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Miscellaneous - 21 PERRY STREET 4/30/2018 (2)
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O Q d ►IJ O O N y N rl� N t0 ci N I'* In Ln r" r U O C � p T 0 J Jj Ln mZ �� a' O W 000 0 N r - Z, Q LL � LO Zd w oo Lo O p: k,-�- �� LL Com Q �� QW Z'O� W �J N `� -: U €11Iki N Q o Q Z o o Ito ['1 tt1ll.Ct#ii.l LL U CY) Z —o r Z co O �� tl'Ellt�t k ks O Q i'''i°' � Z Q U N'� J Q N m � co ? J o) �i j i � � ' `(jr!! Er . x irlilltttt!!t uj }� 0) Q �� t1; dal: U 0 U W 0) > m m f j ) r rttiultillu -. w _m d CV CO H LO 00F- N Z G) LLIm N O m O 00 cl O =� - r .itt1 N } 0 00 N tt� T W LU ° d O a �' m 6 p t N U Fa C FH O = O i Q�• � o M C tq t10 C)" o O m Q N �@ � O U co E Z�'� n��� y Q m LL LTi w (n.(o rp Z 0 0o CO 0O) t O to 0 r- T T T Q Q` O 'w a a) w @ � 0;� �.a) :: .. a)L� " _ O `Q = _ '0 €d C CO N ? LLu- c- o co a'-° � - } m ca � ~ 'U m Li Ii V �< w}. CD`Umo Ii s a Z m to cn 0 UJ to M T O F -;H Q t7 ►� 49 L6.O y X cO LL t) N C ri N Win iii y ' U) LL- U (n LL pWit. j co (E "� co � o 0 N U. o o f° m co C� O. C) 0 co a N o Y oCO m�mXm_XU) v):t:: HmLL2WmrYW m000 LO U�C9Q to SC7oZ � t O-. ~ p. .� N U d -ra) CL a)) Q >cc U a� w3 o� ~~ a� U) 0 i � W O 7 N p p C Wrww2.LLL; ( 2:L -Il,U dW U) . ►IJ DATE: October 16, 2014 TO OWNER OF RECORD Richard Hamel 183 Pillsbury Road Londonderry, NH. 03053-3221 Letter of Compliance PROPERTY LOCATION 21 Perry Street North Andover, MA. 01845 A Health Department ORDER LETTER dated December 18, 2013 was issued to you as owner of record of the property listed above citing violations of the State Sanitary Code, 105 CMR 410.000, Minimum Standards of Fitness for Human Habitation. A re -inspection of the property has found that all of the violations noted on the Order Letter have been corrected. The Health Department would like to thank you for your cooperation. Verely,Grant J P ubhc Health Inspector Xc: File Cc: Avatar Properties BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 0 r clo 2 \ § [ §2 $ 0 � / � 11 � k 2 � � O � \ / 6 # \ / \ � \ z » ° _ . { � B { , \ z ® e ± E \ ` §2 $ 0 � / � 11 � k 2 � � O � Blackburn, Lisa From: Sawyer, Susan Sent: Tuesday, July 01, 2014 10:13 AM To: Blackburn, Lisa Cc: Grant, Michele Subject: 21 Perry Please put in as a complaint investigation. Neighbor called; Armondo 617 947-8223 23 Perry Street Sees a guy replacing windows at 21 Perry; on a ladder in full protective clothing. Armondo tried to talk to someone and they said it was just a window replacement and then when asked, he admitted there was lead on the windows being removed. Armondo wants us to be sure it is being done properly. I asked if they are sanding; he said no. He didn't think they had any drop cloths to collect chips where they are doing some scraping of paint. He has a 3 year old and a pregnant wife; needs to know if he should be concerned. Can he use the air conditioner etc.? I told him they had permits to do the work and they should be following the state regulation. He wants assurance. I told him I would contact the company supposedly doing the work and ask questions about safety and the regulation. Then get back to him. Please remind me. !!! thx Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.see.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. B \ \ § � { 2 IC O � � ;z Town of North Andover L/ CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: October 3, 2013 To: Owner/Agent of Record: Property Location: Property Manager - Chris Hamel Erin and Chris Carta Rep. for Rick Hamel, Owner 21 Perry Street 183 Pillsbury Road North Andover, MA. 01845 Londonderry, NH. 03053-3221 An authorized in was made of your property at the above address on October 2, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work. Proof of contract to be completed within 30 days must be submitted. A re -inspection will be scheduled for seven days after receipt of the order letter for corrective action. Failure to act will result in further action. 105 CMR 410.... Bathroom Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.150(D) Bathroom Tub, Tile, Fixtures and baseboard heating cover, are of an impervious nature. Toilet is continuously running Owner shall provide smooth and impervious ` 6,-'14 Days surfaces and be free from defects which make them difficult to keep clean or create an accident hazard 410.351 Bathroom sink piping is not in working order, pipe leading through the wall is corroded. Owner shall be 0. 14 Days in accordance with accepted plumbing, 1 gasfitting, and electrical wiring standards and shall maintain free from leaks, obstructions or v C other defects 410.501 Bathroom Window is broken 14 days A window shall be considered weather tight only if all pains of glass are unbroken Household Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or comph n well-being 460.100(A) Homes built earlier than 1978, Lead test is required. No letter of compliance will be issued until YES iv there is full compliance to the lead code where a 0 ` child under 6 resides. (see 105 CMR 460.000) Front and Living room Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.501 Five windows in the front room do not open Left window in living room does not open 10 I `1 'YSIS 14 Days A window shall be considered weathertight D only if window opens or closes fully without excessive effort c 410.253 Ceiling fan and light are broken ' 1a Dt ry (4. Owner shall provide and locate electric light �� 14 Days switches and fixtures in good working order Kitchen and Back Hall Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.501 Picture Window in Kitchen: The Left and the right picture windows: do not i v (A)(2) open and close properly. .. A window shall be considered weather tight 14 Days only if the window opens and closes fully without excessive effort. 410.100(B) Counter tops in kitchen chipped, broken and pervious surfaces. ►(Yl� C , 14 Days Facilities required in 105 CMR 4 10. 100 (A) continued Carpet. 14 Days Ceiling is falling in over the bed Molding and ceiling have large gaps between 14 Days them Conditions deemed to endanger or impair health or safety, to be a condition which may endanger or mentally impair the health or safety and well being of a occupant. 410.253 Lighting — No light cover The owner shall provide and so locate electric 14 Das I �� L1 light switches and fixtures in good Basement Regulation # g Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.350 (B) Sewer Pipe is seeping fluids. f/ ^ Every provided toilet shall be connected to the water distribution system (105 CMR 410.18) ` 14 Days and to sanitary drainage, in accordance with accepted plumbing standards ' 410.255 Light fixture broken. Lighting in fluorescent fixture was smoking. Wiring issues. ( p Circuit breakers blow when plugging in appliances, Air Conditioners, etc. w The electrical service supplying each dwelling shall supply sufficient amperage to meet the 14 Days reasonable needs of the occupants. Should the amperage be determined to be inadequate it shall be corrected so that it meets the amperage requirements of 527 CMR 12.00. The Mass Electric Code shall have smooth and impervious surfaces and be free from defects that make them difficult to clean, or creates an accident hazard 410.100(B) Kitchen Sink is chipped, it is extremely old and is pervious to the secretion of bacteria. The facilities required in 105 CMR 410.100(A) 14 Das C "1 Shall have smooth and impervious surfaces and be free from defect that may make it difficult to l keep clean, or creates an accident hazard 410.500 Back Hall: This room is unfit: Possible lead paint, stained sealing tiles, chipping, cracking p peeling paint on walls, unfinished ceiling, unfinished walls. Every Owner shall maintain floors, walls, doors and ceilings in every way fit for its intended 14 Da s use. Further, he shall maintain every structural 1 0 element free from holes, cracks, loose plaster, or other defect renders the area difficult to keep clean. Second Floor Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.253 Boys Room: Ceiling light does not work. Owner shall provide and locate electric light 14 Days switches and fixtures in good working order CMR 780 Boys Room: No bedroom door: \ IRC 2009 14 Days Y Please refer to CMR 780 IRC 2009 Under the 11 building code to meet the requirements 1 CMR 780 Girls Room: No Bedroom door: O IRC 2009 14 Days Please refer to CMR 780 IRC 2009 Under the building code to meet the requirements 410.750 Girls Room: ,n � 1uv � "\ Tacks and tack strips are protruding through the S�,Ttceuq� . • • y, -.,.,,cam t . s You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than 1% of the community's population, include "This is an important legal document. It may affect your rights. You should have it translated." State delivery method to Owner: certified mail: Occupant: regular mail delivery Cc: Chris and Erin Sullivan Carta Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Fred McCarthy — Fire Department File ® Complete items 1, 2, anE13. Also complete item 4 if Restricted Delivery is desired. ® Print your name and address on the reverse so that we can return the card to you. ie Attach this card to the back of the mailpiece, or on the front if space permits. Article Addressed to: ( ttcko.' KMU) Icy . tgq(a S c Su1��— a � ❑ Agent ❑ Addressee C. Date of Delivery D. Is delivery address different from item 1? ❑ Yes If YES, enter delivery address below: ❑ No 3. Service Type eCertified Mail .❑ Express Mail IJ Registered ' 'ieturn Receipt for Merchandise ❑ Insured Ma",. 4. Restricted Dr:,-- :Otra Fee) ❑ V- 2. 7005 0390 00033 4265 8994-1 ' PS Form 3811. February 2004 nnmaefir P f..,. oo,.e; UNITED. STATES POSTAL SERVICE First -Class Mail Postage & Fees Paid USPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box ° NORTH ANDOVER HEALTH DEPT. 1600 Osgood Street, Suite 2035 North Andover, MA 01845 4S i C"PS-7 4. 1D I'��111�'ti'��i'�1111l11'1ji'hill 1111111'll1'1111111#1] fill lilt OF 4ti t r ��SSA C H USE��y Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter lI, Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: December 18, 2013 To: Owner/Agent of Record: Rick Hamel — Owner Chris Hamel — Representative Richard Morway — Property Manager 183 Pillsbury Road Londonderry, NH. 03053-3221 Property Location: Erin and Chris Carta 21 Perry Street North Andover, MA. 01845 An authorized inspection was made of your property at the above address on December 18, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work and submit contractual paperwork to the North Andover Health Department. A re -inspection will be scheduled for seven days after receipt of the order letter for corrective action. Failure to act will result in further action. 105 CMR 410.... Living Room Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.482 All New Smoke detectors go off without warning or cause. Owner shall provide, install, and maintain in operable condition smoke detectors and Carbon Monoxide detectors Replace Smoke Detectors that are not good working order. 410.253 Basement light fixture and Living room light YES fixture. Faulty electrical wiring. Wiring was smoking when switch was activated. Owner shall provide and so locate electric light switches in good working. Hire a Licensed electrician to check for faulty wiring throughout the house. Submit to Health Department a complete summary of findings within 7 days. 410.481 No owner information is posted. If the owner is a realty trust or partnership, the name, address and telephone number of the managing trustee or partner shall be posted. Post information Bathroom Regulation # g Description p ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.351 Bathroom drain leaks The owner shall install or cause to be installed, in accordance with accepted plumbing, gas fitting and electrical wiring standards, and shall maintain free from leaks, obstructions or other defects Have a licenses plumber repair pipe 410.500 Bathroom tile is covered with mold throughout the grout and possible chronic water problem behind the tile walls. Every owner shall maintain floors, walls, etc. watertight and free of dampness. Hire professional remediation company to determine the extent of the problem behind the wall tiles. Submit a full report of the problem to the Health Dept. in 7 days of the receipt of this Order Letter. 410.150(D) Bathtub Fixture — Both hot and cold fixtures — broken Owner shall provide smooth and impervious surfaces and be free from defects which make them difficult to keep clean or create an accident hazard. OF qti 9SSACHUS�� You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than 1% of the community's population, include "This is an important legal document. It may affect your rights. You should have it translated." Michele Grant Cc: Erin and Chris Carta - Tenant Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Lisa Blackburn Repair bathtub faucets Second Floor Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.253 Hallway light Fixture on second floor does not have a cover. Owner shall provide and so located electrical light switches and fixtures in good working order Replace light cover Garage Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.500 Garage door is non-operable Every owner shall maintain other structural elements of his dwelling Repair to the original state You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than 1% of the community's population, include "This is an important legal document. It may affect your rights. You should have it translated." Michele Grant Cc: Erin and Chris Carta - Tenant Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Lisa Blackburn Department of Public Health & Department of Labor �Y Fd l��t NOTIFICATION OF DELEADING WORK ll: 15�i1�j %t4`e+ All sections of this form must be completed in order to comply with the notification requirements of M.G.L. C. 111§197, 454 CMR 22.00 and 105 CMR 460.000, as most recently amended Contractor performing project SCOtt AulS0f1 Lead Paint Inspector Gary Marciello ADDRESS OF PROJECT: Street Address 21 Perry Street City No. Andover Property Owner Richard & Marcelle Hamel Telephone Number (603) 894-6300 Deleading Method:0 Wet/Dry Scraping [3Demolition Covering If "Other' selected, please License # DC001480 Date of Inspection 10/26/13 Check one: Dwelling is multi -family Start Date Exp. Date 05/20/14 License # M3169 Exp. Date Number Zip 01845 REC TOWN OF ;IN % i ri ANDOVER HEAL i :)':P'ARTMENT Address 183 Pillsbury Rd., Londonderry, NH 03053 ❑ Heat Gun E] Caustics ❑ Other Liquid Encapsulant Q Replacement Single-family) Completion Date, When will work be done: AM 7 PM 4 (Specify times on site) Project Supervisor Name. Worker's Compensation Policy Number In case of emergency contact Tel. # (Contractor's Representative) DELEADING CONTRACTOR Other Weekends? NO # Exp. Date Carrier The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisoning Prevention and Control Regulation!, 105 CMR 460.000, and that the information contained in this notification is true and correct to thebes his/her;knowledge and belief. Date January 31, 2014 Signed "i 96A Company Name SCOTT AULSON 14 CURWEN ROAD, PEABODY, MA 01960 Telephone Number (978) 423-3472 OVER4 Grant, Michele From: Richard Morway <r.morway@avatarproperties.net> Sent: Thursday, October 09, 2014 5:31 PM To: Grant, Michele; Sawyer, Susan Subject: Perry St Attachments: 21 Perry St Compliance.pdf Ladies, Thanks for meeting today. I am enclosing a copy of the lead certificate. Please let me know if you would like anything else with regard to the lead. The floor in the closet is painted. The attic hatch upstairs has been painted. The light bulbs in the basement have been replaced. The hanging light in the basement has been removed. I contacted the plumber. He will be by tomorrow to repair the leak in the basement and tighten the bath faucet. I will call Fred McCarthy at the fire department tomorrow. I just returned to the office now. I didn't want you to wait on this information. Chat soon and thanks again. Avatar Prrgper tees a EmsLeaders in property Management Richard J. Morway 163 Main Street, Suite 201 Salem, New Hampshire 03079 T: 603.894.6300 F: 603.912.5600 www.avatarproperties.net Gary Marciello, Lic#M3169 N & Jt Lead-Tnspectiona[Services, Inc. 137 Beacon Street, Lawrence, MA 01843 978-685-4172 * 617-737-2514 * 508-756-4800 mmlead@vahoo.com LETTER OF FULL DELEADING COMPLIANCE Richard Harrel & Marcelle Hamel 183 Pillsbury Rd Londonderry, NH 03053-3221 Dear Richard Hamel/Marcelle Hamel: This letter is to certify that on 07 / 18114 1 re -inspected your property located at 21 Per St, Unit None, and relevant interior and exterior common areas, in the City/'Fown of North Andover. On that date, those surfaces cited in the initial inspection report by Gary Marciello conducted on 10 / 26 / 13 as being in violation of Massachusetts General Laws, Chapter 111, Section 197, and 105 CMR 460.000; Regulations for lead Poisoning Prevention and Control, were determined to be in current compliance with those same laws. Dust samples were taken and found to be within acceptable limits. Massachusetts law does not require the abatement or containment of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance with the re uirements of the Lead Laws referenced above only as long as there continues to be no peeling chipping or flaking lead paint or other accessible leaded materials, as long as coverings and/or encs sulants forming an effective barrier over such Raint or other leaded materials remain in place, and as log as surfaces reversed to correct lead hazards remain reversed and securely in Place. The law grants you a 30 -day maintenance period to repair deteriorated lead paint or detached coverings over such paint, and to clean up, during which time this Letter remains valid. The second page or reverse side of this letter indentifies the authorized person(s) who performed deleading on the property and a general summary of the methods used to achieve compliance with the Lead laws. A complete Reinspection Report is attached to this letter, which specifies how and on what date each surface was brought into compliance. To the best of my knowledge, the cost of the legally required deleading is $16.750. The CLPPP authorized serial number for this Letter of Full Deleading Compliance is 95593169072214-21. This number is tracked and unique to this address and unit. DO NOT LOSE THESE DOCUMENTS. If The documents are lost you will be required to have additional private inspector services that may cost you significant amounts of money. This Letter of Full Deleading Compliance is only for the address and unit noted above. If you change the street address, unit number or any other identifying information pertaining to the residential premises referred to in this Letter of Full Deleading Compliance, this Compliance Letter may be considered null and void by the Department of Public Health and/or a municipal health office. Uo not alter this document in any way. Altering this document is fraudulent and may endanger the health and safety of child which may result in significant legal consequences. In addition to any potential civil liability which may arise as the result of the alteration of this Letter of Compliance, the Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention program may seek criminal prosecution of any person who alters this document after it is originally issued. Sincerely, Gary Marciello M3169 07/22/14 Inspector License # Date Questions? Call the Department of Public Health at 1-800-532-9571. DO NOT LOSE THESE DOCUMENTS LOFDC - rev 01112 Page l of 2 ADDRESS: 21 Perry St, North Andover, MA Serial Number: 95593169072214-21 Inspection and Deleading History Comprehensive Initial Inspection done on 10/ 26 113 by Gary Marciello License#: M3169 Reoccupancy Reinspection, if needed, done on / / by License#: Final Deleading Reinspection done on 07/ IS /14 by Gag Marciello License#: M3169 DeIeading Contractor Scott AuIson Deleading Methods: ® Scraping ❑ Demolition ❑ heat Gun ® Replacement ❑ Liquid Encapsulation ❑ Other Work was done in the following rooms: Alllinterior room and Exterior License#: ® DC 001480 Exp. Date 05 / 20 / 15 ❑ DS ❑ Power Sanding ❑ Caustics ❑ Covering ❑ Making Intact Work was done on the following components: Jambs, Casing, Trite replacement, Window replacement Start Date: 06/ 23 /14 Finish Date: 071 18 /14 RRP w/additional Moderate Risk Training Moderate Risk Deleader (owner/agent) Deleading Methods: ❑ Replacement ❑ Covering Work was done in the following rooms: Work was done on the following components: Cost: $ 16,750.00 Authorization # MR - Issuance Date: Authorization # - ❑OM❑AM Issuance Date: 1 I ❑ Making Intact (interior) ❑ Capping Baseboards ❑ Making Intact (exterior) ❑ Liquid Encapsulation Start Date: 1 I Finish Date: 1 I Low Risk Deleader (owner/agent) Cost: $ Authorization # - ❑ OL ❑AL Issuance Date: 1 / ❑ OE ❑AE ❑ OB ❑AB Deleading Methods: ❑ Covering ❑ Liquid Encapsulation ❑ Capping Baseboards ❑ Replacement (ONLY doors, cabinet doors, shutters, shelves not affixed, drawers, windows on hinges) Work was done in the following rooms: Work was done on the following components: Start Date: 1 I Finish Date: 1 1 LOPM - rev 01/12 Page 2 of 2 Cost: $ ProScience Analytical Services, line. 22 Crfttv►nirrgs Park, Woburn, MA 01801 Laboratory Reporf Contact: Gary Marciello Client: M & M Lead Inspection Address: 137 Beacon Street Lawrence, MA 01843 Project # N/A P.O.# N/A Project Site: 21 Perry St., N. Andover Telephone: 781-935-3212 Facsi mite: 781-932-4857 Email: chemistrY@proscience.net Batch #: C 280165 Date received: 7/18/2014 Date analyzed; 7/18/2014 Date of report: 7/18/2014 AIHA-LAP, LLC Lab ID: 102754 Lead Analysis in Wipes Using SOP Based on SW846-742013051 Results in POP (Using customer -supplied data) Lab ID Client ID Sample date Description Result* Reporting Limit 10 C 495394 I 7/18/14 Room 5 - FL <RL 14 C 495395 2 7/18/I4 Room 5 - SL <RL 17 C 495396 3 7118114 Room 5 - ww <RL 10 C495397 4 7118114 Rear Hall FL 2 - FL 12 C 495398 5 7/18/14 Room 4 - FL <RL 10 C 495399 6 7/18/14 Room 4 - SL <RL 13 C 495400 7 7/18/14 Room 4 - WW <RL 16 C495401 8 7/18114 Blank <R1 10 Comments Simona Peave , ech. Manager Chemistry Aimee Cormier, Lab Director Page 1 of 1 Unless otherwise indicated, all samples were received in acceptable condition. *All result apply only to the samples as received and are accurate to no more than two significant figures. Unless otherwise indicated, all the quality control criteria for the method above have been met. RL - Reporting Limit( pglft') Blanks are reported in total micrograms; they are not used to correct sample results. The EPA 403 Final Rule (40 CFR 745.63) requires that all wipe samples of settled dust shall be collected using wipes that meet ASTM E1792. The analytical results, for wipes not meeting ASTM E1792, are outside the scope of our environmental lead accreditation. M & M Lead Inspectional Services INVOICE # 3101 Avatar Properties Compliance for property located at 137 Beacon Street Lawrence, MA DATE: 07/22/14 INSPECTION 21 Perry St, North Andover, MA $325.00 PLEASE REFER TO INVOICE # ON YOUR REMITTANCE Lead Inspection / Risk Assessment Report a� Gary Marciello, Lic#M3169 Page 1 Of N & 914 LeadlnsyectionaLSe"ices, Inc. Boston –617-737-2514 Belmont–&1;5-411-1011 Worcester – 978-809-1064 Lawrence – 97USS 4172 mmlead erizon.net StA Street name Street Type Unit 1011 ®�®�©❑❑❑❑❑❑❑❑❑❑❑ o�❑❑❑ 110=111 City Zip Code a❑®®�ao®�❑❑=1111❑❑❑ ®❑®�a Owners Name: Owner Address: Contact Information: Client blame (if differen Client Address: Kee Legend Column COV Covered Via Vinyl Baseboard MET Metal VR Vinyl Rep. Window MR Metal Rep. Window NA Not Accessible NC No Coating Tile 'file (testing Suggested) DC Dropped Ceiling Comments / Notes: Ce& --'9V-63Do Key Treatment Method Kev Treatment Method CAP Capped SCR Scraped COV Covered DIP Dipped ENC Encapsulated REM Removed Ml Made intact REP Replaced PRE Prepared for Enc. REV Reversed VR/MR Vinyl/Metal Rep Window MT Intact SFR Storm Frame Removed Component Does Not Exist Floor#-1—(level within building of unit being inspected) Floor# C 13 u B III A (Street Side) Start Here C Number of Rooms in Unit Prrop�etiy Type: P' Single Family ❑ Multi Family # of Units ❑ Condominium # of Units ❑ Day Care ❑ Other Laundry in Basement? (lyes ❑ ❑Yes N� Finished Space in Basement - Testing Method Used NaZS Expiration Datc: 1 1 X -Ray Fluorescence Model: -6 Serial _&,I a A (Street Side) Start Here Property Diagram 1 Unit Labels A (Street Side) Pb (lead) equal to or greater than 1.4 m/e0 with x-ray fluorescence or positive with NaZS is Dangerous. XRF Calibration Recorded In Log Book ❑�' ✓ - Check off when complete Address verified through USPS ❑r ✓ - Check off when complete Research on Lead Related History for Address ❑.r- ✓ - Check off when complete �AQu 84P e&C �! /0126 /,(.)Inspector's Na es License # Signature Date LIRA revised 01112 Page 4 of . Z� EXPLANATION OF LEAD INSPECTION / RISK ASSESSMENT REPORT FORM COLUMNS This page provides general information needed to understand the lead inspection/risk assessment report. However, you should speak with the inspector/risk assessor before you start to do any work on your home. SIDE Refers to A, B, C, or D side of the building or room. See the diagram on the cover sheet. The "A" side of the building or room is the side facing the street that gives the property its address (usually, it is the front of the building). Keeping