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HomeMy WebLinkAbout0301 WEST MAIN STREET - Health 301'West Agin Street Bld 2 Unit 3 Hyannis,(ColoniE ,Cou A = 269 — 095 000 i i• i I � YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.] ou must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: I y Fill in please: L r, APPLICANT'S YOUR. NAME/S: 7 a , BUSINESS YOUR HOME ADDRESS: Ol - , L . ` TELEPHONE # Home Telephone Number NAME OF CORPORATION. �. NAME OF NEW BUSINESS `. TYPE OF BUSINESS CC'S IS THIS A HOME OCCUPATION? � YES (7D P Asses ADDRESS OF.BUSINESS b � nl MAP/PARCEL NUMBER Z �1 "�cf - (Assessing) 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 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your b s esu in s in this town. 1. BUILDING CO MISSIO R'S OF CE This individ al h'a a n4nft� e f n p mit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION �u hori S MULES AND REGULATIONS, FAILURE TO COMMEN ( COMPLY MAY RESULT IN FINE.. J 2. BOARD OF HEA TH This individual has ee ed of the permit requirements that pertain to this type of business. �� .� ; { ALL ►'UPI i, Authorized Signature** f HAZARDOUS MATERIALS REGUl.A710NS. COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: "t : 1 TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS - NAME OF BUSINESS:' decl n %na L J t e -P�,ET-.� l Smle,A-71 o BUSINESS LOCATION: t n-10,118 4. Aot. q1,%0`:,z4 t,4A• INVENTORY MAILING ADDRESS: '-:�p t A4• q A,V�n n ,:s P A TOTAL AMOUNT: TELEPHONE NUMBER: Slfa- (0� f�Z CONTACT PERSON: V4122Ewe EMERGENCY CONTACT PTELEPHONE NU BER: S'')g - ZCr2-,:�qo MSDS ON SITE? TYPE OF BUSINESS: C l�G n, vL er✓S INFORMATION/RECOMMENDATIO S: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS a The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid 2 Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers �l C41looincluding bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initia s r Town of Barnstable �FZHE T Regulatory Services Barn Thomas F. Geiler, Director A"medcaCitY Public Health Division Q 8 * BARNSTABLE, 9 MASS. g Thomas McKean,Director 2007 �pA 1639. 200 Main Street rED MA'S A' Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 5, 2010 Edward J. &Mary T. Woolley 1809 Pine Glade Circle 8 18 Fort Myers, FL. 33907 a 3� RE: Assessors (map-parcel) 269-095-OOM As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 3;Q1 West Main S reet Hyannis;MA:0260=1 Un-it 1—Bldg 2. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.barnstable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2010 fees included. Please contact me to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4072. Thank you in advance for your cooperation. Teresa Wright Division Assistant Health Division Direct#508-862-4072 Health Master Detail Page 1 of 1 Health Master I Logged In As: TOWN\wrightt Health Master Detail Monday, A Application Center Parcel Lookup Parcel Septic Perc Well Fuel Tank Parcel: 269-095-OOM Location: 301 WEST MAIN STREET, HYANNIS Owner: WOOLLEY, EDWARD I & Business name: _ Business phone:�- Rental property: Fj Deed restricted: f Number of bedrooms :I Contaminant released: F Fuel storage tank permit: G1 i Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 269-095-OOM Condo unit: UNIT 1 Condo complex:COLONIAL COURT Building: BLD 2 Location:301 WEST MAIN STREET Primary frontage: Secondary road: Secondary frontage: Village: HYANNIS Fire district: HYANNIS Sewer acct:2108 Road index: 1813 Interactive map: m' Town zone of contribution:WP (Wellhead Protection Overlay District) State zone of contribution:IN Owner Info Owner: WOOLLEY, EDWARD J & Co-owner:WOOLLEY, MARY T W, Streetl: 1809 PINE GLADE CIRCLE Street2: City: FORT MYERS State: FL Zip: 33907 Count Deed date:03/31/2004 Deed reference:C130-1-301 Land Info Acres: 0 Use: Condominiu MDL-05 zoning:SPLIT Neighborhood: C Topography: Road: Utilities: Location: Construction Info Building No Year Built Effective Area Bedrooms Bathrooms 1 1982 825 2 Bedrooms 1 Full Buildings value:o107,200.00 Extra features: 00.00 Land value: 90.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=26909500M 4/5/2010 COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. Agent X ■ Print your name and address on the reverse Addressee so that we can return the card-to you. B. Received b (Printe Na e) C VDat ,f De ivery ■ Attach this card to the back of the mailpierGe, or on the front if space permits. 