HomeMy WebLinkAbout2416 MEETINGHOUSE WAY/RTE 149 - Health 2416 Route 149 -
West Barnstable
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date —7 Time:
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d In 2' � D Out G• .�
Owner LiZA t '[N N i L SSoiA Tenant 70 NO vil/
Address _2—lq/y Address 2 4116 �J'NAf-Ir'( 1 1.1G W o u S, A 4
�r�Spa E 1N n, 4 5`CAe)LE
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities 1 J
/ i
6. Heating Facilities c--eA S L�`T2l C_
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities Nff,D S S(w �rc-TU (Z-
10. Curtailment of Service �, 52>A S i%M�r��
11. Space and Use
12. Exits �- 'I--vO o�� nn�, 'N-+0°-,Se
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal "` li�ti N
16. Sewage Disposal wA�
17.Temporary Housing lvk
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Ca S70-Y
Number of Bedrooms Number of Vehicles Ilowed (max)
Number of Persons Allowed (max) 21
y� z
Person(s) Interviewed Inspectore\ . f V V VIV
' ^r
If.Public Building such as Store or Hotel/Motel specify here
Fee— ----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appricat ion Ar lVell Construct ion Vermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (P')an individual Well at:
-- .1 ifs
Location — Address —— -- Assessors Map and Parcel — —
---------------------------------------------
wnelr 7 Address
zn
Installer — Driller
0 ---------------------------------------------—— --- -----—
Address
Type of Building
Dwelling--L ws -4 ---------------------
Other - Type of Building_;____—_____,____ No. of Persons-----_---__--___-__—_—__—________
Type of Well- ,�__ Ca acit
Purpose of
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
S"
Application Approved By — _— 1��A
date
Application Disapproved for the following reasons:
CO ( �! date --
Permit No. — Issued
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of CompYiance
THIS IS TO CERTIFY, That t Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by _- -— ----------— - ---- —__--_ —--
Installer
at
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ---------_____________Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE—_- -- - Inspector------------—------------
--------------------------------------- ---------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Velr Congtruct ion Permit
No. � _t �I
Fee ---------------
.Permission is herebyranted— ��'�<�%��-'�( �v �/��i
g -- __ _—/f - — —-------------
--
---------------
to Construct ( ), Alter ( ), or Repair (kJan Individual Well at:
Street
as sho a the ap li tion for a 4�1ell Construction Permit
NO - Date
-----------—-------- -- - - -- -
Jc-� 1 �o DATE Board of Health
—.._
No.----------------- ®f r Fee----- -- ------
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZippCication,f"orlVell Con0ructionPermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (l-)an individual Well at:
Location — Address Assessors Map and Parcel
Owner Address
Installer — Driller Address.
Type of Building ® n
Dwelling —
Other - Type of Building-----_—___________ No. of Persons-------_--..--._
Type of Well-��--- — Capacity-----------------
Purpose of Well
—_— G�-�i ------ ------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate,Dff Compliance hashas been issued by the Board of Health.
/ 3- 11, 06
It
date(
Application Approved By —__—_—____—___—
date
Application Disapproved for the following reasons:
date
Permit No. _--- Issued —_-_---
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of (compliance
THIS IS TO CERTIFY, That t Indivi ual Well Constructed ( ), Altered ( ), or Repaired ( )
by� --- -— -- — - — - -- -- ------ --
C Installer
at__ `L� L� ---- ------ -- -_- - ----__ -- - --- -
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ---------------------Dated----------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE __ _ Inspector----------------------_--------.-----
�f 7
No.---------------- r Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-for Vell Con5tructioni9ermit
Applicatio is hereby made for a permit to Construct ( ), Alter,{ ), or Repair (el)an individual Well at:
Location — Address Assessors Map and Parcel
Aj
Owne Address
Installer — Driller _ Address
Type of Building
Dwelling & [1_c�!
fOther - Type of Building-------------______ No. of Persons-------------------------- --------
Type of Well / _—_---------------— _ Capacity---- ; - - --— ----- --— }
Purpose of Well-----��1?
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
date
5///A
Application Approved By
date
Application Disapproved for the following reasons:— —------------
dace
a� rn ,
Permit No. .— —-- —---- Issued----S�1 I- -- - -- — —— -----------
date
!------------------------------------------.--------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of Compliance —
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
y % Installer
at r•e
1 /� /�i
--- —____ —
-----------------------------------------------------------------------------------------
has been installed,in accordance with,the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ----------------------Dated------------------
t
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE—--- --- ---- - —-- Inspector-------------------------------------------— -
----------------------------m=----_------------------------------ ---------
BOARD OF HEALTH
I,
TOWN OF BARNSTABLE
Ivell Con!5truct ion Permit
No. ------------ Fee
,Permission is hereby granted
to•Construct ( ), Alter ( ), or Repair (i,'�an Individual Well at:
No. -- -� _-- - -
Street
as shown o he ap 11icatio i for 1,1e11 Construction Permit
w (� y
NO.- ------ Date ---- — - ------------------------------------
- - ----------- -- - - -- -
5A p Board of Health
DATE