST III Streetl j PO BOX 2248 Street2 city i HYANNIS state 1MA I Zip 02601 Country US Land Info Acres:0.37 use 4-8 Units MDL-94 Zoning PRD Nghbd 0105 Topography;Level Road iPaved utilities All Public Location Construction Info Building 1 of 2 Year 11880 Roof Ext WOOD FRAME Built Struct° Wall Effect3356 Roof _ ..m_ . AC ON . .. . Area ; Cover' Type} .,.. .. __- Int ...__.. ._._ Bed Style iApartments ..._ .._.,___. Wall ' Rooms Int; Bat Model lCommerclal Floor Carpet Rooms 4 Full .-._._..,_... __._. ....Heat+ ._.m_.,. __-_... _____ Total .. _ Grade'Average Plus Type Rooms http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=27593 2/14/2007 IParcelDetail Page 2 of 3 $MT]47;4,] ,-7. , n= Y Heat! _ Found- Stories Fuel;GaS at ion;Typical .. Building 2 of 2 Year `1950 Roof 1 Ext}WOOD FRAME Built Struct t Wall --- Effect i 1698_- Roof __ i pG EAT ONLY ' Area= Cover 1 I Type style;Apartments ]nt� ___._._____ Bedl.. ...... ... .........._._.� g Wall Rooms• Int Bath Model ;Commercial Floor I`'arpet ROOMS'3 Full I- HGrade{Average Plus eat Total Type - Rooms; Stories Heat[Gas Found-rTypical Fuel ation Permit History Issue Date Purpose Permit# Amount Insp Date Comments 2/24/2000 Remodel/Renov 44296 $10,000 AM 2001 12:00:00 BLDG 2 5 UNIT 2/24/2000 Remodel/Renov 44297 $10,000 1/1/2001 12:00:00 BLDG 1 9 BED AM 7 12/3/1998 New Windows 35137 $2,000 1/1/1999 12:00:00 AM 8/1/1988 B32212 $20,000 11/15/1989 12:00:00 HY DORMER AM 6/1/1983 1 B25168 $0 11/15/1984 12:00:00 HY BARN JAM Visit Histo!y____r.__ Date Who Purpose 5/6/2002 12:00:00 AM Paul Talbot Meas/Listed 4/10/2001 12:00:00 AM Gary Brennan Meas/Est Sales His Line Sale Date Owner Book/Page Sale P http://issgl/intranet/propdata/ParcelDetail.aspx?ID=27593 2/14/2007 Parcel Detail Page 3 of 3 1 2/15/1991 ARENSTRUP, RICHARD D TRS 7439/150 $1 2 7/15/1986 ARENSTRUP, RICHARD D TRS 5183/101 3 JOHNSON, PETER M 2654/321 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcf 1 2006 $430,900 $0 $0 $151,100 2 2005 $268,200 $0 $0 $232,900 3 2004 $90,800 $0 $0 $287,800 4 2003 $179,800 $0 $0 $46,100 5 2002 $195,700 $0 $1,100 $46,100 6 2001 $176,800 $0 $1,100 $46,100 7 2000 $176,400 $0 $500 $20,100 8 1999 $176,400 $0 $500 $20,100 9 1998 $217,000 $0 $900 $20,100 10 1997 $160,500 $0 $0 $19,800 11 1996 $160,500 $0 $0 $19,800 12 1995 $160,500 $0 $0 $19,800 13 1994 $135,400 $0 $0 $74,300 14 1993 $135,400 $0 $0 $74,300 15 1992 $221,000 $0 $0 $82,600 16 1991 $257,900 $0 $0 $103,200 17 1990 $257,900 $0 $0 $103,200 18 1989 $237,800 $0 $0 $103,200 19 1988 $123,800 $0 $0 $39,700 20 1987 $123,800 $0 $0 $39,700 21 1986 $123,800 $0 $0 $39,700 22 1985 $0 $0 $0 $0 � Photos http://issql/Intranet/propdata/ParcelDetail.aspx?ID=27593 2/14/2007 � � � � . . � II _� �__ AW HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 C BOARD OF HEALTH CITY/TOWN D DEPARTMEN ADDRESS GSM SVByW TELEP ONE y i dr Address �I / OccupanC" tom.... Floor Apartment No. No. of Occupa s No.of Habitable Rooms_No.Sleeping Rooms No.dwelling or rooming units No.StgLies R Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers.- Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: c 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 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 ❑ 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.: Mks, Flues V n Safeties: Kitchen Facilities Sin Move 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 VIOLATIO 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 er) "THIS INSPECTION REPORT SI NED AND CERTIFIED UNDER THE PAINS AND PENALTIES O��ERJU�Y." _ 'fn INSPECTOR TITLE AM DATE _J' TIME 0 ' " P.M. 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. � I - f } i FORM30 CI_W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH CITY/TOW N�.A n DEPARTMENT t 0 v� ()) �ci _ 9 ADDRESS GSM SVey`aw TELEPL40NE Address _ Occupan Floor Apart No. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms_ No.dwelling or rooming units--No.Stor et,S E Name and address of owner 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: s 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 t Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: %cks, Flue , Safeties: Kitchen Facilities Sin "Move 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 INSPECTION REPOR I SIGNED AND CERTIFIED UNDER E PAINS AND PENALTIES OF PERJURY INSPECTOR TITLE M DATE 1 ® � TIME ` P.M. 