your back to this street, from the "A" side move clockwise to the "B" side on your left, the "C" side opposite you, and the "D" side to the right. Numbering is from left to right. LOCATION/ Refers to the building component(s) being tested. Some surfaces may be made up of more than one part. For SURFACE example, "Baseboard" may refer to four separate pieces of wood (one on each wall), but is still considered one surface. LEAD The actual lead result. Each surface tested must have a result recorded in the "Lead" column. • A number shows that the surface was tested with an XRF analyzer. A number (or average number) equal to or greater than 1.0 mg/cm'- is a dangerous level of lead. • A "pos" or "neg" shows that the surface was tested with sodium sulfide. "Pas" means that there is a dangerous level of lead. • "N/A" means that the inspector was not able to test the surface. Unless the owner can get a sample to test, the inspector must assume the surface contains lead and require it to be deleaded, if necessary. • "MET" or "MR" means that a metal surface was not tested and only needs to be intact, even if it is a leaded surface. However, metal handrails, metal window sills, and metal railing caps, need to be deleaded if they test equal to or greater than 1.0 Mg/CM2, or is marked "N/A." • For key to abbreviations like "COV", "VB", "VR" or "MR", "NC", "Tile", "DC", see the cover page. • When a component box is slashed and there are test results above and below the diagonal line, the result on the "bottom" represents results below 5 ft. and the "top" result indicates the test result above 5 ft. TYPE OF Not all lead paint must be deleaded, This column tells you IF and WHY a surface needs deleading. The deleading HAZARD standards below may not apply for Interim Controls. Speak to your risk assessor for more information, • "M/1" circled means that the surface is a moveable/impacted surface and must be deleaded in its entirety. • "SF" circled indicates that there is a storm frame present which requires the blind stop and exterior sill be deleaded as interior moveable / impacted surfaces. • "A/M" circled means that the surface is "accessible mouthable" and must be deleaded to a minimum of five feet high, four inches in from the edge or corner. • "L" circled means that the surface is loose and must, at minimum, be made intact. • If more than one choice is circled, the rules for deleading may change depending upon what method of deleading you choose. Speak to the inspector for more information. • "N/A" means the inspector was unable to determine if the surface was a lead hazard. The person doing the deleading must check this surface and follow all the rules for deleading. Speak to the inspector for more information. • If nothing is circled in the column, then it is likely the surface does not need deleading. Speak to the inspector for more information. Remember, this does not mean the entire surface is lead free, it just does not require deleading in its current condition. URG HAZ? This column is only completed during a risk assessment. A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment, not all inspectors are risk assessors. If "Y" is circled, then this surface is considered an "Urgent Lead Hazard" and some type of deleading work is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the.standards for Interim Control. IC METIlI The deleading method or structural repair done to qualify the surface for Interim Control. Refer to the deleading codes key on the cover page, DELEAD The date that the lead inspector reinspects the surface and finds that it has been successfully brought back into DATE compliance. DELEAD The method used to bring a surface into full compliance. Refer to codes in the Key on the cover page of the PCAD METH EXCLUDED The amount of loose paint on a surface as measured by the lead inspector. "N/A" means that the inspector was not SURFACES able to measure the loose paint, but has determined it is more than the cut-off for moderate risk making intact. I.IRA Exp. 8/08 ADDRESS: INSPECTION HISTORY Determination Y Inspector Name: Lic# N Lead Hazards? Signature Comprehensive Initial Inspection -)- 0 N Lead Hazards? Camp Initial Lico2tDust w/Partial PCAD Ey, 77 Assessment P R.A. Name: Lead Hazards? . ,GAP Signature__ �� d'G�ff Addendum (add-on Lico2tDust to Initial Inspection) Y IN 77 Assessment P R.A. Name: Lead Hazards? . ,GAP Signature__ �� d'G�ff Addendum as Full Insp. (Lost Docs) y Lead Hazards? N Walk Through for Ed/Consultation Cityt/�Q Page 2 of INTERIM CONTROL Risk Assessment r enE Signature R.A. Name: . Lid Ut Pb. Hazards? Inspector Name: Lico2tDust Taken for Risk Assessment P R.A. Name: , Lic# . ,GAP Signature__ �� d'G�ff Inspector Name: . Lic# Final Reinspection TF Signature Visual Portion of Inspector Name:_ , Lid Reinspection for P Interim Control RA Name: Lid Signature FF Signature Dust Taken for Risk PF%.M "0111a. "LM Inspector Name: . LIC# Assessment Reins . Signature Signature Visual Portion of Reinspection for R.A. Name: , Lid Interim Control Inspector Name: . LidSignature MF Signature Dust Taken for Risk P R.A. Name: Lic# Assessment Reinsp. F Signature Inspector Name:_ . Lic# Signature REINSPECTION HISTORY Visual Portion of Reocc. Reinspection F Inspector Name: Lic# Signature Visual Portion of Reocc. Reinspection FF Dust Taken for P Reocc. Reins ection F Inspector Name: . Lic# Signature Inspector Name: , Lic# Signature Dust Taken for Reocc. Reinspection FInspector Name: Lid • Signature Visual Portion of Inspector Name: . Lic# Final Reinspection TF Signature Risk Assessment Recertification Y R.A. Name: Lic# Urgent Pb. Hazards? N Signature Dust Taken for RA P R.A Name: Lle# Recertification F Signature POST COMPLIANCE ASSESSMENT DETERMINATIONS PCAD Inspector Name: Lic# 77T I Y N Signature Lead Hazards? Full Inspection Acting as PCAD N8 Inspector Name: .Lic# Lead Hazards? Signature visual Portion ofInspector Name: ,Lic# PCAD Reinspection Visual Portion of F Signature Final Reinspection Inspector Name: Lic# F Dust Taken for P Ins Signature PCAD Reins ection Inspector Name: .Lic# tDnct Taken for Final P Inspector Name: , Lic# F ,Signature Reinsp. (No Reocc) F Signature Dust Taken for PCAD Reinspection F Inspector Name: , Lic# Dust Taken for Final Reinsp. (No Reocc) P Inspector Name:_ LIC# F Signature F Signature ADDRESS: i ePs Apt# REOCCUPANCY CERTI ICATE HISTORY Certificate of Reocctr ane Inspector Name: Lid Only after Signature High/Mod Risk (# rooms rule) Certificate of M pancy Inspector Name: Lid Only after Signature I Iigh/Mod Risk (# rooms rule) Certificate of Reoecupancy Inspector Name:Lid Signature Only after High/Mod Risk (# rooms rule) COMPLIANCE HISTORY Letter of FulI Initial Compliance Inspector Name:_ Lid No prior history/ Signature No signs of UD Letter of Interim Control Inspector Name: Lid No prior Comp. Signature Expires in I yr. Recertification of Inspector Name: Lid Interim Control Inspector Name: Lid Signature , Expires 2 yrs from original Interim Signature Control 8 Letter of Full Deleading Compliance Inspector Name: Lic# Signature Taken Ipp lnspectorName:_ „. . Lic# Dust wipes if No Reocc. Certificate of Maintained Inspector Name: " Lic# Compliance -T FFFF Signature No Work= No Dust Work = 7 Dust Certificate of Restored Compliance Inspector Name:_ Lic# Dust wipes and auth. Signature people CiI . Page 3 of COMPLIANCE HISTORY (CONT.) Certificate of Maintained Inspector Name: Lic# Com liance Signature No Work= No Dust Work = 7 Dust Certificate of Restored Compliance Inspector Name: , Lid Signature Dust wipes and auth, people Certificate of Maintained Inspector Name:_ Lid Com liance Signature No Work= No Dust Work = 7 Dust Certificate of Restored Compliance Inspector Name:_ Lic# Signature Dust wipes and auth. people OTHER HISTORY: WAIVERS/UD/EPA RRP Approved CLPPP Waiver CLPPP Insp. Name: Lid Attach to Comp Does Signature Approved CLPPP Waiver CLPPP Insp. Name: Lid Attach to Comp Signature Docs UD / DES Visual Reins ection Inspector Name: , Lic# Signature No LOC Issued F UD /DES Visual Inspector Name: Lid Reinspection , p Signature No LOC Issued 8 UD IDES Dust Taken Ipp lnspectorName:_ „. . Lic# No LOC Issued F Signature nature UD/DES Dust Taken Inspector Name: Lic# MFNo LOC Issued Signature Risk Assessor (print) Pegg,, Signature Date address of Pra erty: " , ! egg,, _ �� Apt# C€ty °�%'AI4gl� ROOM # SIDE A 8 LOCATION! LEAD SURFACE Up Walls - 0. TYPE OF HAZARD AIM L NIA URG IC iC DELEAD DELEAD HAZ? DATE METH DATE METH Y A 9 Low Walls B -A/M.L NIA Y cn Baseboards 60 AIM L NIA Y A 8 Chair Rail Y AIM L NIA Y Aa a o Radiator ©. AIM L NIA Y Floor [ AIM L NIA Y Ceiling ( AIM L NIA Y �$ Door Door Casing 2 AIM L NIA AIM L NIA Y Y 12 34 Door Jamb Threshold 0 AIM L NIA AIM L NIA Y Y A 8 Door OA A/M L NIA Y BlStop Door Casing CO AIM L NIA Y 12 Door Jamb LL NIA Y 34 Threshold AA AIM L NIA Y A B. Door C A/M L N/A Y C D Door Casing AIM L NIA Y 12 DoorJamb Y AIM L NIA Y 34 Threshold M11 AIM L NIA AIM L NIA Y A B C D Door Door Casing 0,1 A/4, AIM L NIA AIM L NIA Y Y 12 DoorJamb Part Bead AIM L WA Y 3 4 Threshold 4 AN L NIA Y A Closet Door AM L NIA Y B :CI Casing AIM L NIA Y v I Closet Jamb Y AIM L NIA Y Win Casing iCEosetftlis AIM L NIA A/M L NIA Y D Ci Baseboard �j. A/M L N/A Y 1 ;Closet Pole Int Stops QA MII AIM L NIA AIM L N/A Y 2 3 €Closet Shelf !C[Suppons {f A/M L NIA AIM L NIA Y Y 4 Closet Floor AIM L NIA Closet Ceiling A/M L NIA COMMENTS/STRUCTURAL DEFECTS: ruml Y Y KFACE-8- ounaces Elea in tnese boxes SiDE LOCATION TREASURE. LOOSE PAINT IC EC (MORE THAN 288 SQ.INI DATE METHOi) r :s r..VRA Repikooau=8 Page s; ° SIDE can LOCATION/ SURFACE Window Sill LEAD 0,1 TYPE OF HAZARD MA AIM L NIA URG IC HAZ? DATE Y IC DELEAD DELEAD METH DATE METH B Win Apron 0or AIM L NIA Y C Win Casing C1.� AIM L NIA Y D Header Stop Q M11 AIM L NIA Y int Stops t M/I AIM L NIA Y Win Int Sash U MA AIM L NIA Y 2 Exterior Silk NIA Y 3 Part Bead L NIA Y 4 BlStop 'nd 4 F L NIA Y Win €A Sash Window SiR fA L NIA W1 AIM L /VIA Y Y B Win Apron 0.(2 AIM L N/A Y C Win Casing ::Q.L AIM L NIA Y •D Header Stop &.3W AIM L NIA Y n#Stops -:qL.L M11 AIM L NIA Y 1 2P Win Int sash Exterior Sill 0,1 A/4, MR AIM L NIA q V L N/A Y Y 3 Part Bead L NIA Y 4 Blind Stop L NIA Y Win Ext Sash Window Sill ! L NIA MA AIM L NIA Y Y B Win Apron (�, AIM L NIA Y C Win Casing AIM L NIA Y D Header Stop �j. Mil AIM L NIA Y Int Stops QA MII AIM L NIA Y 1 Win frit Sash {f MA AIM L NIA Y 2, Exterior Siii Part Bead AA 01 @_& M L NIA Y Y 4 Blind Ston SF L NIA Y B Win Ext Sash Replace L NIA AIM L NIA Y Y C D A3 p Manffe Win Above 5- Ceiling Moldin 1A AIM L NIA A/M L NIA AIM L NIA Y Y Y AIM L NIA Y AIM L NIA Y J L4 be SIDEJ ' made intact only by LOCATION AIM L NIA Y a license@ d9 ea er, MEASURE: LOOSE PAINT {MORE THAN 288 SQ. IN.} -IC IC DATE METHOD Risk Assessor (print) Lio #t Signature Date Address of P1:00n:��/� �..... AiDt.# ROOM # ,�• SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELI=AD t SURFACE HAZARD HAZ. DATE METH DATE METH $ Up Walls AIM L NIA Y A e LowWalis AIM L NIA Y C D Baseboards AIM L NIA Y A s ChairRaiE AIM L NIA Y D Radiator AIM L NIA Y Floor AIM LNIA Y Ceiling AN L NIA Y A B Door AIM L WA Y C D Door Casing AIM L NIA Y 12 Door Jamb AIM L NIA Y 34 Threshold AIM L NIA Y A B Door AIM L NIA Y C D Door Casing A/M L WA Y 12 Door Jamb AIM LNIA Y 34 Threshold AIM LNIA Y A B Door AIM L WA Y C D Door Casing AIM L NIA Y 12 DoorJamb AIM L NIA Y 34 Threshold AIM L NIA Y A B Door AIM L N/A Y C D Door Casing AIM L NIA Y 12 MDoorJamb AIM L NIA Y 3 4 Threshold AIM L NIA Y A I Closet Door AIM L NIA Y B CI Casing AIM L NIA Y v ;Closet Jamb AIM L NIA Y D {Closetwalfs AIM L NIA Y ICI Baseboard A1M L NIA Y i ;inset Pale AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 Cl Supports A1M L NIAEy 4 Closet Floor AIM L NIA Closet Ceiling A!M L NIA Y :OMMENTS 1 STRUCTURAL DEFECTS: C If I .+�.�31.1 n"%J, vui LdLom IRA= rn IneSe DOXeS SiliE. LOCATION MEASURE, LOOSE PAINT IC 1C (MLIORE T14AN 288 SQ. IN,. DATE METHOD SIDE LOCATION/ LEAD TYPE OF URG IC IC 0ELEA6 DELEAD SURFACE HAZARD HAZ? DATE MM DATE METH 7A) Window SIN MA AIM L NIA Y B Win Apron a AIM L NIA Y C Win casing• A!M L NIA IFY D header Sto .� Mil AIM L NIA Y Int Stops Mil AN L NIA Y 1 Win Int Sash M!{ AIM L NIA Y 2 Exterior Sill F NIA Y 3 Pad Bead LNIA Y Blind Stop LNIA Y Win Ext Sash LNIA Y A Window Sill ( M11 AIM LNIA Y Win Apron (J AIM L NIA Y C Win Casing AIM L NIA Y •D Header Stop 60 Mlt AMM LNIA Y Mni Slops- jfl Y 0 Win Int Sash Y 2 Exterior Sill Y 3 Part Bead Y 4 Blind Stop Y Win Ext Sash Y A Window Sill MA AIM L NIA Y UB Win Apron (� AIM L NIA Y C Win Casing (j, AIM L NIA Y D Header Stop (J. MII AIN} L NIA Y Int Stops MJi PJM L NIA Y 1 Wn Int Sash (jV Mil AIM L NIA Y aExterior Sill Ca/ M/I SF L NIA Y 3 Part Bead (f • MY L N/A Y 4 Blind Stop A L NIR Y Win Ext Sash Z V L WA Y A B Fireplace AJM LNIA Y CD Mantle AIM L NIA Y Ali CD Win Above 5' AIM L NIA Y Ceiling MoldingAIM L NIA Y A/M L NIA Y AIM L N/A Y AIM L NIA Y C L %A 1ZenRooa &= Page S, Of ;a be made Intact only by a licensed de eader. SIDE LOCATION MEASURE: LOOSE PAINT lC IC (MORS THAN 288 $Q. IN.) DATE METHo ) Risk Assessor (print) Lie # Signature Date Address of Pro e & Aot # ROOM # SIDE A 8 LOCATION/ LEAD SURFACE Up Walls TYPE OF HAZARD AIM L NIA URG IC IC DELEAD DELEAD HAV DATE METH DATE METH Y AB Low Walls AIM L NIA Y c o Baseboards ANN L WA Y A s Chair Rail AIM L NIA Y A9 p Radktr AN L NIA Y Floor AIM L NIA Y 1 Ceiling AIM L N/A Y A B C D 12 3 4 Door ANN L WA Y Door Casing AIM L WA Y Door jamb AN L NIA Threshold AIM L NIA Y Y A B C D 12 34 Door AIM L NIA Y Door Casing AIM L NIA Y Door Jamb AIM L NIA Y Threshold AIM L NIA Y A B C D 12 34 Door AIM L NIA Y Door Casing ANN L NIA Y boor Jamb AIM L NIA Y Threshold AIM L NIA Y A B C D 12 34 Door A/M L NIA Y Door Casing AIM L NIA Y Door Jamb AIM L NIA Y Threshold AIN L NIA Y A B C D 1 2 3 4 Closet Door AN L NIA Y Cl Casing AIM L NIA Y Closet Jamb AIM L NIA Y Closet Walls AIM L NIARY Exterior Sill ClBaseboard AMM L NIA MN SF L WA Closet Pole AMI L NIA 3 Closet Shelf ' AIM L NIA Ci Supports AIM L NIA Closet Floor AIM L NIA Y Closet Ceiling AIM L NIA Blind Stop COMMENTS ISTRUCTURAL DEFECTS' LOCATION MEASURE. LOOSE PAINT (MORE THAN 288 SQ. IN.) F VRA RepRoawu 9% Page 1—� Of A SIDE A LOCATION/ SURFACE Window Sill LEAD Q. TYPE OF HAZARD M11 AIM L NIA URG IC IC DELEAD DELEAD DATE METH DATE METH Y B Win Apron fes. ANN L NIA Y C Win Casing 0, A/M L NIA Y Header Slop G.i MII AIN L NIA Y Int Stops 0A AAA AMM L WA Y 1 Win Int Sash G MII AIM L NIA Y 2 Exterior Sill ted/ 1 Mn SF L NIA Y 3 Part Bead C, . IMA L NIA Y 4 Blind Stop*MA L NIA Y A Win Ext Sash Window MAIM 1A L N/A Y Y B Win Apron AN L NIA Y C Win Casing AIM L WA Y -D Header Stop JW AIM L NIA Y Int Stops' MII AIM L WA Y 1 Win Int Sash MN AIM L NIA Y 2 Exterior Sill MN SF L WA Y 3 PartBead MN L NIA Y 4 Blind Stop jMfl SF L NIA Y Win Ext Sash M/I L NIA Y A Window Sill MR AN L NIA Y B Win Apron AIM L NIA Y C Win Casing AIA+! L WA Y D Header Stop MA AIM L NIA Y Int Stops MN AIM L NIA Y 1 Win Int Sash AM AIM L NIA Y 2 Exterior Sill M/I SF L WA Y 3 Part Bead Mil L NIA Y 4 Blind Stop W SF L NIA Y A B Win Fact Sash Fireplace MII L NIA hU L N/A Y Y C D Mantle AIM L NIA Y AB C p Win Above 5` AIM L NIA Y Ceiling Moldin AIM L NIA Y A/M L NIA Y AIM L NIA Y AIM L NIA Y to mese boxes can be made intact only by a licensed defeader. IC IC SIDE LOCATION MEASURE: LOOSE PAINT •1C IC DATE METHOD (MORE. THAN 288 MIN.) DATE METHOD Page Of Risk Assessor (print) /n� Lic # Signature Date rr Address cf Proa o� ,C # Ci/fi[rGt� ROOM # tr SIDE LOCATION I LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC 1 IC IDELEADI DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A e up Walls VJ AIM L NIA Y A W d SIH A B LawWalls 00 -AIM L NIA Y A B c o Baseboards 6.1 AIM L NIA (f L) Mn AIM L NIA AIM L NIA Y A B Chair Rail Mil AIM L NIA MI# AIM L NIA AIM L NIA Y A p Radiator L1 AIM L NIA Y Part Bead Floor D71A AIM L NIA Y Blind Stop Ceiling M4 SF L NIA AIM L NIA Y Win Ext Sash Window sill Door Y Y AIM L NIA Y C D Door Casing d 0 AIM L WA Y 12 34 Doorjamb Threshold 0.1 AIM L NIA AIM L NIA Y Y A B &D Door Door Casing �, AIM L WA AfM L WA Y Y 12 Doorjamb Y A►M L NIA Y 34 Threshold Y AIM L WA Y A B Door Y AIM L NIA Y C D Door Casing Y AIM L NIA Y 12 Door Jamb Y AN L NIA Y 3 4 Threshold Y Y AIM L NIA Y A B C D Door door Casing Y AIM L NIA AIM L NIA Y Y 12 Doorjamb Y AIM L WA Y 34 Threshold Y AIM L NIA Y A Closet Door Y AIM L NIA Y B CI Casing Y AIM L NIA Y C Closetjamb Y AIM L NIA Y D Closet Walls Y AIM L NIA Y CI Baseboard Y AIM L NIA Y 1 Closet Pale Y AN L WA Y 2 Cioset Shelf Y AIM L NIA Y 3 Cl Supports Y AIM L NIA Y 4 Closet Floor Y AIM L WA Y Closet Ceiling AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS: LOCATION MEASURE. LOOSE PAINT (MORE THAN 288 SQ, IN,) LYRA 1ppRmuvq W& IG IC DATE METHOD an aw Mfl AIM L NIA Y B Win Apron 00 AIM L NIA Y C Win Casing Header Stop 6.1 AIM L NIA (f L) Mn AIM L NIA Y Y Int Stags.i Win Int Sash 3 Mil AIM L NIA MI# AIM L NIA Y Y �2 Exterior Sill ZZ, SF 0 NIA Y Part Bead D71A Y 4 Blind Stop M4 SF L NIA Y A Win Ext Sash Window sill 0 WI L WA 0 MII AIM L WA Y Y B Win Apron f! AN L NIA Y Win Casing AIM L WA Y ,�Cy 4s Header S4 (/ Mll A!M L WA Y Int Stops (j'. Mll AIM L NIA Y 1 Winlnt5ash MII AIM L NIA Y (27 Exterior Sal MA SF L NIA Y 3 Part Bead Mil L NIA Y 4 Blind Stop MII SF L WA Y A Win Ext Sash Window Sill l MII L WA MII AUL NIA Y Y B Win Apron AIM L NIA Y C Wtn Casing 0.1 AIM L NIA Y E) Header Stop fQJ.2 WI AIM L NIA Y Int Stops C) -L Mil A1M L NIA Y 1 Win Int Sash rj MII AIM L NIA Y ' Exterior Sill SF & NIA Y Part Bead ¢)NIA Y 4 Blind Stop Mh SF L NIA Y Win Ext Sash MA L NIA Y AB Fireplace AIM L NIA Y CD Mantle AIM L NIA Y AB CD Win Above 5' AIM L WA Y Ceiling Molding AIM L NIA Y AIM L NIA Y AN L NIA Y AIM L NIA Y :an a made Intact only by SIDE LOCATION a licensed a ea er. MEASURE: LOOSE PAINT -IC IC (MORE THAN 288 SQ, IN.) DATE METHOD ��� /il��c►PI%� 3�G�` Inspector (print) lie # Signature Date Risk Assessor (print) Address -of Proaerty: a2 POP Lic# PG �--_. Signature Aot. # Date City.:,f1f LOCATION KITCHEN KItCHE IC DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SLI. IN.) iC DATE IC METHOI SIDE LOCATION IkLEAD SURFACEHAZARD TYPE OF URG IC HAZ? DATE IC DELEAA DELEAD SIDE METH DATE METH LOCATION! LEAD SURFACE TYPE OF URG HAZARD HAZ? A8 Up Walls • AIM L NIA Y A Window Sill Q. W AIM L WA Y A e Low Walls AIM L NIA Y Win Apron AIM L NIA Y A s Baseboards AIM L NIA Y C Win Casing AIM L WA Y A 8 Chair Rail A!M L NIA Y Header Stop [J. W AIM L NIA Y AS co Radiator 03 AIM L NIA Y Int Stops MA AIM L WA Y Floor L'(f AIM L NIA Y V Win Int Sash Cl MA AIM L N/A Y Ceiling AIM L NIA Y �2 Exterior Sill SF L NIA Y Door AIM L NIA Y Part Bead I L WA Y D Door Casing Q AIM L NIA Y 4 61ind Stop MA SF L NIA Y IIC.. W� Door Jamb AIM L NIA Y Win Ext Sash 1` L NIA Y 34 Threshold AIM L NIA Y A Window Sill MA AIM L WA Y A Boor (j. A/M L WA Y It Win Apron AIM L AMA Y C D Door Casing AIM L N/A Y C Win Casing (j AIM L WA Y 1 Door Jamb AIM L AMA Y, D Header Stop MA AIM L WA Y 3 4 Threshold AIM L WA Y Int Stops MA AIM L NIA Y B boar A/M L NIA Y 1 Win Int Sash C, WI AIM L WA Y C D Door Casing © AIM L WA Y V Exterior Sill SF L NIA Y i 2 Door lamb 0.0 AIM L WA Y 3 Part Bead L N!A Y Threshold AIM L N/A Y 4 Blind StopMA SF L WA Y Door C AAvI L WA Y Win Ext Sash Mil L NIA Y C D Door Casing U AIM L WA Y A18 Up Cab Frame 5 0 AIM L WA Y 12 Door Jamb C). AIM L WA Y Up Cab Door Wyju A/M L WA Y 4'Threshold AIM L WA Y Up Cab Walls AIM L N!A Y Closet Door— Arlin L NIA Y 12 Up Cab Shfvs Q AIM L N/A Y B CI Casing AIM L WA Y 34 Supports C• AIM L NIA Y C Closet Jamb AIM L NIA Y Low Cab Fram .0 A!M L NIA Y D Closet Walls Q AIM L NIA Y A B Low Cab Door AIM L N/A Y Ct Baseboard AIM L WA Y Low Cab Wai e,, AIM L NIA Y 1 Closet Pole AIM L N/A Y Low Cab Shly CC) AIM L NIA Y 2 Closet Shelf 00 AIM L N/A Y 12 Supports U.l; AIM L N1A Y 3 Cl Supports CJ A/M L NIA Y 34 Drawers Q AIM L NIA Y 4 Closet Floor [ rd% AAM L WA Y AS Win Above 5' M/I A IVI L N/A Y Closet Ceiling AlM NI Y MA AIM L WA Y COMMENTS 1 STRUCTURAL DEFECTS: rv�i.n r.•. n MA AAM L. N/A MA AIM L NIA MII AIM L WA MA AIM L N/A Y Y Y Y Page 7— Of Ic DATE E METH I DATE°I DMETHD C/�V�UUCU JU RrAUCJ. 7UltCG.G.1 iI.1lGU lid lIICSC UUlCC3 liCill Utl IlIC1Utl E[Riilll Vil1Y Uy Q IRLt acu umaduGI. SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SO. IN.) IC DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SLI. IN.) iC DATE IC METHOI LURA RepKitchen, 8108 Inspector (print) Lic # Signature Risk Assessor (print) Address of Properiv: 91 Lid Signature rl:r�RT :;Apt. # KITCHEN C'C4fi " Date fi W C�Gv« �_� „ SIDEJLOCATION/ LEAD SURFACE TYPE OF URG IC IC DELEAD DELEAD I HAZARD HAZ?j DATE METH DATE METH A S UP Walls . AIM L NIA Y A B Low Walls AIM L N/A Y A B Baseboards AN L N/A Y A B Chair Rail A/M L WA Y A8 Co Radiator AIM L N/A Y Y Floor 4atA/M AIM L N/A Y Mlt A/M L N/A Ceiling AIM L WA Y A B Door L WA Y C Door Casing CA ( I AIM L NIA Y 12 Door Jamb AIM L N/A Y 3 4 Threshold AIM L NIA Y A B Door AN L NIA Y Door Casing Q AIM L N/A Y 12 Door Jamb AIM L NIA Y 3 4 Threshotd AIM L N/A Y AS Door WL N/A Y C D Door Casing AIM L NIA Y 12 Door Jamb AIM L WA Y 34 Threshold AIM L WA Y A B Door AIM L NIA Y C D Door Casing AIM L WA Y 12 Door Jamb A(M L N/A Y 3 4 Threshold AIM L NIA Y A Closet Door AIM L NIA Y B Cl Casing AIM L NIA Y C Closet Jamb Q L) AIM L WA Y DD Closet Walls t; AIM L WA Y CI Baseboard AIM L WAI Y 1 Closet Pole AIM L WA Y 2 ClosetShelt AIM L NIA Y 3 Cl Supports AIM L WA Y 4 Closet Floor V� AfM L NIA Y Closet Ceiling AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS: well slnr,^ Ni Inrw nrn. vl / / ? page/ Of °R6 Date 3 4 Supports City: Date fi W C�Gv« 4111 LOCATION/LEAD SURFACE iC DATE TYPE OF URG 1C IC DELEAD DELEAD HAZARD HAZ? DATE METH DATE METH A Window Sill l Mll AIM L WA Y i Low Cala Wall Win ApronAIM AIM L NIA Y L N/A Y C Win Casing 12 A/M L NIA Y D Header Stop G ,l Mlt A/M L N/A Y AB Int Stops V•� MA AIM L WA Y 1� Wm Int Sash AIM L NIA Y W AIM L NIA Y 2 Exterior Sill IA M! SF L WA Y 3 Part Bead ! L NIA Y 4 Blind Stop MII MII SF L WA Y b Win Ext Sash Fj L N/A Y A Window Sill Win Apron MN AM! L N/A AIM L WA Y Y C Win Casing (7.{) AIM L WA Y D Header Stop (j. M1I AIM L WA Y Int Stops f! MA A/M L NIA Y 1 win Int sash (y MA AIM L NIA Y Exterior Sill SF L NIA Y V Part Bead L WA Y 4 Blind stop MA SF L N/A Y Win Ext Sash 1 L A Y A B Up Cab Frame AIM L WA Y C D Up Cab Door AIM L WA Y Up Cab Wails AIM L WA Y 12 Up Cab Shies AIM L WA Y 3 4 Supports d Uum LSCu utltudutl{, A/M L NiA Y LOCATION Low Cab Fram iC DATE AIM L NIA Y A B Low Cab Door MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) AIM L WA Y C D i Low Cala Wall AIM L NIA Y Low Cab Shtv,, AIM L WA Y 12 Supports AIM L NIA Y :34 Drawers AN L N/A Y AB C o Win Above 5' M11 AIM L NIA Y M/1 AIM l WA Y W AIM L WA Y MA A/M L WA Y MII AIM L N/A 1 MA A/M L N/Al `! I_nVLVulm-IJ OUIIOIVU�l IIa LVU III LI1WW IJUAti,] UalI Vt; IIIdtlu 11ILCIUL UIlly Uy d Uum LSCu utltudutl{, SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SR. IN.) iC DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) iC DATE IC METHO LURA RepKitchen, 8/08 'RR/17prec� Ia 3ib� Inspector (print) Lie # Signature Date Risk Assessor (print) Lid Signature Date Address of Proeti : e _ Ant #_ BATHROOM # SIDE LOCATION! ILEADI TYPEOF JURGI IC 1 IC IDELEADI DELI -AD LURA RepBath, 8/08 Page %r 010�� SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEAD DELEAD SURFACE HAZARD HAZ?j DATE METH DATE METH Low Cab Fram A;M L NIA Y A B Low Cab Door AIM L N/A Y CD LowCabWalls AIM L N/A Y Low Cab Shtv AIM L NIA I HAZARD HAZ?j DATE METH I DATE METH LSURFACE A 8 Up Walls supports AIM L WA ASML NIA Y A a Low Wails 34 AIM L NIA Y A 8 Baseboards A/M L WA Y a e Chair Rail AIM L N/A Y AB c D Radiator A(M L NIA Y C Floor Y AIM L WA Y Ceiling (., AIM L NIA Y Door 00 AIM L NIA Y C D Door Casing 0.