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57-59 Dow Street Deleading Documentation 12-27-2018 RECEIVED Department of Public Health-Childhood Lead Poisoning Prevention Program FEB 042019 Deleading Notification CITY OF SALEM Please complete all sections of this form clearly. Incomplete or illegible forms will be returned. BOARD OF HEALTH Lead Paint Inspector 1 W L1J License= tAt- 0 Inspection Date Propertti,OwTier Property Owtter's Address V anikN y I ame, 6,e O CA Y � _ Zip Code i Authorized person performing work: Sainnang Sa-r Lic=Auih.= i'C 500074 Address ofauthorizedperson 71 OA Summer St. _ Lynn Ma. Zip Code 01905 Telephone Number(718 596-8735 Address where the work will be done: Building Name(if an)) A _ Floor Street Addr - Apt\o_,- — Cit�� Zip Code- ,_�he propem is a multi-family— single familx. De(leading Methodis): ]b Making paint intact(high risk) Making paint intact(moderate :3 Apph ing %inyl siding on exterior a Demolition risk) j Component removal(low risk 4 Scraping Liquid encapsulant components) 10 Component removal`replacement Covering j Other. :i Dipping Capping baseboards The work will begin and Mill finish by The work be done in the Yeses 8 am 5Pm or_ eekends. Samnan Sar �� In Case of Emergence Contact _g _ Da%time Phone (7$1 !._-596-8735_ Evening Phone_ Same -_ The Property Owner must complete and sign the following information: l certitj-that only authorized persons who have complied with the training requirements of the Massachusetts Lead Poisoning Prevention and Control Regulations. 10,;CMR 460.000.will conduct deleading work. I further certifi-that the authorized persons)will not exceed the scope of his her authority and«ill be performing onh•those activities indicated above. All of the information contained in this document is true and correct to the best of my k:no yledue and belief. Dat V-Uk(� Signed_ - LL The following people/agencies must be notified ten days ginning work: I. Occupants of the dwelling unit 2. All other occupants of the residential premises. if any work t%ill be done in the common areas 3. Childhood Lead Poisoning Prevention Pro,-,rmrrL DPH Fax t781) 774-6700 MWRHO Randolph St. Donovan Building Canton. MA 02021 -l_ asbestos and Lead Program. DLXN:D 19 Staniford Street. 1`Floor. Boston. MA 02I 14 Fax(617)626-696i Local Board of Health Code Enforcement a_encA * If the home is on the State Register of Historic Places.call the NIA Historic-al Commission at(617)727-8470 Page 1 of i North Shore Lead Paint Testing Service i P.O. Box 734 Beverly, MA 01915 (978) 927-8152 Lead Inspection I Risk Assessment St.# 57 Street Name Dow Street Type_ St- Unit 2 City Salem _ _Zip Code 01970 Number of Rooms in Unit: 6 Owner Name: 57-59 Dow Street LLC Property Type: Owner Address: 2 Penny Lane BeVedy_ MA 9 15 ❑ Single Family Contact Information: ,John Cavanaugh Q Multi Family #of Units: 4 Client Name(if different from owner): Condominium #of Units: Client Address: ❑ Day Care ❑ Other: Laundry in Basement? ❑✓Yes ❑No Key Lead Column Kev Delead/1C Method Column &I DeleadlIC Method Column COV Covered [COV Covered REM Removed Finished Space in Basement?❑Yes ❑No DC Drop Ceiling I DIP Dipped REP Replaced Possible Pb Water Service Line MET Metal ENC Encapsulated SCR Scraped Yes J No Not Tested MR Metal Rep.Window INT Intact SFR Storm Frame Removed Testing Method Used NA Not Accessible MI Made Intact SLD Sealed NC No Coating PRE Prepared for Enc. STP Stripped Na2S Expiration Date: Tile Tile(testing suggested) � Component Does Not Exist VR/MR Vinyl/Metal Rep Window X-Ray Fluorescence VB Vinyl Baseboard Model: LPA-1 Serial# 2137 VR Vinyl Rep.Window _ C ❑ Demarcation Lines Comments/Notes: ❑ Submitted for Compliance Evaluation Property Diagram/Unit Labels Floor# 2 (level within building of unit being inspected) Floor# C b C b I II I -- - -; -'---- - ; Dow Street �. I I in I I I I I I I I ; D l3 � _: -- -- -- -- --- - - --- -- -- 57 p #2 59 p #2 L . 57 p #159 p #1. •- -_ •__ •.-I I I I ..i___7_--f--i---f--l---i- -i--Y---f--5-_• A(Street Side) Start Here A(Street Side) Start Here A(Street Side) Pb(lead)equal to or greater than 1.0 mg/cm2 with x-ray fluorescence or positive with Na2S is Dangerous. XRF Calibration Recorded in Log Book ✓❑ ✓-Check off when complete Address Verified through USPS ✓-Check off when comple Research on Lead Related History for Address ✓❑ ✓-Check off en ompl e xv-,v,,v.state.ma.us/dph/clppp or 800-532-9571 Thomas w M-1170 �2/ 27 /18 Inspector's Name(print) License# Signature Date T 4lDA _....-A n4mq Address: 57 Dow St. _ Apt# 2 city Salem Page 2 of INSPECTION HISTORY INTERIM CONTROL Determination 4227 Visual R.A.Name: Lic# Inspector Nat1le:Jeffre Baros Lic# Risk Assessment a 1 2 8 1 8 N Signature _ Y Signature, Lead Hazards? Urgent Ph.Hazards? N Dust a en or Comprehensive R.A.Name:_ Initial inspection N Signature. q Inspector Name:Oscar Begin Lic#1t)63 Risk Assessment 7 27 0 1 Y 0 Signature_. � Urgent Pb.Hazards. Lead Hazards? Visual Portion of P R,A,Name: Uc# Comp Initial Reinspection for w/Partial PCAD MNN Inspector Name: Lie# Interim Control F Signature -- Signature T U Lead Hazards? Dust Taken for Risk P R.A.Name:_ Lic# Addendum(add-on Assessment Reins . to Initial Ins ection) Y Inspector Name:- Lic# F Signature N Signature Lead Hazards? Visual Portion of Reinspection for R.A,Name: Lic# Addendum as Full Interim Control P Ins coon Y Inspector N e:Thomas Do Li 1772 F Signature 1 2 2 7 118 N Sign—,atue 1,11 1 Lead Hazards? Dust Taken for Risk P R.A.Name:_ Lic# Assessment Reins . Walk Through