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 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. Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM 0 1 4 NAMEOFBUSINESS: `i15 ` BUSINESS LOCATION: it car �rt �1 MAILING ADDRESS: . A UE, L�� T� ID = Mail To: TELEPHONE NUMBER: �,`?, Board of Health 3 � Town of Barnstable CONTACT PERSON: : �-, -,�. - O � P.O. Box 534 . .: EMERGENCY CONTACT TELEPHONE NUMBER'y A Hyannis, MA 02601 `3 TYPEOFBUSINESS: NA-k. &. Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own _ use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer.Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: i YAYL i)?C / d TELEPHONE: 50cq 7 5 - 93 9 LIST OF.TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that .you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW. USED Gesspool cleaners Automatic transmission fluid ` 1i' Disinfectants Engine and.radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid)- Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED . Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil` ` NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar, Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners; Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint& varnish removers, deglossers Any other products with "poison"labels Paint brush cleaners (including chloroform,formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers - Other products not listed which you feel . (including bleach) may be toxic or hazardous (please list). Spot removers &cleaning fluids L l?.f= ? 1 A) (dry cleaners) 1M I? �S Other cleaning solvents i L L I� � 'A1V1 )V r., i Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS MRVP # Assessors office (1st Floor) Assessors Map and Parcel # , Building Departme t (4th Floor) zoning INSPEC ION FEE $V0.00 RE-INSPECTION FEE $15.00 Request For A Housing Inspection For Certification Under the MA Rental Voucher Program c /- Your Name?Atzk �� .� vim, �.s�' ��L M"k Sh ,Iale-c "- Affiliation (Circle One) EOwneIrDReal E state Agent Tenant Your Address J5 6 Ka. I44171s IV 4 C) d1 Telephone Number (Day),5da-))5 3C jJ (Night) Address of Property Where 1 ti n is Requested Unit/Apt.# 1 Ok4h )lei s J6oj Name of Owner �A&,kS@ G i/c. JlFi cgs' Address /J � 04c, ,i►'\ cS-17 4 07,601 Mailing Address (if different) Telephone Number (Day)6 8'-77 S.S6 JJ (Night) ` 'c - 32 Sir'U 7 0? Will there be any children under the age of six (6) wh 1 be occupying the rental unit? (circle one) Yes QNo• Was the dwelling constructed prior to 1979? Yes No Cl/�erl t&f ---------------------- --------------------- FOR OFFICE USE ONLY: Certification ThQ dwelling, dwelling unit, or rooming unit located at 1' A. 411 Vlzemlo-� J was inspected on :�-vI Z0-vo, by kl&rrHealth Inspe or for the Town of Barnstable anA 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 7 ° Date_�/� 7�11 i FORM30 C,W HOBBS&WARREN rM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN a D `P RTMENT TELEPHONE Address 7 a'w1 Occupant `�� �1�'"44� ��/°� Floor Apartment No. No. of Occupants� � No.of Habitable Rooms_ No.Sleeping Rooms—�_ No.dwelling or rooming units No.Stories_ a Name and address of owner- e�4�+ �V S 44i- 1, �t]'''�i�►I �iSO G 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: .J ?,✓ wss,�,S O(� Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation.-- Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: �• (r� Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: °'` �- jkla i Cvu 4 ❑ MS ❑ ST ❑ P Waste Line: ew� H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: vf� ❑ 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,Sa ties: Kitchen Facilities Sink - d -_ Stove j JLV 1. C Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: IrOL,"i d 3 / Wash Basin,Shower or Tub: I ra fu&w Cv wL Infestation Rats, Mice, Roaches or Other: C f rft-(-< Egress Dual and Obst'n: C714 rp) row• General Building Posted V If Locks on Doors: -0LJ, K,94 4 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 F ERJU AY. " INSPECTOR TITLE- DATE A.M. DATE /} � TIME �' ��`� A.M. THE NEXT SCHEDULED REINSPECTION P.M. k ,.. 4.p ^a7{q y:' M r ed?yam" y?a��,rsirk�4` �+fi.