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HomeMy WebLinkAboutCertification of Local Fire Inspection - Certificate of Inspection - 220 SUTTON STREET 12/9/2019 NT OF PUBLIC HEALTH DIVISION OF HFALTH CARE FACILITY CERTIFICATION LICENSURE&CERTIFICATION LOCAL FIRE INSPECTION Instruct . Im��S- W*Zj . . requesting a fire inspection for licensure purposes. Facilities and programs must return this form completed, or the inspection certificate issued by the head of their local Fire Department,when applying for or renewing a license. Nursing homes and rest homes must maintain on file with the facility proof of quarterly fire inspections as required under 105 CMR 150.015(D). FACILITY/PROGRAM INFORMATION Facility/Program Name /Vo Ltx 5 AA Facility/Program Address v5y" Reason for Inspection: ao�,Wltial Licensure Licensure Renewal El Facility/Program Renovations Nursing Horne or Rest Home Quarterly Inspection (105 CMR 150.01S(D)) INSPECTION INFORMATION This is to document that the above facility/program was inspected on: and 7deteined to be: Date In compliance with local ordinances regarding fire prevention and safety. Not to be in compliance with local ordinances regarding fire prevention and safety. The following violations were observed (list violations,or indicate if a list of violations is attached): q44 Signature of Local F Department Official ` /1A 13 4�jf Typed or Printed flame of Local Fire Department Official Rev.0 /2 5/1 ire.3