for Inspector Name: Lic# F Signature Ed/Consultation Signature Risk Assessment Uc# Y Recertification R.A.Name: REINSPECTION HISTORY I I I M Signature Visual Portion of P Inspector Name: Lic# Urgent Pb.Hazards? Reocc.Reins ection F Signature Dust Taken for P I R.A.Name: Lic# RA Recertification Visual Portion of P Inspector Name: Lic# F 5ignature Reocc.Reins ection F Signature _ POST COMPLIANCE ASSESSMENT DETERMINATIONS Dust Taken for P Inspector Name: Lic# Reocc.Reins ection F Signature PCAD _. Y Inspector Name: Lic# N Signature Dust Taken for P Inspector Name: Lic# Lead Hazards? Reocc.Reins ection F Signature Full Inspection Actin as PCAD Y Inspector Name: Lic# Visual Portion of Inspector Name: Lic# N Signature Final Reins ection P Lead Hazards? I I I I I [F Signature. Visual Portion of P Inspector Name: Lic# Visual Portion of Inspector Name: Llc# PCAD Reins ection Final Reins P _ction F Signature F Signature — Dust Taken for P Inspector Name: ,Lic# Dust Taken for Final P Inspector Name:— Lic# PCAD Reins ection Reins . o Reocc F Signature F Signature Dust Taken for F P Inspector Name: Lic# Dust Taken for Final �F] Inspector Name:— Lic# PCAD Reins ection Reins . o Reocc F SignatureSignature___--- History rev 6/17 Address: 57 Dow St. Apt# 2 city Salem Page 3 of REOCCUPANCY CERTIFICATE HISTORY COMPLIANCE HISTORY(CONT.) Certificate of Certificate of Reocc anc Maintained Inspector Name: Lic# Inspector Name: ,Lic# Compliance Only after Si nature Signature High/Mod Risk 9 No Work=No Dust 4 (#rooms rule Work=7 Dust Certificate of Certificate of Reoccu anc Restored Inspector Name:_ Lic# Compliance inspector Name: Lic# Only after Signature_ Signature High/Mod Risk Dust wipes and auth. #rooms rule) people Certificate of Certificate of Reoccu an Inspector Name: LidMaintained Inspector Name:_ Lic# Compliance Only after Signature Signature High/Mod Risk No Work=No Dust #rooms rule) Work=7 Dust COMPLIANCE HISTORY Certificate of Letter of Full Initial Restored Inspector Name: :Lid- Compliance Inspector Name:__ _ Lic# I Compliance Signature No prior history/ Signature Dust wipes and auth. No signs of UD people Letter of Interim OTHER HISTORY:WAIVERS/UD Control Inspector Name: Lic# Approved CLPPP Waiver Inspector Name: Lic# No prior Comp. Signature Expires in I vr. Attach to Comp Signature Does Recertification of Approved Interim Control Inspector Name: Lic# CLPPP Waiver Inspector Name: :Lic# Expires 2 yrs from Signature_ Signature_ _ original Interim Attach to Comp Docs Control Letter of Full UD/DES Visual Deleading inspector Name:_ _ Lic# Reins ection p Inspector Name: Lilt Compliance 8 Signature F Signature _ Dust wipes if No No LOC Issued Reocc. Certificate of UD/DES Dust Maintained Taken p Inspector Name: Lid- Compliance Inspector Name: Llc# 8 Signature. Signature No LOC Issued No Work=No Dust Work=7 Dust UD/DES Dust Taken Inspector Name: Lic# Certificate of Restored L.EJ Signatures_ .- Com liance Inspector Name: No LOC Issued Signature_ UD IDES Final Dust wipes and auth. eo le Reins ection p Inspector Name:, _ Lids Signature_-- I No LOC Issued History rev 6117 Page 4 of I"1 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 equal to or greater than 1.0 mg/cmz is a dangerous level of lead. • A"pos"or"neg"shows that the surface was tested with sodium sulfide."Pos"means that there is a dangerous level of lead. • "N/A"means that the inspector was not able to test the surface.The inspector must assume the surface contains lead and require it to be deleaded.Speak to the inspector about possible alternative testing options. • "MET'or"MR"means that a metal surface was not tested.Metal handrails,metal window sills,and metal railing caps need to be deleaded if they test equal to or greater than 1.0 mg/cmZ,or are marked"MET"or "N/A".All other metal surfaces must be intact. • For key to abbreviations like"COW,"VB","W'or"MR","NC","Tile","DC",seethe cover page. 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. • 'W'circled means that the surface is a moveable/impacted part of a window 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. • "F"circled means that the surface is a"friction"surface and must be deleaded at all points of potential friction. • "L"circled means that the surface is loose and must,at a minimum,be made intact.Loose leaded floors must be sealed with paint or similar coating and pass a dust wipe. • 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 completed during a risk assessment,which is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment. If"Y"is circled,then this surface is considered an"Urgent Lead Hazard"and deleading 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 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 DATE The date that the lead inspector reinspects the surface and finds that it is in compliance. DELEAD METH The method used to bring a surface into full compliance.Refer to codes in the Key on the report's cover page. 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. RULED OUT Encapsulants only work well if the paint is in good condition.If the inspector sees that there BOX are adhesion problems with eligible surfaces in a room,he/she will rule out encapsulation as a deleading method. LIRA Exp.2017 Thomas Dowd M-1170 7,�4 12 27 18 Page Jr of Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Pro ert : 57 Dow St. A t.