�r+ 1i+�?'fn`" ' } t " Pw_A t t:r"yt �✓'� 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 foundkto 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. t J - (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`MR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 41G.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 7s f V C A_T ION SEWAGE PERMIT NO. VILLAG 'E/ I N S T A LLER'S NAME i ADDRESS p 61 /,4C©m bPf- -I- e U I l D E R OR OWNER wv� k DATE PERMIT ISSUED R DAT E COMPLIANCE ISSUED 76 a Cp W O ` a .r tV YT ILA CAT ION .. S EW A'�G E PERMIT NO. k VIlVLAGE ' t INSTA ILER'S NAME i `oADDRESS R U I L D E R OR OWNER".;. IS ` r) r DATE PERMIT ISSUED -� DATE COMPLIANCE ISSUED 4 to s � � 710 E. No........12✓`._.......... Fps„ ( ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................OF................................-.......--------------------.....---...................... XVVIira ian for Dhipu,ia1 Works Tumitrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... Al............ T. .... F.Nmm'l.s S s ®P ....... '11 14 (� L y�ocation-Address �y`` ����g°� f = or Lot No. ......... :. .MlaSe .............................................. �J� I W.I�L...A: - `�. I .�i�!`. ....................................... Address ber �c. efir►. T a '' --------------------- s Her... ._...... Installer Address d Type of Buildigp Size Lot---drf_9.R..........Sq. feet U Dwelling—No. of Bedrooms.......................................Expansion Attic { ) Garbage Grinder (�v) PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria (ke) a Other fixtures -_-__-----_•---. W Design Flow..............U� <$.__.-_.........____.gallons per person per day. Total daily flow------c RndF ...... ................gallons. WSeptic Tank Liquid capacity./i5_ allons Length................ Width................ Diameter--.-.._-_-_..._- Depth................ x Disposal Trench—No. .................... Width_--�.((_��...�_..._.... Total Length..... Total leaching area---- ..�...�s . ft. Seepage Pit No......:_/1�_--_-___- Diameter........s '__ Depth below inlet..��. ........_. Total leaching area. s d_sq. ft. z Other Distribution box ( ) Dosing/�a Percolation Test Results Performed by.-Gi_! - ' _..-.._.. :. 9 __..._..._. Date... f'_ o..`__� .......... raj Test Pit No. 1. -...minutes per inch Dept-i of Test Pit.................... Depth to ground water.... _,____._...... ._. fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •••• . ..... O Description of Soil------. - _.. - -- ---�� -=---•- - -- ..1--�--- x W ------------ ---------------------- S.I .- U Nature of Repairs or Alterations—Answer when app iiicable._................ -------------------------------------------------•-------------•--------------------............------------------.--------------------------------------------------------------------•-----...._---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I-;?..;. p of the State Sanit y Code— T undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has i s e by he boar f health. Sig d U 1 t� cr-- Dat Application Approved By.---• {C -%s� '� - Date Application Disapproved for the following reasons:............................... -•---••--••---•....----•-------•--••------•-•-•--••---•......................•- ----•••........••-•--•-------•-•-....--•-------•----••---•----•----•----••----••---•-•--••--•----......•-••------••••...-•-•••••--•-•••••--------••-•---•••••---•---- .................................. Date Permit No......................................................... Issued.•....� � l�--�. ..................... Date r No.................'...... Fxs"'.... ..................... THE COMMONWEAL.TH OFrMASSACHUSETTS BOARD OF HEALTH ------4........... ..............OF........................................ x . AVV irafiou for Dtgpn,ial Worko Tomtrurtiun "amit Application is hereby made for a Permit to Construct ( 01" or Repair ( ) an Individual Sewage Disposal System at ............i�......Y� ....... ..vtvi 5 ..... �s a -- fbg -------- Lot o ocation-Address -... or . 150 like -_.. ................... .............•••••............................. N s - ..... •...•• .... W mawpw er Owner �t Vi e Address ,.a --••..............••---•--.....-------••--......--------•-•-------................0..._.......... ........