15 & 17 Housing Inspections CITY/TOWN
DEPARTMENT
ADDRESS
TELEPHONE
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suoi diritti. Lei pub ottenere una traduzione di questo modulo a:
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[WRITE IN BOARD OF HEALTH ADDRESS AND TELEPHONE NUMBER ABOVE[
ARTICLE II
%?STATE SANITARY CODE
ADDRESS:_—_ /9 1—fe"si `'-7E (r). __ NO OCCUPANTS ___
�
(JP C� ,y(
OCCUPANT: C"""�- t�1 R 1 FLOOR: __ ___APT. NO.:
NO. DWELLING UNITS: ___------NO. ROOMING UNITS:
NO.STORIES: _— BASEMENT: _-
TYPE STRUCTURE: __ FRAME:_-_
BRICK; _SEMIDETACHED:___ DETACHED:_
NO. OF HABITABLE ROOMS: (T__
NO. OF SLEEPING ROOMS: _-
OWNER: )2Efe
,
ADDRESS: _ ___
-I V L�
REGULATION
BATHROOM
X=VIOLATION
YES
3.1A(a) 3.16(a)
3.1AIb) 3J8(b)
3.1A(c) 3.12(c)
3.10 3.2
4.1 (9.1 & 9.2)
5.1 19.1 & 9.2)
9.1 & 9.2
7.3& 9.3
7.4 & 9.3
13.1 & 13.1A
13.1
Is toilet with seat available?
NO
Is washbasin available?
Is shower or bathtub available?
Are the facilities in a clean, smooth, impervious and sanitary condition?
Is cold water for facilities available (with sufficient quantity)?
Is hot water for facilities available (120 F . 140 F)
Are the facilities properly connected to drain line?
Is there at least one light fixture in good repair?
Is there an electrical outlet in good repair at washbasin?
Are the windows in good repair weathertignt and fit for the use intended?
1
3.1 & 13.6
Are the doors in good recalr and fit for the use intended?
Are the walls in good repair and fit for the use intended?
13.1 & 13.6
8.1A&8.18
13.6
14.5
Are the floors in good repair and fit for the use intended?
I s there proper ventilation?
Are the floors and walls of nonabsorbent material
REGULATION
2.1
2.1(a)
41(9.1 &9.2)
5.1 (9.1 &9.2)
9.1 &9.2
2.1(b)
9.3
2.2
7.2(a)
7.2(b)
7.2(c1
13.1 & 13.1A
14.5
13.1
13.1
3.1
13.1
13.6
2.1(c)
8.1A. 8.16(a)
9.3(a) 9.31b1
9.4
Are the exterior openings properly screened?
KITCHEN
Is the room suitable?
Is sink available and of sufficient size and capacity?
Is cold water for the sink available with sufficient quantity and pressure)?
Is hot water for sink available 1120 F - 140 F)?
Is sink properly connected to drain lines?
Is there a working stove and oven?
Is the stove and oven oroperly connected ana vented?
Are the facilities clean, smooth, impervious, nonabsorbent?
Is there one light fixture in good repair?
Are there two electrical outlets in good repair?
Are the windows (if kitchen exceeds 70 sq. ft.) equal to at feat 10%of the floor area
Are the windows in good repair,weathertight and fit for the use intended?
Are
he exterior openings properly screened?
Are the doors in good repair and fit for the use intended?
Are the walls in good repair and fit for the use intended?
Are the ceilings in good repair and it for the use intended? ',sir
Are the floors in good repair and fit for the use intended?
Is the floor imoervious and easily cleanable?
Is there adequate space and facilities for inhaling of Refrigerator?
Is there sufficient yen
flat
on
Are all owner installed appliances properly installed?
Are all occupant installed appliances properly installed?
n
X- VIOLATION
YES NO
EGULATION I LIVING ROOM
1a ? --
ncal outlets in good rep
3
13
1
1
14.5
REGULATION
7.1(81
7.1(b)
7.11b)
8.1A, 8.1BIe
13.1A
13.1
13.1
13.1
14.5
11
REGULATION
7.1(a)
7.1(b)
7.11b1
8.1A, 8.18(e)
13.1A
13.1
13.1
13.1
Are all exterior openings screened?
a i�li17R1
�14�.5 II
Are
Is
here two separate eiec
here one outlet and one light
Is there proper ventilation ?
ixture in good repa
ight and fit for the use intended?
e use intended?
Are the windows in good repzir, weathers
Are the walls i n good repair and `it i�to --��-
size
Are the floors In good repair and fit for the use Intended
Are all exterior openings screened
SLEEPING ROOM = 1 (Identify)
Is there sufficient natural light?
Are there two separate electrical outlets in good repair?
Is there one outlet and one light fixture in good repair?
Is there proper ventilation?
Are the windows in good repair,weathertight and fit tor the use intended
Are the walk in good repair and tit far the use intended?
Are the ceilings in good repair and ft for the use intended?
Are the floors in good repair and fit for the use intended?
Are all exterior openings screened?
Is there adequate space for the number of occupants?