# 2 city: Salem ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE I METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls Cdll L N/A Y A Window Sill fWl AIM L NIA Y A B Low Walls L NIA Y B Win Apron 5 r3 L NIA Y A B Baseboards 011 L NIA Y C Win Casing 0 1) L N/A Y A B Chair Rail L NIA Y D Header Stop �l Mil L NIA Y AB Radiator 0,6) L NIA Y Int Stops M/I L N/A Y Floor jjY L(](dust) N/A Y 1 Win Int Sash VIP, Mn L N/A Y Ceiling L NIA Y 2 Exterior Sill Mn SF L N/A Y AJ Door q 1 NIA Y 3 Part Bead M/I L N/A Y C D Door Edge r D NIA Y 4 Blind Stop MII SF L WA Y 12 Door Casing 'Oil L NIA Y Win Ext Sash VfL MII L NIA Y 3 4 Door Jamb 0110 F L N/A Y A Window Sill M/1 AIM L NIA Y Threshold 0.1 L N/A Y B Win Apron L NIA Y A B Door A 0 L NIA Y C Win Casing L NIA Y ®D Door Edge 61 1 F L NIA Y D Header Stop M11 L NIA Y 12 Door Casing 010 L NIA Y Int Stops Mll L N/A Y 34 Door Jamb 4a�,, F L NIA Y 1 Win Int Sash M/I L NIA Y Threshold L NlA Y 2 Exterior Sill Mn SF L N/A Y A B Door L NIA Y 3 Part Bead INI L N/A Y C D Door Edge F L NIA Y 4 Blind Stop INI SF L NIA Y 12 Door Casing L NIA Y Win Ext Sash IM11 L NIA Y 34 Door Jamb F L N/A Y A Window Sill M/l A/M L N/A Y Threshold L NIA Y B Win Apron L NIA Y Closet Door 06 L N/A Y C Win Casing L NIA Y A CI Door Edge 01 F L N/A Y D Header Stop Mp L NIA Y Cl Casing L NIA Y Int Stops MA L N/A Y C Closet Jamb F L NIA Y 1 Win Int Sash Mll L N/A Y D Closet walls L NIA Y 2 Exterior Sill W SF L N/A Y CI Baseboard L 1 Y 3 Part Bead Mn L N/A Y 1 Closet Pole atb L NIA Y 4 Blind Stop Mn SF L NIA Y 2 Closet Shelf d&k L NIA Y Win Ext Sash MA L N/A Y 3 Cl Supports alA L N/Al AB Fireplace L NIA Y 4 Closet Floor 0. L❑(dust) NIA1 Y I I I CD Mantle 7L L NIA Y t C N `` AB Closeeiling L I. Y CD Win Above 5' ©A L WA Y COMMENTS I STRUCTURAL DEFECTS: Ceiling Moldi L NIA Y F Mil A17 L WA Y F M11 AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F MA AIM L NIA Y by a Deleader(MORE THAN 288 SO.IN.) F Wl AIM L NIA Y IC IC F M/l A/M L WA Y SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD F WI AMI L N/A Y ElCheck the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LURA Rep 2017 Room Th 1; omas Dowd M-1170 Q�Qr/� 12 27 18 Page of Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Pr pert : 57 Dow St. A .# 2 city: Salem ROOM# SIDEJLOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE I HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls L /A Y Window Sill 0&, Mn A/M L N/A Y A B Low Walls L N/A Y B Win Apron 0.1 L NIA Y A B Baseboards r L Y C Win Casing 0,0 L N/A Y A B Chair Rail L NIA Y D Header Stop t MII L NIA Y Al Radiator tb L N/A Y Int Stops 01.( M/I L NIA Y Floor { L[](dust) NIA Y Win Int Sash qP, IMA L NIA Y Ceiling L NIA Y 2 Exterior Sill J mn SF L NIA Y B Door L N/A Y 3 Part Bead M/1 L NIA Y Door Edge F L N/A Y 4 Blind Stop Mn SF L N/A Y 12 !Do:o:r oor Casing L IA Y Win Ext Sash MII L NIA Y 34 Jamb , F L NIA Y Window Sill , MA ` N/A Y Threshold 0141 L NIA Y B Win Apron 'rie L N/A Y A B Door A L NIA Y C Win Casing `j.I I L N/A Y C D Door Edge F L NIA Y D Header Stop , Mil L N/A Y 112 Door Casing L NIA Y Int Stops M/I L NIA Y 34 Door Jamb F L NIA Y 1 Win Int Sash K Mn L NIA Y Threshold L NIA Y @ Exterior Sill VA,_Mn SF L N/A Y A B Door L N/A Y 3 Part Bead II L N/A Y C D Door Edge F L N/A Y 4 Blind Stop M/I SF L N/A Y 12 Door Casing L N/A Y Win Ext Sash Mn L NIA Y 34 Door Jamb F L N/A Y Window Sill M I AI L NIA Y Threshold L N/A Y B Win Apron 1V(0 L NIA Y Closet Door L N/A Y C Win Casing qqlL N/A Y A Cl Door Edge F L N/A Y D Header Stop 1.11 M/I L NIA Y B Cl Casing L NIA Y Int Stops q1T1 Mn L N/A Y C Closet Jamb F L NIA Y 1 Win Int Sash tjAA Mn L NIA Y D Closet Walls L N/A Y 2 Exterior Sill VIL I M/I SF L NIA Y Cl Baseboard L NIA Y 3 Part Bead Mll L NIA I Y 1 Closet Pole L NIA Y 4 Blind Stop M/1 SF L N/A Y 2 Closet Shelf L NIA Y Win Ext Sash M/1 L N/A Y 3 Cl Supports L N/A Y A B Fireplace L NIA Y 4 Closet Floor L[](dust)NIA Y C D Mantle d. L NIA Y Closet Ceiling L N/A Y A o Win Above 5' +t� L N/A Y COMMENTS/STRUCTURAL DEFECTS: Ceiling Moldi L NIA Y F M1I AIM L NIA Y O t F NUI AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact •% t3 F Nv1 AN L(JlA Y by a Deleader(MORE THAN 288 SQ.IN.) F M/1 AIM L N/A Y IC IC F NUI AIM L NIA Y SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD F NJ AVM L NIA Y ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LYRA Rep 2017 Room Thomas Dowd M-1170244ewl 12 27 18 Page7—of � Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Address of Prooe : 57 Dow St. Aot.# 2 city: Salem ROOM#._ PSIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls L IA Y A Window Sill 9 Mil AIM L N/A Y A B Low Walls L NIA Y B Win Apron Q r`Z L N/A Y A B Baseboards d L N/A Y Win Casing o c` L NIA Y A B Chair Rail L NIA Y D Header Stop o f M/l L N/A Y AB Radiator L N/A Y Int Stops 010 Mil L N/A Y n Floor OtO L Q(dust) N/A Y Win Int Sash Mil L N/A Y Ceiling OM L N/A Y 2 ExtedorS WI SF L N/A Y Door 01N. L N/A Y 3 Part Bead y M11 L NIA Y C D Door Edge 4 i I F L N/A Y 4 Blind Stop MII SF L N/A Y 12 Door Casing L NIA Y Win Ext Sash MII L N/A Y 34 Door Jamb t F L WA Y A Windowsill NI A/M L N/A Y Threshold L NIA Y �B Win Apron L NIA Y B Door L N/A Y Win Casing L NIA Y C D Door Edge f F L N/A Y D Header Stop Q t 1 Mil L N/A Y 12 Door Casing L NIA Y Int Stops 01 M/1 L NIA Y 34 Door Jamb F L NIA Y 1 Win Int Sash MA L WA Y Threshold 0 SU L NIA Y Exterior Sill Mil SF L N/A Y A B Door L NIA Y 3 Part Bead MA L N/A Y C D Door Edge F L NIA Y 4 Blind Stop Mn SF L NIA Y 12 Door Casing L N/A Y Win Ext Sash V11 L N/A Y 3 4 Door Jamb F L NIA Y A Window Sill M/1 AIM L NIA Y Threshold L N/A Y B Win Apron AL NIA Y Closet Door L N/A Y C Win Casing 41 L NIA Y ��A Cl Door Edge &I F L N/A Y D Header Stop MA L NIA Y Cl Casing L N/A Y Int Stops MA L N/A Y Closet Jamb F L N/A Y 1 Win Int Sash MA L N/A Y D Closet Walls 10 L NIA Y 2 Exterior Sill MA SF L NIA Y CI Baseboard Ofil L CNjl Y 3 Part Bead MA L N/A Y 1 Closet Pole Q�'0 1 L NIA Y 4 Blind Stop M/l SF L N/A Y 2 Closet Shelf Oro L N/A Y Win F.xt Sash Mn L NIA Y 3 CI Supports Q iX L NIA Y AB Fireplace L NIA Y 4 Closet Floor 0 v 1 L❑(dust) NIA Y CD Mantle L N/A Y NV AB Closet Ceiling L' J Y CD Win Above 5' D f L NIA Y COMMENTS/STRUCTURAL DEFECTS: Ceiling-mot&7 L NIA Y F Mn AIM L NIA Y F M11 AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F MA AIM L N/A Y by a Deleader(MORE THAN 288 SQ.IN.) F MII AIM L N/A I Y IC IC F MII AIM L NIA Y SIDE LOCATION I MEASURE:LOOSE PAINT DATE METHOD F MA AAN L NIA Y Check the box if this ROOM is RULED OUT for encapsulation El because there are 3 or more AIM surfaces with adhesion problems LIRA Rep 2017 Room Thomas Dowd M-117 Q rr AA& 9-67 L 121 271 18 Page I Of y� Inspector(print) Lic# Signature Date Risk Assessor(print) Lic# Signature Date Addimss of Proee : 57 Dow St. A t.# 2 city! Salem KITCHEN SIDE LOCATIONI 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 HAZ. DATE METH DATE METH A s Up Walls $&I L N/A Y A Window Sill ��� M/I AIM L N/A Y A B Low Walls L N/A Y Win Apron L NIA Y A 9 Baseboards O i L N/A Y C Win Casing X1 L NIA Y A e Chair Rail L NIA Y D Header Stop 0,0 MA L NIA Y AB Radiator (��? L N/A Y Int Stops Oi f M/I L N/A Y CD Floor A�) L (dust) N/A Y © Win Int Sash MA L N/A Y Ceiling 060 L N/A Y 2 Exterior Sill (/ Mil SF L N/A Y B Door L NIA Y 3 Part Bead 11 L MA L WA Y C D Door Edge F L NIA Y 4 Blind Stop MII SF L N/A Y 1 2 Door Casing D FZ L N/A Y Win Ext Sash MA L NIA Y 3 4 Doorjamb Oil I F L NIA Y A Window Sill f0 MA AIM L NIA Y [ThTh ® Win Apron L N/A Y reshold Qt L NIA Y A B Door L N/A Y C Win Casing Q L NIA Y D Door Edge F L NIA Y D Header Stop 0#0 MA L NIA Y 112 Door Casing 0.3 L NIA Y Int Stops 0 t! Mn L NIA Y 34 Door Jamb 0* F L NIA Y 1 Win Int Sash 4 M/I L NIA Y Threshold dip I L NIA Y ® Exterior sill MA SF L N/A Y A Door L NIA Y 3 Part Bead M/I L N/A Y Door Edge F L N/A Y 4 Blind Stop M/1 SF L N/A Y 2 Door Casing ti L N/A Y Win Ext Sash >Jx— Mil L NIA Y 34 Door Jamb F L N/A Y AFL Up Cab Frame l L NIA Y Threshold 01 L NIA Y D Up Cab Door Qt, L NIA Y Closet Door L NIA Y Up Cab Walls 0 IJU L NIA Y A CI Door Edge F L N/A Y 12 Up Cab Shlvs /f c L NIA Y B Cl Casing L NIA Y 34 Supports Q s L N/A Y C Closet Jamb F L NIA Y Low Cab Fram L N/A Y D Closet Walls L NIA Y A Low Cab Door L N/A Y Cl Baseboard L N/A Y C6 Low Cab WalisTj L NIA Y 1 Closet Pole L N/A Y Low Cab Shivs iqi` L NIA Y 2 Closet Shelf L N/A Y 12 Supports 0A L NIA Y 3 Cl Supports L NIA Y 34 Drawers 0! I L N/A Y 4 Closet Floor L[](dust) NIA Y A p Win Above 5' 01 L N/A Y Closet Ceiling L NIA Y Ceiling Moldin 0,0 L N/A Y COMMENTS I STRUCTURAL DEFECTS: , ) F M11 AIM L WA Y 1 F MA AIM L NIA Y G pe, ,Q F W1 AIM L NIA Y F Wl AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F M/I AIM L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) F M/I AIM L N/A Y IC IC F AAA AIM L NIA Y SIDE LOCATION MEASURE:LOOSE PAINT DATE METHOD F M1NI AIM L N/A I Y Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems LYRA Rep 2017 Kitchen Thomas Dowd M-1170 -A 12/ 27 / 18 Page!Of Inspector(print) Lic# Signature Date Risk Assessor(print) Signature Date Address of Pronerv: 67 Dow St. Apt.,# 2 _ Cily: Salem _ PANTRY SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG 1C IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Up Walls L N/A Y A B Up Cab Frame L N/A Y A B Low Walls L NIA Y C D Up Cab Door L N/A Y A B Baseboards Q L N/A Y Up Cab Walls L N/A Y A B Chair Rail L N/A Y 12 Up Cab Shivs L NIA Y AB c B Radiator L N/A Y 34 Supports V. L NIA Y Floor Q, L❑(dust) NIA Y A B Up Cab Fram L N/A Y Ceiling L N/A Y C D Up Cab Door L NIA Y B Door L NIA Y Up Cab Walls L NIA Y C D Door Edge F L NIA Y 12 Up Cab Shivs L N/A Y 12 Door Casing L NIA Y 34 Supports L NIA Y 34 Door Jamb aq I F L N/A Y Low Cab Fram L N/A Y Threshold [ L N/A Y A B Low Cab Door L NIA Y A B Door L NIA Y C D Low Cab Walls L N/A Y C D Door Edge F L N/A Y Low Cab ShIvs L NIA Y 12 Door Casing L N/A Y 12 Supports L NIA Y 34 Door Jamb F L N/A Y 34 Drawers L N/A Y Threshold L NIA Y Low Cab Foam 0, L NIA Y Closet Door L N/A Y ro Low Cab Door i L N/A Y A Cl Door Edge F L NIA Y Low Cab Wall L Y B CI Casing L N/A Y Low Cab Shlv L Y C Closet Jamb F L N/A Y 12 Supports Y D Closet Walls L N/A Y 34 Drawers L& Y Cl Baseboard L NIA Y Low Cab Fram L N/A Y 1 Closet Pole L N/A Y A B Low Cab Door L NIA Y 2 Closet Shelf L N/A Y C D Low Cab Walls L N/A Y 3 Cl Supports L NIA Y Low Cab ShIv L N/A Y 4 Closet Floor L❑(dust) NIA Y 12 Supports L N/A Y Closet Ceiling L N/A Y 34 Drawers L NIA Y A B Up Cab Frame L N/A Y Window Sill t MH A/M L N/A Y C D Up Cab Door L NIA Y J Win Apron L NIA Y Up Cab Walls L N/A Y C Win Casing L NIA Y 12 Up Cab Shlvs L N/A Y D Header Stop Ogg M11 L NIA Y 3 4 Supports L NIA Y Int Stops M11 L NIA Y . F Mll A/M L NIA Y 1 Win Int Sash V Mll L N/A Y COMMENTS/STRUCTURAL DEFECTS: 2 Exterior Sill Mn SF L N/A Y 3 Part Bead M11 L N/A Y 4 Blind Stop M11 SF L N/A Y Win Ext Sash 1 L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact F MII AIM L NIA Y by a Deleader(MORE THAN 288 SQ.IN.) �(,� d F W AIM L NIA Y SIDE LOCATION MEASURE:LOOSE PAINT IC IC T F M11 AIM L NIA Y DATE METHOD F M/I A/M L N/A Y a Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems LIRA Rep 2017 Pantry Thomas Dowd _ M-1170 7444 12 /27 118 Page [o Of Inspector(print) Lic# Signature Date 1 / Risk Assessor (print) Lic# Signature Date Address of Pro : 57 Dow St. Apt.