( AIM L NIA Y 12 Door Jamb {1 AIM L NIA Y 34 Threshold AIM L NIA Y A B Door (,?L AIM L N/A Y Door Casing— -0 AIM L WA Y 12 Doordamb U( AIM L NIA Y 3 4 Threshold A/M L NIA Y A. Closet Door AN L WA Y MA A/M L NA Cl Casing AMI L N/A Y C Closet Jamb Y A1M L WA Y D Closet Walls C).j A/M L NIA Y Cl Baseboard A/M L NIA Y 1 Closet Pale A/M L WA Y 2 Closetsheif 00 AIM NIA Y 3 Cl Supports AMI L NIA Y 4 Closet Floor Y AM L NIA Y Closet Ceiling Ca j AVM L NIA Y A B Up Cab Frame A/M L NSA Y C D Up Cab Door AIM L NIA Y Y Up Cab Walls A/M L NIA Y 12 Up Cab Shlvs AMM L NIA Y 34 supports AIM L NIA Y MA RML VA Y Wt AIM L NIA Y MA AIM L NIA Y COMMENTS ISTRUCTURAL DEFECTS: EXCLUDED SURFACES: Surfaces listed in these boxes c SIDE LOCATION MEASURE: LOOSE PAINT IC to (MORE THAN 288 SQ. IN.) DATE METHOD LURA RepBath, 8/08 Page %r 010�� SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEAD DELEAD SURFACE HAZARD HAZ?j DATE METH DATE METH Low Cab Fram A;M L NIA Y A B Low Cab Door AIM L N/A Y CD LowCabWalls AIM L N/A Y D Low Cab Shtv AIM L NIA Y 1 2 supports AIM L WA Y 34 Drawers AfM L WA Y A Window Sill MA AIM L N/A Y B Win Apron (j0 1 AIM L N/A Y C Win Casing Cl AIM L NIA Y D Header Stop 1 M/I AIM L NIA Y Int Stops - 00 M/I AIM L NIA Y 1 Win Int Sash (JJ MA A/M L NIA Y ,P2 Exterior sillt' SF f)N/A Y 3 Part Bead L NIA Y 4 Blind Stop MA SF L NIA Y Win Ext Sash L WA Y AS co Win Above 5' MA AIM L NA Y AS Co Ceiling MoldjP4 MA AMM L NA Y OB CD Medicine Cab 00 MA* AN L NA Y AS Go 1wall DIC MA A/M L NA Y MA A/M L NA Y MA AIM L NA Y MA .A/M L NA Y MA A/M L NA Y W AVM LNA Y MA AIM L NA Y MA AIM L NA Y MA AIM L NA Y MII AIM L NA Y MA A/M L NA Y MA AAAI L NA Y M/1 AIM L NA Y MA AAM L NA Y COMMENTS/ STRUCTURAL DEFECTS: an ne macie intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT IC I IC (MORE THAN 288 SQ. IN,) DATE METHO (print) Lic # Signature Date tisk Assessor (print) kddress of Property: 2 ��-Q- Lic # Signature ... : _ Apt. # Date Ci - Al L A . Interi # or ' —S, Common Hallway: Front ea Floor # 31DE A D A B e 8 A8 c p �C D �}2 34 6 C D 1 r� 3 4 A B Ca 12 3 4 A B C D 12 3 4 A B C D # A B C LOCATION/ SURFACE UP Walls LEAD C) I TYPE OF HAZARD AIM L N/A URG IC ICDELEAD DELEAD HAZ? DATE METH DATE METH Y SIDE A B C D 1 2 3 4 A � D '0 491 2 /f3 4 of A B C D 1 2 3 4 LOCATION/ SURFACE Closet Door LEAD TYPE OF HAZARD AIM L NIA URG HAZ? Y Low Walls AIM L N/A Y C! Casing AIM L NIA Y Baseboards 0 AIM L NIA Y Closet Jamb AIM L NIA Y Chair Rail AIM L NIA Y Closet Walls A/M L NIA Y Radiator AIM L NIA Y CI Baseboard AIM L N/A Y Floor AIM L NSA Y Closet Pole AIM L N/A Y CeilingAIM L NIA Y �.. Closet Shelf AIM L N/A Y Door (Ja AIM L N/A Y Cl Supports AIM L NIA Y Door Casing @L WA Y Closet Floor AIM L NIA Y Door lamb (j AIM L N/A Y Threshold AIM L NIA Y Closet Ceiling AIM L NIA Window Sill L NIA Y Y Door - AIM L NIA Y Win Apron G .31 AIM L N/A Y DoorCasing AN L NIA Y Win Casing FN -IA Y Door Jamb C3H A/M L N/A Y Header Stop AIM L NIA Y Threshold AJM L N/A Y Int Stops f 1 L NIA Y Door 17 00 AIM L N/A Y Win Int Sash L NJA Y Door Casing+, AIM L NIA Y Exterior Sill q/ Mf! SF L NIA Y Door Jamb 0.),l A/M L N/A Y Part Bead CU WA Y Threshold A/M L NIA Y Blfnd.StapJAP)L N/A Y Door AIM L NIA Y Door Casing AIM L NIA Y win Ext Sash L N/A Windowsill I IM/i A/M L NIA Y Y Doorjamb AMM L NIA Y Win Apron AIM L N/A Y Threshold AN L WA Y Win Casing AIM L N/A Y Door AMM L NIA Y Header Stop Mil AMI L NIA Y— Door Casing AIM L NIA Y Int Stops AA/! AIM L NIA Y Door Jamb AIM L N/A Y Win Int Sash jMn AAM L N/A Y Threshold A/M L N/A Y Exterior Sill WI SF L NIA Y Closet Door A/M L NIAY Pao Bead MJI L NIA Y Cl Casing A/M L NIA Y Blind Stop Mil SF L NIA Y Closet Jamb AIM L NIA Y Win Ext Sash Mil L NIA Y D 1 2 3 4 Closet walls CI Baseboard Closet Pole Closet Shelf AMM L N/A AIM L NIA AIM L NIA AIM L NIA Y Y Y Y ? A e c o win Above 5' M!I RIM L N/A AB AJM ,1/r M/1 L NIA c a Ceiling Moldin M/I A/M L NIA COMMENTS 1 STRUCTURAL DEFECTS: Y Y Y Cl Supports AIM L N/A Y Closet Floor A/M L N/A Y Closet Ceiling AIM L NIA Y �•...V..VLiJ t7V + nt-OLO, OLHIM&b iisreU in mese poxes can- De made intact only by a LOCATION MEASURE: LOOSE PAINT IC IC SIDE LOCATION (MORE THAN 288 SO. IN.) I DATE I METHOD LYRA RepHall, 8148 Page! 2- of� S Ic DATE I METH IDELIA11 DATEMET D MEASURE: LOOSE PAINT IC IC (MORE THAN 288 SQ. IN.) DATE I METHOD 'Risk Assessor (print) �D Lic # Signature DAfA a4dress of Pro e ! _ A� t� _ City: Vr/kjo& ' ROOM # ._,� page/ 3 Of 21� SIDE LOCATION( LEAD TYPE OF URG IC1C DELEAD DELEAD SIDE LOCATION I LEAD TYPE OF URG IC 1C DELEAD DELEAD Y SURFACE HAZARD HAZ. DATEMETH DATE METH Radiator SURFACE HAZARD HAZ? DATE METH DATE METH rA a Up Wa11s AIMN/A Y AIM L NIA Window sill 11 !!A Y A B Low Walls AIM L NIA Y Part Bead Door 0.0 dG o Baseboards J� L/�N'IA NIA Y ' A B Chair Rai! Y AIM L NIA Y AB ca Radiator ' AIM L NIA Y Y Floor ('J AIM L NIA Y 2 Ceiling �jA A! NTA Y Part Bead Door 0.0 AIM L NIA Y C D Door C2sing AIM L NIA Y 12 Door Jamb Window S11 AJM L NIA Y 34 Threshold AIM L NIA AIM L NIA Y A B Door jj AIM L NIA Y C D Door Casing AIM L NIA Y 12 Doorjamb Win Int Sash AIM L NIA Y 34 Threshold M/t SF L NIA AIM L NIA Y A B Door Y AIM L NIA Y C D Door Casing A AIM L WA Y 12 Door Jamb Win Apron AIM L NIA Y 34 Threshold AIM L NIA AIM L NIA Y A B Door Y AIM L NIA Y CD Door Casing 1 AIM L NIA Y 12 iDoor Jamb Exterior sm AIM L NIA Y 3 4 Threshold MR L NIA AIM L NIA Y A Icloset Door MII SF L NIA AIM L NIA Y B GI Gasing MII L NIA AIM L NIA AJM L NIA Y IClosetJamb AIM L NIA AJM L NIA AIM L NIA AIM L NIA Y D i Closet Walls j AIM L NIA Y ECI Baseboard AIM L NIA AIM L NIA Y i Closet Pole AIM L NIA AIM L NIA Y 2 Closet Shefi AIM L NIA Y 3 Cl Supports AJM L NIA Y 4 1 Closet Floor 'AIM L NIA Y Closet Ceiling AIM L NIA Y !COMMENTS I STRUC t URAL DEFECTS: SIDE LOCATION MEASURE. LOOSE FAINT IC IC (MORE 1 HAN 288 S'0. IN.) DATE METHOD ;VRA RepRoom, eros Win Apron J� L/�N'IA Y C Win Casing L JA Y Header Stop /. 1 AIM C) NIA Y ' int Stops VIA Y �1 Win Ink Sash 6) NIA Y 2 Exterior Bill S NJA Y Part Bead NIA Y 4 Blind Stop S (j1 NIA Y Win Ext Sash NIA Y A Window S11 MIl AIM L NIA Y 8 Win Apron AIM L NIA Y C win Casing AIM L NIA Y •D Header Stop WI AIM L NIA Y inf Stops WI AIM L NIA Y 1 Win Int Sash M11 AIM L NIA Y 2 Exterior Sill M/t SF L NIA Y 3 Part Bead MA L NIA Y 4 Biind Stop MII SF L NIA Y A WWE)d Sash Window Sill IM11 L NIA Mll AIM L NIA Y Y B Win Apron AIM L NIA Y C Wm Casing AIM L NIA Y D Header Stop Mll AIM L NIA Y Int Stops MII AIM L NIA Y 1 Win Int Sash WI AIM L NIA Y 2 Exterior sm Mil SF L NIA Y 3 Part Bead MR L NIA Y 4 Blind S" MII SF L NIA Y B Win Ext Sash Fireplace MII L NIA AIM L NIA Y Y C D AB CD ManItle Win Above 5' Ceiling Moldin AIM L NIA AJM L NIA AIM L NIA Y Y Y AIM L NIA Y AIM L NIA Y AIM L NIA L Y ,an be made intact only SIDE LOCATION by allicensed deleader. MEASURE: LOOSE PAINT -IC 1C (MORE THAN 288 So. IN.) DATE METHOD Risk Assessor (print) Signature Da Address of Property I Apt. # _ City M+RPm 3 '(W SIDE LOCATIONF LEAD SURFACE TYPE OF HAZARD UR N A B Up Wails A/M L WA Y A B Low Walls AIM L NIA Y A B Baseboards A/ML N/A Y A a Chair Rail A/M L NIA Y AB co Radiator Floor AIM L NIA A/M L N/A Y Y Ceiling AIM L N/A Y A B C D 12 3 4 Door A/M L WA Y Door Casing AVM L WA Y Door Jamb AIM L WA Y Threshold AIM L WA Y A B C D 12 34 Door AIM L WA Y Door Casing AIM L WA Y Door Jamb AMI L WA Y Threshold AMI L WA Y A B C D 1 2 3 4 Closet Door Cl Casing AIM L WA A/M L WA Y Y Closet Jamb AMM L NIA Y Closet Walls AIM L NIA Y Cl Baseboard AIM L NIA Y Closet Pole AVM L NIA Y Closet Shelf AIM L N/A Cl Supports AIM L NIA Y Y Closet Floor AIM L NIA Y Closet Ceiling AIM L NIA Y A B D 12 34 Up Cab Frame A/M L WA Y Up Cab Door A/M L WA Y Up Cab Walls AIM L WA Up Cab Shlys AIM L WA Y Y Supports A/M L NIA Y MA AIM L WA Y WAIM L NIA Y MII AIM L WA Y "OMMENTS ISTRUCTURAL DEFECTS: G IC 1C DELEAD DELEAD SI AZ? DATE METH DATE METH r. DE LOCATION/ LEA SURFACE Up Cab Frame j D Up Cab Door Up Cab Walls 6 2 Up Cab Shlys 34 Supports A B Up Cab Frame C D Up Cab Door Up cab wafts 12 Up Cab Shiva3 4 Supports rain Low Cab F A B Low Cab Door G D Low Cab Walk Low Cab Shhr; t 2 Supports 3 4 IDrawers A B Low Cab Door C D Low Cab Wall: Low Cab Sh1w 12 Supports 34 Low Cab Frarr A B Low Cab Door C D Low Cab Wall; Low Cab Shly: 12 Supports 3 4 1 Drawers A lWindowSill B lWin Apron C Win Casing D 1Headerstop 1 2 3 4 Int Stops Win Int Sash Exterior sill Part Bead Blind Stop Win Ext Sash can be made Intact only by TYPE OF HAZARD QN/A Y CyON/A Y AIM DIA Y AIM L N/A Y A/M L / Y A/M L WA Y AIM L WA Y AIM L WA Y AIM L WA Y AIM L WA Y AIM L WA Y A/M L WA Y AIM L NIA Y AIM L WA Y AIM L N/A Y AIM L NIA Y AIM L WA Y AIM I. NIA Y AIM L NIA Y AIM L N/A Y AIM L NIA Y AIM L NIA Y AIM L N/A Y AIM L N/A Y AIM L NIA Y AIM L NIA Y AIM L N/A Y AIM L WA Y M/1 AIM L NIA Y AIM L WA Y AIM L WA Y M1I AIM L WA Y MII AIM L WA Y MR AIM L WA Y Mll SF L WA Y M/I L WA Y M/I SF L NIA Y Page4Of URGI 10 ZDATE I METH IIC DATE D°I DMETHD HA M11 L NIA Y a licensed delea 11 der. LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 80. IN.) IC DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 S0, IN.) IC DATE IC METHOD T TSA a P—P—h— Q/nR Inspector (p int) Lic # Signature I Date Risk Assessor (print)Liu # Signature Date Address of Property: d) .., c� Apt. # City: _ STAIRCASE _ Page Of SIDE LOCATION! LEAD TYPE OF UP.G IC iC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD 34 SURFACE AIM L NIA Y HAZARD HAZ? DATE METH DATE METH J9 D SURFACE HAZARD HAZ? DATE METH DATE METH A B o Up Waifs 34 AIM L NIA Y A A Window SillM/I AIM L NIA Y A B Low Walls00 AIM L NIA Y Door AIM L NIA Y C D Door Casing AMI L NIA Y f3 Win Apron AIM L N/A Y A D Baseboards fl Z AIM L N/A Y Door Casing ; ASM L NIA Y # DOarJamb AIM L NIA Y AIM L NIA C Win Casing A AIM L WA Y A 9 Chair Rail0 .` AIM L NIA Y AIM L N/A Y D Closet Walls A/M L NIA Y SF L N/A Cl Baseboard I A/M L NIA Y 1 Closet Pole , AIM L NIA Y 2 Closet Shelf AIM L NIA Y hteaderStop Cl. Supports MIf A!M L NIA Y AB AIM L N/A Y A/M - L NIA Closet Ceiling AIM L NIA I Y Handrail c ? AIM L NIA Y Balusters AIM L N/A Int Stops M/I AIM L N/A Y C p lRadiatOr A/M L NIA Y Floor r(,tJ AIM L WA Y r=At,LU V=v auhr-K;t6: surtaceS listed in these boxes c LOCATION MEASURE: LOOSE PAINT IC 1C (MORE THAN 288 SQ. IN.) DATE I METHOD LURA Rer)Siair. 8/08 1 Ceiling AIM L NIA Y A Door N/A Y D D1 2 Door Casing NIA Y DoorJamb q. NIA Y 34 Threshold AIM L NIA Y A B Door AIM L NIA Y J9 D Door Casing NIA Y 112 Door is . &ON/A Y 34 Threshold AIM L NIA Y A Door ASM L NIA Y Q 11 2 Door Casing Door Jamb i N/A Y NIA Y 34 Threshold AIM L NIA Y A B Door AIM L NIA Y C D Door Casing AMI L NIA Y 12 Door jamb AIM L NIA Y 34 Threshold Door A1M L N/A Y AIM L NIA Y A B C D Door Casing ; ASM L NIA Y # DOarJamb AIM L NIA Y AIM L NIA Threshold AIM L NIA Y A Closet Door A/M L NIA Y B CI Casing AIM L NIA Y C Closet Jamb AIM L N/A Y D Closet Walls A/M L NIA Y SF L N/A Cl Baseboard I A/M L NIA Y 1 Closet Pole , AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 Cl. Supports AIM L NIA Y 4 Closet Floor AIM L N/A Y A/M - L NIA Closet Ceiling AIM L NIA I Y r=At,LU V=v auhr-K;t6: surtaceS listed in these boxes c LOCATION MEASURE: LOOSE PAINT IC 1C (MORE THAN 288 SQ. IN.) DATE I METHOD LURA Rer)Siair. 8/08 1 Win Int Sash MIf AIM. L WA Y 2 Exterior sill MIA SF L NIA Y 3 Part Bead MA L NIA Y 4 Blind Stop M1I SF L N/A Y Win Ext Sash M/I L NIA Y A Window Sill M/1 A/M L NIR Y B Win Apron A(M L NIA Y Win Casing AIM L N/A Y D Header Stop MA AIM L NIA Y Int Stops M/I AIM L N/A Y 1 Win Int Sash M/I AIM L NIA Y 2 Exterior Sill T.MIESF L N/A Y 3 Part Bead M/I L NIA Y 4 Blind Stop M/I SF L N/A Y Win Ext Sash MA L NIA Y Newel Post AIM L NIA Y Railing Cap A/M - L NIA Y Handrail c ? AIM L NIA Y Balusters AIM L N/A Y Lower rail el AIM L NIA Y Treads AM L N/A Y Risers W AIM L N/ALy Stringer AMI L N/AFloor Edge AIM L WAFloor Casing AIM L NIA M/I AN L N/A Y 77 COMMENTS/STRUCTURAL DEFECTS: an be made intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT 1C IC (MORE THAN OM SO. IN.) DATE METHOD Risk Assessor (print) Lic # Signature Date Address of pro 2 e%R &t, # t^ r /tff c r — ROOM # ....._ Page f6 Ofd' [AE1: LOCATION/ SURFACE Up Walls LEAD aV TYPE OF HAZARD AIM ! WA URG IC HAZ? DATE YWindow IC DELEAD DELEAD METH DATE METH SIDEJ B C D 2 3 4 LOCATION! SURFACE Sill LEAPJ TYPE OF HAZARD ~ MI AIM ! N/A URG IC KAZ. DATE Y IC DELEAD DELEAD -METH DATE METH A B Low Walls 'AIM.L NIA Y Win Apron AIM L NIA Y C D Baseboartis NIA Y Win Casing G AIM N/A Y A a Chair Rail AIM L NIA Y Header Stop 0.- M11 AIM L NIA Y n a Radiator d AIM L WA Y int Sto s p 6. h+Yl AfM L NIA Y " l AIM L NIA Y Vc-elolilng- Win Int Sash Q �,) M11 AIM L WA Y AIM L WA Y Exterior Sill [6() MA SF L NIA Y C D 12 Door N/A. Y Part Bead -W Mli L WA Y _e Door Casing WA Y Blind Stop SF L WA Y Door Jamb NIA Y Win Ext Sash (} MR L NIA Y 34 Threshold AN L NIA Y B C •D 1 (� 3 4 A 8 C D 1 2 3 4 Window SM Q. MR AIM L NIA Y A B D 12 34 Door CeWL NIA Y Win Apron�:� j AIM L N/A Y Door Casing L NIA Y Win Casing [j. AIM L NIA Y Door Jamb NIA Y Header Stop (j W AIM L WA Y Threshold AIM !NIA Y Inti stops (j . NUI ARM L NIA Y �A B 149 12 34 Door L NIA Y Door Casing L NIA Y Win IM Sash 0-A MR AIM L NIA Y Exterior Sill ((.t j MA SF L NIA Y Door Jamb L NIA Y Part Bead CZL) JMR L NIA Y Threshold AIM L NIA Y Blind Shap AA 60 & L NIA Y AB CD 12 3 4 Door AIM L NIA Y Door Casing AIM L NIA Y Win Ext Sash 0), WI L NIA Y Window Sill MR AIM L NIA Y Door Jamb AMM L NIA Y Win Apron AIM L NIA Y Threshold AIM L N/A Y Win Casing AIN L NIA Y A; B D 1 2 Closet Door '' L NIA Y Header Stop MI AIM L N/A Y CI Casing L NIA Y Int Stops MR AIM L NIA Y Closet Jamb L NIA Y Win Ent Sash MR Aim L NIA Y Closet Wails AIM L NIA Y Exterior all Mil SF L N/A Y CI Baseboard AA AIM L Y Part Bead MR L N/A Y Closet Pole Attu! L N)A Y Blind Stop MA SF L NIA Y Closet Shelf AN L NIA Y Win Ext SashMI L NIA Y 4 1 Cl Supports r NIA Y AS C D Fireplace AIM L WA Y Closet Floor �. AIM L NIA Y Mantle AIM L WA Y Closet Ceiling AIM L NIA Y A n Win Above 5' AIM L WA Y COMMENTS I STRUCTURAL DEFECTS: Ceiling Moldin AIM L NIA Y AIM. L NIA Y AIM L N/A Y AIM L NIA Y LU U_ A Surfaces listed in these boxes can be made intact only by 2 licensed de ;a - der. -SIDE LOCATION MEASURE. LOOSE PAINT (MORE THAN 288 SQ. IN.) IC DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) -IC DATE IC METHOD LIl.RA doom, Slob Risk Assessor (pdnt) Lic # Signature Address of Proe : 9 ROOM # Page �OE _2_� SIDE LOCATIONI SURFACE LEAD TYPE OF URG IC HAZARD €JAZ? DATE IC DELEAD DELEAD METH DATE METH SIDEJ LOCATION/ LI MID SURFACE TYPE OF URG IC HAZARD HAZ? DATE IC DELEAD DELEAD METH DATE METH A B Up Walls AIM L NIA Y A B C D 1 2 3 4 Window SIII MII AIM L NIA Y A B Low Walls AIM L NIA Y Win Apron AIM L NIA I Y A B C D Baseboards AIM L NIA Y Win Casing A1M L NIA Y A B Chair RaiE AN L NIA Y Header Slop MA AIM L NIA Y AB CD lRadiator AIM L N/A Y Int Stops M/I AIM L NIA Y Floor AIM L NIA Y Win Int sash MA AIM L NIA Y Ceiling AIM LVA Y Exterior StII MA SF L NIA Y A B Door AIM L NIA Y Part Bead MA L NIA Y C Q Door Casing AIM L NIA Y Blind Stop MA SF L NIA Y 12 Door Jamb AIM L NIA Y Win Ext Sash MR L N/A Y 3 4 Threshold AIM L NIA Y A B C •D 1 2 3 4 Window Sill M/1 AN L NIA Y A $ Door AIM L NIA Y Win Apron AIM L NIA Y C D Door Casing AIM L NIA Y Win Casing AIM L NIA Y 12 Door Jamb AIM L N/A Y Header Stop M/I AIM L NIA Y 3 4 Threshold AIM L NIA Y tntStops M11 AMM L NIA Y A B Door AIM L NIA Y Win Int Sash W1 AIM L NIA Y C D Door Casing AIM L NIA Y Exterior Sill M11 SF L NIA Y 12 Door Jamb AIM L NIA Y Part Bead MA L NIA Y 3 4 Threshold A/M L NIA Y IBFind Stop WI SF L NIA Y A B Door AIM L NIA Y I IWIn Ext Sash MA L NIA Y C D Door Casing j AIM L NIA Y A B C D 1 2 3 4 Window Sill MR AAVs L N7A Y 12 Door Jamb AIM L WA Y Win Apron AIM L NIA Y 3 4 Threshold AIM L NIA Y Win Casing AIM L NIA Y ' A Closet Door L NIA Y Header Stop Mil AIM L NIA Y 1$ CI Casing ixL NIA Y Ent Stops M/I AIM L NIA Y 51 's. Closet Jamb L NIA Y Wm Int Sash MR AIM L NIA Y 'C€oset Walls ()� AIM L NIA Y Exterior Sill M11 SF L NIA Y 'C€ Baseboard ()NIA Y ,' Part Bead MR L NIA Y Closet Pale fi. AIM L NIA Y Bend Stop M11 SF L NIA Y 2 Icioset shelf or A!M L NIA Y Win Ext Sash MA L NIA Y 3 (Cs Supports j. L NIA Y A B C D Fireplace AIM L NIA Y Closet Floor AIM L NIA Y Mange AAM L NIA Y Closet Gelling { G.1 AIM L NIA Y AB c p Win Above 5' A/M L NIA Y §COMMENTS 1 STRUCTURAL DEFECTS: 9 s Ceiling Motdint AIM L NIA Y AIM L NIA Y AIM L NIA Y Aim L NIAY EXCDED SUR FAM: uriaces listed in these Axes can be made iniacfi only y a fcensed eIeader. 1 SIDE _OCA':1ON MEASURE. LOOSE PAINT (MORE THAN 288 SO, IN €C DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT {MORE THAN 28B SQ_ 1N.} ]C DATE IC METHOD 3 UfR.A ReaReow, W8 Risk Assessor (print) A n Lic # Signature Date ROOM Page %g0;415 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ, DATE METH DATE METH SURFACE HAZARD HAV DATE METH DATE METH B Up Walls ('E{/ A/M L NIA Y A Window Sill Mil AIM L NIA Y AC T3 B Low Walls AIM L NIA Y B Win Apron 00 AIM L NIA Y U Baseboards t" NIA YC Win Casing AIM L NIA Y A a Chair Rail AIM L 'NIA Y D Header Stop C)a MA AIM L NIA Y AB C c Radiator A/M L NIA Y Int Slaps M11 AIM L NIA Y FloorC AIM L NIA Y 1 Win Int Sash MII AIM L NIA Y Ceiling AIM L N/A Y 2 Exterior Sill F L NIA Y P$ Door AIM L WA Y 3 Part Bead L NIA Y D Door Casing f'Y NIA Y 4 Blind Stop L NIA Y g1 2 Door Jamb NIA Y Win Ext Sash L NIA Y 3 4 Threshold Door AIM L NIA AIM L NIA Y Y A Window Siil B Win Apron WI AIM L NIA AIM L NIA Y Y A B C D Door Casing AIM L NIA Y C Win Casing AIM L NIA Y 1.2 Door Jamb AIM L NIA Y •D Header Stop MII AIM L NIA Y 3 4 Threshold Door AIM L NIA AIM L NIA Y Y nt Sups MR AIM L NIA 1 Win IM Sash MIl AIM L NIA Y Y IAB l C D Door Casing AIM L NIA Y 2 Exterior Sill MII SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead MR L NIA Y 134 Threshold Door AIM L NIA AIM L NIA Y Y 4 'Mind Stop Mil SF L NIA Win Ext Sash M11 L NIA Y Y A B C D boar Casing IDoor AIM L WA Y A Window Sill MR AN L NIA Y ( 12 Jamb AIM L NIA Y B Win Apron AIM L NIA Y 3 41 Threshold 'Closet Door A/M L NIA A/M L NIA Y Y C D Win Casing Header Stop AIM L NIA Mil A/M L NIA Y Y —A B jCl Casing AIM L NIA Y Int stops MII AIM L NIA Y I Gloset Jamb AIM L NIA Y 1 Win Int sash MIl AIM L NIA Y Closet Walls AIM L N/A Y 2 lExtarior Sill M/i SF L WA Y F Ci Baseboard AIM L NIA Y 3 Part Bead M11 L NIA Y 1 Closet Pole AIM L NIA Y 4 Blind Stop MR SF L NIA Y 2 Closet ShellAIM L NIA Y Win Ext Sash M/1 L NIA Y 3 {Ci supports AIM L NIA Y AB Fireplace AIM L N/A Y 4 ;Closet Floor AIM NIA Y CD Mantle AIM L NIA Y Closet Ceiling AIM L NIA Y AS co Win Above 5' AIM L NIA Y COMMENTS / STRUCTURAL DEFECTS: Ceiling Moldin AIM L NIA Y 2 )1W-1A0W ZNMrA—C�' AIM .L WA Y AIM L NIA Y AIM L WA Y EWILIDED L1 ASurfaces listea In these boxes can a made Intact only by a licensed de eader. S.rDEld' LOCATION MEASURE. l_OOSE PAINT IC IC SIDE LOCATION MEASURE: LOOSE PAINT -IC IC (EvIORE THAN 288 SG! !N-) DATE METHOD(MORE THAN 288 SQ, IN.) DATE METHOD a ixORA R0PR*0 m, sM Risk Assessor (print) Lic 4 �1. Signature Date Address of Pro e S Ant # Ci Roots # �_ " Page /10' �� SIDE LOCATION/ LEAD TYPE OF URGIG IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A 8 Up Walls AIM L NIA Y A Window Sill 0 MR AJM L NIA Y A B Low Walls -AIM L NFA Y g Win Apron AIM L NIA Y Ap Baseboardsqq WAY (i Win Casing AIM L N/A Y A g Chair Rail AIM L NIA Y D Header Stop ,� MR AIM L NIA Y G D Radiator 0 AIM L NIA Y Int Stops ' t3.I MA AIM L NIA Y Floor �� AIM L NIA Y 1 Win Int Sash MA AIM L NIA Y Ceiling AIM L NIA Y 2 Exterior Sill C� MR SF L NIA Y B Door (I' . AIM L NIA Y $ Part Bead MR L NIA Y C D Door Casing L N/A Y 4 Blind Stop (f WI SF L NIA Y i 2 Door Jamb L NIA Y Win Fact Sash MA L NIA Y :i 4 Threshold L NIA Y A Window Ski M11 AIM L NIA Y Door AIM L NIA Y 8 Win Apron AMM L NIA Y I;D Door Casing q. L WA Y C Win Casing AIM L NIA Y 2 Door Jamb - LNIA Y14 D Header Stop MII AIM L NIA Y 34 Threshold AIM L NIA Y 1nt Stops MA AMI L NIA Y AB Door A/M L NIA Y 1 Win Int Sash WI AIM L NIA Y C D Door Casing AIM L N1AY 2 Exterior Sill MR Sr L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead MR L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop WI SF L NIA Y A 8 Door AAvI L NIA Y Win Ext Sash MR L NIA Y C D Door Casing AIM L NIA Y A Window Sill W AIM L NIA Y 12 Door Jamb AIM L NIA Y B Win Apron AIM L NIA Y 34 Threshold AM L NIA Y C Win Casing AIM L NIA1 Y A Closet Door (j� AIM L NIA Y D Header Stop MA AM L NIA Y S Cl Casing L NIA Y Int Stops Mn AIM L NIA Y AC Closet Jamb L NIA Y 1 Win Inf Sash MA AMS L NIA Y �D close[ Walls AA,9 L ff/jI Y 2 Exterior SIII W SF L NIA Y 1 CI Baseboard L NIA Y 3 Part Bead MR L NIA Y Closet Pole AIM L NIA Y 4 Blind Stop MR SF L NIA Y 2 Closet Shed AIM L NIA Y Win Ext Sash MIR L NIA Y 3j Cl Supports OLNIA Y A 8 Fireplace ARVI L WA Y 4 Closet Floor AIM L NIA Y CD Mantle AIM L NIA Y Closet Ceiling AIM L NIA Y p Win Above 5' AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS: Ceiling MoldinE AIM L NIA Y AIM L NIA Y AIM L NIA Y AIM L NIA Y MCODED SOK FACES: u ces listed in these boxes can be made intact only by a licensed deleader. 11DE LOCATION MEASURE. LOOSE PAINT IC IC SIDEJ LOCATION MEASURE: LOOSE PAINT -IC lC I (MORE THAN 288 SO. IN.) DATE METHOD (MORE THAN 288 80, IN.) DATE METHOD i LMA RepRooim6 VM Inspector Lic # Sign2ture /64,16- Date G-dG Date Risk Assessor (print) tic # Signature Date Address of Pro erty A t. # Cif -,0, Ael,�GrJ STAIRCASE lylA O A SIDE LOCATIOW - - - - LEAD TYPE OF vn t r, /yc URG IC IC DELEAD DELEAD URG IC SURFACE HAZARD HAZ?, DATE METH DATE METH A o Up Wails AIM L NIA Y A B Low Walls AMI L NIA Y A 8 Baseboards AIM L NIA Y A e Chair RailJ�; AIM L MIA Y A8 Win Casing AIM L NIA CD lRadiator AIM L NIA Y MII Floor A/M L NIA Y _41Ent Ceiling AIM L NIA Y A B Door AIM L NIA Y k4w. M/l Door Casing Y 2 Exterior Sill AIM L NIA Y 12 DoorJamb a AIM L NIA Y 3 4 Threshold AIM L NIA Y A B Door J AN L NIA Y C D Door Casing AN L N/A Y 12 Door JambA!M L N/A Y 34 Threshold A(M L NIA Y A B Door A/M L N/A Y C D Door Casing AIM L NIA Y 12 Doorjamb ! A/M L NIA Y 3 4 Threshoid AIM L NIA Y A B Door AIM L WA Y C D Door Casing AIM L NIA Y 1 2 Doorjamb AIM L NIA Y 3 4 Threshold AIM L NIA Y A B Door AIM L N/A Y C D Door Casing AIM L N/A Y W Door Jamb AIM L WA Y 3 Threshold AIM L NIA Y A Closet Door A/M L NIA Y B CI Casing AIM L NIA Y C Closet Jamb AIM L NIA Y Y Newel Post D Cioset walls AIM L WA Y Cl Baseboard AIM L NIA Y 1 Closet Pole AIM L NIA Y 2 Closet Shell AIM L NIA Y 3 Cl Supports AIM L N/A Y 4 Closet Floor AIM L NIA Y Closet CeilingIT AIM L NIA Y Treads('� Cvf�l 1Inrn- L_AvT>,V VCLJ SURFACES: Irsteci in these boxes c LOCATIO_73N MEASURE. LOOSE PAINT IC IC (MORE THAN 288 S4. IN.) DATE METH00 LVRA ReDSiair. 8108 -70 Page W1 Of SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH A Window Sill M/I AIM L NIA Y B Win Apron AIM L NIA Y C Win Casing AIM L NIA Y lD Header Stop MII AMI L NIA Y _41Ent Stops MII AIM L NIA Y 1 Win Int Sash k4w. M/l AIM L NIA Y 2 Exterior Sill MIl SF L NIA Y 3 Part Bead Wl L WA Y 4 Blind Stop Mil SF L NIA Y Win Ext Sash WI L NIA Y A Window Si[i M/I AIM L NIA Y B Win Apron AIM L NIA Y —Y C Win Casing AIM L WA D Header Stop Mil AIM L WA Y Int Stops Mil AIM L NIA Y 1 Win Int Sash MA AIM L WA Y 2 Exterior Sill W SF L WA Y 3 Part Bead MA L NIA Y 4 Blind Stop I. IM/1 SF L NIA Y Win Ext Sash IMP L NIA Y Newel Post AIM L NIA Y Railing Cap AIM L NIA Y Handrail , AIM L NIA Y Balusters AIM L NIA Y Lower rail _ AIM L WA Y Treads('� A/M L NIA Y Risers Qr AIM L N/A Y Stringer AIM L WA Y Floor Edge Cae AIM L WA Y Floor Casing AIM L NIA Y MI! AIN/ L N/A I Y COMMENTS/STRUCTURAL DEFECTS: an be made intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT IC fC (MORE THAN 289 80, IN.) DATE METHOD (print) U0 # %1 �l- Date ,Risk Assessor (print) L;c' Signature Date Address of Pro erty: EXTERIOR ASI '�.. �.-.. SIDE LOCATfOV LER TYPE OF URGlC iC DEL EAD DELEAD SIDE A SURFACE HAZARD uAZ? DATE METH DATE METH A HAZARD Siding <GV L NIA Y Window S[I[ Corner Boards 1, L NIA Y A A Lower Trim p/ L NIA Y AIM L NIA Y Upper Trim EU L NIA Y AIM • L WA Win Abcve 10 L ,ylA Y A L N1A Porch Above A L NIA Y Ce? Win Sash Storm Door AN L NIA Y Y Cei Win FrameL Door AIM L NIA Y NIA A Door Casing A; -M L RA Y A 1 2 Door Jamb A1M L NI v A Cellar Win Sill 3 4 Threshoid AIM L NIA Y � Cal Win Sash Kidplate AIM L WA Y VM L NIA Y Storm Door ;VM ? NIA Y A A/M L WA Door AM L NIA Y Screen Frame A Door Casing AM L NIA Y Y 1 2 Door ,iami; AIM L WA Y AIM L NIA 3 T hreSEiGid AVM L NIA Y A AIM L NIA Kickplate AIM L NIA , Ce! Win Fram AIM .L NIA Y Screen Frame Dor AN L NIA Y AIM L N!A A Door Casing AiM L WA Y 2 Door Jamo A1M L NV'A Y Cel Win Sash i �3 d Threshold A Gel Win Frame nVM L NIA Y AAA L WA Y Window SiIE (� A/M ! NIA Y A Win Casing 1'4/ Aim L NIA Y Foundation r Window Sash c. AiM L NiA Y Bulkhead Window Sill t "% AM. L N,•A Y AIM 1. ,NlA A) win Casing fV AVML NIA Y A A/M L NIA Window' Sash AIM L NiA Y Shutters Window Sill fp,V A/M L NIA Y Y A 'Nin Casing fe A,`M L NiA Y AIM L NIA Y fincore Sash l� l n'M L NIA Y A Lamp Past I11 NIA Y Handrail j COMMENTS I STRUC ")-RAL DEFECTS: Y Excluded Surfaces: Surfaces listed in this box can be made intact only by a licensed deleader .LOCATION ME;suRF:LOOSEPAINT IC !C (MORE 'HAN .440 50. IN.) DATE mE� 14 A n A A A Page °Z1 Ofa 3, LOCAT[ONI LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH Window S[I[ PJM L NIA Y Win Casing AIM L NIA Y Window Sash AIM • L WA Y Cellarwin Sif[ ,{� . L N1A Y Ce? Win Sash A/M L N1 Y Cei Win FrameL NIA Y Saeen Frame, 0S AIM 'L N/A Y Cellar Win Sill AIM L NIA Y Cal Win Sash VM L NIA Y Cel Win Fram A/M L WA Y Screen Frame AIM L NIA Y Cellar Win Sill AIM L NIA Y Cel Win Sash AIM L NIA Y Ce! Win Fram AIM .L NIA Y Screen Frame AIM L N!A Y CeWW[nBill AN L NrA Y Cel Win Sash AIM L NIA Y Gel Win Frame AAA L WA Y Saeen Frame AN L NIA Y Foundation N1A Y Bulkhead AIM 1. ,NlA Y Fences A/M L NIA Y Shutters AIM L NIA Y Newel post AIM L NIA Y Railing Cap AIM '•- NIA Y Handrail j AIM L NIA Y Balusters AIM L NIA Y Lower Rail VM L N/A Y Treads V A(M L NiA Y Risers �L- AIM 'L NrA v Stringer t✓ A.VM L NiA Y i attiref AIM L NIA Y Drain pipes L NIA Y ElecConduit r NIA Y Oil Fill Pipe L NIA Y Overhang kIPA L NIA Y -1 I pQt I IVQUJL;l Must be less than 400 wn ;or play area .11200 ppm for bare soil) LOCATION .aR$A MEASURF-MEN7 SUI -7 REM_O i; 5ouar6 Feet (PPM) DATE METH Play Area Bare soil Comments: Risk Assessor (print) TYPE'OF i_icft Signature Address of Proper#,,: "Ol I D&QF,,, Window Siff AIM L NIA EXTERIOR S Side B Win Casing AIM ! NIA t_ # SIDE LaCATiONI LEAD iYPE OF URG 10 IC DELEAD DELEAp B SURFACE HAZARD HAZ? DATE I+AETFi DATE MEi H Siding e L NIA Y AIM L NIA Comer Boards (`a,/ L NIA Y Y l� Lower Trim P.V L NIA Y $ Cel Win Sash Upper Trim 6'V L NIA Y AIM L NIA Win Above 5' Ca/ L NiA Y Y Porch Above 5,L NIA Y $ Cel Win Sash Storm Door AIM L NIA Y AIM is NIA GOoF AIM L WA Y Y B Door Casing AIM L NIA Y B Cel Win Sash 1 2 Door Jamb Aflv4 L NIA Y AIM L NIA 3 4 Threshald AIM L NIA Y Y Kictpla`te AN L NIA Y B 8uikhead Storm Door AIM L NIA Y , AIM L NIA Door G. ® Door Casing AIM L NIA Y Y (V AIM L NIA Y Railing Cap Doorjamb AIM L NIA i Y AIM L :VIA 3 4 Threshold Q (,! rCf2 AIM L NIA Y Y rGckplate ,/ AN L NIA Y reas L Door > Q ` AIM L NIA Y AIM L; NIA Door Casing } AIM L N;A, Y Y 1 4) Door Jamb AIM Y Drain Floes L NIA L NIA Y L NIA 3 4 Threshold AIM i_ NIA Y Y Window Sii! AIM L NIA Y B win Casing VFA L NIA Y AREA MEASIJI'P.kMNT =r Wir.