SLEEPING ROOM -^t-2 (Identify)
Is there sufficient natural li grit?
Are there two separate electrical outlets in good repair?
Is there one outlet and one Ilgnt fixture In good repair?
Is there proper ventilation?
Are the windows in good repair, weethertight and fit for the use intended?
Are the walls in good repair and fit far the use intended?
Are the ceilings in good repair and fit for the use intended?
Are the floors in good repair and fit for the use intended?
REGULATION SLEEPING ROOM 3 (Identify)
7 1(a) Is there sufficient natural light?
7 1(b) I Are there two separate electrical outlets in good repair?
7.1(b) Is mere one outlet and one light fixture in good repair? _
th rt ght d fit for the
13.1 A
Are the windows in good
13 1 Are the walls in good repair and fit for the use intended?
13 1 Are the ceilings in good repair and for the use intended?
Are all exterior openings
screened?
Is there adequate space for the number of occupants?
14.5
11
ULATIONS COMMON AREA AND EXITS
Are interior common area properly illuminated at all times-
Are there operational and sufficient and prooerly located lignt switches and fixtures?
Are the windows in good repair, weathertight and fit for the use intended?
A Are the doors in good repair, weathertignt and fit for the use intended.
X'VIOLATIONS
YES iI NO
5
1
1
.8 & 15.9 Are all common areas clean?
1
Are the stairways n good repair and fit for the use intended?
1.3&13.4 Are handrails in good repair and fit for the use intended?
Are all required balusters or other devices m place?
3.4 entry 5 ro er lack?
8.3
( Is every eny door of a dwelling unit fined wish a p F
8 3 Does the main entry door of a dwelling close and lock automatically.
8.6 1 Is the building properly posted with the name of owner?
12 I Are the common bathroom facilities clean?
12.1 & 12.2
Are there sufficient and properly maintained exits?
I I
REGULATIONS EXTERIOR _____..mm.=••••••••••or
Are tals
Are the structural elements in good repair.
Are all required hand railings and balusters in place and in good repair?
Are there walls or protective railings as required?
Is the storage of rubbish and garbage proper (occupants)?
3.1
13.1
13.1
13.1
13.1
13.3.13.4 & 13.5
13.4
15.4
15.3
15.10
13.1
Are the sufficient and prooerly located receptacles?
Are the private passageways or rignts of way clean and sanitary?
Are the gutters and down spouts In good repair and fit for the use intended?
LATI ONS
GENERAL
X•VIOLATIONS
YES NO
Are all required services are available and working?
Is heat being supplied at proper terperatures. 68 F -78 Fl?
Are hot water heating facilities in o
'god repair?air?
Are all required facilities pro p y rd and vented?
ve
ve
All space heaters in use meet the proper Location?
Ping in use? en?
Is there no temporary
Is the electrical service safe and adequate?
14 2& 14.3 The dwelling is free of insectlrodent presence? cond
rc maintained in a clean and sanitary
Is the dwelling un
the occupants?
ion by
GULATION
ONE
tIATERIALLY
)ETERMIP
IN EC OR
DATE
THE NEXT SCHEDULED REINSPECTION IS:
OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY
AND WELL—BEING OF THE OCCUPANT AS
IMPAIR THE HEALTH THE CODE 0 R THE AUTHO IZED INSPECTOR.
BY REGU�AT10� 29.2 OF THE / !
' �— —___
TITLE _
cr
TIME
DATE
A.M.
P.M.
TIME
LOWING IS A BRIEF SUMMARY OF SOME OF THE LEGAL REMEDIES TENANTS MAY USE IN
TO GET HOUSING CODE VIOLATIONS CORRECTED.
snt Withholding (General Laws Chapter 239 Section 8A)
ode Violations Are Not Being Corrected you may be entitled to hold back your rent payments.You can do
tout being evicted if'.
our dwelling unit or common areas contain code your collations which
hic about re serious
s enough
violations
You can P
rove that V air your health or safety and that Y
b ore your or behinds our rent. a building.
before you wcre betied in Y
f the rent into court'iif a judge orders you to pay it. (For this it is
You did not cause the violations and they can be repaired while you continue to live in
You are prepared to pay any portion °
best to put the rent-money aside in a safe place.)
Chapter 111 Section 127L). ourself. If your local code
Repair and Deduct (General Laws Cusp make the repairs y your your local
safety
ei ce allows that you to use code v rent money to Oendanger or materially impair y
The law tom violations,you may be able to use this remedy_ It
made)within five days
rnement agency certifies that there are code violations which
to four them rent within
any year to
and your the
enter into a written contract to have them m
ielhbeing cur landlord has received written notice ° you can use up
begin necessary repairs (or to after notice Y
owner fails to beg 14 days a
�,r notice or to completerepairs within 1 and Chapter 239
se the repairs. ter 186,Section 18 a
Retaliatory Rent Increases or Evictions Prohibited (General Laws Chap
a complaint to your local code
Section 2A). months after
your rent or evict you in retaliation for making co e which
not increase o y our rent or tries to evictewithin
n eviction hs
The owner may good reason for the�forcement agency about code violations. If the owner raises if he or she tries this.
the complaint he Cr she able have toe landlord for damages DU have made ally to sue th
nrelated to your complaint.You may be
Receivership (General Laws Chapter 1111 Sections
127C-H).