•......................................................................................... Installer Address Type of Buildi4 Size Lot___1191071.........Sq. feet aDwelling—No. of Bedrooms._.. ..................................Expansion Attic (A# G rbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers `( ) — Cafeteria ( � dOther fi iLures ••-•••••-••---•---•----••----------•---------•-•-----...----••-•-••---••--•--------•-- Design Flow. -----.---•..............`:__:=_:___._ allons per person per day. Total daily flow ___...__................_..__..........gallons. W ; WSeptic TankLiquid capacity.�� allons Length................ Width....._..___..... Diameter___..........._. Depth................ x Disposal Trench—No. ................... Width........... Total Length....... Total leaching area......,+.,. , ft. Seepage Pit No....___.- .._... Diameter.................... Depth below inlet__._...__.......... Total leaching area......._..........sq. ft. Z Other Distribution box ( ) Dosing a a Percolation Test Results Performed by.._..11.FF__.__.... Date.... ......... ,.1 Test Pit No. 1. ! '...minutes per inch Depth of Test Pit____________________ Depth to ground water.._..'_____.__..._ G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x -------A--,s--------- D Description of Soil.=....... W .------------------•----.......--•-•--••-----.--- :- -----------------------------------------------.................................... -----------------------------------•---------- .....-------•--•- ------------------------- V Nature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------- -----------------------------------•------------. ---------•--•-----........--•-•--•-----•--••---••---•-•••-----•--••••---••---•-•--•-•••-•-•••--•••-•----------•---•----.--•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of is p 5 of the State Sanit Co e Th -undersigned further agrees not to place the s stem in operation until a Certificate of Compliance has is y e board' health. Si d. g✓ Date'" Application. Approved B �' -----•. ---- W' / - ........................................4cs-CJ PP PP Y--•_._�.. --.......•-•-• Date Application Disapproved for the following reasons-........................................... ------••-------------------...-----•---------------•-••--........... ...........................-............................................................................................................................................................................. Date PermitNo......................................................... Issued...................................................... _ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD .OF HEA ......OF..... . .... .................�......................�........ C�rr�ifirtt#r ,af �n�t��i��trr `-'' S RTIFY Th of Individual Sewage Disposal System constructed or Repaired by ........... ................ --........----------•-.......-•-----•---......... ......•-•....._.._........ at..----�!•.----•-• GL ''??s �'�G ' t e R has been insta din accordance with the provisions ofof�Zhe State Sanitary CoeJe•as,c c in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE ,OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE =d 1 ... Inspector........... ---------•------------------•---------•------- THE COMMONWEALTH OF MASSACHUSETTS BOARDX H.........OF...........: ............................ FEE........................ rrmit r 'I-- PerF ion . reb ranted. --- ........................... = Y g ............... to Const !y a ir'( an IndiV� Ji S .w ge Disp yst 1st at No.. ' '- Street / /y, �.� as shown on the application for Disposal Works Construction Pegiiiy No. i Dated----------------------------------- ...... �C ................... Board of Health DATE------.... = = P..J............................................. FORM I255 HOBBS & WARREN. INC.. PUBLISHERS f 1 ill i f `\ 2i 1 1 1,1 1 l : l 1 I 1 ` ti \ Z- _ 10 - 1 Syr ---'� i'Ft f Z4 •�r I ( l r: Y ` - 1 14 P)it1 1� � I IJ N 1 f 1 • ' L O A MR iNJ• , v 5,f,-T MAA s/4,-I i I�a� i 3ccy-�F w• 'F � �(��-LD�U`'��:..3 _ �t:�"(G S�`i"�4� 1 dL�7f x �-� - 1 ov G•P�. �xp.. -r�Ta;. tic-*�tG►.l = 950ac, ICJ 1�1ATES�. 3 $1 �r�r�'...•ATIC%k �G�-T� � � ! hl v/u!V I•l •?!G'.. W-f .:. Lodi Lie V��T65e- AA JO"ky�.o�j �::r 0� � I Ll r5l