14 D. Is delivery address different from Rem 1? ❑Yes 1. Article Addressed to: A If YES,enter delivery address below: ❑No '�ry Edward J. & Mary T. Woolle 1809 Pine Glade Circle 3. Service Type :Fort Myers, FL. 33907 rtified Mail ❑Express Mail i ❑Registered ❑Return Receipt for Merchandise l ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) p.Ye3 2. Article Number 3 .. . . . (Transfer from sen4ce labeo- - i=7 0'0 5' 116 0 0'0 0 319 0 •.95 3 3 '•. PS Form 38111 February 2004 Domestic Return Receipt 102.595-02-M-t.sao UNITED STATES POSTAL SERVICE c I First-Class Mail i Postage&Fees Paid I USPS I Permit No.G-10 I I • Sender: Please print your name, address, and ZIP+4 in this box • I � I I � (I I � I I Town of Barnstable 1 Public Health Department 200 Main Street Hyannis, MA. 02601 I i � 111111 fill 11111111111111111111NII$dbIlid I11J1111111111111 m t-rl • 0— CUM C3 Postage $ C3 O Certified Fee Postaa, O Return Receipt Fee -We (Endorsement Required) ; r3- ResMCted Delivery Fee \ '-a _(EndorsementRequired) Total Postage&Fees ul v I Sent To 11:3bluw�t-------�-�------------------ Cal/t`�------------- �` Streer,dpr.No., pp Q or PO Box No. �p0C�RLr�� City,staie+ZiP+4 ------------------------------------------------------------------- :�� 111 i Certified Mail Provides:n A mailing receipt an as� ay)ZOOZ aunr'008E wjoj Sd o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. a Certified Mail is not available for any class of international mail. e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ® For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. n For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". • If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. i , Town of Barnstable of Regulatory Services Barnstable Thomas F. Geiler,Director ;mericaCity Public Health Division Q 8 * BARNSTABLE, 9 MASS. Thomas McKean, Director ap 039. �0 2007 ATEo 200 Main Street Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 5, 2010 Sandra Lee Moscicki 185 Beechtree Drive Brewster, MA. 02631 RE: Assessors (map-parcel) 269-095-OOR As of October 1, 2006 a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at'301�West Main Street Hyannis, MA. 02601, Unit 6 Bldg. 2. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.ban-istable.ma.us. Go to the Health Division page by looking in the Department Menu. There is a link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate 2010 fees included. Please contact me to schedule inspection of the property as soon as possible. If there are tenants presently occupying the property please provide the contact information being sure to include a daytime phone number for all tenants. For your use an occupant's permission form has been included to allow for inspections to be performed in the tenant's absence. Failure to comply with this ordinance will result in the issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4072. Thank you in advance for your cooperation. Teresa Wright Division Assistant Health Division Direct##508-862-4072 'Health"Master Detail, Page 1 of 1 Health Master � Logged In As: TOWN\wrightt Health Master Detail Monday, A Application Center Parcel Lookup Parcel Septic Perc Well Fuel Tank Parcel: 269-095-OOR Location: 301 WEST MAIN STREET, HYANNIS Owner: MOSCICKI, SANDRA LEE Business name: Business phone i� Rental property: F Deed restricted: F--J Number of bedrooms Contaminant released: Fi Fuel storage tank permit: I Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 269-095-OOR Condo unit: UNIT 6 Condo complex:COLONIAL COURT Building: BLD 2 Location: 301 WEST MAIN STREET Primary frontage: Secondary road: Secondary frontage: Village: HYANNIS Fire district: HYANNIS Sewer acct:0615 Road index: 1813 Interactive map: � ] Town zone of contribution:WP (Wellhead Protection Overlay District) State zone of contribution:IN Owner Info Owner: MOSCICKI, SANDRA LEE Co-owner: Streetl: 185 BEECHTREE DR Street2: City: BREWSTER State: MA Zip: 02631 Count Deed date: 10/21/2003 Deed reference:C130-6-301 Land Info Acres: 0 Use: Condominiu MDL-05 Zoning:SPLIT Neighborhood: 0 Topography: Road: Utilities: Location: Construction Info Building No Year Built Effective Area Bedrooms Bathrooms 1 1982 825 2 Bedrooms 1 Full Buildings value:tt107,200.00 Extra features: xc0.00 Land value: xc0.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=2690950OR 4/5/2010 N p . Ln n, a ' Ir O Postage $ O -14 00 Certified Fee y± p Return Receipt Fee Postmark, (Endorsement Required) ( Here M Re r11 (Endo�rseme t Requirred) \\ Total Postage&Fees $ u7 entTo � C3 M-AJ` " LC7 MOSC ' Ck' Sheet,Apt No.;----Q- -------/-�-------------------------------------------------------- OrPO Box No. �O 5 F�C�C FI � JK i Ve✓ ------------- —�� --S ---- •---------------------- City,State,ZIP+4-7 :01 01 - _. r Certified Mail Provides: s�anay)ZoOZaunr'ooeew,od sd n A mailing receipt a o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. e Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. n For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,pfease complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also.complete A. Signature item 4 if Restricted Delivery is desired. _. ❑Agent I ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. R eive y(Printed Name) C gate of Delivery A Attach this card to the back of the mailpiece, ,�^ L,v or on the front if space permits. !