-dow Sash AIM L NIA Y window Sill AIM ;. NIA Y ;PPM B Vvir) Casing AIM L NIA Play Area r Vlindow Sash AIM NIA Y Window Sill AIM L NiA Y Win Casing Alhd L NIA' IV Y Window Sash AIM L N+A Y B Lamp Prost L NIA Y COMMENTSISTRUCTURALDEPECTS: YActrs3 Excluded Surfaces: Surfaces listed in this box car: be made intact only by a licensed deleader a S!CE LOCA <ION c MEASURE: LOOSE PAINT i0 IC € ^ {MORE THAN '44C SQ. IaN. DATE ME?H A A L, i P, A FtcpEXt. P,. S,o8 Date SIDE LOCATION/ LEAD TYPE'OF URG iC IC DELEAD DELF_AD B SURFACE HAZARD HA27 DAT-, METH GATE METH Window Siff AIM L NIA Y B Win Casing AIM ! NIA Y n Window Sash . AIM L NIA Y Cellar Win SillC,,,/ AIM- L WA Y B Cel Win Sash AIM L NIA Y it Cei Win Frame �•. + AIM L NIA Y Screen Frame tP,/ AIM L NIA Y Cellar Win Sill AIM L NIA Y $ Cel Win Sash AIM L NIA Y Cel Win Frame AIM L NIA Y Screen Frame AIM L NIA Y Cellar Win Sill AIM L NIA Y $ Cel Win Sash AIM L NIA Y Ir Cal Win Frame AIM is NIA Y Screen Frame AIM L NIA Y Cellar Win Sill AIM L NIA Y B Cel Win Sash AIM L N/AEY Cel Win Frame AIM L NIA Screen Frame AIM L NIA Y Foundation L N1A Y B 8uikhead AIM L NIA v :::J Fences— L , AIM L NIA — — Y Shutters AIM L NIA Y Newel post kM L NIA Y Railing Cap AIM L NIA Y + AIM L :VIA Y NHandraofllel AIM L NIA Y AIM L NIA Y reas L AIM L NIA Y Risers L'" AIM L; NIA Y Stringer AIM L NIA Y Lattice AfM t NIA Y Drain Floes L NIA Y B Efec Conduit L NIA Y Oi[ Fill Pipe L NIA Y Overhang Trim AIM L NIA Y Soil Test Results (Must be less than 400 ppm for play area 11200 ppm for bare soil) LOCATION AREA MEASIJI'P.kMNT RESUTDATEE EMED REMED Square Feet) ;PPM ME-r,.H Play Area Bare soli Comments: Hisk Assessor (print) Lice' Signature Date Address of Pro erl : "��. Apt. # C i t V EXTERIOR C Side 22 � PagevKJOf� SIDE C LOCATION! SURFACE LEAD TYPE OF HAZARD URG IC HAZ? DATE IC DELEAD DELFA11 METH DATE METH 110E C LOCATION! LEAD SURFACE TYPE OF URG IC IC DELEAD DELEAD HAZARD HAZ? DATE METH DATE METH C Siding aj., LNIA Y DATE G 4 Window Sill AIM L NTA Y Corner Boards CV L NIA Y Win Casing AIM L NTA Y Lower Trim c j L NIA Y Window Sash AIM L NTA Y UpperTrim ''r;./ L N/A Y C # Cellar Win VI A/M L NIA Y Win Above 5' !#4 L NIA Y Cal Win Sash AIM L NIA Y Porch Above 6Z L NIA Y Cal Win Fame AIM 'L WA Y Storm Door ATM L WA Y Sween Frame AIM L NTA Y C 1 2 34 Door AVM L NIA Y C Cellar Win Sig AIM L NIA Y Door Casing AIM L NIA Y Cel Win Sash AIM L N/A Y Door Jamb AIM L NIA Y Cel Win Frame AIM L N/A Y Threshold AIM L NIA Y Screen Frame AIM L NIA Y Kickpl8te AIM L NIA Y C # Cellar Win Sill AIM L NTA Y Storm Door AVM L NIA Y Cel Win Sash AIM I NIA Y Door -AIM L NIA Y Cel Win Frame PJM L NIA Y Door Casing AIM L NIA Y Screen Frame AIM L WA Y 1 2 3 4 Door Jamb AIM L NIA Y C # C C Cellar Win Sill AIM L N/A Y Threshold AIM L NTA Y Cel Win Sash AIM L N/A Y Kickplate AIM L NIA Y Cel Win Frame A/M L NSA Y C 1 2 3 4 Door A/M L WA Y Door Casing AVM L NIA Y Screen Frame AMI L NIA Foundation CAV L NIA Y Y Door Jamb AIM L N/A Y Bukhead AIM L NIA Y Threshold AIM LVA , Y Fences A/M L N/A Y {,i # Window Sill AIM L NTA Y Win Casing AIM L NIA Y Shutters AIM L NIA Newel post AIM L NIA Y Y Window Sash AIM L NIA Y Railing Cap A/M L NIA Y C Window Sill AIM L N/A Y Handrail AN L NIA Y Win Casing AAM L NIA Y Balusters AIM L NIA Y Window Sash AVM L NIA Y Lower Rail AIM L NIA Y C # Window Sill AIM L WA Y Treads AVM L NIA Y Win Casing AIM L NIA Y Risers AIM L NIA Y lWindow Sash AIM L NIA Y Stringer "AIM L N/A Y C Lamp Posy L NIAJ Y I I Lattice AIM L NIA Y COMMENTS I STRUCTURAL. DEFECTS: C I A A Q...4 n...e_ _ 4:_ C Drain Pipes L NIA Y Elso Conduit L NIA Y Oil Fill Pipe L WAI Y Overhang Tri AN L NIA Y V oa. wL LRL-OJ•IIW LUV Ll I li Itb UU7, W1 Ue rIIdue 5011 .1 est Results intact Dniv by'a licensed deleader (Mi mt ha lace th;;n AM nnm few nlbV Tran 1 1 ON) nnm fnr k— mill SIDE LOCAT ION MEASURE: LOOSE PAINT IC IC LOCATION AREA MEASURENNIENT RESULT REMED REMED A (MORE THAN 1440 SQ- IN.) DATE METH ( Square Feet) (PPM) DATE METH A Play Area A Bare Sail A Comments: x LURA RepExLC, 8108 Aisk Assessor (print) UOF S I rgnat.,re Date Address of ProQery: Apt• ^ 1!,, II XTERiOR D Sloe rI L NIA Y SIDE LOGAT ION1 LEAS `YP_ OF URG iC IC DELEAD DELEAD .D supe c- ' L NIA Y HAZARD rAZ % DATE METH DATE METH Siting ev _ NiA Y AIM L NIA Y Corner Boards CAI L N1A Y D Lower Trim (w L 41A Y Storm Door Upper Trim !!) L NIA Y D Win Above 5' ,4Y N1A Y AIM L NIA . Y Po - Doorjamb !tV AA4 L NiA Y ,OMMEN T S i STRUCTURAL DEFECTS Excluded Surfaces: Surfaces listed in this box cart be made intact only by a licensed deleader IDE LOCATFON zMEASURE: LOOSE PAINT iC iC A {MORE THAN 1440 5G, IN.) DATE METH A A A A LUP,A RepEvD, q%03 Pago tc)f�� SIDE re'I Above o rI L NIA Y URG iy Storm boor (J, A/M L NIA Y Door % Q ' L NIA Y D Door Casing AIM L NIA Y 1 2 Door Jamb �,� AIM L NIA Y 3 4 Threshold �`�i AIM L NIA v Kickplate AIM L NIA :JM L NA Y Storm Door Cellar Win Sili (W AIM L NIA Y Y Door D AIM L NIA Y D Door Casing Y AIM L NIA . Y 1 2 Doorjamb !tV AA4 L NiA Y 3 4 Threshold AAM L NIA Y Kickplate Y k'M L NIA Y Door AIM L NIA Y D boor Casing D AIM L NIA Y i 2 Doorjamb Y AIM L NIA Y 4 Threshold i AIr,4 L NIA Y Y Window Sill AIM L NIA Y D Win Casing Y AIM L WA Y Window Sash AIM L NIA Y Y Window Sill D AIM L N'A Y `D Win Casing Y 'A/M L NIA v window Sash AIM L NIA Y Y Window Sili AiM L N•'A Y D Win Casing Y AVM L NiA Y 'Vindow Sash AVM L NIA v D Lamp post D L i A y ,OMMEN T S i STRUCTURAL DEFECTS Excluded Surfaces: Surfaces listed in this box cart be made intact only by a licensed deleader IDE LOCATFON zMEASURE: LOOSE PAINT iC iC A {MORE THAN 1440 5G, IN.) DATE METH A A A A LUP,A RepEvD, q%03 Pago tc)f�� SIDE LOCATIONI LEAD TYPE OF URG iy 1C s7ELEAQ DELEAQ D SURFACE HAZARD HAZ? DATE METH DATE METH Window Sill AN L WA Y D Win Casing TAIM L NIA Y Window Sash AIM L NIA Y Cellar Win Sili (W AIM L NiA Y D Cel Win Sash NIA Y J Cel Win Frame !tV A1M L NIA Y Screen Frame AIM L N/A Y Cellar Win Sill AIM L NIA Y D Cel Win Sash t1ev AIM L NIA Y Cel Win Fram i AIM L IVA Y Sween FrameAIM L NIA Y Cellar Win Sill AIM L NIA Y D Cel Win Sash AIM L N/A Y Cel Win Frame AIM L NIA Y Screen Frame A/M L NIA Y Cellar Win sill AIM L NIA Y D Cel Win Sash AIM L NIA Y r Cel Win Frame AIM L NIA Y Screen Frame AIM L NIA Y Foundation L NiA Y D Bulldmead AML NIA Y Fences AIM L NIA Y Shutters �(/� ARut L WA Y Newel post AIM L NIA Y Railing Cap AIM L NIA Y Handrail AIM 'L NAA Y D Balusters AIM .L NIA Y Lower Rail AIM L NIA Y Treads AIM L NIA Y Risers AIM L WA Y Stringer { AAM L NIA Y Lattice AIM L NiA Y Drain Pipes L NIA Y i } Elec Conduit L NIA Y Oil Fill Pipe L N/A Y Overhang Tri.Z L NIA Y Soil Test Results (Bust be less man 400 ppm for play area 11200 ppm for bare soil) LOCATION AREA MEASUREMENT RESUL, REMED REMED ( Square Feet) (PPM) DATE METH Play Area Bare soil Comments: Risk Assessor (print) LN Signature Date .A r Address of Pro rt : -PeAAW� - Apt. 4 City: ! � GARAGE `'�.• ,..�._._ I Paged Of a� SIDE A LOCATION/ SURFACE LEAD TYPE OF HAZARD URG IC HAZ? DATE IC DELEAD DELEAD METH DATE METH SIDEJ G LOCATION/ SURFACE LEAD TYPE OF HAZARD URG IC IC DELEAD DELEAD HAZ? DATE METH DATE METH A Siding ! L _ NIA Y Lower Trim G Siding Cw L NIA Y Corner Boards L NIA Y Corner Boards L NIA Y Lower Trim L NIA YT Lower Trim L NIA Y Upper Trim L NIA Y Upper Trim l[3/ L NIA Y Y Door ` (.,I AIMVNIAI Y I IDoor AIM L NIA Y A/M L NIA A Door Casing Door Jamb Threshold Window Sill A IWInCasing Win Sash A IFoundation COMMENTS /ST WA Y l NIA Y AIM L NIA Y AIM L NIA Y AIM L N/A Y AIM L NIA Y L NIA Y DEFECTS: SIDE B 0 F G Door Casing A/M L NIA Y Door Jamb AIM L NIA Y Threshold A/M L NIA Y Window Sill LTJ NFA Y C Win Casing 12 NIA Y Win Sash ;�y� dL WA Y C lFoundation L NIA Y COMMENTS 1 STRUCTURAL DEFECTS: 1 GWf.-'r.4 i :eS can be made intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT IC to C (MORE THAN 1440 SO. IN.) DATE METHOD C C C LOCATION' LEAD Y URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH Siding y L NIA Y Corner Boards L NIA Y Lower Trim L NIA Y Upper Trim ccv L NIA Y Door AIM L N/A Y Door Casing A/M L NIA Y Door Jamb AIM L NIA Y Threshold AIM L NIA Y Window Sill WA Y LOCATION' LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH Siding y L NIA Y Corner Boards L NIA Y Lower Trim L NIA Y Upper Trim ccv L NIA Y Door AIM L N/A Y Door Casing A/M L NIA Y Door Jamb AIM L NIA Y Threshold AIM L NIA Y Window Sill WA Y Casing NIA Y Win sash T-CFoundation kN/AWin Y Foundabon L NIA ViENTS 1 STRUCTURAL DEFECTS' Im IN C IR LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH• S{ding y L NIA Y Comer Boards L NIA Y Lower Trim L N/A Y Upper Trim L NIA Y Door AIM L NIA Y Door Casing AIM L N/A Y Door Jamb AIM L NIA Y Threshold AIM L NIA Y Window Sill WA Y Win Casing NIA Y Win Sash! NlA Y Foundabon L NIA Y MENTS I STRUCTURAL DEFECTS: C C `s EXCLUDED SURFACES: Surfaces fisted in these boxes can be made intact IDEi OCA7[ON MEASURE: LOOSE PAINT IC!C SIDE LOCATION 13 (MORE THAN 1440 SQ. K) DATE METHOD I D U/RA RcpGaragc, Slog a licensed deleader. MEASURE: LOOSE PAINT (MORE THAN 1440 SQ. IN,) IC IC DATE METHOD Grant, Michele To: Richard Morway Cc: Sawyer, Susan; Blackburn, Lisa Subject: FW: Resizedlmage951389200434537.jpg Attachments: Resizedlmage951389200434537.jpg; ATT00001.txt Dear Richard, Please see the attachment. There is a black substance that appears to be mold that would have been generated by chronic dampness issues. Please refer back to the 1st order letter as this appears to be a different problem as you described this morning. Please follow the criteria of the order letter. Thank you Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant0townofnorthandover.com Web -----Original Message ---- From: Grant, Michele Sent: Wednesday, January 08, 2014 12:04 PM To: Grant, Michele Subject: ResizedImage951389200434537.jpg www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 Grant, Michele From: CYNTHIA AZIZ [cinjj@yahoo.com] Sent: Tuesday, January 07, 20143:59 PM To: Grant, Michele Subject: Re: 21 Perry Street NA MA Michele: I hope you had a great New Years..Thank you for forwarding me the requested docs. Is there anything additional that you may have? What is the status of any other action the town may consider taking against the owners. Thank you for all of your help. Cynthia J. Aziz, Esq. Minasian & Aziz 127 So. Broadway Lawrence, MA 01843 978-682-5560 On Monday, December 30, 2013 11:19 AM, "Grant, Michele" <mgrant townofnorthandover.com> wrote: Dear Cindy, Please see the attached files, As per your request. If there is any other information you need, please call the number listed below. Sincerely Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant(atownofnorthandover. com Web www.TownofNorthAndover.com -----Original Message ----- From: noreply(aD-townofnorthandover.com [mai Ito: noreply(a)-townofnorthandover.coml Sent: Monday, December 30, 2013 10:12 AM To: Grant, Michele Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 12.30.2013 10:12:24 (-0500) Queries to: noreplyQtownofnorthandover.com 1 Lead inspection I Risk Assessment Report Page 1 Of5 Gary Marciello, Lic#M3I69 _W & J4 Lead TnspectionalSe"Ices, Inc. 9299 — 617-737-2514 Belmont — 855411-1011 Worcester — 978-809-1064 Lawrence — 978-6854172 Mmlead verizon.net StA Street Mame Street Type Unit ®o❑❑❑ oF❑❑❑ ❑❑❑❑❑ City Zip Code a❑®®ado®®❑❑❑❑❑❑❑❑ a®®©� Owners Name:_ w.P 9,cz � -4.1"1--Z- Owner Address: / F3 Al/_ZS S ZIA V :Q.7) Contact Information: //1'oevoE �. /`� e Client Name (if different from owner): 4_j1A,,,4,e A®B t --,e Client Address: add - 9 1 Key Legend Column COV Covered Via Vinyl Baseboard MET Metal VR Vinyl Rep. Window MR Metal Rep. Window NA Not Accessible NC No Coating Tile Tile (testingSUggested) DC Dropped Ceiling Comments / Notes: Key Treatment Method Key Treatment Method CAP Capped SCR Scraped COV Covered DIP Dipped ENC Encapsulated REM Removed Ml Made Intact REP Replaced PRF; Prepared for Enc. REV Reversed VR/MR Vinyl/MelalRep Window INT Intact SFR Storm Frame Removed Component Does Not Exist F' loor#__L_(level within building of unit being inspected) Floor# C B 1 B 10 A (Street Side) Start Here C E* Number of Rooms in Unit Prop/erty Type: P' Single Family ❑ Multi Family # of Units ❑ Condominium # of Units ❑ Day Care ❑ Other Laundry in Basement? Q yes ❑ ElLIQ N� Finished Space in Basement Yes Testing Method Used NazS Expiration Date: I l X -Ray Fluorescence Model:_ Serial 4 l a A (Street Side) Start Here Property Diagram / Unit Labels A (Street Side) Pb (lead) equal to or greater than I.0 to/cmc with x-ray fluorescence or positive with NazS is Dangerous. XRF Calibration Recorded In Log Book Check off when complete Address verified through USPS Of ✓ Check off when complete Research on Lead Related History for Address D— ✓ - Check off when complete (Qp. •84pewk2 )13j 6 9 �� Inspector's Na es License # Signature Date LIRA [wised 01/12 1 ADDRESS: ICE $ -1' Apt# INSPECTION HISTORY Determination y Inspector Name: Lic# N Lead Hazards? Signature Comprehensive Initial Inspection It N Lead Hazards? Comp Initial Lico*jt— w/Partial PCAD y N Lead Hazards? R.A. Name: Addendum (add-on Lico*jt— to Initial Inspection) Y N Assessment P R.A. Name: ,Lic# Signature_ Lead Hazards? F Addendum as Full Insp. (Lost Does) y Lead Hazards? N Walk Through for Ed/Consultation City,,it/dQ Page 2 of INTERIM CONTROL Risk Assessment Y R.A. Name; .,, .Lic# Urgent Hazards? N I Signature Inspector Name: 4e Lico*jt— Dust Taken for Risk Assessment P R.A. Name: ,Lic# Signature_ F Signature Visual Portion of Inspector Name'_ , Lie# Reinspection for P Interim Control RA Name: Lie# Signature , Signature Dust Taken for Risk P F%. Inspector Name:_ . Lie# Assessment Reins . Signature Signature Visual Portion of Reinspection for R.A. Name: , Lic# Interim Control Inspector Name: . Lic# MF Signature Signature Dust Taken for Risk R.A. Name: Lie# Assessment Reinsp. !F] Signature Inspector Name:_ Lint Signature REINSPECTION HISTORY Visual Portion of Reocc. Reinspection P inspector Name: Lic# IF Signature Visual Portion of Reocc. Reinspection P _JTJF Dust Taken for P Reocc. Reinspection F, Dust Taken for Reocc. Reinspection F Inspector Name: . Lie# Signature Inspector Name: , Lic# Signature Inspector Name: Lit # Signature Visual Portion of P Inspector Name: . Lie# Final Reinspection F Signature Visual Portion of Final Reinspection B Inspector Name: Lic# F Signature Dust Taken for Final Inspector Name: , Lie# Reins . (No Reocc } [F� Signature Dust Taken for Final Reinsp. (No Reocc }' Inspector Name:___ Lic# F Signature Risk Assessment Recertification y R.A. Name: Lic# Urgent Ph. Hazards? Signature Dust Taken for RA P RA Name: Lic# Recertification F Signature POST COMPLIANCE ASSESSMENT DETERMINATIONS PCAD Inspector Name: Lic# Y N Signature Lead Hazards? Full Inspection Acting as PCAD N8 Inspector Name: Lie# Lead Hazards? Signature Visual Portion of BInspector Name: , Lie# PCAD Reinspection F Signature Dust Taken for M Inspector Name: Lic# PCAD Reins ection Signature Dust Taken for PCAD Reinspection FFSignature Inspector Name: , Lic# ADDRESS: �Q Apt REOCCUPANCY CERTI ICATE HISTORY Certificate of Reoccu ane inspector Name: LidOnly ager Signature High/Mod Risk (# rooms rule) Certificate of Reoccupancy Only after IIigh/Mod Risk (# rooms rule) Certificate of Reoccupancy Only after High/Mod Risk (# rooms rule) COMPLIANCE Letter of Full Initial Compliance No prior history/ No signs of UD Letter of Interim Control No prior Comp. Expires in i yr. Recertification of Interim Control Expires 2 yrs from original Interim Control Letter of Full Deleading Compliance Dust wipes if No Reoce. Certificate of Maintained Compliance No Work= No Dust Work = 7 Dust Certificate of Restored Compliance Dust wipes and auth. people Inspector Name: Lic# Signature Inspector Name:_ Lic# Signature HISTORY Inspector Name:_ Lic# Signature Inspector Name: Lid Signature Inspector Name: Lic# Signature Inspector Name: Lic# Signature Inspector Name:_ v Lic# Signature # City //, CVc,t Page 3 of COMPLIANCE HISTORY (CONT.) Certificate of Maintained InspeetorName: Lic# Compliance Signature No Work= No Dust Work = 7 Dust Certificate of Restored Compliance Inspector Name: , Lic# Signature Dust wipes and auth, people Certificate of Maintained Inspector Name:_ Lic# Com Bance Signature No Work= No Dust Work = 7 Dust Certificate of Restored Compliance inspector Name: Lic# Signature Dust wipes and auth. people OTHER HISTORY: WAIVERS/UD/EPA RRP Approved CLPPP Waiver CLPPP Insp. Name: Lic# Attach to Comp Docs Signature Approved CLPPP Waiver CLPPP Insp. Name: Lic# Attach to Comp Signature Docs UD / DES Visual Reins ection Inspector Name: , Lic# P Signature No LOC Issued FF UD /DES Visual Inspector Name: , Lic# Reins ection 8 Signature No LOC Issued F UD / DES Dust Taken p Inspector Name:_ , Lic# Inspector Name:Lic# F_ � No LOC Issued Signature 9 Signature UD/DES Dust Taken Inspector Name: Lic# P No LOC Issued F ]Signature— Page 4 of �Z� EXPLANATION OF LEAD INSPECTION / RISK ASSESSMENT REPORT FORM COLUMNS This page provides general information needed to understand the lead inspection/risk assessment report. However, you should speak with the inspector/risk assessor before you start to do any work on your home. SIDE Refers to A, B, C, or D side of the building or room. See the diagram on the cover sheet. The "A" side of the building or room is the side facing the street that gives the property its address (usually, it is the front of the building). Keeping your back to this street, from the "A" side move clockwise to the `B" side on your left, the "C" side opposite you, and the "D" side to the right. Numbering is from left to right. LOCATION/ Refers to the building component(s) being tested. Some surfaces may be made up of more than one part. For SURFACE example, "Baseboard" may refer to four separate pieces of wood (one on each wall), but is still considered one surface. LEAD The actual lead result. Each surface tested must have a result recorded in the "Lead" column. • A number shows that the surface was tested with an XRF analyzer. A number (or average number) equal to or greater than 1.0 mg/cm' is a dangerous level of lead. • A "pos" or "neg" shows that the surface was tested with sodium sulfide. "Poe' means that there is a dangerous level of lead. • "N/A" means that the inspector was not able to test the surface. Unless the owner can get a sample to test, the inspector must assume the surface contains lead and require it to be deleaded, if necessary. • "MET" or "MR" means that a metal surface was not tested and only needs to be intact, even if it is a leaded surface. However, metal handrails, metal window sills, and metal railing caps, need to be deleaded if they test equal to or greater than 1.0 Mg/CM2, or is marked "N/A." • For key to abbreviations like "COV", "VB", "VR" or "MR", 'INC,,, "Tile", "DC", see the cover page. • When a component box is slashed and there are test results above and below the diagonal line, the result on the "bottom" represents results below 5 ft. and the "top" result indicates the test result above 5 ft. TYPE OF Not all lead paint must be deleaded. This column tells you IF and WHY a surface needs deleading. The deleading HAZARD standards below may not apply for Interim Controls. Speak to your risk assessor for more information. • "M/1" circled means that the surface is a moveable/impacted surface and must be deleaded in its entirety. • "SF" circled indicates that there is a storm frame present which requires the blind stop and exterior sill be deleaded as interior moveable / impacted surfaces. • "A/M" circled means that the surface is "accessible mouthable" and must be deleaded to a minimum of five feet high, four inches in from the edge or corner. ■ "L" circled means that the surface is loose and must, at minimum, be made intact. ■ If more than one choice is circled, the rules for deleading may change depending upon what method of deleading you choose. Speak to the inspector for more information. • "N/A" means the inspector was unable to determine if the surface was a lead hazard. The person doing the deleading must check this surface and follow all the rules for deleading. Speak to the inspector for more information. • If nothing is circled in the column, then it is likely the surface does not need deleading. Speak to the inspector for more information. Remember, this does not mean the entire surface is lead free, it just does not require deleading in its current condition. URG HAZ? This column is only completed during a risk assessment. A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment, not all inspectors are risk assessors. If "Y" is circled, then this surface is considered an "Urgent Lead Hazard" and some type of deleading work is required to qualify for Interim Control. 1C DATE The date the licensed risk assessor determines the surface meets the. standards for Interim Control. IC METH The deleading method or structural repair done to qualify the surface for Interim Control. Refer to the deleading codes key on the cover page. DELEAD The date that the lead inspector reinspects the surface and finds that it has been successfully brought back into DATE compliance. DELEAD The method used to bring a surface into full compliance. Refer to codes in the Key on the cover page of the PCAD METH EXCLUDED The amount of loose paint on a surface as measured by the lead inspector. "N/A" means that the inspector was not SURFACES able to measure the loose paint, but has determined it is more than the cut-off for moderate risk making intact. LIRA Exp. 8/08 Risk Assessor (print) p Lic # Address of Pro e : ! ROOM# SIDE A e LOCATIONI LEAD SURFACE Up Walls _ �0, TYPE OF HAZARD AIM L NIA URIG; IC iC DELEAD DELEAD HAZ? DATE METH DATE METH Y A B Low Walls B -AIM L NIA Y C n Baseboards AIM L NIA Y A B Chair Rail Y AN L NIA Y AA c A Radiator Q. AIM L NIA Y Floor &V I AIM L NIA Y Ceiling 6ZT A1M L NIA Y A B Door 2 AIM L NIA Y C Door Casing AIM L NIA Y 12 3 4 Jamb Mhold Q AIM L NIA AIM L NIA Y Y A B Door dj AIM L NIA Y Door Casing Co AIM L NIA Y 12 Door Jamb LL NIA Y 3 4 Threshold C AIM L NIA Y A B. Door AIM L NIA Y C D Door Casing Y AIM L WA Y 12 Dooijamb MA AIM L NIA AIM L NIA Y 34 Threshold G�- � AIM L NIA Y A B C D Door Door Casing Part Bead AIM L NIA AIM L NIA Y Y 12 Doorjamb 4 AIM L NIA Y 3 4 Threshold AIM L N1A Y A Closet Door AIM L NIA Y B : Cl Casing Y AIM L MIA Y Win Casing ,CiosetJamb AIM L NIA AIM L NIA Y D !Closet Walls [�. AIM L NIA Y Ci Baseboard Int Stops 0.0 AIM L NIA Y 1 !Closet Pole Win Int Sash AIM L NIA Y 2 3 3 1Closet Shelf 10 Supports 2, AIM L NIA AIM L NIA Y Y 4 Closet Floor AIM L ]INVA AIM L COMMENTS I STRUCTURAL DEFECTS: a R x t PM, r r Y Y UCU JLJKrf lt+t:7: JtlltaCes IlStett in these boxes SiC> LOCATION MEASURE. LOOSE PAINT IC IC (MORE THAN 288 Sa IN DATE METHOD r UARA Revl2o=6 =8 Date Page �O"2 SIDE can LOCATkONI SURFACE Window Sill LEAD 0,1 TYPE OF HAZARD MA AIM L N/A URG IC HAZ? DATE Y IC DELEAD DELEAD METH DATE METH B Win Apron Q AIM L NIA Y C Win Casing C1,� ANA NIA Y I? Header Stop Q MA AIM L NIA Y Int Stops A MA A!M L NIA Y 49 Win Int Sash U MA AIM L NIA Y 2 Exterior Silk NIA Y 3 Part Bead L NIA Y 4 Blind Stop F L NIA Y Win Ext Sash Window Sikl L NIA M/i AIM L NIA Y Y B Win Apron 0.t7 AIM L NIA Y C Win Casing (j. AIM L NIA Y •D Header Stop rv. MA AIM L N!A Y of Stops CT MA AIM L NIA Y 1 CV Win Int Sash Exterior Sill G�- � MA AIM L NIA L NIA Y Y 3 Part Bead L NIA Y 4 Blind Stop L NIA Y Win Ext Sash Window Sill J L NIA h6lf AIM L NIA Y Y B Win Apron C). AIM L NIA Y C Win Casing (� AIM L NIA Y D Header Stop [�. MII AIM L NIA Y Int Stops 0.0 Wl ASM L NIA Y 1 Win Int Sash CI MA AIM L NIA Y 2, Exterior SIA ad 1 NIA M L NIA Y Y 4 [8,IjLndStoD SF L NIA Y 13 in Ext Sash Freplace L NIA AIM L NIA Y Y C G AS C D Mange Win Above 5' Calling Moldin AIM L NIA AIM L NIA AIM L NIA Y Y Y AIM L NIA Y AIM L VIA Y be SIDE made intact only by LOCATION AIM L NIA Y a ficensed a ea er. MEASURE: LOOSE. PAINT (MORE THAN 288 So. IN.) -IC IC DATE METHOD Risk Assessor (print) Lic #I Signature Date Address of Pro e �/� �....