# 2 City. Salem BATHROOM# 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 HAZ. DATE METH DATE METH A B Up Walls O�a� L N/A Y A B Up Cab Frame L NIA Y A B Low Walls L N/A Y C D Up Cab Door L WA Y A B Baseboards l L N/A Y Up Cab Walls L WA Y A B Chair Rail L WA Y 12 Up Cab Shlvs L NIA Y Al CD Radiator L WA Y 34 Supports L NIA Y Floor L (dust) NIA Y Low Cab Fram a1 L NIA Y Ceiling a L N/A Y A@ Low Cab Door Q, L WA Y B Door TIT L WA Y C D Low Cab Walls&A L NIA Y D Door Edge F L NIA Y Low Cab ShM 01\ L NIA Y 12 Door casing L N/A Y 12 Supports 0-1 L N/A Y 34 Door Jamb Q,` F L NIA Y 3 4 Drawers Q. L NIA Y Threshold �, L N/A Y A Window Sill Qt.% M/I AIM L N/A Y A Door L NIA Y Win Apron to L NIA Y Door Edge F L NIA Y Win Casing Q, L N/A Y DoorCasing Qt. L NIA Y Header Stop 9 4 Mn L NIA Y 3 4 Door Jamb F L NIA Y Int Stops i I MII L NIA Y Threshold 11 1 L N/A Y 1 Win Int Sash W L NIA Y A B Door L N/A Y 2 ExteriorSill MA SF L NIA Y C D Door Edge F L NIA Y 3 Part Bead Mi L NIA Y 12 Door Casing L N/A Y 4 Blind Stop M/1 SF L NIA Y 3 4 Door Jamb F L N/A Y Win Ext Sash M/1 L NIA Y AB Threshold L WA Y co Win Above 5' TIT L NA Y Closet Door L NIA Y Ceiling Moldin L NA Y A CI Door Edge F L N/A Y A B AB Medicine Cab Q.� L NA Y B CI Casing �Z L N/A Y F Wl AIM L N/A Y Closet Jamb 8a F L N/A Y F M11 AIM L WA Y Closet Walls t l L N/A Y F M11 AIM L N/A Y Cl Baseboard d 40 L WA Y F MA AIM L NIA Y 1 Closet Pole L N/A Y F MII AIM L WA Y 2 Closet Shelf t L N/A Y F MA AIM L NIA Y 3 Cl Supports L N/A Y F WII AIM L WA Y 4 Closet Floor OT L❑(dust) Q Y F W AIM L N/A Y Closet Ceiling L$/j Y F MIl AIM L NIA Y F MII AIM L N/A Y F WI AIM L N/A Y F M/I AIM L N/A Y F Mn AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: by a Deleader(MORE THAN 288 S0.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC IC DATE METHOD Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems LYRA Rep 2017 Bath Z6Thomas Dowd M-1170 12 r 271 18 Page ��Of�! Inspector(print) Lic# Signature Date r r Risk Assessor(print) Lic# Signature Date A^dress of Pro ert , 57 Dow St. A t.# 2 city: Salem HALLWAY:Interior # or Common Hallway: Front Rear Floor# 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 HAZ? DATE METH DATE METH A B Up Walls / L /A Y Closet Door L NIA Y A B Low Walls L N/A Y A Cl Door Edge F L N/A Y A B Baseboards Q. L N/A Y B Cl Casing L N/A Y A B Chair Rail L NSA Y C Closet Jamb F L N/A Y AGCD Radiator 1z L N/A Y D Closet Walls L N/A Y Floor D,, L[](dust) N/A Y Cl Baseboard L NIA Y Ceiling L N/A Y 1 Closet Pole L NIA Y B Door L N/A Y 2 Closet Shelf L NIA Y C D Door Edge diU F L N/A Y LSTjA 3 CI Supports L NIA Y 12 Door Casing 17#'1, L N/A Y 4 Closet Floor L (dust) NIA Y 34 Door Jamb F L N/A Y Closet Ceiling L NIA Y Threshold t9c L N/A Y A Window Sill M/I AIM L NIA Y AV Door L N/A Y B Win Apron L N/A Y C D Door Edge F L N/A Y C Win Casing L N/A Y 12 Door Casing 0 L NIA Y D Header Stop M11 L N/A Y 3 4 Door Jamb d 4 j F L NIA Y Int Stops M11 L NIA Y Threshold d to L N/A Y 1 Win Int Sash W L N/A Y A B I Door 611 L N/A Y 2 Exterior Sill W SF L N/A Y D Door Edge ONZ, F L NIA Y 3 Part Bead Mil L N/A Y 12 Door Casing % L NIA Y 4 Blind Stop Mil SF L N/A Y 3 4 Door Jamb O t F L NIA Y Win Ext Sash Mn L N/A Y Threshold dt L N/A Y A Window Sill Mil AIM L N/A Y A B Door 0 tt L NIA Y B Win Apron L N/A Y qQ DoorEdge jqt F L N/A Y C Win Casing L N/A Y 12 Door Casing 6111 L NIA Y D Header Stop W L NIA Y 3 4 Door Jamb 6,U F L NIA Y Int Stops M1I L N/A Y A Door L N/A Y 1 Win Int Sash Mil L N/A Y 1 Door Edge NIA Y 2 Exterior Sill W SF L N/A Y 1 Casing L N/A Y 3 Part Bead MII L N/A Y Jamb F L NIA Y 4 Blind Stop W SF L N/A Y D Closet Walls L N/A Y Win Ext Sash Mil L N/A Y AB Cl Baseboard L N/A Y CD Win Above 5' L N/A Y 1 Closet Pole L NIA Y Ceiling Molding L N/A Y 2 Closet Shelf L N/A Y „__ = F W A/M L N/A Y 3 CI Supports L NIA Y ____ A/M L NIA Y 4 Closet Floor L❑(dust)NIA Y F WI AIM L N/A Y Closet Ceiling'-t—1 L NIA Y COMMENTS/SZELCTURAL DEFECTS: EXCLUDED SU ACES:Surfaces listed in these boxes can only be made intact by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC DATE 1C METHOD Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems LLRA Rep 2017 Hall Thomas Dowd M-1170 12127118 PageaO OF-I Inspector(print) Lie# Sbfnature Date Risk Assessor(print) Lie# Signature Date Address of Pro ert : 57 4ow St. Apt.# 2 cit : Salem HALLWAY:Interior # or Common Hallway: Front Rear Floor#_ SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC 1C DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Up Walls t9! L NIA Y Closet Door L WA Y A B Low Walls L NIA Y A Cl Door Edge F L NIA Y A e Baseboards L N/A Y B Cl Casing L N/A Y A B Chair Rail L N/A Y C Closet Jamb F L N/A Y AB Radiator L NIA Y D Closet Walls L N/A Y Floor L❑(dust) N/A Y CI Baseboard L N/A Y Ceiling L NIA Y 1 Closet Pole L NIA Y �—B Door L N/A Y 2 Closet Shelf L N/A Y C D Door Edge F L NIA Y 3 CI Supports L N/A Y 12 Door Casing t L NIA Y 4 Closet Floor L❑(dust) N/A Y 3 4 Door Jamb F L NIA Y Closet Ceiling L N/A Y Threshold t L NIA Y A Window Sill M11 A/M L NIA Y A B Door L �A Y B Win Apron L N/A Y (L9 Door Edge Zp CF L NIA Y C Win Casing L N/A Y 12 Door Casing 1. L N/A Y D Header Stop M/1 L N/A Y 3 4 Door Jamb t F L N/A Y Int Stops MA L NIA Y Threshold ail L N/A Y 1 Win Int Sash M11 L NIA Y A B Door L N/A Y 2 Exterior Sill Mil SF L NIA Y C D Door Edge F L N/A Y 3 Part Bead M/I L NIA Y 12 Door Casing