/_ ` 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: 13 No I I I Sandra Lee Moscicki 185 Beechtree Drive 3. Service Type i I Brewster, MA. 02631 'certified Mail ❑Express Mail ❑Registered ❑Retum Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Deliver y?(Extra Fee) ❑Yes 2. Article Number , i: ;: :?_ 7:p pis 11,6 0':0 0 j j D 119 9 5 5 7! (Transfer from service labeq "`^ F"" LPS Form 3811 i February 2004 Domestic Return Receipt 1o25s5,02-M1540 1 ' I 1 1. 1 ? . . i.' i. . UNITED S TA • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division 200 Main Street Hyannis, MA, 02601 Certified Mail#7008 1830 0002 0500 7850 rti Town of Barnstable Regulatory Services HARNSTA81 M. v MASS, Thomas F. Geiler, Director gar-""'=�' Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office' 508-862-4644 Fax: ,508-790-6304 00 February 10, 2009 Barnstable Housing.Authority 146 South Street Hyannis, MA 02601 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 301 West Main Street Apt# 11, Hyannis was inspected on February 5, 2009 by Timothy O'Connell, Health Inspector-for the Town of Barnstable. This inspection was conducted on the basis.of the Town of Barnstable rental registration The following violations of the State Sanitary Code were observed.: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Paint (finish) in tub within bathroom was observed to be peeling and chipping. You are directed to correct the violations listed above within thirty(30) days of your receipt.of this notice by refinishing paint within tub in bathroom. You may request a hearing before the Board of Health if written petition requesting same . is received within ten (1:0) 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. 4. PER ORDER OF T BOARD OF HEALTH omas McKean, R.S., CH Director of Public-Health Town of Barnstable QAOrder letters\Housing violations\ 301 w main apt 1 l.doc x r � FORM30 C�� HOBBS&WARREN'm THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH CITY/TOW w DEPARTMENT e Qc ADDRESS ,M SVBy`eW TELEPHONE V✓"""'V Address 301 W _ Occupant_. Floor Apartment No. No. of Occupants _, No.of Habitable Rooms No.Sleeping Rooms ;L— No. dwelling or rooming units_ No.Storie �(j A Name and address of owner &A 4 (, Remarks eg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows.- Roof Gutters, Drains: Walls.- Foundation: 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 L © TO-7;) 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 REPORT I IGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUFI .', INSPECTOR TITLE A al 14 - DATE TIME i 6 0� P 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. _ .. . . ,.>... ..,-,:n...•.±s.n sn+.,a.a.« ,s.a, ,-ri-....,,.,q;,,,.xt:rp,as c +�-+�' t.5 l r � •' °.w�ar^!a.;d"+"' ...jf"y�r.+y.,FF++7An.. 4f-J'�"'.k• -i'�-.+.cti.....r f-i<..,r;;:« .:. .,• TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 &W H013BS&WARREN , BOARD OF HEA TH CITY/TOWN W 'ohAa DEPARTMENT S. ADDRESS! GSM SV 9�eW Ail TELEPHONE Address Floor Apartment No. No.of Occupants_ , No.of Habitable Rooms No.Sleeping Rooms_ _. r No.dwelling or rooming units No.Stories 4 Ij Name and address of ownerp W i }: 1 ( �� V7 # 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: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: ` ~ Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y 0 N L,,_`_E. ui '�Re air TYPE: ; Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents ELECTRICAL Panes, 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 t Bathroom �� % � • d,1�. �- ' C 1.1 9 Pantry .. ... . . � rn „ Den _ . Living Room'- Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: j Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats;Mice, Roacf;es 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.£.:,; �. INSPECTOR �' -•�' t TITLE � A.M. DATE 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. L I i i y - C ^'' __ _ �� _ �.-�� r __ I ' _ _ � -S� �� f I �'-��- - i �_� � �I r�� - , ' � h °��'� F J `` _ r • 1'L � '�� ti� � � � u � � '+, �'' � _ I }a: _ T ti - � � , _ I _ _ ' � I� _ � � . , � _ 'r� � � :� ' 1 � Ir 'Z' i T ,'I J- 7 -•L ti �" I � f I { y �• � •tip - L �• -ft •,7�,y.,,s ik 4 t 410 C r 10 Mai 4040 lip Ss � 5 ' � L