__ Ant. # ROOM # SIDE LOCATION/ LEAD TYPE OF URG €C IC DELEAD DELEAD URG I IC HAZ? DATE Y t SURFACE HAZARD HAZ. DATE METH DATE METH A n Up Walls AIM L WA Y A a Low Walls AIM L NIA Y A 8 c a Baseboards AIM L NIA Y A s Chair Rall AN L NIA Y A8 i _0j Radiator AIM L NIA Y Y Floor AIM L NIA Y M!i AIM L NIA Ceiling AIM L NIA Y A B Door AIM L NIA Y C D Door Casing AIM L NIA Y 12 j Door Jamb AIM L NIA Y 3 4 Threshold A1M L NIA Y AB Door AIM L NIA Y C D Door Casing AIM L NIA Y 12 Door Jamb AIM L WA y 3 4 Threshoid AIM L -NIA Y AB Door AIM L WA Y C D Door Casing AIM L WA Y 1 2DoorJamb 0 AIM L WA Y 3 4 Threshold AIM L NIA Y A B IDoor AIM L NIA Y C D Door Casing AIM L NIA Y 12 poor Jamb AIM L NIA Y 3 4 IThreshold AIM L NIA Y A I Closet Door AIM L NIA Y $ CI Casing ASM L WA Y IClosetJamb AIM L NIA Y DClosetVVails AIM L NIA Y I ICI Baseboard AIM L NIA Y 1 ;,Inset Pole AIM L NIA Y € 2 Closet Shelf AIM L NIA Y 3 Cl Supports AIM L NIA Y s 4 CEoset Floor i AIM L NIA Y Closet Ceiling AIM L NIA Y !COMMENTS I STRUCTURAL DEFECTS., .X 0 L WA AIM L NIA G I! n Juridues u5ied in these poxes C SiLE. _GCA i tg1I MEASURE. LOOSE PAINT IC IC (MORE THAN 288 SQ. IN.; DATE METHOD 4 Page S, Gf a SIDE F;A LOCATION/ SURFACE Window Sill LEAD TYPE OF HAZARD W AIM L NIA URG I IC HAZ? DATE Y IC DELEAD DELEAD METH DATE METH B Win Apron a AIM L NIA Y C Win Casing C1. AIM L N/A Y D Header Sto � MA AIM L N/A Y int stops 03IMA AIM L NIA Y 1 Win Int Sash M!i AIM L NIA Y 2 Exterior Sill F NIA Y 3 Part Bead L NIA Y Blind Slop L NIA Y A C M$ash L NIA Wl AIM L NIA AMt L NIA Y Y Y C AIM L NIA Y •D Header Stop MI€ AM L NIA Y iniStops MII AIM L WA Y 0 Win Int Sash C).1 W AIM L NIA Y 2 3 Extedor Sill Part Bead L NIA L NIA Y Y 4 Blind Stop L NIA Y A Win Ext Sash Window Sill W€n Apron 61 (� L NIA lM AIM L N/A AIM L NIA Y Y Y C Win Casing AIM L NIA Y D Header Stop Mil AIM L NIA Y Int Stops M/l A/M L NIA Y 1 aExterior Win Int Sash Sill CjQ Cal Mil AIM L NIA MA SF L NIA Y Y 3 Pari Bead (J. Mil j ELNIA Y 4 Blind Stop Y AB W€n Ext Sash Fireplace .X 0 L WA AIM L NIA Y Y C 0 A8 c B Mantla Win Above 5' Ceiling Molding..AIM AIM L NIA AIM L NIA L WA Y Y Y AIM L NIA Y AIM L N/A Y an be SIDE AIM L NIA Y made intact only y a licensed de eader. LOCATION MEASURE: LOOSE PAINT (MORS THAN 288 SQ. IN.) IC IC DATE METHOI) Risk Assessor (print) Lic # Vuriature fate Address of p e PL Am # C' Kvum # SIDE= LOCATION? LEAD SURFACE A S Up Walls TYPE OF HAZARD AIM L NIA URG IC IC F00 DATE METH Y DELEAD DELEAD DATE METH A D Law Walls -A1M L WA Y f: i C D Baseboards AIM L WA Y Win Casing A s Chair Rail AIM L NIA Y (� A8 p Radiator A AIM L NIA Y Floor AIM L NIA Y 1 Ceil'utg AIM L NSA Y Y A B Door j AIM L NIA Y Mli SF L NIA CD Door Casing AIM L WA Y G . 12 3 4 Door Jamb Threshold AIM L NIA AIM L NIA Y Y Blind Slop A B Door JI AIM L NIA Y A C 13 Door Casing AIM L NIA Y 12 Door Jamb AIM L NIA Y Y 34 Threshold AN L NIA Y AIM L WA A B Door AIM L NIA Y C D Door Casing AIM L NIA Y tnt Stops 12 Door Jamb AIM L NIA Y 1 34 Threshold AIM L NIA Y AB Door AIM L NIA Y Y C D Door Casing AIM L WA Y Mfl L NIA 12 Door Jamb AIM L WA Y 34 Threshold AN L NIA Y Win Ext Sash A Closet Door AIM L NIA Y A B Cl Casing AIM L NIA Y C Closet Jamb AIM L NIA Y Y D Closet Walls AN L NIA Y AIM L NIA Y Cl Baseboard AIM L WA Y 1 Closet Pole AIM L NIA Y Int Stops 2 Closet Shelf A!M L NIA Y 1 3 Cf Supports AIM L NIA Y 4 Closet Fioor AMM L NIA Y Y Closet Ceiling AMI L NIA Y Mfl L NIA COMMENTS I STRUCTURAL DEFECTS: 4 MLU DED SURFACES: Surfaces listed in these boxes c SIDE LOCATION MEASURE. LOOSE PAINT (MORE THAN 288 SQ- IN.) IC DATE IC METf#OD Y A B Fireplace AIM L NIA Y C D Mantle AIM L NIA F VAA RcpRoam�, US Page 1- A-� SIDE A LOCATION/ SURFACE Window sill LEAD Q, TYPE OF HAZARD MIE AIM LN1A URG IC HAV BATE Y IC DELEAD DELEAD METH DATE METH B Wn Apron f: i AIM L NIA Y C Win Casing 6, AIM L NIA Y (� Header Stop 01 1111 AIM L NIA Y Int Stops C}? Mll AIM L NIA Y 1 Win Int Sash C101MIl AIM L NIA Y 2 Exterior Sill (,gl Mli SF L NIA Y 3 Part Bead G . MI€ L NIA Y 4 Blind Slop A L NIA Y A Win Ext sash Window l 1A MA AIM L NIA Y Y B Win Apron AIM L NIA Y C Win Casing AIM L WA Y •D Header Stop M/I AIM L NIA Y tnt Stops INI AIM L NIA Y 1 Win Int Sash MA AIM L NIA Y 2 Exterior -Sill W SF L NIA Y 3 Part Bead Mfl L NIA Y 4 Blind Stop MA SF L NIA Y Win Ext Sash MII L NIA Y A Window Sill MIE AIM L NIA Y B Win Apron AIM L NIA Y C Win Casing AIM L NIA Y D Header Stop W AIM L NIA Y Int Stops Mil AIM L WA Y 1 Win int Sash W AIM L NIA Y 2 Exterior Sill MII SF L NIA Y 3 Pad Bead Mfl L NIA Y 4 Blind Stop W SF L NIA Y Win Ext Sash WL NIA Y A B Fireplace AIM L NIA Y C D Mantle AIM L NIA Y AB o D Win Above 5` AIM L NIA Y Ceiling Moldin AIM L NIA Y AIM L NIA Y AIM L NIAY AIM L NIA Y an a ma a Intact ort y ry a licensed Neader. SIDE LOCATION MEASURE: LOOSE PAINT (MORE. THAN 288 Sa IN.) -IC. DATE IC METHOD Risk Assessor (print) /� Lie # Signature Date Address of Prorty:ty: d f ovie ROOM # SIDE A 9 LOGATIONI SURFACE Lip Wes(fV LEAD r.�r1 TYPE OF HAZARD .AIM L NIA URG IC IC HAZ? DATE METH Y DELEAD DELEAD' DATE METH A B LkwWalls AIM L NIA A!M L WA Y C c o Baseboards Y Y AIM L NIA Y int Stops Win Int Sash A B Chair Rail Y Y AIM L NIA Y Exterior Sill p iator V AIM L NIA Y Pert Bead / r i (' AIM L NIA Y arnd Stop ng Y AIM LNIA Y Win`ExtSosh Window Sill 0,31 Mll L NIA 00 Wl AIM L NIA r AIM L NIA Y G C D Door Casing Q0 1 AIM L WA Y 12 3 4 Doorjamb Threshold 0.11 AIM L NIA AIM L WA Y Y (f A B moor 77 AIM L WA Y G. (9D Door Casing 0- AIM L WA Y j, { 12 Doorjamb AIM L NIA Y 34 Threshold AIM L WA Y A B Door AIM L NIA Y I C D Door Casing AIM L WA Y 0.11 12 Door Jamb AMI L WA Y 34 Threshold AIM L NIA Y A B C D Door Door Casing AIME L NIA AIM L N/A Y Y 12 Doardamb AIM L WA Y C). 34 Threshold AIM L NIA Y L3 A Closet Door AIM L NIA Y B CI Casing AIM L NIA Y C Closetdamb AIM L NIA Y D Ctosetwalls AIM L NIA Y AIM L NIA Cf Baseboard AIM L NIA Y 1 Closet Pale AIM L WA Y 2 ciosetshelf AIM L NIA Y 3 Cl Supports AIM L NIA Y 4 Closet Floor AN L NIA Y AIM L NIA Closet Ceiling AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS: EXCLUDED SU RFAGES:Surfaces bted Inthese boxes C SIDEJ LOCATION MEASURE. LOOSE PAINT (MORE THAN 288 SQ. IN.) IC DATE IC METHOD LURA RepRv=6 8108 Page Of SIDEJ1OCAT1ON1 A SURFACE Window sift LEAD TYPE OF HAZARD (`,R� MA AIM L N/A URG IC HAZ? DATE Y IC DELEAD DELEAD METH DATE METH B Win Apron AIM L NIA Y C Win Casing Header Stop AIM L NIA (J() MA AIM L NIA Y Y int Stops Win Int Sash G.i C) M1I AIM L NIA MII AIM L NIA Y Y 2 Exterior Sill SF N/A Y 3 Pert Bead / m Y 4 arnd Stop MA SF L NIA Y A Win`ExtSosh Window Sill 0,31 Mll L NIA 00 Wl AIM L NIA Y Y B Win Apron G AIM L NIA Y C Win Casing AIM L NIA Y Header Spee (f W AM L WA Y n#Stops G. WI AIM L WA Y 1 Win IM Sash j, { M11 AIR L NIA Y Exterror Sill MII SF L NIA Y 3 Part Bead W L WA Y 4 Blind Stop I Mil SF L WA Y A Win Ext Sash Windowsill 0.11 M11 L WA MII AN L NIA Y Y B Win Apron AIM L NIA Y C Win Casing AIM L NIA Y �D Header Stop Mil AIM L NIA Y Int Stops C). Mll AIM L NIA Y 1 Win Int Sash L3 MII AIM L NIA Y 2 Exterior Sill Part Bead SF NIA ()NIA Y Y 4 Blind Stop MA SF L NIA Y Win Ext Sash Mn L NIA Y A B lFireplare AIM L NIA Y C D Mantle AIM L NIA Y A6 e a Win Above 5' AIM L NIA Y Ceiling Molding AIM L NIA Y AMI L WA Y AIM L NIA Y an be made intact any AIM L NIA Y y a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ, IN.) •IC DATE 1C METHOD Inspector (print) Lic # Signature Date Risk Assessor (print) Address of Propertyy Lic# Signature ,.�5 A . # a lium lavu urlactu 1. Date� City: r ift�.dc LOCATION KITCHEN IC DATE IC METHOD ---r LOCATtON MEASURE: LOOSE PAINT (MORE THAN 289 SLI. IN.) lC DATE IC METHOI SIDE LOCATION/ SURFACE LEAD TYPE OF URG IC IC DELEAD DELEAD HAZARD HAZ? DATE METH DATE METH siDE LOCATEON/ LEAD SURFACE TYPE OF URG HAZARD HAZ? A 8 Up Walls • AIM L NIA Y A Window Sill p. W A/M L WA Y A e Low WaIIS AIM L NIA Y lea Win Apron AIM L NIA Y A 9 Baseboards Abut L NIA Y C Win Casing('j AAM L WA Y A 8 Chalr Rail AIM L NIA Y Header Stop (j. MA A(M L NIA Y All Co Radiator 03 AIM L NIA YInt Stops W AIM L WA Y Floor e0jjj AIM L NIA Y 1 Win int Sash 6jlf W AIM L WA Y Ceiling AIM L WA Y 2 Exterior Sill SF L WA Y Door AIM L NIA Y 3 Pal Bead I L WA Y C'. D Door Casing 6) ( AIM L NIA Y 4 Blind Stop W SF L NIA Y //�� WL Door Jamb AIM L NIA Y Win Ext SashI` L WA Y 3 4 Threshold AIM L NIA Y A Window Silf oo I MA AIM L WA Y A floor {j . A/M L WA Y Win Apron AIM L VA Y C D Door Casing AfM L NIA Y C Win Casing (} AIM L WA Y 1 Daor Jamb Q. AAu! L NIA Y © Header Stop rMII AIM L WA Y 34 Threshold AIM L WA Y Int Stops 0- MA AIM L N/A Y B Door AIM L NIA Y 1 Win Int Sash p:, M/I AIM L NIA Y C D Door Casing © AN L NIA Y L Exterior Sill SF L NIA Y 12 Door Jamb O►.i) AJM L WA Y 3 Part Bead Iff L NIA Y Threshold AIM L WA Y 4 Blind Stop 7�7MA SF L WA Y Door (j AIM L WAI Y Win Ext Sash WI L N/A Y C D Door Casing NM L WA Y 1A B Up Cab Frame t j AIM L WA Y 12 Door Jamb A/M L WA Y Up Cab Door AIM L NIA Y 4 Threshold AIM L NIA Y r34 Up Cab Walls ( , AIM L WA Y Closet Door .(3 NM L WA Y Up Cab Shays Q A/M L NIA Y B Cl Casing �(f. AIM L NIA Y Supports G' AIM L NIA Y C CloseiJamb A M L NIA Y Low Cab Fram .(,? AIM L WA Y D Closet Walls AIM L WA Y A B Low Cab Door 10116 01 AtM L N/A Y Ct Baseboard AAAA L WA Y ffq Law Cab WalE A/M L NIA Y 1 Closet Pole AIM L NIA Y Low Cab ShlyAIM L NIA Y 2 Closet Shelf Q AIM L NIA Y 12 Supports AIML NIA Y 3 CI Supports U AIM L NIA Y 34 Drawers AU L NIA Y 4 Closet Floor ( f) A IVI L WA Y C B Win Above 5' M/I AIM L WA Y Closet Ceiling AIM gd Y MA A M L WA Y COMMENTS 1 STRUCTURAL DEFECTS: MA AIM L. WA MA AIM L NIA MIt AIM L WA MA AIM L NIA Y Y Y Y Page 7— OI �� DATE I METH IG IDIFLEADI DAE DATE LAVLUULU JV Rf out MUM 10tau Ill n1C.70 UUAM l,Qil UC lilduu ittlaw Willy Ur a lium lavu urlactu 1. SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SO. IN.) IC DATE IC METHOD SIDEJ LOCATtON MEASURE: LOOSE PAINT (MORE THAN 289 SLI. IN.) lC DATE IC METHOI LURA RepKitchen, 8108 t_ '49e5L !I►Ir�C'1?/,� 31�i�f Inspector(print) Lic# Risk Assessor (print) n Lic# Address of Prooerty: 9 (���R�� _ - KITCHEN C'�y Signature Signature} . _ _ ___ Apt. # MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) Date Date City; � Gi/� i page/! Of SIDE LOCATION/ LEAD SURFACE TYPEOF URG 'CIC HAZARD HAZ? DATE DELEAD DELEAD METH DATE METH SIDE LOCATION/ SURFACE LEAD TYPE OF URG 1C HAZARD HAZ? DATE IC DELEAD DELEAD METH DATE METH A B Up Walls, AIM L NIA Y A Window Silll MA AIM L WA Y A B Low Walls WM L NIA Y 6 Win Apron AIM L NIA Y A s Baseboards AIM L NIA Y C Win Casing A/M L NIA Y A B Chair Rail AIM L WA Y D Header Stop G.l M11 AIM L NIA Y AS Radiator AIM L NIA Y Int Stops V•" tut/l AIM L WA Y Floor AIM L WA Y 1� Win int Sash W AIM L NIA Y Ceiling AIM L NIA Y 2 Exterior Sill M/ SF L NIA Y A B Door AIM L NIA Y 3 Part Bead 1 L N/A Y C Door Casing Oil AIM L NIA Y 4 Blind Stop . MA SF L NIA Y 1 2 Door Jamb A/M L NIA Y Win Ext Sash j b L NIA Y 3 4 Threshold AIM L NIA Y A Window SM Mll AMM L N/A Y A S Door AIM L N/A Y Win Apron AMI L NIA Y Door Casing Q AIM L N/A Y D Win Casing Q.() AIM L NIA Y 12 Door Jamb AIM L WA Y D Header Stop 2. WI AIM L NIA Y 34 Threshold AIM L NIA Y Int Stops U W AAM L NIA Y A 8 Door AIM L N/A Y 1 Win Int Sash 01 MA AIM L NIA Y C D Door Casing AIM L N/A Y Exterior Silt SF L NIA Y 12 Door Jamb A/M L WA Y 3 Part Bead L WA Y 34 Threshold AIM L WA Y 4 atind Stop W SF L N/A Y A 8 Door AIM L NIA Y Win Ext Sash L A Y C D Door Casing AIM L NIA Y A 8 Up Cab Frame AIM L WA Y 12 Door Jamb AMI L NIA Y C D Up Cab Door A/M L NIA Y 3 4 Threshold AIM L NIA Y Up Cab Wails AIM L NIA Y A Closet Door AIM L NIA Y 12 Up Cab Sbtvs AIM L NIA Y g Cl Casing AN L N/A Y 34 Supports AAM L NiA Y C Closet Jamb Q {} AAN L NIA Y Low Cab Fram AIM L NIA Y D Closet Walls � AIM L NIA Y A B Law Cab Door AIM L NIA Y CI Baseboard .� AIM L NIA Y C D Low Cab Wall AM L N/A Y 1 Closet Pole AIM L NIA Y Low Cab Sh A1M L NIA Y 2 Closet Shelf ,.ems l AIM L NIA Y 12 Supports AIM L NIA Y 3 Ci Supports AIM L WA Y 34 Drawers AIM L NIA Y 4 Closet Floor AIM L NIA Y AB Co Wan Above 5' MA PJM L N/A Y Closet Ceiling AIM L N/A Y M/t A/M l NIA Y COMMENTS / STRUCTURAL DEFECTS: MA AN L NIA MA AIM L NIA M11 AN L NIA MA AIM L NIA Y Y Y Y EXCLUDED SURFACES: Sul1aces listed in these coxes can be made intact only by a licensed deleader. SIDEJ LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) IC DATE lC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ, IN.) IC DATE IC METRO LURA RepKitchen, 8108 Page I/ of ;?!5� Inspector(Print) Lie# Signature [ Date Risk Assessor (print) Lic# Signature Date Address of Prooerty: ZCSC- rr • �. A 1, # Cif ;"fiv 4a BATHROOM # , SIDE LOCATION/ SURFACE LEAD TYPEOF HAZARD URG IC HAZ? DATE IC DELEAD DELEAD METH DATE METH SIDE LOCATION/ LEAD SURFACE TYPE OF HAZARD URG IC HAZ? DATE IC DELEAD DELEAD METH DATE METH A B 4.2 Up Wails 0 AIM L WA Y AB CD 12 3 4 Low Cab Fram AIM L NIA Y A 8 Low Waifs AIM L NIA Y Low Cab Door AIM L N/A Y A B Baseboards A/M L WA Y Low Cab Walls AIM L NIA Y A B Chair Rail A/M L NIA Y Low Cab Shly A/M L NIA Y AS c o Radiator AIM L NIA Y Supports AIM L WA Y Floor AIM L NIA Y Drawers AIM L NIA Y Coiling [r AIM L NIA Y A B C D 1 2 3 4 Window Sill W AIM L WA Y C D 12 3 4 Door 00, AIM L NIA Y Win Apron (}0 AIM L WA Y Door Casing 0. AIM L WA Y Win Casing CI I AN L WA Y Door Jamb .0 A/M t WA Y Header Stop - M/I AIM L NIA Y Threshold AIM L NIA Y Int Stops OQ Mll AMI L N/A Y AB VD 12 3 4 Door C?' AIM L WA Y Win Int Sash Ci[ MA AIM L NIA Y Door Casing— Ey AIM L WA Y Exterior Sill SF f)WA Y Door Jamb U( A/M L NIA Y Part Bead L NIA Y Threshold wlo'A/M L WA Y Blind Stop Mfl SF L N/A Y A. Closet Door AIM L N/A Y Win Ext Sash L WA Y CI Casing AIM L N/A Y n Win Above 5' MY AIM L NA Y C Closet Jamb d. AIM L WA Y AS CS Ceiling Mokfir4 MA AIM L NA Y D Closet wallse G� AIM t WA Y o © Medicine Cab 00 MII AIM L NA Y Cl Baseboard AIM L NIA Y o Wall OIC W AIM L NA Y 1 2 3 4 Closet Pale AMM L WA Y MA AIM L NA Y ClosetSheff 00 AIM NIA Y Mn AIM L NA Y Cl Supports AIM L WA Y M(I .A/M L NA Y Closet Floor AIM L NIA Y WAIM L NA Y Closet Ceiling 0.1 AIM L N/A Y WAIM L NA Y A B C D 12 34 Up Cab Frame AIM L NIA Y MA AIM L NA Y Up Cab Door AIM L NIA Y Mh AIM L NA Y Up Cab Walls A/M L N/A Y MA AIM L NA Y Up Cab Shlvs AIM L N/A Y M/I AIM L NA Y Isupports AIM L NIA Y W AIM L NA Y MA AIM L N/A Y NA Y tvllt AIM L NIA Y LWIAIMNA Y W AIM L N/A Y NA Y COMMENTS 1 STRUCTURAL DEFECTS: COMMENTS 1 STRUCTURAL DEFECTS: EXCLUDED SURFACES: Surfaces listed in these boxes SIDE LOCATION MEASURE: LOOSE PAINT IC IC (MORE THAN 288 SQ. IN.) DATE METHOD can be made intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) IC IC DATE METHO LF/RA RepBath, 8108 FA_ (print) Lic # Signature �)%)61 Date Risk Assessor (print) Lic # Signature Date Address of Pro e : al�+Q_ _ A t. # city: r Page 12 Of � S HAL LWA . Intello or ` Common Hallway: Front ea Floor # SIDE LOCATION! SURFACE LEADJ TYPE OF HAZARD URG HAZ? IC IC DELEAD DELEAD DATE METH DATE METH SIDE LOCATION! SURFACE LEAD TYPE OF URG IC IC DELEAD DELEAD HAZARD HAZ? DATE METH DATE METH A Up Walls � AIM L NA Y A B C D 1 2 3 4 Closet Door AIM L NIA Y A B Low Wails AIM L NIA Y CI Casing A1M L NIA Y A 8 Baseboards A1M L NIA Y Closet Jamb AIM L NIA Y a Chair Rail AIM L WA Y Closet Walls AIM L NIA Y c D Radiator AIM L WA Y CI Baseboard AN L NIA Y Floor �(,�f AIM L NIA Y Closet Pole AIM L NIA Y Ceiling L AIM L NIA Y Closet Shelf AIM L NIA Y C D I ft Door Q� A/M L WA Y Cl Supports AIM L NIA Y Door Casing L NIA Y Closet Floor AIM L WA Y Door Jamb 0 :� AIM L NIA Y Closet Ceiling AIM L NIA Y 3 4 Threshold AIM L NIA Y A D i 2 3 4 Window Sill L NIA Y B C D 4 3 4 Door C). AMI L NIA Y Win Apron 23 AIM L WA Y Door Casing AIM L WA Y Win Casing L NIA Y Door Jamb AAu! L NIA Y Header Stop AIM L WA Y Threshold AIM L N/A Y Int Stops f I L WA Y A B 12 3 4 Door ` 0 (,� AN L NIA Y Win Int Sash L N/A Y Door Casing Ci. AIM L NIA Y Exterior Sill CW MA SF L NIA Y Door Jamb p AIM L WA Y Part Bead NIA Y Threshold AIM L WA Y Blind.Stop L NIA Y A S Door AIM L WA Y Win Ext Sash L NIA Y C D 12 3 4 Door Casing AIM L WA Y A Window Bill I IM11 AIM L NIA Y Door Jamb AlM L MIA Y B Win Apron AMM L NIA Y Threshold AIM L WA Y C Win Casing AIM L NIA Y A B C 13 # Door AIM L MIA Y D Header Stop MII AIM L NIA Y Door Casing AIM L NIA Y Int Stops AAIi AIM L NIA Y Door Jamb AIM L NIA Y 1 Win Int Sash MII AIM L N/A Y Threshold AIM L NIA Y 2 ExterlorSill MII SF L NIA Y A B C D 1 2 3 4 Closet Door AIM L WA Y 3 Part Bead MII L NIA Y Cl Casing A!M L NIA Y 4 Blind Stop MII SF L NIA Y Closet Jamb AIM L NIA Y Win Ext Sash MA L NIA A 6 c o Win Above 5' Mll FUM L MIA AS CCeiling Moldin MIl A/M L WA MII AIM L NIA COMMENTS I STRUCTURAL DEFECTS: Y Y Y Y Closet Walls AIM L NIA Y CI Baseboard AIM L NIA Y Closet Pole AIM L WA Y Closet Shelf ARG1 L NIA Y Cl Supports AIM L NIA Y Closet Floor AIM L NIA Y ClosetCeiting AIM L NIA Y cAVLUUCU awnr-Auro; z)uriaces iisieo in Tllese boxes Can- be made intact on SIDE LOCATION MEASURE: LOOSE PAINT IC IC SIDE LOCATION (MORE THAN 288 SO. IN.) DATE METHOD LFRA RepHall. 8108 a licensed deleader. MEASURE: LOOSE PAINT (MORE THAN 288 SO. IN.) DATE I METHOD Risk Assessor (print) [� Lic # Signature Address of Property: � ! _�� Apt # Citl._Il/'/���° ROOM #_I SIDE LOCATEONf LEAD TYPE OF URG IC 1C DELEAD Win Apron �. SURFACE Y HAZARD HAZ. DATE IDILIAD METH DATE METH A 9 Up Walls A1<01A Y I AIM 9) NIA A s LOW Walls AIM L MIA Y Y c D Baseboards �j NIA Y A $ Chair Rail S NIA AIM L NIA Y 3 �s cn Radiator Y AIM L NIA Y Blind Stop S - (j1 NIA Floor AIM L NIA Y NIA Mn AIM L NIA Y Y Ceiling k& AI NIA Y Y 10 Door 0.0 AIM L NIA Y C D Door Casing I% AIM L NIA Y 1 1 2 Door Jamb Q, AIM L NIA Y Win Int Sash 3 4 Threshold AIM L NIA Y Mfi SF L NIA A 13 Door 3 AIM L NIA Y Y C D Door Casing Blind Stop A1M L NIA Y 12 Door Jamb MII L NIA Mn AIM L NIA AIM L NIA Y B 3 4 Threshold Y AIM L NIA Y Win Casing A B Door AIM L NIA Y WI AIM L NIA C D Door Casing AIM L NIA Y Y 12 Door Jamb Win int Sash AIM L NIA Y 34 Threshold M11 SF L NIA AIM L NIA Y 3 A B Door Y AAM L NIA Y Blind Slop C D Door Casing AIM L NIA Y Mll L NIA AIM L NIA 12 iDooriamb C D AS o D AIM L NIA Y Y Y Y 3 4 Threshold AW L NIA Y 3 A Closet Door AN L NIA AIM L NIA Y 9 CI Casing Y AIM L NIA Y a licensed de Bader. MEASURE: LOOSE PAINT (MORE THAN 288 So. IN.) u lClosetJamb AIM L NIA Y D iCiosetwalts AIM L NIA Y j ICI Baseboard AIM L NIA Y i ClosetPoie AN, L NIA Y 2 Closetshelf AIM L NIA Y 3 Cl supports AIM L NIA Y 4 Closet Floor AIM L NIA Y Closet Ceiling AIM L NIA Y COMMENTS I STRUCtURAL DEFECTS: i t t EXCLUDED SURFACES; urraces listed in these Sojxes SIDE-OCAT.1GN MEASURE. LOOSE PAINT IC IC `s (I'AORE i HAN 288 S0, IN.; DATE METHOD i 3.RA RcvRoo o =8 Page 133 Of 91� SIDE:J A can LOCATION I LEAD SURFACE Window Sill TYPE OF HAZARD n NIA URG IC HAZ? DATE Y IC DELEAD DELEAD METH DATE METH B Win Apron �. J L NIA Y C Win Casing [NIA Y �D Header Stop /. I AIM 9) NIA Y Int Stops 6AA Y 1 Win Ink Sash O NIA Y 2 Exterior Bill S NIA Y 3 Part Bead NIA Y 4 Blind Stop S - (j1 NIA Y A Win Ext Sash Window Sim NIA Mn AIM L NIA Y Y B Win Apron ASM L NIA Y C Win Casing AIM L NIA Y D Header Slop MII AfM L MIA Y inl Stops M11 AMI L NIA Y 1 Win Int Sash Mil AIM L NTA Y 2 Exterior Sill Mfi SF L NIA Y 3 Pari Bead Mn L NIA Y 4 Blind Stop M11 SF L NIA Y A Win Ext Sash Windowsui MII L NIA Mn AIM L NIA Y Y B Win Apron AIM L NIA Y C Win Casing AIM L NIA Y ❑ Header Stop WI AIM L NIA Y Int stops Mn AIM L N/A Y 'E Win int Sash M/1 AIM L NIA Y 2 Exterior sm M11 SF L NIA Y 3 Part Bead Mn L WA Y 4 Blind Slop W1 SF L NIA Y B Win Ext Sash Fireplace Mll L NIA AIM L NIA Y Y C D AS o D Mante Win Above 5' Cer'fing Moldin AIM L NIA AIM L N/A AIM L NIA Y Y Y AIM L NIA Y AN L NIA Y AIM L NIA Y be made intact only by SIDEJ LOCATION a licensed de Bader. MEASURE: LOOSE PAINT (MORE THAN 288 So. IN.) -IC 1C DATE METHOD Risk Assessor (printf Signature Data, Address of Propet, 1 Ee� ' Apt. # City: PageyOf SIDE LOCATIONf SURFACE LEAD TYPE OF HAZARD URG IC HAZ? DATE 1C DELEAD DELEAD METH DATE METH SIDE LOCATION/ LEAD SURFACE TYPE OF HAZARD URG IC IC DELEAD DELEAD HAZ? DATE METH DATE METH A B Up Walls AIM L WA Y C D 12 3 4 Up Cab Frame j C{ (2 NIA Y A B Low Walls AIM L NIA Y Up Cab Door /�f ()WA Y A a Baseboards AIM L NIA Y Up Cab Walls t AIM CkA Y A B Chair Rail AIM L NA Y Up Cab ShIvs ri'j:� AIM L N/A Y A B A D Radiator AIM L NIA Y SupportsfvrAIM L I Y Floor AIM L N/A Y IA B G D 12 34 Up Cab Frame AIM L WA Y Ceiling AIM L NIA Y I Up Cab Door A/M L NIA Y A B Door AIM L NIA Y Up Cab Walls AIM L WA Y C D Door Casing AIM L WA Y Up Cab ShIvs AIM L NIA Y 12 Door Jamb AIM L NIA Y Supports AIM L WA Y 3 4 Threshold AIM L NIA Y A B G D 12 3 4 Low Cab Fram AN L NIA Y A B C D 12 34 Door AN L WA Y Low Cab Door AN L NIA Y Door Casing AIM L WA Y Low Cab wall AIM L NIA Y Door Jamb AIM WA Y Low CabSh AIM L WA Y Threshold AIM L WA Y supports AIM L NIA Y A Closet Door AIM L WA Y Drawers AIM L NIA Y B C D 1 2 Cl Casing AIM L WA Y AID C D 1 2 3 4 Low Cab Fmm AIM L WA Y Closet Jamb AN L NIA Y Low Cab Door j AIM L NIA Y Closet Walls AIM L NIA Y Low Cab Walls AIM L NIA Y Cl Baseboard AIM L NIA Y Low Cab ShIv AIM L NIA Y Closet Pole AIM L NIA Y Supports AIM L NIA Y Closet Shelf AIM L WA Y Drawers AIM L NIA Y 3 4 Cl Supports AIM L NIA Y A B C D 12. 34 Low Cab Fram AIM L NIA Y Closet Floor AIM L NIA Y Low Cab Door AIM L NIA Y Closet Ceiling AIM L NIA Y Low Cab Walls AIM L NIA Y A B C D Up Cab Frame AIM L WA Y Law Cab ShN AIM L NIA Y Up Cab Door AIM L WA Y Supports PJM L NIA Y Up Cab Walls AIM L NIA Y Drawers AIM L WA Y 12 Up Cab ShIvs AIM L WA Y A B C D 1 2 3 4 11 Window Sill MII AMI L NIA Y 34 Supports AIM L NIA Y Win Apron PJM L WA Y MIl AIM L WA Y Win Casing AIM L WA Y W A/M L NIA Y Header Stop MA AIM L WA Y Mfl A1M L WA Y Int Stops M11 AIM L WA Y COMMENTS /STRUCTURAL DEFECTS; ' r'Vl11 I Irl n I IRP' 1-n. Win Int Sash MA AIM L WA Y Exterior Sill M/1 SF L WA Y Part Bead M/i L WA Y Blind Stop M11 SF L NIA Y Win Ext Sash M11 L NIA Y UCV ,7VR�l14L.7..7Uf ft3(:t;'S' IfSltu'U IR [RESe ❑C]YP.R [:AR R[3 RTAf1P_ IRTAf:T [1lIIV r1V fa IIl41ffCOA /YGFC7fyGY SIDEJ LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SO. IN.) IC DATE IC METHOD SIDEJ LOCATION MEASURE: LOWE PAINT (MORE THAN 288 SQ, IN.) IC DATE IC METHOD T T/D a ue..o,,.1 ' QjAQ Inspector Lic # Signature �i Date Risk Assessor (print) r^� Lic Signature Date f Address of Property: �[ i �� �: .. A t. # city: f� STAIRCASE JS_AVIII� TYPE OF URG IC SIDE LOCATlONi LFJ1D TYPE OF UP.G IC !C DELEAD DELEAD HAZ? DATE SURFACE A HAZARD HAZ? DATE METH DATE METH A B o Up Walls JL AIM L NIA Y A 8 Low Walls A/M L NIA A/M L N/A Y A o Baseboards �1� AIM L NIA Y AB Chair Rai! Q AM L NIA Y AB A!M L NIA Y CD Radiator M/1 AIM L NIA Y Floor Cf� AIM L N/A Y AIM, L N/A Ceiling AIM L WA Y A DoorN/A SF L NIA Y Y 3 Door Casing N/A y 12 Doorjamb q -CL 60NIA y 3 4 Threshold Y AIM L NIA Y AB Door L NIA AIM L N/A Y D Door Casing MA NIA Y 12 Door Jamb Win Apron N/A Y 3 4 Threshold C AIM L NIA Y AOaor 6D Y AIM L NIA Y MA Door Casing Y NIA Y 12 Doorjamb AIM L NIA 17 N/A Y 34 Threshold MA AIM L NIA Y A B Door ExterlorSll! AMI L NIA Y -- CD CD Door Casing 3 AtM L NIA Y 12 Door Jamb AIM L N/A Y 3 4 Threshold Y A/M L N/A Y A B Door L NIA AIM L N/A Y C D Door Casing ; AIM L N/A Y # Doorjamb Railing Cap AIM L N/A Y Y Threshold AIM L N/A Y A Closet Door AIM L N/A Y B C, Casing Y AIM L NIA Y C Closet Jamb AIM L NIA AIM L NIA Y D Closet Walls AIM L NIA Y Cl Baseboard iJ L NIA Y 1 Closet Pole { AIM L NIA Y 2 Closet Shelf Y AIM L N/A Y 3 CI Supports A/M L N/A A/M L NIA Y 4 Closet Floor AIM L N/A Y Closet Ceiling AIM L NIA Y Y COMMENTS ISTRUCTURALDEFECTS: 0UFIJdCeS 1131150 In mese DoxeS C LOCATION MEASURE: LOOSE PAINT IC IC (MORE THAN 288 SQ. !N.) I DATE METHOD LURA RepSrair, 8/08 Page SIDE LOCATION/ LEAD TYPE OF URG IC 1C DELFJIO DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH A Window Sill M/l AIM L NIA Y B Win Apron A/M L NIA Y C Win Casing A/M L NIA Y D Header Stop M/I A!M L NIA Y Int Stops M/1 A/M L N/A Y 1 Win Int Sash M/I AIM, L N/A Y 2 Exterior Sill MIE SF L NIA Y 3 Part Bead M/I L N/A Y 4 Blind Stop Mill SF L NIA Y Win Ext Sash M/I L NIA Y A Window Sill MA A/M L NIA Y B Win Apron AMM L N/A Y C Win Casing AIM L N/A Y D Header Stop MA AIM L NIA Y Ent Stops M/I AIM L NIA Y 1 Win Int Sash MA A/M L NIA Y 2 ExterlorSll! M/! SF L NIA Y 3 Part Bead M/I L N/Al Y 4 Blind Stop M/I SF L N/A Y Win Fri Sash MA L NIA Y Newel Post AIM L NIA Y Railing Cap A/M L NIA Y Handrail G ? AIM L NIA Y Balusters AIM L NIA Y Lowerrail. AIM L NIA Y Treads AIM L NIA Y Risers A/M L NIA Y Stinger AMM L NIA Y Floor Edge A/M L N/A Y Floor Casing AIM L WA Y AAII AN L NIA Y COMMENTS ISTRUCTURALDEFECTS: an be made intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT IC IC (MORE THAN 288 S4. IN) DATE METHOD Risk Assessor (print) Lic # Signature Date Address of Pro e 2 fee q - j A t. # fcit ROOM # Page JA OF .2� SIDE A 6 LOCATION/ SURFACE Up Walls LEAD (% TYPE OF HAZARD AIM L NIA URG IC HAZ? DATE Y IC DELEAD DELEAD METH DATE METH SIDEJ 6 B C D 2 3 4 LOCATION) SURFACE Window Sill LEAD TYPIC OF HAZARD MA AIM L NIA URG IC HAZ. DATE Y IC DELEAD DELEAD METH DATE METH rr 13 i B Low Walls -AIMI- NIA Y Win Apron 00 AIM L N/A Y A8 Baseboards NJA Y Win Casing G AIM L NIA Y A s Chair Rail AIM L NIA Y Header Stop G MII AIM L NIA Y AS Radiator 0 AIM L NIA Y int Stops -6. MII AIM L NIA Y Roor (A) AIM L WA Y Win Int Sash at) M11 AIM L NIA Y Ceiling AIM LOA Y Exterior sill ' MA SF L NIA Y C D 12 Door NIA Y Part Bead C'a) Mlt L WA Y Door Casing WA Y Blind Stop SF L MIA Y Door Jamb NIA Y Win 1=xtSash W L NIA Y 3 4 Threshold AIM L MIA Y B C •D 1 3 4 Window SM 0. MIt AIM L N/A Y AB D 12 34 Door C L MIA Y Wur Apron Ct ASM L MIA Y L NIA Y Door CasingWAIMILWA Win Casing (/. AIM L MIA Y Door Jamb WA Y Header Stop UOL MY AIM L WA Y Threshold Y 'Int. Stops —0.1 Mn AIM L NIA Y AB CC 12 34 Door �. L NIA Y _j_ L WA Y Win Int Sash (f MR AIM L NIA Y Exterior Sill (W MIt SF L NSA Y Door Jamb qQ WL NIA Y Part BeadCA) MII L MIA Y Threshold AIM L NIA Y Blind Stop A ifo I# L NIA Y AB Dom AIM L NIA Y Win Ext Sash OZ MA L NIA Y C D 12 34 Door Casing AIM L MIA Y A 8 C D 1 2 3 4 Window Sill MR AIM L NIA Y DoorJamb AIM L NIA Y Win Apron AIM L NIA Y Threshoid AIM L NIA Y Win Casing AIM L NIA Y A B� C D 1 2 Closet Door L NIA Y Header Stop MR AIM L NIA Y Cl Casing L NIA Y Int Stops M11 AIM L WA Y Closet Jamb AYL MIA Y Win Int Sash MA AIM L NIA Y Closet Walls AJM L NIA Y Exterior Sill MJ1 SF L MIA Y Cl Baseboard AA AIM L Y Part Bead MR L NIA Y Closet Pole AIM L NIA Y Blind Stop MA SF L NIA Y Closet Shelf AIM L NIA Y Win Ext Sash Mn L NJA Y 3 4 Cl Supports Q Ci o NIA Y AS CD AS Fireplace AIM L MIA Y IClosetRoor �. AIM L NIA Y Closet Ceiling I alAIM L NIA Y Mantle AIM L NIA Y Win Above 5' A1M L NIA Y COMMENTS 1 STRUCTURAL DEFECTS: Ceiling Moldin AIM L NIA Y AIM L NIA Y AIM L NIA Y AIM 7 NIA Y LU U. A Surfaces listed to theseboxes can be made Intact only y a licensedda eader. SIDEJ LOCATION MEASURE. LOOSE PAINT (MORE THAN 288 SQ. IN.) IC DATE IC METHOD SIDE LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) -1C DATE IC METHOD L&R.A RcpKeom, SID8 Page 0-61 S;DE LOCATIONI SURFACE LEAD TYPE OF HAZARD IKAZ?