District or Superior Court to allow rent to be paid
I Rent R spend to much of the rant
f health may Peen a the D may p four months'rent
The occupants ineeded ato/co the board Th
The court may then appoint a"receiver''who ding limitation of
into court rather than to the ow receiver is not subject to a spending money as is needed to correct the violation. The
rent.
You may be entitled to sue your landlord to have all or some of your your dwelling unit does
Breach of Warranty of Habitability our rent returned if y
B
not meet minimum standards of habitability.
fi. Unfair and Deceptive Practices (General Laws Chapter 93A).violation of the consumer protection act and regulations for
THE P
Renting an apartment with coda violations is a BEFORE YOU DECIDE TO
which you may sue an owner. - IT 1S ADVISABLE THAT YOU
PRESENTED ABOVE IS ONLY A SUMMARY OF THE LAW, YOU SHOULD
WITHHOLD RENT OR TAKE ANY OTHER LEGAL ACTION,
ATTORNEY. IF YOU CANNOT AFFORD TO CONSULT AN ATTORNEY.
WITHHOLD
CONSULT AN
CONTACT THE NEAREST LEGAL SERVICES OFFICE WHICH I
(NAME)
(ADDRESS)
(TELEPHONE NUMBER)
CHAPTER II
oom 410.150
120°
between
seat
tub
t cold
STATE SANITARY
Occupant's Name_
it of Dwelling Units
M lk llabitable Rooms
Address of Owner
Regulation
of Stories_
0 Bedrooms
Violations
ater
ion
connection
Violations
:chen 410.100
is ien
ad
or
is
�igerato
ectrical
ctrical li ht
fixture
at
a
ion
er (suffic
to
rs
indow) (
(door & windo
n_ connection &
Violati
Livin Room
or one
is (2
r
0
ens
ndo
Pantr
ets (2
hting
s
ling
or
ido
eens
Violations
Din
one
n_ Room
4th ligh
.4S0
E
R
ation
Violations
In Roam #1
natural lt.ht
Or
1 outlet
adequate
r occupant?
ing Room ik2
nt natural lighten
s or 1
.th outle
.250 A
.251 B
951 A
.500
.500
.500
:e adequate 9
for occupant.
lee in Room 4k3 frlAdti
lent natural lightin_
.ets or
th outlet
^_r.ecrw
n
-"ere adequate
e for °coup_
C
nor area
lows
rs
lin
Is
lotS
a s
anon bathroom clean
Common Area
imne
aches
t (Exterior
ar
r iv
rubbish
ate wa 5
utters and do
Loaf
mad am
?ntr li_hts
:rat
xking and available
ngng facilities good
and 64
120 to 1400
•s vented
ter
wirin
al
and rodents
sanitar
Regulation
Violations
service
:cellaneous
ade uate
pector
text scheduled reinspection is:
Date
a.m.
Time
a.m.
o.m.
CHAPTER II
ccupants_
Structure
/
throom 410.
er bet
Apt. a_
g F
STATE SANITARY CODE
Occupant's Name
a of Dwelling Units__
N 4 Habitable Rooms_
Address of Owner
150
Regulation
Violations
.150A
and seat
sin
tub
en t cold
or
a
Violations
1itchen 410.100
n sink sufficient size
and oven
for refrigerato
_ets electrical
lectrical light fixture
Ln
i
lotion window) (mechanical)
water (sufficient •ressures
ater
0
tens
nb i
Violations
Living Room
lets (2 or one with light)
hting
is
li
,or
tdo
reens
cks
Panty or Dinin: Room
itlets (2 or one with light)
ghting
ills
loor
indo
creens
ocks
.500
.480 E
Re:ulation
Violations
it
i
th
1 outlet
z adequate
or occu•ant?
•ing Room #2
.ent natural li:hti
ee
!ts or 1
h outlet
250 A
251 B
.251 A
.500
.500
.500
.500
L5
ere adequate
for occupant
Slee in Room #3
cient natural lighting
lets or 1
ith outlet
in
r
ows
ens
here adequate
:e for occupant?
Common Area & Exit (Interior
erior area Illuminated properl
dow
eens
irs
Li in
LI
s
JOTS
airwa s
bathroom clean
mmon
Common Area & Exit (Exterio
limn
aches
oundation
tairs
se & rubbish
vate wa s
Cers and down
arb
alt
too
ead paint
En
.253 B
s
General
ervices working and available
eating facilities in good
r?
68° and 64
ater 120° to 140°
ities vented
Regulation Violations
.200
heater
ira
- ro.er
i
11 gni
Mad
1
MIECINIMINIallairanala
1 I
ttass �.
tanTe
:rical sery
:ts and rodents
Lin_ sanitar
ce
ad
uate
Miscellaneous
nspector
Date
next scheduled reinspection is:
i Titl chi
a.m.
p.m.
Date Time