L N/A Y 4 Blind Stop M/I SF L N/A Y 3 4 Door Jamb F L WA Y Win Ext Sash M/I L N/A Y Threshold L N/A Y A Window Sill M/I A/M L NIA Y A B Door L N/A Y B Win Apron L N/A Y C D Door Edge F L N/A Y C Win Casing L N/A Y 12 Door Casing L NIA Y D Header Stop W L N/A Y 34 Door Jamb F L N/A Y Int Stops M/I L N/A Y Closet Door L N/A Y 1 Win Int Sash M11 L N/A Y A CI Door Edge F L N/A Y 2 Exterior Sill M11 SF L N/A Y B CI Casing L N/A Y 3 Part Bead M11 L NIA Y C Closet Jamb F L N/A Y 4 Blind Stop M/I SF L N/A Y D Closet Walls L NIA Y Win Ext Sash M11 L NIA Y CI Baseboard L N/A Y ABC D Win Above 5' L N/A Y 1 Closet Pole L NIA Y Ceiling Molding L N/A Y ILL 2 Closet Shelf L WA Y F M11 AIM L NIA I Y 3 CI Supports L NIA Y F W A/M L N/A Y 4 Closet Floor L[-](dust) N/A Y F Mll AIM L WA I Y Closet Ceiling L N/A Y COMMENTS 1 STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION I MEASURE:LOOSE PAINT IC DATE IC METHOD ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more AIM surfaces with adhesion problems LYRA Rep 2017 Hall Thomas Dowd M-1170 ��� 12 J 27 J 18 Page rr 3 Of Iq Inspector(print) Lic# Signature Date _ 1 J Risk Assessor(print) Lic# Signature Date Address of Property: 57 Dow St, Api.# 2 al : Salem STAIRCASE# ON T 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 HAZ? DATE METH DATE METH A B Up Walls N/A Y A Wiiiaow Sill M/I A/M L N/A Y SLLA a Lour Walls -3,9 , L N/A Y B Win Apron L N/A Y n e Baseboards J1 It L L N/A Y C Win Casing L NIA Y A B Chair Rail Q L N/A Y D Header Stop Mil L N/A Y AS CD Radiator L N/A Y Int Stops M/I L NIA Y Floor a L❑(dust) N/A Y 1 Win Int Sash MA L NIA Y Ceiling 00 L NIA Y 2 Exterior Sill M/l SF L NIA Y B Door 0 NIA Y 3 Part Bead MA L NIA Y C D Door Edge y F L IA Y 4 Blind Stop Mll SF L N/A Y 12 Door Casing L N/A Y Win Ext Sash Mll L N/A Y 3 4 Door Jamb F L N/A Y A Window Sill 7 Mn A/M L N/A Y tdo L N/A Y B Win Apron L N/A Y AB DoorL N/A Y C Win Casing L N/A Y D Door EdF L N/A Y D Header Stop Mil L N/A Y 2 Door Caair, U NIA Y Int Stops MA L NIA Y 34 Doorjamb F L N/A Y 1 Win Int Sash MA L NIA Y Threshold L NIA Y 2 Exterior Sill MA SF L NIA Y AB Door L NIA Y 3 Part Bead Mil L NIA Y C Door Edge �. F L N/A Y 4 Blind Stop MA SF L NIA Y Door Casing L NIA Y Win ExtSash] M/I L WA Y 34 Doorjamb F L NIA Y Newel Post s L N/A Y Threshold L N/A Y Railing Cap A/M L N/A Y A B Door L N/A Y Handrail t A/M L N/A Y CD Door Edge F L N/A Y Balusters oil L N/A Y 12 Door Casing L N/A Y Lower rail L N/A Y 34 Door Jamb F L N/A Y Treads p�� F L N/A Y Closet Door L N/A Y Risers L N/A Y A Cl Door Edge F L NIA Y Stringer (� L N/A Y B Cl Casing L N/A Y Tread edge>5 fit L NIA Y C Closet Jamb F L NIA Y Landing floor 19t l L❑(dust) N/A Y D Closet Walls L NIA Y Floor Edge © o L N/A Y CI Baseboard L NIA Y Floor Casing L NIA Y 1 Closet Pole L N/A Y F MA A/M L NIA Y 2 Closet Shelf L NIA Y F MA AMf L N/A Y 3 Cl Supports L NIA Y F MA W L NIA Y 4 Closet Floor L❑(dust) N/A Y F MA AIM L N/A Y Closet Ceiling L NIA Y F MA A/M L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact COMMENTS/STRUCTURAL DEFECTS: by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC IC DATE METHOD Check the box if this ROOM is RULED OUT fo=encapsulabon because there are 3 or more AIM surfaces withlem LYRA Rep 2017 Stair 7J Thomas Dowd M-1170 b' l� 12 /27 / 18 Page��f� a� Inspector(print) Lic# Signature Date 1 I Risk Assessor(print) Lic# Signature Date Address of Propeq4 57 Dow St. Ark,m 2 City: Salem STAIRCASE# d 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 HAZ? DATE METH DATE METH A B Up Walls NIA Y A Window Sill . M11 A/M L NIA Y A B Low Walls L NIA Y B Win Apron Qil L NIA Y A B Baseboards L N/A Y Win Casing L N/A Y SLI A B Chair Rail L N/A Y D Header Stop o d WI L NIA Y AB �nt CD Radiator L N/A Y Int Stops U,,t WI L N/A Y Floor 01A LQ(dust) NIA Y 1 Win Int Sash M/I L N/A Y Ceiling FN L NIA Y 2 Exterior Sill I SF L NIA Y Door 78 L NIA Y 3 Part Bead VIF7 M11 L NIA Y C D Door Edge Z F L N/A Y 4 Blind Stop W SF L N/A Y 12 Door Casing L NIA Y Win Ext Sash M11 L NIA Y 3 4 poor Jamb „) F L NIA Y A Window Sill M/I AIM L N/A Y Threshold Q L NIA Y B Win Apron L N/A Y Doors L NIA Y C Win Casing L NIA Y C D Door Edge F L N/A Y D Header Stop M/I L NIA Y 12 DoorCasing Q t L NIA Y IntStops M11 L NIA Y 34 Door Jamb 414 F L NIA Y 1 Win Int Sash M/1 L NIA Y Threshold L N/A Y 2 Exterior Sill Mll SF L N/A Y A B Door ttl &A/A Y 3 Part Bead M11 L N/A Y C D Door Edge SI-b F L N/A Y 4 Blind Stop M/I SF L NIA Y 2 Door Casing v l` L NIA Y Win Ext Sash M/l L N/A Y 34 Door Jamb d• F L N/A Y Newel Post O c l L NIA Y Threshold + L N/A Y Railing Cap Q<< A/M L N/A Y A B Door L N/A Y Handrail 076 AIM L NIA Y C D Door Edge F L N/A Y Balusters L NIA Y 12 Door Casing L NIA Y Lower rail L NIA Y 34 Door Jamb F L N/A Y Treads �, F L NIA Y Closet Door A L N/A Y Risers 0#0 L N/A Y A Cl Door Edge F L NIA Y Stringer 0 1( L N/A Y B Cl Casing 4 1 L NIA Y Tread edge>5 6 L N/A Y C Closet Jamb F L NIA Y Landing floor dil I L ❑(dust) N/A Y D Closet Walls L NIA Y Floor Edge Qt I L NIA Y Cl Baseboard L NIA Y Floor Gasing L NIA Y 1 Closet Pale L NIA Y F M11 AIM L WA Y 2 Closet Shelf L NIA1 Y F MR AIM L WA Y 3 Cl Supports L WA Y F MII AIM L NIA Y 4 Closet Floor L (dust) N/A Y F W AIM L WA Y Closet Ceiling L N/A Y F Mn AIM L WA Y EXCLUDED SUR CES:Surfaces listed in these boxes can only be made intact COMMENTS I STRUCTURAL DEFECTS: by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IT IC DATE METHOD ❑ Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more A/M surfaces with adhesion problems II LYRA Rep 2017 Stair 2� C Thomas Dowd M-1170 12/ 27 / 18 Page-1 Of l Inspectorr(print) Lic# Signafure Date Risk Assessor(print) Lic# Signature Date Address of Pro a : 57 Dow St. Apt.# 2 city: Salem BASEMENTILAUNDRY AREA 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 HAZ?j DATE METH DATE METH AB Walls 0% L N/A Y A B Serviceboard d L NIA Y AB_LL Walls a L,a L !A Y L414 A B Shelves L NIA Y AB C B Walls L NIA Y C D Supports L N/A Y AB Walls UL NIA Y A B Shelves L N/A Y As c o Baseboards L NIA Y C D Supports L NIA Y AB CD Chair rails L N/A Y A B Shelves L N/A Y Floor 0 L (dust) NIA Y C D Supports L N/A Y Ceiling L NIA Y A B Window frame M/I L NIA Y AB Chimney L NIA Y C D Window Sash M11 L NIA Y AB Support Colu 0,.! L NIA Y 12 Exterior Sill MA L N/A Y A Door &AA Y 34 Part Bead M11 L NIA Y Door Edge F L /A Y Win Ext Sash M/1 L N/A Y 12 Door Casing /A Y A B Window frame MA L NIA Y 34 Door Jamb S F /A Y C D Window Sash MA L N/A Y Threshold L NIA Y 12 Exterior Sill M/1 L N/A Y A oor /A Y 34 Part Bead M/1 L N/A Y oor Edge F L N/A Y Win Ext Sash MA L WA Y 12 Door Casing v L NIA Y A B Window frame M/1 L NIA Y 34 Door Jamb ^/L F L N/A Y C D Window Sash MA L NIA Y Threshold L N/A Y 12 Exterior Sill MA L N/A Y Closet Door L WA Y 34 Part Bead MA L N/A Y A Cl Door Edge F L N/A Y Win Ext Sash J IM11 L N/A Y B CI Casing L NIA Y Newel Posts p t L NIA Y C Closet Jamb F L WA Y A B Handrail AIM L N/A Y D Closet Walls L NIA Y C D Balusters L N/A Y CI Baseboard L NIA Y 12 Lower rail L NIA Y 1 Closet Pole L NIA Y 34 Treads k F L N/A Y 2 Closet Shelf L N/A Y Risers ©� L N/A Y 3 CI Supports L NIA Y Stringer L N/A Y 4 Closet Floor L❑(dust) NIA Y Tread Edge L NIA Y Closet Ceiling L NIA Y Landing floor L ❑(dust) N/A Y A s Cabinets L NIA Y A B Oil Tank L N/A Y A B Benches L NIA Y A D Win Above 5' L N/A Y C D Supports L N/A Y F M/I A/M L N/A Y A e Pipes �e� L NIA Y FMII AIM LN/A Y A B JLL Sink L N/A Y FM/1 AIM L NIA Y A e Drainpipe IL L N/A Y 4 F Mn AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made intact Comments/Structural Defects by a Deleader(MORE THAN 288 SQ.IN.) SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD Check the box if this ROOM is RULED OUT for encapsulation El because there are 3 or more A/M surfaces with adhesion problems LYRA Rep 2017 Bsmnt/Laundry Thomas Dowd M-1170 2",kM6&Y 12127 118 Page L b Of A Inspector(Print) Lic# Signature Date . I 1 Risk Assessor (print) Lic# Signature Date Address of Pr : 57 Dow St it 2 Cit : Salem EXTERIOR A Side SIDE LOCATION/ LEAJ TYPE OF URG IC IC DELEAD DELEAD SIDEJ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH A SURFACE HAZARD HAZ. DATE METH DATE METH Siding 0. L NIA Y Window SillG8 A1M L NIA Y Comer Boards L NIA Y A Win Casing L NIA Y A Lower Trim p.0 L N/A Y I Window Sash Ce L N/A Y Upper Trim jV N/A Y Cellar Win Sili AIM L NIA Y Win Above 5' oA/ NIA Y A Cal Win Fram L NIA Y Porch Above 5'�� L IA Y # Cal Win Sash L NIA Y Storm Door L NIA Y Screen Frame L NIA Y Strm Door Edge F L NIA Y Cellar Win Sill C,7 A/M L NIA Y Door (P NIA Y A Cal Win Frame L NIA Y 2 Door Edge L NIA Y # 3 Cell Win Sash L NIA Y 3 4 Door Casing L N/A Y ✓Screen Frame L NIA Y Door Jamb qtq F N/A Y Vh Cellar Win Sill AIM L N/A Y .51 Threshold Q. L N/A Y A Cel Win Fram L N/A Y Kickplate Cd L N/A Y #q Tel Win Sash L NIA Y Storm Door L NIA Y Screen Frame L NIA Y Strm Door Edge F L NIA Y Foundation 0 t L NIA Y Door 6p L N/A Y A Bulkhead L N/A Y 1 Door Edge F L N/A Y Fences NIA Y 3 4 Door Casing L N/A Y Shutters L NIA Y q L N/A Y 1 Door Jamb t F L /A Y Newel post O�1 S Threshold DA L NIA Y Railing Cap OrO AIM L NIA Y Kickplate 0,N L)NIA Y Handrail (9j) AIM L NIA Y Door L N/A Y A Balusters © LL N/A Y A Door Edge F L N/A Y Lower Rail 0&0 L N/A Y 1 2 Door Casing L N/A Y Treads 0.1 F L NIA Y 3 4 Door Jamb F L N/A Y Risers 0.1 L NIA Y Threshold L NIA Y Tread edge 0,0 L N/A Y Kickplate L NIA Y Landing floor Q; L NIA Y Window Sill IA/ A/M L N/A Y Stringer ip, L NIA Y A Win Casing G L NIA Y Lattice L NIA Y # j Window Sash fL. L N/A Y Drain Pipes p#I L N/A Y Window Sill AIM L NIA Y A Elec Conduit d i l L NIA Y A Win Casing L NIA Y Oil Fill Pipe L N/A Y # Window Sash L N/A Y Overhang Trim L N1A Y COMMENTS I STRr tTURAL DEFECTS: A ILampPost L N/A Y A F hM NM L NIA Y A F MII A1M L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT IRESULr REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH A Play Area A Bare Soil A Comments: A LIRA Rep 2017 Ext A Thomas Dowd M-1170 2io1'w piwg, 12/ 271 1 S Page 70f L Inspector(print) Uc# Signature Date Risk Assessor (print) Lic# Signature Date A dr ss of Property! 57 Dow St. Apt.#2 city: Salem EXTERIOR B Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD HAZ? DATE METH DATE METH B SURFACE HAZARD HAZ? DATE METH DATE METH Siding ®, L NIA Y Window Sill AIM L N/A Y Comer Boards L NIA Y B Win Casing L N/A Y B LowerTrim L NIA Y # 7j lWindow Sash L NIA Y Upper Trim L N/A Y Cellar Win Sill 6^1 AIM L N/A Y Win Above 5' L N/A Y B Cal Win Frame L NIA Y Poach Above 5' L N/A Y #/1 Cal Win Sash L NIA Y Storm Door Q L NIA Y Screen Frame Ca L NIA Y Strm Door Edge #J F L NIA Y Cellar Win Sill AIM L N/A Y B Door Q, L NIA Y B Cal Win Fra —O L N/A Y '671 2 Door Edge � F L N/A Y #Z Cal Win Sash L N/A Y 3 4 Door Casing C&,) L N/A Y Screen Frame G L N/A Y Door Jamb J,j F L N/A Y Cellar Win Sill AIM L NIA Y Threshold DJ L NIA Y B Cel Win Fra L NIA Y Kickplate C^ L N/A Y # Cel Win Sash L NIA Y Storm Door L N/A Y Screen Fram L N/A Y Strm Door Edge F L N/A Y Foundation 0,F L N/A Y B Door L NIA Y B Bulkhead L N/A Y 1 2 Door Edge F L N/A Y Fences Q! L N/A Y 3 4 Door Casing L N/A Y Shutters L N/A Y DoorJamb F L N/A Y Newel post 19.1 L NIA Y Threshold L N/A Y Railing Cap 04 A/M L N/A Y Kickpiate L N/A Y Handrail 619 AIM L NIA Y Door L NIA Y B Balusters L N/A Y B Door Edge F L N/A Y Lower Rail ,Q L N/A Y 1 2 Door Casing L N/A Y Treads F L NIA Y 3 4 DoorJamb F L N/A Y Risers (j L N/A Y Threshold L N/A Y Tread edge A}b L NIA Y Kickpiate L N/A Y Landing floor jj C, L N/A Y Window Sill A/M L N/A Y Stringer pt, L NIA Y B Win Casing L N/A Y Lattice L N/A Y # Window Sash L N/A Y Drain Pipes 0•) L N/A Y Window Sill COV AIM L NIA Y B Elec Conduit L WA Y B Win Casing L N/A Y Oil Fill Pipe L N/A Y #?