� URG IC DATE IC DELI AD DELEAD METH DATE METH SIDEJ LOCATION! LEAD SURFACE TYPE OF URG IC HAZARD HAZ? DATE 1C DELEAD DELEAD METH DATE METH A Up Walls AIM L NIA Y A B C C 1 2 3 4 Window Sill Mll AIM L WA Y A B Low Walls AIM L NIA Y Win Apron AIM L NIA Y A a Baseboards AIM L NIA Y Win Casing AIM L NIA Y A B Chair Rail AIM L NIA Y Header Stop MA AIM L NIA Y AB CD Radiator AIM L NIA Y Int Stops MA AIM L NIA Y Floor AIM L NIA Y Win int Sash MA AIM L NIA Y Ceiling AIM L NIA Y Exterior Siii Mn SF L NIA Y A B C D 12 Door AIM L NIA Y Part Bead MIl L NIA Y Door Casing AIM L NIA Y Blind Stop W1 SF L NIA Y Door Jamb AIM L NIA Y Win Ext Sash MII L NIA Y 3 4 Threshold AfM L NIA Y A B C •D 1 2 3 4 Window Sill Wl AIM L NIA Y A 8 C D 12 3 4 Door AIM L NIA Y Win Apron AIM L NIA Y Door Casing AIM L NIA Y Win Casing AIM L NIA Y Door Jamb AIM L NIA Y Header Stop MII AIM L NfA Y Threshold AIM L NIA Y tnf stops MA AIM L NIA Y A B C D 12 3 4 Door AIM L NIA Y Win Int Sash MIl AIM L NIA Y Door Casing AIM L NfA Y Exterior sill WI SF L NIA Y Door Jamb AN L NIA Y Part Bead MA L NIA Y Threshold AIM L NIA Y Blind Stop WI SF L NIA Y A B Door AIM L NIA Y Win Ext Sash MI1 L NIA Y C D 12 134 Door Casing AIM L NIA Y A B C D 1 2 3 4 Window Sill MA AIM L NIA Y Door Jamb AIM L NIA Y Win Apron AIM L NIA Y Threshold1. AIM L NIA Y Win Casing AIM L NIA Y 5 A B S v W < 1 2 Closet, Door L NIA Y Header Stop M11 AIM L NIA Y CI Casing Q- L NIA Y Int Stops M11 AIM L NIA Y i Cl oseL Jamb L NIA Y Wm Int Sash W AIM L NIA Y I ��osei wails [g� AIM L MIA Y 1 Exterior Sill MA SF L MIA Y Ci Baseboard q.ql()N/A Y Part Bead MIi L NIA Y Clasa( Pole 6r.k LlAIM L NIA Y Blind Stop WI SF L NIA Y Closet Shelf (j .j AIM L NIA Y Min Ext Sash I MA L NIA Y 3 4 ICi Supports I C1 41 L NIA Y A B C D Fireplace AIM L NIA Y ICloset Floor AIM L NIA Y Mantle AIM L MIA Y Closet Geliin g C)AIM L NIA Y A B c D Win Above 5' AIM L NIA Y aCOMMENTS I STRUCTURAL DEFECTS: s Ceiling Moldinc AIM L NIA Y AFM L NIA Y AIM L NIA Y AIM L NIAJ Y E'A"CLUDEDSURFAC SuHaces listed In these pxes can be made cniact only by a licensed delleader. c SIDE _OCA; iON MEASURE. LOOSE PAINT {MORE THAN 288 5Q IN IC DATE IC METHOD SIDE LOCATION URE: LOOSE PAINT ;(MMORIETHAN 28B SQ_ IN.) -1CHMETHOD DAT I.3€RA aR-eaReow, 8108 Risk Assessor (print) IN Lic # Signature Date ROOM Page /90t-? SIDEJLOCATION/ LEAD TYPE OF URG 1C iC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ2 DATE METH DATE METH I Up Walls �(rV AJM L NIA Y A Window Sill Mil A/M L NIA Y A B Low Walls AIM L NIA Y 13 Win Apron AIM L NIA Y C o Baseboards ( N1A Y C Win Casing AIM L NIA Y A B Chair Rail AIM L NIA Y D Header Stop (,. MY AIM L NIA Y AB cos AIM L WA Y � Int Slops MII AIM L NIA Y Floor AIM L NIA Y 1 Win Int Sash IWI AIM L WA Y it Ceiling A/M L NIA Y 2 Exterior Sill kA 0 69 L NIA Y $ Door AIM L WA Y 3 Part Bead L NIA Y C D Door Casing WA Y 4 Blind Stop L NIA Y 12 Door Jamb cf,NIA Y Win East Sash L NIA Y 3 4 Threshold Door A/M L NIA AIM L NIA Y Y A Window Sill B Win Apron M1I AIM L NIA AIM L NIA Y Y A B C D Door Casing A/M L NIA Y C Win Casing AIM L NIA Y 1.2 Door Jamb AIM L NIA Y •D Header Stop WI AIM L NIA Y 34 Threshold Door AIM L NIA AIM L NIA Y Y nt Stops MA AIM L WA 1 Win Int Sash MR AIM L N/A Y Y A B C D Door Casing Ar'M L NIA Y 2 Exterior Sill Mll SF L NIA Y 1 2 Door Jamb AIM L NIA Y 3 Part Bead W L NIA Y 3 4 Threshold Door AIM L NIA AIM L NIA Y Y 4 Blind Stop Mil SF L NIA Win Ext Sash M11 L NIA Y Y A B C D Door Casing A1M L NIA Y A Window Siii MR AIM L NIA Y 12 Door Jamb AIM L WA Y B Win Apron AIM L NIA Y ,34 I Threshold tCloset Door AIM L NIA AIM L NIA Y Y C D Win Casing Header Stop AIM L WA Mil AIM L MIA Y Y A B I Cl Casing AIM L NIA Y Int stops M11 AIM L NIA Y C ' Closet Jamb AIM L NIA Y "k Win Int Sash M11 AIM L NIA Y D `'Closet Walls A/M L N/A Y 2 Exterior S111 MA SF L NIA Y jCi Baseboard AIM L N/A Y 3 Part Bead M11 L NIA Y 1 Closet Pole AIM L NIA Y 4 Blind Stop MR SF L NIA Y 2 Closet Shelf AIM L NIA Y Win Ext Sash MA L NIA Y 3 1 C Supports AIM L NIA Y B Fireplace AIM L NIA Y 4 !Closet Floor AIM L NIA Y O D Mantle AIM L NIA Y Ciasst Ceiling A1M L N/A Y CoAl Win Above 5' AIM L NIA Y COMMENTS i STRUCTURAL' DEFECTS: Ceiling Moldi AIM L NIA Y -V&JIA iO .) �JA�t� AIM L NIA Y AIM L NIA Y !' AIM L WA Y EX LU b U '. A urraces liste in these axes can a made intact only y a Licensed de eader. k JiDEll OCATiON MEASURE. LOOSE PAINT IC IC SIDE LOCATION MEASURE: LOOSE PAINT dC IC (MORE THAN 288 SQ IN j DATE METHOD (MORE THAN 288 SQ, IN.) DATE METHOD r' Page n" �� Risk Assessor (print) Lic 4 Address of PropA:al .St'erty_ C�. 'Apt ROOM#�--. Signature # Date Ciiv �✓' 6t SIDE LOCATION! LEAD SURFACE A B Up Walls A $ Low Walls r D Baseboards A g Chair Raii c D Radiator 0 Floor SCJ TYPE OF HAZARD A1M L NIA -A/M L NIA NIA AIM L NIA AIM L NIA AIM L NIA URG IC HAV DATE Y Y Y Y Y Y I—IC DELEAD DELEAD METH DATE METH SIDE A �( D 1 LOCATION LEAD TYPE OF SURFACE= HAZARD Window Sill O W AIM L NIA Win Apron # AIM L MIA Win Casing AAu! L MIA Header Stop MA AIM L NIA Int Stops '6-1 MA AIM L NIA Win Int Sash. M11 AIM L NIA URG IC HAZ. DATE Y Y Y Y Y Y IC DELEAD DELEAD METH DATE METH Ceiling L AIM L NIA Y 2 Exterior Sill C�) Mn SF L MIA Y B Door (I . C D Door Casing 12 Door Jamb A1M L MIA L NIA L NIA Y Y Y 3 4 Part Bead Blind Stop Win Fad SashM11 CAMil L NIA '('j Mil SF L NIA L NIA Y Y Y 34 Threshold L WA Y A Window SW MII AIM L WA Y Door A/M L NIA Y 8 Win Apron AIM L NIA Y C D Door Casing q. L WA Y C Win Casing AIM L NIA Y 12 Door Jamb L NIA Y -D Header Stop M11 AIM L NIA Y 3 4 Threshold AIM L NIA Y Int Stops Wl A IVI L NIA Y A B Door AIM L NIA Y 1 Win lot Sash WI AIM L NIA Y C D Door Casing JF AIM L WA Y 2 ExieriorSill MA Sr- L NIA Y 112 Door Jamb AIM L WA Y 3 Part Bead W L MIA Y 34 Threshold AIM L NIA Y 4 Bfiind Stop WI SF L NIA Y A B Door AIM L 141A Y Win Ext Sash Mil L NIA Y C D Door Casing AIM L NIA Y A Windowsill MA AIM L NIA Y 12 B Door Jamb A IVI L NIA Y Win Apron AN L NIA Y �34 C D �Th:reshoid A1M L N!A Y Win Casing AAut L NIA Y QQ AIM L NIA Y header Stop W AIM L NIA Y B Cl Casing L NIA Y int Stops MA AIM L NIA Y C 1 Closet Jamb L NIA Y Win Ind Sash MII A/M L NIA Y D 2 Closet Walls AIM L rlY Exterior Sill W SF L MIA Y Cl Baseboard L NIA Y Part Bead MII L NIA Y 3 1 4 Closet Pole 0 . AIM L NIA Y Blind Stop MR SF L NIA Y 2 Closet Shelf c AIM L NIA Y Win Ext Sash MY L NIA Y 3 lei Supports q L NIA Y AB Fireplace AAM L NIA Y 4 Ic D IMantla Closet Floor AIM L NIA AIM L NIA Y Closet Ceiling AIM L WA Y A a c D Win Above 5' AIM L MIA Y COMMENTS I STRUCTURAL DEFECTS: Ceiling Molding jA A1M L NIA Y A1M L NIA Y AIM L NIA Y AIM L NIA Y E4-1 MUDED SURFACES' Surfaces listed to these boxes can be made intact only by a licensed de eader. SfDE LOCATION MEASURE. LOOSE PAINT IC IC SIDE LOCATION MEASURE: LOOSE PAINT -IC IC (MORE THAN 288 SO. IN.) DATE METHOD (MORE THAN 288 SQ, IN.) DATE METHOD LYRA RepRoomn RM r� Inspector Lic 4 Signature I(JJ61 Date Risk Assessor (print) Lic # Signature Date Address of Pro eb, S7� Ant. 9r..+t•�l� ,!/ �i. STAIRCASE - Y4fc + LAUAAet4 ARnd SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH i DATE METH A o Up'Yalls AIM L N/A Y A eC 171 Low Walls AIM L NIA Y A 8 Baseboards A!M L N/A Y A e Chair Rail AIM L N/A Y AB Y B Win Apron CKBDoor or AIM L NIA Y C Win Casing AIM L NIA Y AIM L NIA Y AIM L NIA Y M/1 A/M L NIA Y Door Casing AIM L NIA Y 12 Doorjamb (r AIM L NIA Y 34 Threshold AIM L NIA Y A B Door AIM L NIA Y C D Doorcasing AIM L NIA Y 1 2 Door Jamb AIM L N/A Y 34 Threshold AIM L N/Al Y AB Door AIM L NIA Y CD Door Casing AIM L NIA Y 1 2 Doorjamb ! AIM L WA Y 34 Threshoid LL AIM L NIA 7Y AB Door AIM L WA Y C D Door Casing IIJ NM L NIA Y 12 Doorjamb AIM L NIA Y 34 Threshold AIM L NIA Y A B Door AIM L N/A Y C D Door Casing AIM L NIA Y # Door ,lamb AIM L WA Y 2 Threshold AIM L N/A Y A closet Door A/M L NIA Y B Cl Casing AIM L NIA Y C Closetjamb AIM L NIA Y D Closet Walls Aim L NIA Y Cl Baseboard AIM L NIA Y 1 Closet Pole , AIM L NIA Y 2 Closet Shelf AIM L NIA Y 3 Cl Supports AIM L NIA Y 4 Closes Floor AIM L WA Y Closet Ceiling AIM L 7VA Y LOCATION MEASURI=: LOOSE PAIN' T (MORE THAN 288 SQ. IN.) LYRA ReDSrair. 8/08 Page W1 Of SIDEJLOCATION/ LEAD TYPEOF URG [C IC DELEAD DE-LEAD SURFACE HAZARD HAZ?J DATE METH I DATE METH A Window Sill W1 AIM L NIA Y B Win Apron AIM L NIA Y C Win Casing AIM L NIA Y LD Header Stop M/1 W. L NIA Y Int Stops . Mil AIM L NIA Y 1 Win Int Sash M/I AIM L NIA Y 2 Exterior Si11 M1l SF L NIA Y 3 Part Bead M/I L WA Y 4 Blind Stop M/l SF L NIA Y Win Ext Sash Awl L NIA Y A Window Sill MA AIM L NIA Y B Win Apron AIM L N/A Y C Win Casing AIM L NIA Y D Header Stop WUl AIM L NIA Y Int Stops MIl AIM L NIA Y 1 Win Int Sash MA AIM L NIA Y 2 Exterior Sill MA SF L N/A Y 3 Part Bead MA L N/A Y 4 Blind Stop M/1 SF L NIA Y Win Ext Sash M/1 L NIA Y Newel Post AIM L NIA Y Railing Cap Handrail A/M L NIA A/M L N/A Y Y Balusters A/M L N/A Y Lower rail. AIM L WA Y Treads �,'7 AAM L NIA Y Risers Q` AIM L N/A Y Slinger (91) AIM L NIA Y Floor Edge C6LI A/M L WA Y Floor Casing ( AlM L N/A Y M11 AIM L NIA Y COMME=NTS / STRUCTURAL DEFECTS: in inese DOXeS can n IC IC SID DATE METHOD e intact only ly a licensed deleader. LOCATION MEASURE: LOOSE PAINT (MORE THAN 288 SQ. IN.) ICIC I DATE METHOD Risk Assessor (print) Uc± Signature Date Address of Property_ �.-PAV9 - EXTERIOR S'sDE A A A SitlP-! TIN;LEA SUM�t`ACE Siding ( Corner Boards Cdf/ LowerTrima/ Upper Trim n€/ Win Above ti4L Porch Above 0 Storm Door Door - VPPEOF HAZARD L N/A L NIA L M/A L MIA y!p L VIA A'U LNIA -A/M L MIA - URG €C iC DELEAD DELEAD HAZ?i DATE METH DATE METH Y Y Y Y Y Y Y Y A Door Casing Ahs L N1A Y 1 2 Door Jamb AW L NIA Y 3 4 Threshold AMM L NIA Y Ki*late A/M L WA Y Storm Door win L CTIA Y, door AM L MIA Y A DoorCasirig AM L WA Y 1 2 Door jamb ArM L WA Y 3 4 Threshold AMM L NIA Y Kickplate AIM L NIA Y Door AIM L MIA Y A NM L WA Y ' 2 FThrasjQSd NM L U,'A Y 3 ? ArM L N/A Y Window Sill AIM L NIA Y A Win Casing 11,q/ AIM L MIA Y Window Sasn t:lij A1M L IVA Y Window Sill t AN L IVA Y Csing 6V A Ed.a, z :, Sash AiM L NIA Y i Alte9 L WA Y Window Sill FdM L N/A Y A 'Nin Casing rev A'M L NlA Y Winnow sash fkl ! :,M L NIA Y A Lamc PostL MIA Y T S I STRL'C-URAL DEFECTS: L N/A 1COMMEN Screen Frame /-----AICA :s Y Foundation 1 L ,VMA Y z AIM L ,NIA Exclu;ed Surfaces: Surfaces listed in this box can bP mneiP :rttact only by a licensed deleader IDE LG, 11AEASURF: LOOSE PAINT IC !C A (MORE THAN ?4417 1.1"RA krpEx[:\. J:IiS SIDI A A A A A A A A A Page Z1 Of AJ s LCCATIOV1 LEAD TYPEOF URG IC IC DELEAD DELEAD SURFACE 'HAZARD HAZ? DATE METH DATE N,ETq Window Sill AIM L IdiA Y Win Casing 7 k/ AN L N/A Y WindowWh AIM. L N1A Y Cellar Win S , L NIA Y Cei Win Sash, L4 AIM L WA Y Cel YJin'ram L NIA Y Screen Frame S AN N/A Y Cellar Win Sill AMM L MIA Y Gel Win Sash A•IM L ,WA Y Cel Win Frain A/M L MIA Y Screen Frame AIM L N/A Y Cellar Win Sill AIM L N/A Y Get win Sash AIM L NIA Y Cel Win Frame AIM -i_ NIA Y Screen Frame A/M L NIA Y Cellar Win Sill AU L NMA Y Cel Win Sash AM L NIA Y Cat Wm Fram L N/A Y Screen Frame /-----AICA AIM L MIA Y Foundation dV L ,VMA Y Bullhead AIM L ,NIA Y Fences A/M L NIA Y Shutters AIM L NMA Y Newel post AN L NIA Y Paling Cap AIM L MIA Y Handrail j AIM L N;IA Y Balusters AIM L NIA Y Lower Rail MCA L NIA Y r&adS ` AIM L WA Y Risers A!N , N!A Y String"! L A.rM L NiA Y r anice ' AIM L N/A Y Drain Pipes L N/A Y ElecConduit r MIA Y Oil Fill Pipe L NIA Y Overhang Tr L MIA v Wvu iCJS nC3UlW ( Must be less than 400 ppm ;or play area* 11200 ppm for bare soil) LOCATION .AREA MEASUREME1V1' RrSUL i REMED REMEO ,. 5auara Feet (?PM) DATE METS Play Area Bare soil Comments; Risk Assessor (pnitt) TYPE'OF Lio Signature Address of prooeiqv� al Prize, s7y - GXTERIOR B Side AIM L NIA __.. `. AAt• # �__ kE LOCATiON/ ILEAD iYPEOp Y DELEAD SURFACE HAZARD �URGDELEAD J DATE METH Sidinge L NIA Y Comer Boards rdi =LNIA Y Lower Trim rl/ L NIA Y Upper Trim CV L NIA Y Win Above 5' CeV L NiA Y Porch Above 5 L .NIA Y Storm DoorPA N/A Y GooraUTA De Jar Win SillAlM Y B oar CasingN/A $ Cel Win Sash Y l 2 Door JambNIA Cel Win Frame Y 3 4 ThresholdN/AKickplateNIA Screen Frame AIM L WA Y Celiar Win Sill Y Storm Door IA Y Door Door' Casing NIA Y V g/ AIM L N/A Y 2 Doorjamb AN L NIA v 3 4 Threshold {1 A/M L NIA Y i<oicplate i A,� A/M L NIA Y Door a ` AIM L NIA Y Door Casing } AIM L NIA Y 1 41 Door Jamb AIM AIM L NIA Y L N/A AIM L N/A 3 4 Threshold AIM L NIA �V_ WndowSil! AIM L NiA Y B bVin Casing AIFA L NIA Y r Wir40wSash A/M L NIA Y Windowsill AIM ; WA Y $ Win Casing LI A/M L NIA Y Vdindow Sash AIM L NIA v Window Sill AIM L NIA Y Win Casing A!M L NIA Y T Window Sash AIFA L NIA AIM L N/A B Lamp Post L NIA Y COMMENTS I STRUC T URAL DEFECTS: LOCA T ION AREA MEASUREMEMNTRESULT R£IvIED R£MED Square Feet l !PPM; pA17 METH ExCluded Surfaces: SuFfaCeS iisted in -this box can be made intact only by a licensed deleader I S!DE LOCA <ION p MEASURE: LOOSE PAINT tC IC {MORE THAN id4CSQ. IN. DATE METH A i A L- Q RcpE3:f;, brill Date page2Z Of T-100ATION/ LAD TYPE'OF URG is ICDELEAD DEI.EAD RFACE HAZARD HA2? DATE METH DATE METH Window Siff AIM L NIA Y l3 Win Casing A/M s NIA Y n Window Sash . AIM L NIA Y Cellar Win Sill & AIM- L WA Y B Cel Win Sash 4/ AIM L NIA Y 9 Cei Win Frame �' . ► AIM L WA Y Screen Frame i�/ AIM L NIA Y Cellar Win Sill AIM L NIA Y B Cel Win Sash A/M L NIA Y 9 Cel Win Frame AIM L NIA Y Screen frame AIM L WA Y De Jar Win SillAlM L NIA Y $ Cel Win Sash AIM I, NIA Y Cel Win Frame AIM is N/A Y Screen Frame AIM L WA Y Celiar Win Sill AIM L N/A Y B Cel Win Sash AIM L NIA Y Cel Win Frame AIM L NIA Y Screen Frame AIM L N/A Y Foundation 'L NIA Y B Bulkhead A/M L N/A Fences L A/M L NIAEY Shutters AIM L N/A Y ARA L NIA Y AIM L NIA Y 4andraii6li AIM L N/A Y B AIM L NIA Y AN L N/A Y Treads C. AIM L NIA Y Risers AIM L'N!A Y Stringer AIM L NIA Y Lattice AIM L N/A Y Drain Pipes L NIA Y B ElecConduit L NIA Y Ot[ FSI[ Pipe 7-- L NIA Y Overhang Trim AIM L N/A Y Soii Test Results (Must be less than 400 ppm for play area 11200 ppm for bare soil) LOCA T ION AREA MEASUREMEMNTRESULT R£IvIED R£MED Square Feet l !PPM; pA17 METH Play Area Bare soil Comments: Risk Assessor (print) Lice' Signature Date Address of Properly:. 0, Apt. # City& k• EXTI~RIOR C Side Page ®�30f �� SIDE C LOCATION/ SURFACE LEAD TYPEOF URG IC HAZARD HAZ? DATE lC DELEAD DELEAD METH DATE METH SIDE C LOCATION/ LEAD SURFACE TYPE OF URG IC IC DELEAD DELEAD HAZARD HAZ? DATE METH DATE METH C Siding Ctrl/ L N1A Y (MORE THAN 1440 SQ. IN.) C # Window Sill AIM L NIA Y Corner Boards 0-Lif L NIA Y Wln Casing AMU L NIA Y Lower Trim CV L 141A Y Window Sash AIM L NIA Y UpperTrim "eJ L NIA Y tJ Cellar Win Sill AIM L NIA Y Win Above 5' !1 L NIA Y Cal Win Sash AIM L NIA Y Porch Above 5' . L NIA Y Cat Win Frame AIM 'L WA Y Storm Door AIM L NIA Y Screen Frame AIM L NIA Y C 1 2 3 4 Door AIM L NIA Y C # Cellar Win Sill AIM L NIA Y Door Casing 4 AIM L NIA Y Cel Win Sash AIM L N/A Y Door Jamb AIM L NIA Y Cel Win Frame AIM L N1A Y Threshold AIM L NIA Y Screen Frame AIM L NIA Y Kickplate AIM L NIA Y C # Cellar Win Sill AIM L NIA Y C Storm Door AIM L WA Y Cel Win Sash AIM 'L WA Y Door -AIM L NIA Y CelftFfame AIM L NIA Y Door Casing AIM L NIA Y Screen Frame AIM L NIA Y 1 2 3 4 Door Jamb AIM L NIA Y C # Cellar Win Sill AN L NIA Y Threshold A/M L NIA Y Cel Win Sash AIM L NIA Y Klckplate AIM L NIA Y Cel Win Frame AIM L NIA Y Door AIM L NIA Y Screen Frame," rame AIM L NIA Y C 1 2 3 4 Door Casing AIM L NIA Y C Foundation C41/ L NIA Y Door Jamb AIM L NIA Y Bulldlead AIM L NIA Y Threshold AIM LVA Y Fences AIM L NIA Y Window Sill AIM L NIA Y Shutters AIM L NIA Y G # Win Casing AIM L NIA Y C Newel post AIM L NIA Y Window Sash AIM L NIA Y Railing Cap AIM L NIA Y C # . Window Sill AIM L NIA Y Handrail AIM L NIA Y Win Casing' AJM L NIA Y Balusters AIM L NIAJ Y Window Sash ANN NIA Y Lower Pail AIM L NIA Y C # Window Bill AIM L NIA Y Treads AIM L NIA Y Win Casing AIM L NIA Y Risers j AIM L NIA Y Window Sash AIM L NIA Y Stringer AIM L NIA Y C Lamp Post L NIA Y Lattice AMI L NIA Y COMMENTS I STRUCTURAL, DEFECTS: C Drain Pipes L NIA Y Elec Conduit L NIA Y Oil Fill Pipe L NIA Y Overhang Tfirr L WA Y Excluded Sunaces: aunacesatstea In tnts box can Derr?, e Soil Test Results intact only by a licensed deleader (Must be less than 400 DDM for nlav area 11200 onm for hare snip SIDE LOCATION MEASURE: LOOSE PAINT IC EC LOCATION AREA MEASUREMENT RESULT REMED REMED A (MORE THAN 1440 SQ. IN.) DATE METH ( Square Feel) (PPM) DATE METH A Play Area A Bare soil A Comments: A' LURA RcpExiC, 8105 Aisk Assessor (print)Lie# Signa -,.,re nn Address of Properv: r� l Y_vaDate .. 44' ,- EXTERIOR D Side SIDE LOCATION./ LEAj TYPE OF URC [C IC DELEAD DELEAD D SUPFACE LICATIOW �:,AZARD ^4DATE METH DATE METH URG +C Siding tib/ NiA Y HAZARD Corner Boards ty/ L N!A Y D Lower Trim (w L NiA v Upper Trim ! r/ L N/A Y D Win Above 5' NiA Y Porch Above 5' � L NIA Y AIM L NIA Door �. AIM L NIA Y AIM L NiA !Storm oor % O L NIA Y D Door Casing (etl A/M L N/A Y 1 2 Door Jamil �.� AIM L N/A Y 34 Threshold 7 AIM L WA v Kickplate)VM Cellar Win Sill L NIA Y Y Storm Door D A/M L NIA Y AN L NIA Door AIM L NIA Y D Door Casing Y AIM L NIA . Y 1 2 Door Jamb AIM L NIA AN L NIA Y 3 4 Threshold A1M L NIA Y Kickplate Cel Win Sash AN L N/A Y Y Door AN L N/A Y D boor Casing AIM L NIA Y i 2 Door Jamts Y AN L N/A Y 3 4 Threshold AIM L NIA AIM L NIA Y D Window Sill AIM L NIA Y D Win Casing Cel Win Fram AIM L N'A Y Y Window Sash AIM L NIA Y A/M L NIA Window Sill AIM L N'A Y Win Casino Y A/M L NIA Y LTD, window Sasr, A/M L NIA AIM L NIA Y ' Window Siii AW L N/A Y D Win Casing Strutters AIM L WA Y Y rJindow Sash A/M L N/A Y D Lamp PostL NIA v COMMENTS i STRUCTURAL DEFECTS: Excluded Surfaces: Surfaces listed in this box can be made Intact only by a licensed deleaaer IDE tOCATfG,v ia1EA5UR@: LflOSE PAINT ;C iC A {MORE THAN 1440 SC. W.i DATE McTH LIMA RepExtD. S/0S Paged l ofj 11DE LICATIOW LEAD TYPE OF URG +C 1C DELEAQ DELEAD D SURFACE HAZARD HAZ3 DATE MATH DATE METH Wind= SI[[ AN L NIA Y D Win Casing AIM L NIA Y Window Sash AIM L NIA Y Cellar Win Sill (W AIM L NiA Y D Cel Win Sash [/ A✓lv1? NIA Y # J Cel Win Frame t �� AIM L NIA Y Screen Frame 7 A/M L NIA Y Cellar Win Sill AIM L NIA Y D Cel Win Sash t eV AN L NIA Y 0 Cel Win Frame j+jV A/M L NIA Y Screen Frame AIM L NIA Y Ca[lar Win Sill AIM , L NIA Y D Cel Win Sash AIM L NIA Y Cel Win Frame A/M L N/A Y Screen Frame AIM L NIA Y Cellar win Sill AIM L NIA Y D Cel Win Sash AIM L NIA Y Cel Win Fram A/M L NIA Y Screen Frame A/M L NIA Y Foundation L NiA Y D Bulkhead A/M L NIA Y Fences AIM L NIA Y Strutters �(/�} AIM L NIA Y Newel post AIM L NIA Y Railing Cap A/M L NiA Y Handrail A/M L NIA Y D Balusters AIM L ;VIA Y Lower Rail AIM L NIA Y Treads �f j ` AIM L NIA Y Risers L AN L NIA Y Stringer { AIM L NIA Y Lattice AIN L NIA Y Drain Pipes L NIA Y D Elec Conduit L NIA Y Oil Fill pipe L NIA v Overhang Tri AIM L NIA Y Soil Test Results (Must be less than 440 ppm for play area 11200 ppm for bare soil) LOCATION AREA MEASUREMENT RESUL: REMED REMED (Square Feet) {PPM) DATE METH Play Area safe soil Comments: �2 d Siding!U/ AIM L N/A Y L NIA �d�G%� Page +P Ot �� Inspe r (print) Lic # Y Signatuf Date Y Risk Assessor (print) Pep Address of Propenv: �� i`�' GARAGE Lic# j' Signature Apt. # Date �A City Y SIDE LOCATION/ LEAD TYPE OF URG IC 1C DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH A Siding!U/ AIM L N/A Y L NIA Y C Siding (u f L NIA Y Corner Boards L WA Y Corner Boards L NIA Y Lower Trim L NIA Y Lower Trim L NIA Y Upper Trim L NIA Y Upper Trim eq/1 L NIA Y A Door `lbAIM V N1A Y C Door AIM L NIA Y Door Casing 614CY NIA Y Door Casing AIDE L NIA Y Door Jamb i &CLI NIA Y Door Jamb AIM L WA Y Threshold AIM L NIA YThreshold AIM L NIA Y 5lOE B 0 f LOCATION' Window Sill AIM L N/A Y URG IC 10 DELEAD DELEAD SURFACE Window Sill VIVA NIA Y A Win Casing AIM L NIA Y L NIA C 1win Casing t' NIA Y L NIA Win Sash AIM L NIA I Y L NIA Win Sash a- NIA Y A lFoundallon L NIAJ Y I Door C lFouridation L N!A Y COMMENTS / STRUCTURAL DEFECTS: COMMENTS 1 STRUCTURAL DEFECTS: Y Door Jamb A/M L NIA Y rvvul rC Gah AIM L NIA Y EXCLUDED SURFACES: Surfaces fisted in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE: LOOSE PAINT ICIC SIDEJ LOCATION MEASURE: LOOSE PAINT IG 1C A NIA (MORE THAN 1440 SO, IN.) DATE METHOD C L NIA (MORE THAN 1440 SO. IN.) DATE METHOD A C C `' C A C A C 5lOE B 0 f LOCATION' LEAD TYPE OF URG IC 10 DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH Siding R/ L NIA Y Corner Boards L NIA Y Lower Trim L NIA Y Upper Trim L WA Y Door AIM L NIA Y Door Casing AIM L NIA Y Door Jamb A/M L NIA Y Threshold AIM L NIA Y Window SillAlp N/A Y Win Casing NIA Y Win Sash T -c NIA Y Foundation 67 L NIA Y OENTS / STRUCTURAL DEFECTS - I Im I II7 IC LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH. Siding R/ L N/A Y Comer Boards L NIA Y Lower Trim L NIA Y Upper Trim/ L NIA Y Door AM! L NIA Y Door Casing AIM L NIA Y Door Jamb AIM L NIA Y Threshold AIM L NIA Y WA Y "Foundalbon. NIA Y Sash NIA Y L NIA Y VENTS I STRUCTURAL DEFECTS: C C `' EXCLUDED SURFACES; Surfaces fisted in these boxes can be made intact o SIDE LOCATION MEASURE: LOOSE PAINT IC IC SIDE LOCATION B (MORE THAN 1440 SQ. IN.) DATE METHOD D a D B D B p LI/RA RepGarage, Sion a licensed deleader. MEASURE: LOOSE PAINT (MORE THAN 1440 SQ. IN,) IG I iC DATE METHOD .����y.. .����� � . � >y� � y. \ / /� ƒ%� a�� /�,; � � � w. - � " � � f �. ,�, ����� w� � xy� y.. n w� % f��\} � / . �� � � /� � � \� � <� >: w. . y a� � y: � y:/� � \�����^�^���� \ � � . \ � , , \ � � �� +���«©� +� � »»:»� � «wm�: � � »®� � f t, m Grant, Michele From: ce.carta@verizon.net Sent: Tuesday, January 07, 2014 6:09 PM To: Grant, Michele Subject: RE: FW: Message from "ComDev-Health-Ricoh" Rick Hamel is now the official owner of the property? Sent from my Verizon Wireless 4G LTE smartphone -------- Original message -------- From: "Grant, Michele" Date:01/07/2014 4:35 PM (GMT -05:00) To: "'ce.carta@verizon.net"' Subject: FW: Message from "ComDev-Health-Ricoh" Hello Erin, Please see the attached secondary "Order Letter". Please call if you have any other questions. Sincerely, Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email m rantktownofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: noreplygtownofnorthandover.com[mailto:noreplygtownofnorthandover.com] Sent: Tuesday, January 07, 2014 4:34 PM To: Grant, Michele Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 01.07.2014.16:33:56 (-0500) Queries to: noreplygtownofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal i Grant, Michele From: Grant, Michele Sent: Monday, December 30, 2013 11:19 AM To: 'cinjj@yahoo.com' Subject: 21 Perry Street NA MA Attachments: 201312301012.pdf; 201312301116.pdf Dear Cindy, Please see the attached files, As per your request. If there is any other information you need, please call the number listed below. Sincerely Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St I Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant0townofnorthandover.com -----Original Message ----- From: noreply(@townofnorthandover.com [mailtc Sent: Monday, December 30, 2013 10:12 AM To: Grant, Michele Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ri Scan Date: 12.30.2013 10:12:24 (-0500) Queries to: noreply@townofnorthandover.com Please note the Massachusetts Secretary of and from municipal offices and officials ar refer to: httn://www.sec.state.ma.us/nre/nr Please consider the environment before pri 1 s . G , D G�I'1� �s y Grant, Michele From: Grant, Michele Sent: Monday, December 30, 2013 11:19 AM To: 'cinjj@yahoo.com' Subject: 21 Perry Street NA MA Attachments: 201312301012.pdf; 201312301116.pdf Dear Cindy, Please see the attached files, As per your request. If there is any other information you need, please call the number listed below. Sincerely Michele E. Grant Public Health Agent Town of North Andover 1600 Osgood St Suite 2,035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mgrant0townofnorthandover.com Web www.TownofNorthAndover.com -----Original Message ----- From: noreply(atownofnorthandover.com[mailto:noreply(@townofnorthandover.com] Sent: Monday, December 30, 2013 10:12 AM To: Grant, Michele Subject: Message from "ComDev-Health-Ricoh" This E-mail was sent from "ComDev-Health-Ricoh" (Aficio MP C3002). Scan Date: 12.30.2013 10:12:24 (-0500) Queries to: noreply0townofnorthandover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. 1 M MINASIAN & AZIZ ATTORNEYS AT LAW 127 SOUTH BROADWAY P.O. BOX 346 LAWRENCE, MASSACHUSETTS 01843 Telephone: (978) 682-5560 (978) 688-6066 Facsimile: (978) 687-7288 HAIG J. MINASIAN (1916-1985) ROBERT H. MINASIAN, ESQ. " CYNTHIA J. AZIZ, ESQ.* *Licensed in MA December 11, 2013 North Andover Health Department 1600 Osgood Street Suite 2035 North Andover, MA 01845 Attn: Michelle Grant RE: Property located at 21 Perry Street, North Andover, MA Of Counsel: MICHAEL T. RYAN Licensed in MA & NH Zoila Garrity, Paralegal i, c-rs 14t, Z013 Dear Ms. Grant: Please be advised that this office represents Christopher and Erin Carta who reside at 21 Perry Street, North Andover, MA. After consulting with my clients I have reviewed the Correction Order for Housing Inspection which you issued on or about 10/3/1.3. Kindly advise and forward a report to this office relative to what repairs were done and when, as well as what action, if any, the Town of North Andover may be considering as against the Owners/Agents of Record, Richard Hamel and Marcelle Hamel. May I hear from you. CJA/zg Cc: Christopher and Erin Carta Very truly yours, 6 Cynthia .Aziz Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: October 3, 2013 To: Owner/Agent of Record: Property Location: Property Manager - Chris Hamel Erin and Chris Carta Rep. for Rick Hamel, Owner 21 Perry Street 183 Pillsbury Road. North Andover, MA. 01845 Londonderry, NH. 03053-3221 An authorized in was made of your property at the above address on October 2, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work. Proof of contract to be completed within 30 days must be submitted. A re -inspection will be scheduled for seven days after receipt of the order letter for corrective action. Failure to act will result in further action. 105 CMR 410.... Bathroom Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.150(D) Bathroom Tub, Tile, Fixtures and baseboard heating cover, are of an impervious nature. Toilet is continuously running Owner shall provide smooth and impervious vp'&-14 Days surfaces and be free from defects which make them difficult to keep clean or create an accident hazard 410.351 Bathroom sink piping is not in working order, pipe leading through the wall is corroded. Owner shall be 0. 14 Days in accordance with accepted plumbing, gasfitting, and electrical wiring standards and shall maintain free from leaks, obstructions or other defects Bathroom Window is broken 14 days A window shall be considered weather tight only if all pains of glass are unbroken Household Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 460.100(A) Homes built earlier than 1978, Lead test is required. No letter of compliance will be issued until YES there is full compliance to the lead code where a child under 6 resides. (see 105 CMR 460.000) Front and Living room Regulation # Description ✓ if conditions may Time limit for endanger or impair health, Safety or compliance well-being 410.501 Five windows in the front room do not open Left window in living room does not open 14 Days A window shall be considered weathertight only if window opens or closes fully without excessive effort 410.253 Ceiling fan and light are broken i Owner shall provide and locate electric light Days switches and fixtures in good working order Ar Kitchen and Back Hall Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.501 Picture Window in Kitchen: The Left and the right picture windows: do not (A)(2) open and close properly. 1 lu° A window shall be considered weather tight 14 Days only if the window opens and closes fully without excessive effort. 410.100(13) Counter tops in kitchen chipped, broken and pervious surfaces. 14 Days Facilities required in 105 CMR 410.1.00 (A) I. • S�K'JLED /�6 continued Carpet. 14 Days Ceiling is falling in over the bed Molding and ceiling have large gaps between 14 Days them Conditions deemed to endanger or impair health or safety, to be a condition which may endanger or mentally impair the health or safety and well being of a occupant. 410.253 Lighting — No light cover. J r ff 1 14 Days The owner shall provide and so locate electric light switches and fixtures in good Basement Regulation # ` g Description p ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.350 (B) Sewer Pipe is seeping fluids. Every provided toilet shall be connected to the water distribution system (105 CMR 410.18) 14 Days and to sanitary drainage, in accordance with accepted plumbing p p mbmg standards 410.255. Light fixture broken. Lighting in fluorescent fixture was smoking. Wiring issues. p Circuit breakers blow when plugging in appliances, Air Conditioners, etc. The electrical service supplying each dwelling shall supply sufficient amperage to meet the 14 Days reasonable needs of the occupants. Should the amperage be determined to be inadequate it shall be corrected so that it meets the amperage requirements of 527 CMR 12.00. The Mass Electric Code shall have smooth and impervious surfaces and be free from defects that make them difficult to clean, or creates an accident hazard 410.100(B) Kitchen Sink is chipped, it is extremely old and is pervious to the secretion of bacteria. The facilities required in 105 CMR 410.100(A) 14 Days Shall have smooth and impervious surfaces and be free from defect that may make it difficult to keep clean, or creates an accident hazard 410.500 Back Hall: This room is unfit: Possible lead paint, stained sealing tiles, chipping, cracking peeling paint on walls, unfinished ceiling, unfinished walls. 14 Days Every Owner shall maintain floors, walls, doors and ceilings in every way fit for its intended use. Further, he shall maintain every structural element free from holes, cracks, loose plaster, or other defect renders the area difficult to keep clean. Second Floor Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or Compliance well-being 410.253 Boys Room: { Ceiling light does not work. 14 Days Owner shall provide and locate electric light switches and fixtures in good working order ; CMR 780 Boys Room: No bedroom door: �.��` IRC 2009 14 Days Please refer to CMR 780 IRC 2009 Under the building code to meet the requirements CMR 780 Girls Room: No Bedroom door: p IRC 2009 14 Days y Please refer to CMR 780 IRC 2009 Under the building code to meet the requirements 410.750 Girls Room: Tacks and tack strips are protruding through the ' `� You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary language by greater than 1% of the community's population, include "This is an important legal document. It may affect your rights. You should have it translated." Michele Grant Health Agent North Andoveril Department State delivery method to Owner: certified mail: Occupant: regular mail delivery Cc: Chris and Erin Sullivan Carta Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Fred McCarthy — Fire Department File Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: December 18, 2013 To: Owner/Agent of Record: Rick Hamel — Owner Chris Hamel — Representative Richard Morway — Property Manager 183 Pillsbury Road Londonderry, NH. 03053-3221 Property Location: Erin and Cluis Carta 21 Perry Street North Andover, MA, 01845 An authorized inspection was made of your property at the above address on December 18, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work and submit contractual paperwork to the North Andover Health Department. A re -inspection will be scheduled for seven .days after receipt of the order letter for corrective action. Failure to act will result in further action. 105 CMR 410.... Living Room Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.482 All New Smoke detectors go off without warning or cause. Owner shall provide, install, and maintain in operable condition smoke detectors and Carbon Monoxide detectors Replace Smoke Detectors that are not good working order. 410.253 Basement light fixture and Living room light YES fixture. Faulty electrical wiring. Wiring was smoking when switch was activated. Owner shall provide and so locate electric light switches in good working. Hire a Licensed electrician to check for faulty wiring throughout the house. Submit to Health Department a complete summary of findings within 7 days. 410.481 No owner information is posted. If the owner is a realty trust or partnership, the name, address and telephone number of the managing trustee or partner shall be posted. Post information Bathroom Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.351 Bathroom drain leaks The owner shall install or cause to be installed, in accordance with accepted plumbing, gas fitting and electrical wiring standards, and shall maintain free from leaks, obstructions or other defects Have a licenses plumber repair pipe 410.500 Bathroom tile is covered with mold throughout the grout and possible chronic water problem behind the tile walls. Every owner shall maintain floors, walls, etc. watertight and free of dampness. Hire professional remediation company to determine the extent of the problem behind the wall tiles. Submit a full report of the problem to the Health Dept. in 7 days of the receipt of this Order Letter. 410.150(D) Bathtub Fixture — Both hot and cold fixtures — broken Owner shall provide smooth and impervious surfaces and be free from defects which make them difficult to keep clean or create an accident hazard. � Nursiy.. �gss�us���y You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may�permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary la page by greater a 1% of th6 community's population, include "This is an important legal document. It may affect your rights. Y1 ' sho Id have it tra 's ated." Cc: Erin and Chris Carta - Tenant Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Lisa Blackburn Repair bathtub faucets Second Floor Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.253 Hallway light Fixture on second floor does not have a cover. Owner shall provide and so located electrical light switches and fixtures in good working order Replace light cover Garage Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.500 Garage door is non-operable Every owner shall maintain other structural elements of his dwelling Repair to the original state You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may�permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary la page by greater a 1% of th6 community's population, include "This is an important legal document. It may affect your rights. Y1 ' sho Id have it tra 's ated." Cc: Erin and Chris Carta - Tenant Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Lisa Blackburn FAI October 23, 2013 Michele Grant A Division of Avatar Financial Services, Inc. Health Agent North Andover Health Department 1600 Osgood Street, Suite 2035 No. Andover, MA 01845 RE: 21 Perry Street, No. Andover Dear Inspector Grant, Avatar Properties was recently hired to manage the above mentioned property. I have been made aware of. a Correll ion Ordo► for Housir►g Inspection dated October 3, 2013 and an Order to Corf•ect Violatio►►s dated October 1.5, 2013. There is a substantial list of violations that need to be remedied. It will be necessary for us to hire licensed contractors to complete the tasks as outlined. The iTIOSt important issue at this point is the lead test. I have made arrangements to have the, property tested by a qualified testing agency. I will provide your office a copy of the test results once completed. I will be in touch with you as progress is being made at the property. Thank ,you for your understanding and patience. Richard Morway Avoiar Properties 163 Main Street, Suite 201 • Salem, NH 03079 • Tel: 603-894-6300 0 Fax: (603) 912-5600 OF NORT qti _01 5 �4SSACHV`'�� North Andover Health Department Community Development Division November 5, 2013 Avatar Properties 163 Main Street Suite 201 Salem, NH 03079 Re: 21 Perry Street Dear Mr. Morway, The Health Department has received your letter dated October 23, 2013. Thank you for your formal notification of your hiring as the manager of the property noted above, however our file needs notification from the owner. To date the property owner has never contacted this office. As mentioned in the letter there are multiple issues. The lead violation package is deadline driven and is clearly detailed in the information. I understand that the proper inspection has begun and I expect that those deadlines will be adhered to. The sanitary code violation letter however is now in non-compliance. The letter requested either corrective action to be completed within fourteen (14) days or proof of a contract for repairs from one or more professionals detailing the action to be taken and a time line. This time line would be the basis of request for an extension. As stated in the Order Letter, if a letter of extension, accompanied with the proper details such as; signed contracts and details of correction is not received, than a complaint to the Housing Court will be submitted against the owner. Please submit all requests by November 12Th at the latest. Thank you for your cooperation in this matter. Sincere y, san S er, SfiREHS Health ire Cc: Chris Hamel, Manager 1600 Osgood Street, Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com A Division of Avatar :Financial Services, Inc. November 11, 2013 Susan Sawyer, RS/RENS Health Director North Andover Health Department 1600 Osgood Street, Suite 2035 No. Andover, MA 01845 RE: 21 Perry Street, No. Andover Dear Director Sawyer, NOV 14 NQ TOWN QV NUR I H ANDOVER I am in receipt of your letter dated November 5th concerning the above address. Per your letter, you would like notification directly from the owner he has hued us to manage his property. I have asked him for your notification. I am hopeful one is forthcoming. You mentioned in your letter the owner has yet to contact your office. Please note first, Mr. Hamel has mental challenges. What is an easy task for you or I is a more daunting challenge for Mr. Hamel. When we appear before the judge Mr. Harnel's disabilities will be obvious. In addition, we have been in touch with your office both by the telephone and iii writumg. At no time have the concerns of the City been brushed. off or sidestepped. Once we were notified there was a lead paint issue we inunediately ordered a full inspection of the property by a licensed lead inspector, M&M Lead Inspectional Services from Lawrence. The inspection has been paid in full. We are waiting for our copy. I carulot guarantee the deadlines will be adhered to. We have little control over the inspector. We have however explained the circumstances surrounding this property. We have asked them to do what they could to expedite the report. We have not proceeded with any corrective actions until we knew the extent of the lead. We do not want to be responsible for disturbing the lead paint creating further issues. We have been in touch with Cornerstone Electrical who will be doing the required electrical repairs. We have bc,m in touch with Rocky's Plumbing & Heating. They will be doing the plumbing work. Todd Woekel will be our licensed contractor to do the carpentry repairs. We do not have "contracts' with these vendors. We have worked with them in the past and feel they are very competent to handle the requested repairs. We have yet to hire a lead removal company as we do not have the report. Thai* you for your understanding and patience. Please advise me of the City's court date so 1 can make myself available. Truly, 77 �Richard Morway Avatar Properties 163 MainStreet, Suite 201 e Salem, NH 03079 a Tel: 603-894-6300 a Fax: (603) 912-5600 Grant; Michele From: Richard Morway [r.morway@avatarproperties.net] Sent: Friday, December 20, 2013 3:54 PM To: Grant, Michele Subject: Perry St Hey Michele, I hope this email finds you well. I wanted to let you know I have been making progress on Perry Street. I had a full lead test done on the house. I received bids to get the house de-leaded. We have hired a company to do the work. They will be making arrangements with the tenants the first of January. I did not want to disrupt the tenants holidays. Once the lead has been removed I will be able to finish your list in short time. The electrical was completed some time ago. The electrician installed new lights, switches and hardwired smokes. The life and safety was completed right away. This was not lead related so I could expedite this portion of the list. Assuming I can get the lead done in early January I should have the balance of the repairs done by the end of January. That is the time table I am shooting for. I have the plumber and carpenter,ready to go. Thank you for your patience. We should have this one off your desk shortly. Please have a great Christmas and safe New Year! .Auat r Pi6j edfes Leaders hi Property 1ltartaneatent Richard J. Morway 163 Main Street, Suite 201 Salem, New Hampshire 03079 T: 603.894.6300 F: 603.912.5600 - www.avatarproperties.net Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: htti):/Iwww.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. Blackburn, Lisa From: Blackburn, Lisa Sent: Thursday, November 07, 2013 11:41 AM To: Grant, Michele Subject: 21 Perry St. Richard Morway returned my call. l scanned the letter to his email. He said that the lead testing was done and he. is waiting on the full report to come in. He can't do anything regarding the lead paint until he receives the report. He has hired an electrician and he will be calling the tenant to set up a time to do the electrical work. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburngtownofnorthandover.com Web www.TownofNorthAndover.com Grant, Michele From: Richard Morway [r.morway@avatarproperties.net] Sent: Friday, December 20, 2013 3:54 PM To: Grant, Michele Subject: Perry St Hey Michele, I hope this email finds you well. I wanted to let you know I have been making progress on Perry Street. I had a full lead test done on the house. I received bids to get the house de-leaded. We have hired a company to do the work. They will be making arrangements with the tenants the first of January. I did not want to disrupt the tenants holidays. Once the lead has been removed I will be able to finish your list in short time. The electrical was completed some time ago. The electrician installed new lights, switches and hardwired smokes. The life and safety was completed right away. This was not lead related so I could expedite this portion of the list. Assuming I can get the lead done in early January I should have the balance of the repairs done by the end of January. That is the time table I am shooting for. I have the plumber and carpenter ready to go. Thank you for your patience. We should have this one off your desk shortly. Please have a great Christmas and safe New Year! Zrnroe ctaclers In Property Nanagernent Richard J. Morway 163 Main Street, Suite 201 Salem, New Hampshire 03079 T: 603.894.6300 F: 603.912.5600 www.avatarproperties.net Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. Please consider the environment before printing this email. NORTH ANDOVER HEALTH DEPARTMENT 27 Charles Street • North Andover, MA 01845 Tel. 978 688-9540 • Fax: 978 688-9542 email: healthdept@townofnorthandover.com Complaint Investigation/Inspection Report U.S. Postal ServiceTM RERTIFIED MAILT� RECEITestic Mail Only; No Insurance Coverage,P_rovided) C3 Rea Delivery Fee r (Endo m t Required) Im Total Po F Lr) C3 Sent To G1,4h ' / or PO Box No. !/l� --------------------k Ciry; Slate, ZIP+4 /` D � 0 7 M �I ftDmmmbft Certified Mail Provides: ■ A mailing receipt (99,anaa)auL oozaunr'ooeeo-:1sd ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First -Class Mail® or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. 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Internet access to delivery information is not available on mail addressed to APOs and FPOs. WARD HILL STA WARD HILL, Massachusetts 018359992 2445930630-0097 12/26/2013 (800)275-8777 03:47:00 PM -- Sales Receipt Product Sale Unit Final Description Qty Price Price SALEM NH 03079 Zone -1 $0.46 First -Class Mail Letter 0.80 oz. Scheduled Delivery Day: Sat 12/28/13 Return Rcpt (Green $2.55 Card) @@ Certified $3.10 Label #: 70050390000342658994 Customer Postage -$6.11 Subtotal: $0.00 Total: $0.00 Paid by: @@ For tracking or inquiries go to USPS.com or call 1-800-222-1811. Order stamps at usps.com/shop or call 1-800-Stamp24. Go to usps.com/clicknship to print shipping labels with postage. For other information call 1 -800 -ASK -USPS. Get your mail when and where you want it with a secure Post Office Box. Sign up for a box online at usps.com/poboxes. Bill#:1000301504022 Clerk:05 All sales final on stamps and postage Refunds for guaranteed services only Thank you for your business Note: Priority Mail Express refund restrictions in effect for mailing dates Dec. 22 - 25 HELP US SERVE .OU BETTER Go to- https://Posta;experience.com/Pos TELL US ABOUT YOUR RECENT POSTAI-. EXPERIENCE Y; . .NIC' COUNTS Customer Copy 1�� OCL O` 9 a �9SSACHUS�� � Town of North Andover CORRECTION O R D E R for HOUSING INSPECTION Issued under the provisions of The State Sanitary Code, Chapter II, Minimum Standards of Fitness for Human Habitation 105 CMR 410.00 Date: December 18, 2013 To: Owner/Agent of Record: Rick Hamel — Owner Chris Hamel — Representative Richard Morway — Property Manager 183 Pillsbury Road Londonderry, NH. 03053-3221 Property Location: Erin and Chris Carta 21 Perry Street North Andover, MA. 01845 An authorized inspection was made of your property at the above address on December 18, 2013. This inspection revealed violations of the State Sanitary code, Chapter II, as listed below. Owner must repair within seven days or contact a contractor for work and submit contractual paperwork to the North Andover Health Department. A re -inspection will be scheduled for seven .days after receipt of the order letter for corrective action. Failure to act will result in further action. 105 CMR 410.... Living Room Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.482 All New Smoke detectors go off without warning or cause. Owner shall provide, install, and maintain in operable condition smoke detectors and Carbon Monoxide detectors Replace Smoke Detectors that are not good working order. 410.253 Basement light fixture and Living room light YES fixture. Faulty electrical wiring. Wiring was smoking when switch was activated. Owner shall provide and so locate electric light switches in good working. Hire a Licensed electrician to check for faulty wiring throughout the house. Submit to Health Department a complete summary of findings within 7 days. 410.481 No owner information is posted. If the owner is a realty trust or partnership, the name, address and telephone number of the managing trustee or partner shall be posted. Post information Bathroom Regulation # Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.351 Bathroom drain leaks The owner shall install or cause to be installed, in accordance with accepted plumbing, gas fitting and electrical wiring standards, and shall maintain free from leaks, obstructions or other defects Have a licenses plumber repair pipe 410.500 Bathroom tile is covered with mold throughout the grout and possible chronic water problem behind the tile walls. Every owner shall maintain floors, walls, etc. watertight and free of dampness. Hire professional remediation company to determine the extent of the problem behind the wall tiles. Submit a full report of the problem to the Health Dept. in 7 days of the receipt of this Order Letter. 410.150(D) Bathtub Fixture — Both hot and cold fixtures — broken Owner shall provide smooth and impervious surfaces and be free from defects which make them difficult to keep clean or create an accident hazard. 0 You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary la uage,by greater �1% of th6 community's population, include "This is an important legal document. It may affect your rights. Y ` � sho ld have it slated." �II Cc: Erin and Chris Carta - Tenant Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Lisa Blackburn Repair bathtub faucets Second Floor Regulation # g Description ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.253 Hallway light Fixture on second floor does not have a cover. Owner shall provide and so located electrical light switches and fixtures in good working order Replace light cover Garage Regulation # Description p ✓ if conditions may Time limit for endanger or impair health, safety or compliance well-being 410.500 Garage door is non-operable Every owner shall maintain other structural elements of his dwelling Repair to the original state. You are hereby ORDERED to correct these violations within the noted time limit. Failure to comply within the allotted time period, or subsequent violations, may result in a criminal complaint against you. You have a right to request a hearing before the Board of Health/Health Director. This request must be made by you, in writing, and filed within seven days after the day this order was served. If you request a hearing, all affected parties will be informed of the date, time and place of the hearing and of their right to inspect and copy all records concerning the matter to be heard. The petitioner has the right to represented at the hearing. Condition exist which may permit the occupant of the dwelling to exercise one or more statutory remedies. If a non-english language is spoken as a primary la uage,by greater �1% of th6 community's population, include "This is an important legal document. It may affect your rights. Y ` � sho ld have it slated." �II Cc: Erin and Chris Carta - Tenant Susan Sawyer — Health Director Gerald Brown — Inspector of Buildings Lisa Blackburn MINASIAN & AZIZ ATTORNEYS AT LAW 127 SOUTH BROADWAY P.O. BOX 346 LAWRENCE, MASSACHUSETTS 01843 Telephone: (978) 682-5560 (978) 688-6066 Facsimile: (978) 687-7288 HAIG J. MINASIAN (1916-1985) ROBERT H. MINASIAN, ESQ. * Of Counsel: CYNTHIA J. AZIZ, ESQ.