/Window Sash L NIA Y Overhang Trim L N/A Y COMMENTS/STRUCTURAL DEFECTS: B Support Cimn L N/A Y B F Mn AIM L NIA Y B F M/I AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area!1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREiMiT✓TTP RESULr REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (RPM) DATE METH B Play Area B Bare Soil B Comments: B LURA Rep 2017 Ext B Thomas Dowd M-1170 �4wxr- 9ZO4� 12/ 27 / 1S Page Of Inspector(print) Lic# Signature Date Risk Assessor (print) Lic# Signature Date Address of Pro ert ! 57 Dow St. Apt.#2 city: Salem EXTERIOR C Side SIDE LOCATION/ LEAO TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD C SURFACE HAZARD HAZ. DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH Siding Q, L N/A Y Window Sill AIM L N/A Y Comer Boards L N/A Y C Win Casing Cd L NIA Y C Lower Trim L NIA Y lWinclow Sash IV& L N/A Y Upper Trim N/A Y Cellar Win Sill A/M L N/A Y Win Above 5' L N/A Y C Cal Win Frame 1.111v it N/A Y Porch Above 5' L NIA Y # Cal Win Sash if wl L N/A Y Storm Door L NIA Y Screen Frame Id N/A Y Strm Door Edge d„ F L N/A Y Cellar Win Sill AIM L N/A Y Door ,. N/A Y C Cal Win Frame L NIA Y 2 Door Edge ®NIA Y # Cel Win Sash L NIA Y 3 4 Door Casing C&N, L N/A Y Screen Frame '(�9 NIA Y Door Jamb , F N/A Y Cellar Win Sill AIM L NIA Y Threshold �f L N/A Y C Cel Win FrameL N/A Y Kickplate rj L NIA Y Cel Win Sash L N/A Y Storm Door Qro� L NIA Y Screen Frame L NIA Y Strm Door Edge 0 wo F L NIA Y Foundation I L N/A Y Door h NIA Y C Bulkhead 0 ii L N/A Y 1 Door Edge L NIA Y Fences 0,7, L N/A Y 3 4 Door Casing L NIA Y Shutters L N/A Y Door Jamb S F N/A Y Newel post 04, L NIA Y Threshold 6• L NIA Y C Railing Cap A/M L N/A Y Kickplate L N/A Y Handrail AIM L NIA Y Door ! L NIA Y Balusters L NIA Y C Door Edge F L N/A Y Lower Rail 011 L NIA Y 1 2 Door Casing L N/A Y Treads Tel F L NIA Y 3 4 Door Jamb F L N/A Y Risers YL L NIA Y Threshold L N/A Y Tread edge L NIA Y Kickplate L NIA Y Landing floor /11G L N/A Y Window Sill A/M L NIA Y Stringer L NIA Y C Win Casing L NIA Y Lattice 17 L NIA Y #1 L NIA Y Drain Pipes t L N/A Y Window Sill AIM L NIA Y C Elec Conduit L N/A Y C Win Casing d L N/A Y Oil Fill Pipe L N/A Y # 1ndow Sash L N/A Y Overhang Trim L N/A Y COMMENTS I STRUCTURAL DEFECTS: C Support Cim L N/A Y C Shed 0,01 F M/1 AIM L NIA Y C F Mil AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area/1200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESULT REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE I METH C Play Area C Bare Soil C Comments: C LIRA Rep 2017 Ext C Thomas Dowd_ M-1170 _ _ b/ 12127 118 Page j-7 Of �! Inspector(Print) Lic# Signature Date Risk Assessor (print) tic# Signature Date Address of Property: 57 Dow_ St. Apt.#2 , City: Salem EXTERIOR D Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ? DATE METH DATE METH D SURFACE HAZARD HAZ. DATE METH DATE METH Siding di L NIA Y Window Sill Col AIM L N/A Y Comer Boards L NIX Y D Win Casing L N/A Y D Lower Trim L N/A Y # Window Sash V L N/A Y UpperTrim NIA Y Cellar Win Sill Cd AIM L N/A Y Win Above 5' 64, L N/A Y D Cel Win Fram L N/A Y Porch Above 5' . L N/A Y # Gel Win Sash L N/A Y Storm Door 0,) L NIA Y Screen Frame 64V L N/A Y Stml Door Edge Q 10 1 F L N/A Y Cellar Win Sill 7 L NIA Y D Door a-01 L NIA Y D Cel Win Fra yj N/A Y 1 2 Door Edge e),Q I F L N/A Y #2,Cel Win Sash CJV L N/A Y 3 4 Door Casing L NIA Y Screen Frame (,A/ L N/A Y Door Jamb %, F NIA Y M Cellar Win Sill A/M L N/A Y Threshold 60 L N/A Y D Cel Win Frame L N/A Y Kickplate G L N/A Y # Cel Win Sash L N/A Y Storm Door L N/A Y Screen Frame L N/A Y Strm Door Edge F L NIA Y Foundation r L NIA Y D Door L NIA Y D Bulkhead L NIA Y 1 2 DoorEdge F L N/A Y Fences A& L N/A Y 3 4 Door Casing L NIA Y Shutters L NIA Y Door Jamb F L NIA Y Newel post 0.1 L N/A Y Threshold L N/A Y Railing Cap 614 AIM L NIA Y Kickplate L NIA Y Handrail 0,1 A/M L N/A Y Door L N/A Y D Balusters 6.l L N/A Y D Door Edge F L N/A Y Lower Rail L NIA Y 1 2 Door Casing L N/A Y Treads F L NIA Y 3 4 Door Jamb F L NIA Y Risers L N/A Y Threshold L N/A Y Tread edge d L NIA Y Kickplate L N/A Y Landing floor L L N/A Y Window Sill ✓ AIM L N/A Y Stringer L N/A Y D Win Casing UV L N/A Y Lattice L N/A Y # I IW!ndowSash L NIA Y Drain Pipes e* L N/A Y Window Sill Col A/M L WAI Y D ElecConduit L WA Y D Win Casing L NIA I Y Oil Fill Pipe L NIA Y #V Window Sash L ITAI Y I Overhang Trirr L N/A Y COMMENTS/STRUCTURAL DEFECTS: D Support Clmn ,4L N/A Y D F MII AIM L NIA Y D F MR AIM L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can only be made Soil Test Results(Must be less than 400 ppm for play area 11200 ppm for bare soil) intact by a Deleader(MORE THAN 2880 SQ.IN.) LOCATION AREA MEASUREMENT RESUL REMED REMED SIDE LOCATION MEASURE:LOOSE PAINT IC DATE IC METHOD (Square Feet) (PPM) DATE METH D Play Area D Bare Soil D Comments: D LYRA Rep 2017 Ext D