* MICHAEL T. RYAN Licensed in MA & NH 'Licensed in MA Zoila Garrity, Paralegal December 11, 2013 North Andover Health Department 1600 Osgood Street Suite 2035 rr'E- ECEIVED North Andover, MA 01845 Attn: Michelle Grant LI (Q1 RE: Property located at 21 Perry Street, North Andover, MA Wr'Mr,,`' Dear Ms. Grant: Please be advised that this office represents Christopher and Erin Carta who reside at 21 Perry Street, North Andover, MA. After consulting with my clients I have reviewed the Correction Order for Housing Inspection which you issued on or about 10/3/13. Kindly advise and forward a report to this office relative to what repairs were done and when, as well as what action, if any, the Town of North Andover may be considering as against the Owners/Agents of Record, Richard Hamel and Marcelle Hamel. May I hear from you. Very truly yours, CynthiarAzzilz CJA/zg Cc: Christopher and Erin Carta A Division of Avatar Financial Services, Inc. November 11, 2013 Susan Sawver, RS/REHS Health Director North Andover Health Department 1600 Osgood Street, Suite 2035 No. Andover, MA 01845 RE: 21 Perry Street, No. Andover Dear Director Sawyer, RECEIVED NOV 14 2013 TOWN OF NORTH ANDOVER HEALTH DEPARTMENT I am in receipt of your letter dated November 5th concerning the above address. Per your letter, you would like notification directly from the owner he has hired us to manage his property. I have asked him for your notification. I am hopeful one is forthcoming. You mentioned in your letter the owner has yet to contact your office. Please note first, Mr. Hamel has mental challenges. What is an easy task for you or I is a more daunting challenge for Mr. Hamel. When we appear before the judge Mr. Hamel's disabilities will be obvious. In addition, we have been in touch with your office both by the telephone and in writing. At no time have the concerns of the City been brushed off or sidestepped. Once we were notified there was a lead paint issue we immediately ordered a full inspection of the property by a licensed lead inspector, M&M Lead Inspectional Services from Lawrence. The inspection has been paid in full. We are waiting for our copy. I cannot guarantee the deadlines will be adhered to. We have little control over the inspector. We have however explained the circumstances surrounding this property. We have asked them to do what they could to expedite the report. We have not proceeded with any corrective actions until we knew the extent of the lead. We do not want to be responsible for disturbing the lead paint creating further issues. We have been in touch With Cornerstone Electrical who will be doing the required electrical repairs. We have been in touch with Rocky's Plumbing & Heating. They will be doing the plumbing work. Todd Woekel will be our licensed contractor to do the carpentry repairs. We do not have "contracts' with these vendors. We have worked with them in the past and feel they are very competent to handle the requested repairs. We have yet to hire a lead removal company as we do not have the report. Thank you for your understanding and patience. Please advise me of the City's court date so I can make myself available. Truly, Avatar Properties 163 Main Street, Suite 201 9 Salem, NH 03079 e Tel: 603-894-6300 • Fax: (603) 912-5600 Blackburn, Lisa From: Blackburn, Lisa Sent: Thursday, November 07, 2013 11:41 AM To: Grant, Michele Subject: 21 Perry St. Richard Morway returned my call. I scanned the letter to his email. He said that the lead testing was done and he is waiting on the full report to come in. He can't do anything regarding the lead paint until he receives the report. He has hired an electrician and he will be calling the tenant to set up a time to do the electrical work. Lisa Blackburn Health Department Town of North Andover 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone 978-688-9540 Fax 978-688-8476 Email Iblackburn@townofnorthandover.com Web www.TownofNorthAndover.com of !jog as 0 .e R�saC�rUGCd. ay+A�r���� 1 North Andover Health Department (ommunity Development Division November 5, 2013 Avatar Properties 163 Main Street Suite 201 Salem, NH 03079 Re: 21 Perry Street Dear Mr. Morway, The Health Department has received your letter dated October 23, 2013. Thank you for your formal notification of your hiring as the manager of the property noted above, however our file needs notification from the owner. To date the property owner has never contacted this office. As mentioned in the letter there are multiple issues. The lead violation package is deadline driven and is clearly detailed in the information. I understand that the proper inspection has begun and I expect that those deadlines will be adhered to. The sanitary code violation letter however is now in non-compliance. The letter requested either corrective action to be completed within fourteen (14) days or proof of a contract for repairs from one or more professionals detailing the action to be taken and a time line. This time line would be the basis of request for an extension. As stated in the Order Letter, if a letter of extension, accompanied with the proper details such as; signed contracts and details of correction is not received, than a complaint to the Housing Court will be submitted against the owner. Please submit all requests by November 12th at the latest. Thank you for your cooperation in this matter. Z er, HS re Cc: Chris Hamel, Manager 1600 Osgood Street, Unit 2035, North Andover, Massachusetts 01845 Phone 978.688.9540 Fox 978.688.8476 Web www.townofnorthandover.com A Division of Avatar Financial Services, Inc. October 23, 2013 Michele Grant Health Agent North Andover Health Department 1600 Osgood Street, Suite 2035 No. Andover, MA 01845 RE: 21 Perry Street, No. Andover Dear Inspector Grant, Avatar Properties was recently hired to manage the above mentioned property. I have been made aware of a Correction Order for Housing Inspection dated October 3, 2013 and an Order to Correct Violations dated October 15, 2013. There is a substantial list of violations that need to be remedied. It will be necessary for us to hire licensed contractors to complete the tasks as outlined. The most important issue at this point is the lead test. I have made arrangements to have the property tested by a qualified tasting agency. I will provide your office a copy of the test results once completed. I will be in touch with you as progress is being made at the property. Thank you for your understanding and patience. Richard Morway Avatar Properties 163 Main Street, Suite 201 • Salem, NH 03079 e Tel: 603-894-6300 a Fax: (603) 912-5600 4 Blackburn, Lisa From: Sawyer, Susan Sent: Thursday, October 10, 2013 7:40 AM To: linda.dube@state.ma.us Cc: Grant, Michele; Blackburn, Lisa Subject: RE: lead test at 21 Perry Street Hi Linda, I just wanted to confirm the appointment for the test for this afternoon and give you my cell #; 978 490-6678. Feel free to call me or the office (978 688-9540) if you have any issues. Thank you, Susan From: Sawyer, Susan Sent: Friday, October 04, 2013 10:38 AM To: linda.dube(&state.ma.us Cc: Grant, Michele; Blackburn, Lisa(LBlackburn(@townofnorthandover.com) Subject: lead test at 21 Perry Street Hi Linda, I spoke to the renters and they would like to have the lead determination. I tentatively scheduled us for 2PM on Thursday, Oct 101h. If you would prefer a different time or date please let me know and we will contact them. We also have soils tests in the morning that day so later seemed better for us. Our day usually ends at 4:30. 1 really appreciate this opportunity. Continuing training is very important, and personally I do better learning in the field rather than in a classroom. Susan 21 Perry Street, North Andover http://csc-ma.us/PROPAPP/display.do?linkld=2249786&town=NandoverPubAcc Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawyer@townofnorthandover.com Web www.TownofNorthAndover.com Y4 � 4 _W X1:622.a . S'4Su cG��a RCceu. Grant, Michele From: Sawyer, Susan Sent: Friday, October 04, 2013 10:38 AM To: linda.dube@state.ma.us Cc: Grant, Michele; Blackburn, Lisa Subject: lead test at 21 Perry Street Hi Linda, I spoke to the renters and they would like to have the lead determination. I tentatively scheduled us for 2PM on Thursday, Oct 101h. If you would prefer a different time or date please let me know and we will contact them. We also have soils tests in the morning that day so later seemed better for us. Our day usually ends at 4:30. 1 really appreciate this opportunity. Continuing training is very important, and personally I do better learning in the field rather than in a classroom. Susan 21 Perry Street, North Andover http://csc-ma.us/PROPAPP/display.do?Iinkld=2249786&town=NandoverPubAcc Susan Sawyer Public Health Director Town of North Andover 1600 Osgood Street Suite 2035 North Andover, MA 01845 Phone 978.688.9540 Fax 978.688.8476 Email mailto:ssawver@townofnorthandover.com Web www.TownofNorthAndover.com Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/ore/preidx.htm. Please consider the environment before printing this email. of Public The address i. I REQUEST FOR DETERMINATION OF LEAD HAZARDS ! . AND ENFORCEMENT OF THE LEAD LAW Date: 6 v %b 20J3 ,���- S Z l �1✓ z y+ 2-- --nn� , request the , /�"w �� �'�epartment print name of occupant to inspect my residence or dwelling unit for lead paint. its residence or unit: --17, �, be 4 Street and Spartment Number t:> l Massachusetts. City or Town Zip code The telephone riumber to reach me there is: ( IV Phone Number The child (ren under the age of six (6) years who reside(s) in this household is/are: n ; Name (Birth date Name Birth date Name Birth date Name Birth date Was the residence built before 1978? _:X Yes No I understand that the lead determination requested may include all rooms of the dwelling unit or residential pre ises, common areas, porches and accessible exterior areas, as well as other buildings within the property lines. I further understand that if there is a child under six (6) years of age �n residence, and; he determination hereby requested identifies lead hazards in violation of Massachusetts General Laws, (chapter 111, section 197, and Regulations for Lead Poisoning Prevention and Control, 105 Code of Massachusetts Regulations 460.110 and .750, such violations must be either deleaded for full compliance, orl the unit must be brought under interim control, at the property owner's expense. The property owner must correct all violations, whether for full compliance or interim control, within 120 days of the receipt of an Order to Correct Violations. The property owner must also submit within 60 days of the receipt oif such an Order, a copy of a signed contract with a licensed deleader, if one will be necessary for t e required work. If the owner or his/her agent is going to perform owner/agent, deleading i 1 BOH Request for Determination Revised 11/04 I work, the owner must also submit a special form within 60 days. If the owner fails to comply with the Order to Corre t Violations, the Health Department shall initiate judicial proceedings against the owner to enforce the Order. ! The Massachu etts Department of Public Health's Childhood Lead Poisoning Prevention Program conducts rand .m audits of inspections conducted by private inspectors and"risk-assessments"conducted by private risk assessors following lead determinations. Such monitoring is performed to assure the quality. of services being provided to the public. By requesting this determination, you agree to allow CI,PPP:access to your residential premises or dwelling unit after the initial determination and prior to your returning once any delea mg, whether for full compliance or interim control, is completed. Not allpnvate inspections or private risk assessments will be audited, so you may not hear from CLPPP requ'estirig access`.for these additional visits. gnatle of 0 2 BOH Reauest for DI termination Revised 11/04 Department of Public Health & Department of Labor FdY� NOTIFICATION OF DELEADI\G WORK tti-` ti51i� j : r t All sections of this form must be completed in order to comply with \ �•�w« the notification requirements of M.G.L. C. 111§197, tom= 454 CNIR 22.00 and 105 C NIR 460.000, as most recently amended Contractor performing project Scott AulS0f1 License # DC001480 Exp. Date 05/20/14 Lead Paint Inspector Gary Marciello Date of Inspection 10/26/13 ADDRESS OF PROJECT: License # M3169 Exp. Date Street Address 21 Perry Street Apt. Number City No. Andover Zip 01845 Property owner Richard & Marcelle Hamel Address 183 Pillsbury Rd., Londonderry, NH 03053 Telephone Number (603) 894-6300 Deleading Method:[Z] Wet/Dry Scraping ❑ Heat Gun ❑ Liquid Encapsulant []Demolition ❑ Caustics ❑✓ Replacement []Covering ❑ Other If "Other' selected, please explain Check one: Dwelling is multi -family Start Date 04/18/14 When will work be done: AM 7 Single-family 1_._ o OtherF7--]_ Completion Date 04/28/14 PM 4 (Specify times on site) Weekends? NO Project Supervisor Name V License # Exp. Date Worker's Compensation Policy Number Carrier In case of emergency contact .Tela (Contractor's Representative) DELEADING CONTRACTOR The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisonin revention and Control Regulatidns, 105 CMR 460.000, and that the information contained in this notification is true and correct to the st of his/h' know b an lief. Date April 9, 2014 Signed Company Name SCOTT AULSON Address 14 CURWEN ROAD, PEABODY, MA 01960 Telephone Number (978) 423-3472 OVER-* Grant, Michele From: Richard Morway [r.morway@avatarproperties.net] Sent: Friday, January 10, 2014 9:39 AM To: Grant, Michele Cc: davidmtrovato@gmail.com Subject: Lead Report Attachments: Lead Report.pdf; Bath 1.JPG Michele, Here is a copy of the lead report for Perry St. Sorry for the delay in getting this to you. We had an interesting day in court yesterday. The case was continued for 60 days It appears the people that hired me to work at the property did not have the authority to do so. There are five owners of the property. Apparently no one person has the right at this point to take over the management until the Will has been probated. I have been asked to stand down from doing any additional work at the property. The two attorneys will be contacting Merrimack Valley Lead Paint to request a receiver be appointed to manage the property and complete the tasks. At this point the plumbing has been completed. The electrical has been completed and inspected. The shower will be all set today. The area in the picture you sent me was soft and removed. We pulled back the tiles until we reached a solid area of the wall. The angled portion of the wall was compromised. We installed hardy board in both the angled area and where the faucet was. The area was then retiled. Please see the picture enclosed. I will keep you up to date as this continues to unfold. Please let me know if there is anything you would like from me. It was nice seeing both you and Susan this week. Have a great weekend. va r Froper tlfe s g Lcea&rs In Property Management Richard J. Morway 163 Main Street, Suite 201 Salem, New Hampshire 03079 T: 603.894.6300 F: 603.912.5600 www.avatarproperties.net Please note the Massachusetts Secretary of State's office has determined that most emails to and from municipal offices and officials are public records. For more information please refer to: http://www.sec.state.ma.us/pre/preidx.htm. 02:41P FROM:WORK 9789750987 T0:19786888476 P.11— Department of Public Health & Department of Labor NOTIFICATION OF DELEADING WORK � All sections of this form must be completed in order to comply with the notification requirements of M.G.L. C. 111§197, 454 CMR 22.00 and 105 CMR 440.000, as most recently amended Contractor performing project SCOtt AUISOn License # DC001480 Exp. Date 05/20/14 Lead Paint Inspector Gary Marciello Date of Inspection 10/26/13 License # M3169 Exp. Date ADDRESS OF PROJECT: Street Address 21 Perry Street Apt. Number City No. Andover Zip 01845 Property Owner Richard & Marcelle Hamel Address 183 Pillsbury Rd., Londonderry, NH 03053 Telephone Number (603) 894-6300 Deleading Method: Wet/Dry Scraping ❑ Heat Gun ❑ Liquid Encapsulant ❑Demolition 0 Caustics Replacement []Covering ❑ Other If "Othee' selected, please explain Check one: Dwelling is multi -family Single-family Other Start Date 03/03/14 Completion Date 03/07/14 When will work he done: AM 7 PM 4 (Specify times on site) Weekends? NO Project Supervisor Name License # Exp. Date Worker's Compensation Policy Number Carrier In case of emergency contact Tel. # (Contractor's Representative) DELEADING CONTRACTOR The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations. 454 CMR 22.00. and the Lead Poisoning)yrevention and Control Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the bA. of his/herknowledmond halief. February 14, 2014 Company Name Scott AulSon Address 14 Curwen Road, Peaboyd, MA 01960 Telephone Number (978)423-3472 OVER -4 Received Time Mar. 11, 2014 3:02PM No.0464 MINASIAN & AZIZ ATTORNEYS AT LAW 127 SOUTH BROADWAY P.O. Box 346 LAWRENCE, MASSACHUSETTS 01843 Telephone: (978) 682-5560 (978) 688-6066 Facsimile: (978) 687-7288 HAIG J. MINASIAN (1916-1985) ROBERT H. MINASIAN, ESQ. CYNTHIA J. AZIZ, ESQ.* *Licensed in MA February 28, 2014 Town of North Andover Health Department 1600 Osgood Street Building 20; Unit 2035 North Andover, MA 01845 Attn: Michelle Grant Health Agent Re: Property Located at 21 Perry Street, North Andover, MA Dear Ms. Grant, MAR OC 2014 HEALTX DEPARTMENT Of Counsel: MICHAEL T. RYAN Licensed in MA & NH Zoila Garrity, Paralegal Could you please advise as to the status of the correction order, both the original and the supplemental, relative to the above property. We have a court date of March 27, 2014 and I wish to know what, if any, work has been completed. I thank you for your assistance in this matter. Very truly yours, � I C" 7 „ou4 Cynthia J. Aziz, Esquire CJA/ki cc. Christopher & Erin Carta MINASIAN & AZIZ ATTORNEYS AT LAW 127 SOUTH BROADWAY P.O. Box 346 LAWRENCE, MASSACHUSETTS 01843 Telephone: (978) 682-5560 (978) 688-6066 Facsimile: (978) 687-7288 HAIG J. MINASIAN (1916-1985) ROBERT H. MINASIAN, ESQ. CYNTHIA J. AZIZ, ESQ.- *Licensed in MA hiAR 0 3 2014 TOWN of K r(TH L EALTN DEPARTiVIENT� February 28, 2014 David M. Trovato, Esquire The Willows Office Park 809 Turnpike Street North Andover, MA 01845 Re: Avatar Properties v. Christopher and Erin Carta Dear Attorney Trovato, Of Counsel: MICHAEL T. RYAN Licensed in MA & NH Zoila Garrity, Paralegal It is my understanding that a hearing has been scheduled for March 27, 2014 at 9:00 am. Kindly advise as to what, if any, work has been done on the property. Very truly yours, i Cynth' . Aziz, Esquire CJA/ki 21 PERRY STREET TIME LINE 10/2/13 9:14 am Complaint came in the Health Department regarding 21 Perry St. Michele Grant called back Erin Carta and left a message for her to call the Health Department. Erin called the Health Department back and an inspection was set up for 2:30 that day. 10/3/13 Order letter typed up and sent out to owner and renter. (received by Chris Hamel on 10/8/13 and Richard Hamel on 10/11/13) 10/10/13 Lead test set up for property Week of 10/14/13 Avatar Properties took over as property management. Letter of committal needed, action plan based on the order letter and letter of extension was needed from Avatar. 10/23/13 Letter from Avatar Properties was received stating they were hired as the property management company. 11/5/13 Letter sent out by Health Dept. to Avatar Properties (Richard Morway) and Chris Hamel requesting them to forward requests by 11/12/13 the latest. 11/7/13 Call received by Richard Morway stating that the lead test was done and he was waiting on the full report to come in. He stated that work on the lead paint can't be done until full report is received. An electrician was hired and he will be calling the tenant to set up a time to do the electrical work. He stated he would get everything in writing and send the Health Dept. a letter. 11/14/13 Letter dated 11/11/13 was received from Avatar Properties. 12/11/13 Letter received from Minasian & Aziz stating they were representing tenants at 21 Perry St. 12/18/13 Re -inspection of order letter by Health Department. Items not completed. Another order letter is written up and sent out to owner, property management and tenants. 12/20/13 Email received from Richard Morway regarding work that has been completed at Perry St. 12/30/13 File copies were made and scanned over to Cynthia Aziz, tenants lawyer. 1/7/14 Other than what was documented on the Dec. 18th order letter, no other work has been done. Spoke with Erin Carta and she stated that Avatar called today and wants to do work tomorrow. The Carta's and their attorney will be in court on Thursday regarding this case. h0k4-Ll C(3) J all vyj.� c a�n.us, Co°n �un� ksk� c� t�1�s5� cd@tin��� 1'neJoi� �uan�' Cw✓� e �v � l i i Gars �NuS i�me�- of i � 1I COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT Plaintiff Defendant MOTION WITH HEARING AT LAWRENCE SESSION The undersigned hereby moves this Court [_] to continue this case until [_] to amend [_] to dismiss this case [_] to remove default or dismissal and for relief from judgment and set the case for trial on [_] to stay execution until [_] to issue execution [_] to order payment of the judgment within [30 days] [ ] [ ] other for the following reasons: This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o'clock a.m. Thursday, 20 I (gave) (mailed) a copy of this motion on to Signature and date Name Address Address Telephone L� COMMONWEALTH OF MASSACHUSETTS NORTHEAST HOUSING COURT Plaintiff No. Defendant MOTION WITH HEARING AT LAWRENCE SESSION The undersigned hereby moves this Court [_] to continue this case until [_] to amend [_] to dismiss this case [_] to remove default or dismissal and for relief from judgment and set the case for trial on [_] to stay execution until [_] to issue execution [_] to order payment of the judgment within [30 days] [ ] [ ] other for the following reasons: This motion will be heard by the Northeast Housing Court at Courtroom 3, Northeast Housing Court, 2 Appleton Street, Lawrence, at 9:00 o'clock a.m. Thursday, , 20 I (gave) (mailed) a copy of this motion on to Signature and date Name Address Address Telephone N-18-2014 01:13P FROM:WORK ;•\ to I I 9786850753 TO:9786888476 P.1 Department of Public Health & Department of Labor NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. C. It 1§191, 454 CMR 22.00 and 105 CMR 460.000, as most recently amended Contractor performing project Scott AUISon License # DC001480 Exp. Date 05/20/15 Lead Paint Inspector Gary Marciello ADDRESS OF PROJECT: Street Address 21 Perry Street City No. Andover Property Owner Richard & Marcelle Telephone Number (603) 894-6300 Date of Inspection 10/26/13 License # M3169 Exp. Date YV ,J'rr1 3 Deleading Method:0 Wet/Dry Scraping []Demolition j J✓�'�/�!I i ❑Covering If "Other" selected, please explain _ -- A, - Check one: Dwelling is multi -family,- - .- - ( ( (�_.�►�L�Jd Start Date 06/25/14 When will work be done: AM 8 PM Project Supervisor Name Worker's Compensation Policy Number_ In case of emergency contact — (Contractor's Representative) - h DELEADiNG CONTRACTOR — - — -- - The undersigned hereby states, under the pa[ _ —iweaith of Massachusetts Deleading Regulations, 454 Cl NR 460.000, and that the information contained in this notify, Date June 16, 2014 Company Name SCOTT AULSON Address 14 CURWEN ROAD, PEABODY, MA 01960 Telephone Number (978) 423-3472 OVER -4 Received Time Jun.18, 2014 1:39PM No.0750 N-18-2014 01:13P FROM:WORK 9786850753 TO:9786888476 P.1 ter" Department of Public Health & Department of Labor NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. C. I11§197, 454 CMR 22.00 and 105 CMR 460.000, as most recently amended Contractor performing project SCOtt Aulson License # DC001480 Exp. Date 05/20/15 Lead Paint Inspector Gary Marciello Date of Inspection 10/26/13 License # M3169 Exp. Date ADDRESS OF PROJECT: Street Address 21 Perry Street Apt. Number City No. Andover Zip 01845 Property Owner Richard & Marcelle Hamel Address 183 Pillsbury Rd., Londonderry, NH 03053 Telephone Number (603) 894-6300 Deleading Method:E] Wet/Dry Scraping ❑ Heat Gun ❑ Liquid Encapsulant []Demolition ❑ Caustics Q Replacement []Covering 0 Other If "Other" selected, please explain Check one: Dwelling is multi -family Start Date 06/25/14 Single-family Other Completion Date 06/27/14 When will work be done: AM 8 PM 4 (Specify times on site) Weekends? NO Project Supervisor Name License # Exp. Date Worker's Compensation Policy Number. In case of emergency contact Tel. #_(__JI (Contractor's Representative) DELEADING CQNTRACTOR Carrier The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00, and the Lead Poisoning P evention and Control Regulations, 105 CMR 460.000, and that the information contained in this notification Is true and correct to the b of his/het nowle nd eL Date June 16, 2014 Signed ' Company Name SCOTT AULSON Address 14 CURWEN ROAD, PEABODY, MA 01960 Telephone Number (978) 423-3472 OVER -4 Received Time Jun. 18, 2014 1:39PM No.0750 �� rf��� �,�„ � `'A<<s �� �sP'r'd�. k y r r� u � t- OF1710ES OF: APPEALS BUILDING CONSERVATION HEALTH PLANNING MADE BY: Of "OR t, Town Of m a NORTH ANDOVER Ss4 Hue f.4 DIVISION OF PLANNING & COMMUNITY DEVELOPMENT KAREN 1-1.1'. NELSON, DIRECTOR L 120 Main Street North Andover, Massachusetts O 1845 (617)685.4775 DATE ADDRESS: 2 �RZ�/ S TEL. NATURE OF COMPLAINT bA65 Of-- 1`0,45+1 ,A:j Z-3 pi gT l;y ST LOCATION: ZZ -2 -?15 X OCCUPANT 7 UWNER �( � /JGt/6�7A ADDRESS ZC;) Zvyf� DO NOT WRITE BELOW THIS LINE REFERRED TO DATE OF INVESTIGATION 3` RESULT OF INVESTIGATION 1,00KS LQ� J�,04) SMAUt_. No, RECOMMENDATIONS: ACTION TAKEN: