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0162 FEDERAL STREET - Street Files (2)162 Federal Street orth Shore QuidenQe Qtr. Form #39) 1 'VIM Y"FV \1\GV • V/ J1 * * * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 01/14/92 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 12/09/91 by LT. GREGOIRE Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: f 4o,4✓ Joseph F. Sullivan, Chief Salem Fire Department. Grlrm All (`o, R(•7) s * * * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 10/17/91 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 07/07/91 by INSP MARFONGELLI Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Joseph F. Sul•livan, Chief Salem Fire Department. Form 44D (Rev. 8/87) Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Group Home Inspection Name of facility ki6W- %Lf' — 4—/J</ G,¢-T/ 0 "--/✓ 7;/i j/> G/s' Address ! �o ,- /• U f _ Name of licensee //�.g 1-rhr.04.-G.e-T'o--v S4 h/>G�S / ,,- C.- Address /, 2 - /c,4. i2.4- S l City -.Sid- L.e State /&%G • Zip o /f > 0 Telephone 7 � 2- WO Date of inspection / ' _ v �/ f- f • LL.t,-o,e — " •ri- Inspector: 4T• /eA/ ea Company _u Responsible parties to notify in the event of an emergency: Name Address Telephone Reference: Massachusetts State Building Code, Section 424.0 NFiPA 101, Life Safety Code Form #41X (06/88) (Circle one) Y N Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Group Home Inspection 1 Is the Building Inspector's Certificate of Occupancy posted? ��q-- 2. Maximum occupancy allowed: "---- - 4-- Number of residents between the ages of seven (7) and fifteen (15) years of age inclusive. (12 max) �/f Number of residents sixteen (16) years of age or older. (25 max.) n-- - 42- - 0 N 3. Is one (1) means of egress and one (1) escape route serving each floor, remote as possible from each other .and leading to grade provided? 0 N 4. Are all exits properly marked? N 5. Are all egresses clear of obstruction? N 6. Is a full fire alarm system with panel provided? Y N 7. Is a ' drill switch provided? Y N 8. Date most recent drill conducted: 0,-4%-o i-/-- N '9. Is a fire drill procedure conspicuously posted? 0 N 10. Do all interior stairways have smoke detectors connected to alarms audible throughout? Y N 11. Has an emergency shelter agreement been formulated for the shelter of occupants in the event of an emergency? Y 12. Are there any conditions which would constitute a fire or safety hazard to the occupants? Note: Fire Drill Criteria: Occupants of group homes must egress the building within two and one-half minutes (2-1/2 min). The person initiating the drill shall cause to be blocked any one point in the principal egress route to simulate a hazardous condition and the internal alarm system shall be activated for two and one-half minutes. Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Group Home Inspection Name of facility ,r � x c A T+otv S, , v i c X s Address ! a .t 4)t4/ cr Name of licensee .Se*n Address City Telephone 7 V ,Z S/V O State Date of inspectioJ 8 . 6 , / Inspector: -g„.;,, U Mtchau///s/T i&yNCI, Zip az9/0 ComnY is a o/ Responsible parties to notify in the event of an emergency: Name Address Telephone PA N A R-N g / y0 4 h4 y/ /aw 0 A {/ 7 ill li,i fa P u/ O S g pl, 6G i/i ryTare ) i?c/ tr 3 0 2 S0 Reference: Massachusetts State Building Code, Section 424.0 NFiPA 101, Life Safety Code (Circle one) N Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Group Home Inspection 1 Is the Building Inspector's Certificate of Occupancy posted? 2. Maximum occupancy allowed: Number of residents between\the ages of•seven (7) and fifteen (15) years of age inclusive. (12 max) Number of residents sixteen (16) years of age or older. (25 max.) .. i 3. Is one (1) means of egress and one (1) escape route serving each floor, remote as possible from each other .;and leading to grade provided? 4 , 4. Are all exits properly marked?.'., - 5. Are all egresses clear of obstruction? 6. Is a full fire alarf system with panel provided? 7. Is a drill switch provided? %r 8. , Date most recent drill conducted: J Nitai y / 99.2. 9. Is a fire drill procedure conspicuously posted? 10. Do all interior stairways have smoke detectors connected to alarms audible throughout? 11. Has an emergency shelter agreement been formulated for the shelter of occupants in the event of an emergency' 12. Are there any conditions:,which would constitute,a'fire or safety hazard to the occupants? Note: Fire Drill Criteria: Occupants of group homes must egress the building within two and one-half minutes (2-1/2 min). The person initiating the drill shall cause to be blocked any one point in the principal egress route to simulate a hazardous condition and the internal alarm system shall be activated for two and one-half minutes. . o SALEM FIRE DEPARTMENT - INSPECTION REPORT POST ADDRESS: /K2 F ral �t �? TYPE OF NAME OF OCCUPANCY: Mk/A c 69.tecai / ,N Sr✓ice byL2CCUPANCY di,11'L ADDRESSij. r4ihIkL /0 TEL. BLDG. OWNER g74,1{,60 cf/I'dADDRESS game TEL. 711S- 9YO P.T.N.. Po.rf el. ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable, condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have'a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? yeS /UO /vv Form #16 (Rev. 1/79) 17.. Does this occupancy have an interior fire 4alarm system? Yt". 18. Date -of last test of the interior fire alarm system? I/Ain/101AM 19. Does this occupancy have a direct Fire Alarm connection?' Vec Master Instant / I Type :Box N ADT# Alarm 0 ✓ AFAiL 3M# Other 20. Is emergency liahting system or units provided? 21. Are' all emergency lighting units in good operating conditio-,?eS 22. Does the occupancy have any unusual condition which would j constitute a special fire hazard? ,\Jo 23. Are all flammables stored in proper containers and/or stored in an approved storage area? ve s 24. Are all areas used for storage maintained in a safe manner? /'S 25. Are basement areas free of any rubbish accumulation? q, 26. Does the heating system, including the chimney, appear to be in a safe operating condition? co S 27. Ts a current fuel oil permit posted and storaae proper? >/es 28. ?re there any electrical hazards? 20.-Toes the occupancy appear to have any structural defects? 1,0 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? A) write a brief description,of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form f25D was issued: Date: e/71q1 Approved by D.C. in charge of Insp. Inspected by: Approved by: Date: omp y Officer Form 016 (Rev. 1/79) P.T.N. checked by F.A. 4. 4tia SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: / , j __/ v? NAME OF OCCUPANCY: /:;_del Ya / S " C)Ghe, 4 P.T.N. R1t_1( de,sok, BLDG. OWNER 51; ct✓Lj P d r/:s ) TYPE OF Gina OCCUPANCY cJ ADDRESS 3q aef(c,t A'%/ gozG� ADDRESS j Nerd TEL . 7YS=. 3q(6 $ TEL. ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? (e,� 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other.fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? Y-2,5 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? Non1t, 6. Do outside sprinkler and standpipe F.D. connections �/ appear to be in good and usable condition?- Ye, 5, 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? Y-e-S 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? V 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? Y� 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? 1t_ S Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? Y C 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? yes Master Instant Type :Box # u 3C( ADT# Alarm # AFA0 3M* Other 20. Is emergency lighting system or units provided? Y2.s 21. Are all emergency lighting units in good operating Condition? yej 22. Does the occupancy have any unusual condition which would constitute a'special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? /VO Yt 24. Are all areas used for storage maintained in a safe manner? %2.s 25. Are basement areas free of any rubbish accumulation? Yes 26. roes the heatinc system, including the chimney, appear V to be in a safe operating condition? .s�,S II. Ts a current fuel oil permit posted and storage proper? /041,C. 28. 7re there any electrical hazards? /tl'() 2°. ;ors the occupancy appear to have any structural defects? /" 30. Has a Form 25D (Inspection Recommendation Form), been made A and issued for this inspection? / Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: Inspected by: Cc,t Ai , Approved by: Approved by D.C. in charge of Insp. Date: ' Compan`y Officer Form #16 (Rev. 1,/79) P.T.N. checked by F.A. Atlas Alarm Corp. 1239 WASHINGTON STREET, WEYMOUTH, MA 02189 (617-337-8866) FIRE ALARM INSPECTION REPORT PAGE #1 TO: \ ql S C.:. /uoL /5... /Izo) Feekred pi 01417 ATT: MASTER/TRANSMITTER BOX NO. T - 7 INSPECTION LOCATION: S7) r` • CUST. # r-Sa FREQUENCY # ALARM `CIRCUITS AHJ g ) r rY'P Inspector's Section (All responses reference current inspection) N.A. = NOT APPLICABLE 1. Control and Supervisory Panels a. Did all controls and annunciator panels test satisfactorily? isles 0 No ❑ N.A. b. Did system trouble signals test satisfactorily? fl"Yes 0 No 0 N.A. 2. Secondary (stand by) power supply a. Are batteries in satisfactory condition? R-7fes 0 No 0 N.A. 3. Alarm Indicating appliances a. Did audible alarms test satisfactorily? I'ps 0 No 0 N.A. b. Did visible alarms test satisfactorily? �'�es 0 No 0 N.A. 4. Automatic fire detectors a. Did heat detectors test satisfactorily? ®'Yes 0 No 0 N.A.__ b. Did smoke detectors test satisfactorily? 0 Yes 0 No a.3d.A. c. Did flame and/or gas detectors test satisfactorily? 0 Yes 0 No 4.A. 5. Sprinkler waterflow and supervisory devices a. Did waterflow switches test satisfactorily? 0 Yes 0 No I r N.A. b. Did pressure switches test satisfactorily? ❑ Yes 0 No 9-N.A. c. Did supervisory switches test satisfactorily? 0 Yes 0 No B°N.A. 6. Manual fire boxes and two way telephone a. Did manual fire boxes test satisfactorily? E}'T es 0 No 0 N.A. b. Did two way telephones test satisfactorily? 0 Yes ❑ No -..N.A. 7. Emergency Ca11 a. Did emergency call system test satisfactorily? 0 Yes 0 No Ip.N.A. • 8. Miscellaneous a. Did miscellaneous devices test satisfactorily? 0 Yes 0 No El-KA. 9. Master box or other connection a. Did master box or other connection test satisfactorily? trYes 0 No ❑ N.A. 10. System left in service . . . he's 0 No 11. Remarks: Oia Loop Resistance, of Line Type Heat Detection -N.A. 12. Adjustments or Corrections Made OIL/ 13. Parts Replaced/,air 0 14. The Inspector suggests the following }necessary improvements, repairs, or replacements. These suggestions are not the result of an Engineering Survey. /d " 15. Inspector suggested improvements, repairs, replacements were discussed with the undersigned owner or owner's representative 0 Yes 0 No 13-N.A. 16. Explanation of "No" Answers IGNAT li,E INSPECTO ,_,,. , _,....„...„,,,,, , ,..........„.........., S G ATURE OWNER OR O it'S EEPRESENTATIVE (PRII4T NAM )._..,� j DATE Inaccordance with NFPA guidelines, you the subscriber must retain a copy of the report on the premises for at least 5 years. CONTINUED PAGE #2 ❑ Yes, ❑ iWA. Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 06/15/93 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 05/14/93 by CAPT.ABRAHAM Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Joseph F. Sullivan, Chief Salem Fire Department. Fnrm ddn (RPv_ R/R71 Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection * * * * * Date: 01/04/93 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 12/04/92 by LT.HUDSON Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Joseph F. Sullivan, Chief Salem Fire Department. Form 44D (Rev. 8/87) Name of facility Address Name of licensee Address City Telephone Date of inspection Inspector: Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Group Home Inspection Health & Educational Services 162 Federal Street Same Salem State MA Zip (nun 745-2440 12/4/92 Lt. Hudson Company F.P.B. Responsible parties to notify in the event of an emergency: Name William Madaus Paul O'Shea Address Telephone 4 Linebrook Rd. Topsfield 887-6427 15 Winter Island Rd. 745-0250 Reference: Massachusetts State Building Code, Section 424.0 NFiPA 101, Life Safety Code Pf+rm i41X (06/881 (Circle one) o Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Group Home Inspection 1 Is the Building Inspector's Certificate of Occupancy posted? 2. Maximum occupancy allowed: Number of residents between the ages of seven (7) and fifteen (15) years of age inclusive. (12 max) Number of residents sixteen (16) years of age or older. (25 max.) U N 3. Is one (1) means of egress and one (1) escape route serving each floor, remote as possible from each other and leading to grade provided? D N 4. Are all exits properly marked? 05 N 5. Are all egresses clear of obstruction? N 6. Is a full fire alarm system with panel provided? N 7. Is a drill switch provided? N 8. Date most recent drill conducted: 9/92 LJ N 9. Is a fire drill procedure conspicuously posted? GJ N 10. Do all interior stairways have smoke detectors connected to alarms audible throughout? Y N 11. Has an emergency shelter agreement been formulated for r the shelter of occupants in the event of an emergency? Y 12. Are there any conditions which would constitute a fire or safety hazard to the occupants? Note: Fire Drill Criteria: Occupants of group homes must egress the building within two and one-half minutes (2-1/2 min). The person initiating the drill shall cause to be blocked any one point in the principal egress route to simulate a hazardous condition and the internal alarm system shall be activated for two and one-half minutes. SALEM FIRE DEPARTMENT - INSPECTION REPORT i ADDRESS: /4� :1;J))-ems/ S� TYPE OF NAME OF OCCUPANCY: g 4* tair/car m) rViccS OCCUPANCY P.T.N. Qvf age4 ADDRESS .//)i/riter'l/4,01 jd TEL. fjy5- 02.0. BLDG. OWNER ADDRESS TEL. ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? VeS 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? yes 3. Are facilities provided for the safe disposal of rubbish? yes 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? yes 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallway4clear of any obstructions that may interfere with the emergency exit of occupants? Mb 8. Are all interior occupied spaces clean and consistant I/6S 9. Are all necessary Licenses and Permits posted & dated? yes 10. Are the occupants complying with all regulationsand conditions, -as prescribed on the Licenses and Permits? yes 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? ycs 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? ycs with good housekeeping practices? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauves showing satisfactory readings?' Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? YeS Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? `/cs 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? — Master Instant Type :Box N ADT* Alarm M AFA0 3M0 Other 20. Is emergency liahtinq system or units provided? yeS 21. Are all emergency lighting units in good operating condition? yes 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 00 23. Are all flammables stored in proper containers and/or stored in an apFroved storage area? ye5 24. Are all areas used for storage maintained in a safe manner? y2S 25. Are basement areas free of any rubbish accumulation? yeS 26. roes the heatinc system, including the chimney, appear to be in a safe operating condition? yes 27. ;s a current furl oil permit posted and storage proper? 7eS 28. tre there any electrical hazards? 00 ?Q. ;-,As the occupancy appear to have any structural defects? Vo 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? 00 write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List cach.remark with item number for identification. Name of person to whom Form 025D was issue Date: Approved by D.C. in charge of Insp. Date: Inspected by: ,/v r r Approved by: Company Officer Form #16 (Rev. 1/79) P.T.N. checked by F.A. * * * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 06/15/93 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 05/14/93 by CAPT.ABRAHAM Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Joseph F. Sullivan, Chief Salem Fire Department. Form 44D (Rev. 8/87) Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 12/09/93 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 11/08/93 by CAPT.MILLER Inspection. status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: (24A44.1.^.0 Robert W. Turner, Chief Salem Fire Department. Form 44D (Rev. 8/87) FIRE Lriu iriCATE OF INSPECTION In accordance with the requirements of General Laws, Chapter 111, Section 51, this Fire Certificate of Inspection issued by the head of the local Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. Health and Education Services, Inc. NAME OF CLINIC 162 Federal Street, Salem, MA 01970 ADDRESS OF CLINIC was inspected on 5 - E 1 _ 1 L1 by DATE NAME OF OF INbrrx:lvx I HEREBY t:rituir t THAT THIS INSTITUTION COMPLIES WITH THE IDCAL ORDINANCES. YES X NO If answer is "NO", indicate violations and recommendations. Violations: Recommendations: ISSUED BY: Signature Head of Local Fire Department INSTRUCTIONS: FIRE DEPT. TO RETURN TWO COMPIEIED COPIES TO CLINIC CLINIC TO RETURN ONE COPY TO: Division of Health Care Quality 10 West Street - 5th Floor Boston, MA 02111 FIRE.1 * * * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 07/07/94 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.M., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 05/11/94 by LT.BRENNAN Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General,Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Robert W. Turner, Chief Salem Fire Department. Form 44D (Rev. 8/87) ADDRESS: SALEM FIRE DEPARTMENT - INSPECTION REPORT PAVIA '4- mod. (At , SQr''e.fs TYPE OF NAME OF OCCUPANCY: 1 I, (22 Ce(d!ri 1 5/1. OCCUPANCY Q F.,'p p- P.T.N. DoIIV g3a"-The/_ ADDRESS ti S u rn Yyl-P r51,. 54.1„ TEL NI— 4614 BLDG. OWNER) ))LL { E�Le .Prbave, ADDRESS So' 5'9-/P7,-e._ TEL. ANSWER ALL QUESTIONS: EITHER. "YES"/ "NO"/ OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? ,VD Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? 18. Date of last test of the interior fire alarm system? /2 rd) 19. Does this occupancy have a direct Fire Alarm connection? Master Instant Type :Box # ADT* Alarm # Y/ AFA# 3M# Other 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? � J 23. Are all flammables stored in proper containers and/or stored in an aprroved storage area? 24. Are all areas used for storage maintained in a safe manner? Y-e S 25. Are basement areas free of any rubbish accumulation? 26. roes the heating system, including the chimney, appear to be in a safe operating condition? 27. Ts a current fuel oil permit posted and storage proper? 28. lre there any electrical hazards? 2Q. C`-es the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? n Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: /) _. g- 5 7 Inspected by: C L,i7)/Wir - -.0 Approved by: Ail , ✓jPA;a4 Company Officer Approved by D.C. in charge of Insp. Date: Form #16 (Rev. 1/79) P.T.N. checked by F.A. SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: ' TYPE OF NAME OF OCCUPANCY: d , ����J--Lo OCCUPANCY P.T.N. 40,41 , I )e4,f ADDRESS // rU ��v��r sr TEL. -7V/ « / �� 38?-S79S BLDG. OWNER /40://'�' p u-L • ,_54v- •ADDRESS TEL . %_ z OSTf ANSWER ALL QUESTIONS: EITHER "YES"/ "NO"/ OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and "free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping,practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Doesthis occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Form #16 (Rev. 1/79) 4 N, 17.%Does this occupancy have an interior fire alarm system? 18.-Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? Master Instant Type :Box # ADT# Alarm # AFAit 3M* Other 20. Is emergency liahtinq system or units provided? ,.c.1}L� 0 21. Are all emergency lighting units in good operating condition? 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or /7 stored in an approved storage area? ' 24. Are all areas used for storage maintained in a safe manner? 25. Are basement areas free of any.rubbish accumulation? �j.)L.> 4 26. roes the heatinc system, including the chimney, appear to be in 'a safe operating condition? 27. Ts acurrent fuel oil permit posted and storage proper? e 28. 7re there any electrical hazards? Po 20. ;-)Ps the occupancy appear to have any structural defects? �d 30. Has a Form 25D (Inspection Recommendation Form), been made Zd and issued for this inspection? Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form-#58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification.- , Name of person to whom Form #25D was issued: Date: Approved by D.C. in charge of Insp. Date: Inspected by: — —47a Z 2,,t/p,LA.d Approved by: ompany Officer Form #16 (Rev. 1/79) P.T.N. checked by F.A. Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 09/27/94 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H. Inspection type: Quarterly Hosp. & Ambulatory Care (B) This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 09/12/94 by LT. STEVENS Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Robert lr.' Turner, Chief Salem4Eire Department. Form 44D (Rev. 8/87) SALEM FIRE DEPARTMENT - INSPECTION REPORT POSTE ADDRESS: /E,Z PE 2 /iL NAME OF OCCUPANCY: P.T.N. HEYi-Lil/ r` A-7) VC-4 7al S (/. TYPE OF OCCUPANCY 61--y C.e-3 ADDRESS TEL. BLDG. OWNER 4.L,;,-, �.f ADDRESS TEL. ANSWER ALL QUESTIONS: EITHER "YES" "NO"l OR "NONE". 1. Are the approaches to the building free and clear? 5 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? f't-S 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants?� 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? NO/1%- 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? °ems 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? s 9. Are all necessary Licenses and Permits posted & dated? 3°E-5 10. Are the occupants complying with all regulations and conditions,;as prescribed on the Licenses and Permits? 3E5 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? Pe'"S' 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.'&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Ale Form #16 (Rev. 1/79) 17.. Does this occupancy have an interior fire alarm system? f/E5 Form #16 (Rev. 1/79) Inspected by: Awe/ Approved by: Company Officer 18. Date of last test of the interior fire alarm system? ? 19. Does this occupancy have a direct Fire Alarm connection? C s. Master Instant Type :Box # ADT# Alarm # AFA#_ _•3M# Other 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? 1'L'$ 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? IWO 23. Are all flammables stored in proper containers and/or stored in an approved storage area? Yew 24. Are all areas used for storage maintained in a safe manner? AI'r 25. Are basement areas free of any rubbish accumulation? f'6-3 26. Does the heating system, including the chimney, appear. to be in a safe operating condition? 7E3 27. Is a current fuel oil permit posted and storage proper? HE'S 28. Are there any electrical hazards? A/o 29. Does the occupancy appear to have any structural defects? 4/m 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? Atl Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: Approved by D.C. in charge of Insp. Date: P.T.N. checked by F.A. If Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection * * * * * Date: 11/29/94 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 11/18/94 by LT. BRENNAN Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Robert W. Turner, Chief Salem Fire Department. SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: l (2. c/tr( 45 TYPE OF NAME OF OCCUPANCY: Ne '//j L& S47,//cis OCCUPANCY ay..!bj67,z<4 P.T.N. /24/ t ,4'tl ADDRESS TEL&57-c5ns'" BLDG. OWNER ?-4.4G- 1 S _ ADDRESS TEL.,j�=02$-2) ANSWER ALL QUESTIONS: EITHER "YES"1 "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? `/ 3. Are facilities provided for the safe disposal of rubbish? Y 4S 4. Are all outside egress paths free from any obstructions r that may interfere with the safe exit of the occupants? y el 5. Do porches and fire escapes, appear to be in a safe condition and •free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? Yl6 7. Are entrances and hallways clear of any obstructions �/ that may interfere with the emergency exit of occupants? ec 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? Vt4- 10. Are the occupants complying with all regulations and i/ conditions, as prescribed on the Licenses and Permits? 1`�> 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? ie4 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? ]`�S 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? D Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? V4' 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? Master Instant Type :Box * ADTM Alarm N AFA* 3M* Other 20. Is emergency lighting system or units provided? Y®5 21. Are all emergency lighting units in good operating cond:tio-,? j4e5 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an aprroved storage..area? )1t°4' 24. Are all areas used for storage maintained in a safe manner? Ye-5 25. Are basement areas free of any rubbish accumulation? ee, 26. roes the heatinc system, including the chimney, appear kl to be in a safe operating condition? Ye4 27., Is a current fuel oil permit posted and storage proper? Y e S 29. Fre there any electrical hazards? i‘lo °. r-As the occupancy appear to have any structural defects? N� 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? N Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name 7)f person to whom Form *25D was issued: Date: 1/0/-49//ct Inspected by: / / Approved by: Approved by D.C. in charge of Insp. Date: Company Officer Form *16 (Rev. 1/79) P.T.N. checked by F.A. * * * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 4/5/95 File number: 9 Occupancy type: Clinic Distribution: Mass. D.F.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on April by _ Capt. William Hudson Inspection status: Approved 5, 1995 The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Robert W. Turner, Chief Salem Fire Department. Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 06/06/95 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 04/26/95 by LT. MONAHAN Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of. inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Robert W. Turner, Chief Salem Fire Department. * * * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 10/10/95 File number: 9 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 08/28/95 by CAPT. RICCI Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Robert W. Turner, Chief Salem Fire Department. Form_-- 4 4D__ (Rev. 8 / 8 7 ) Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 05/20/96 File number: 33 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 04/19/96 by LT. PAYNE Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: famet4A— Robert W. Turner, Chief Salem Fire Department. Form 44D (Rev. 8/87) Salem Fire Department LEGAL RELEASE jj I do. hereby acknowledge that I am the at....j al_... ?.AR0h Sr of the ,9gir D es located Salem, Massachusetts. I also acknowledge that I requested assistance from the Salem Fire Department and requested, of said department, forcible entry into the premises. If damage is incurred in the performance of this action, I will assume complete responsibility. I also release the Salem Fire Department and all its personnel and the City of Salem from any demand, action, causes of action, suits, accounts, contracts, agreements, damages and any and all claims, demands and liabilities whatsoever of every name and nature both in LAW and in EQUITY as a result of such action. Miljj/<4/itness.. q(°)11,,s- FORM 27 Name Address. Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection * * * * Date: 02/22/88 Occupancy type: Clinic Distribution: Mass. D.P.H., Hosp. & Ambulatory Care (B) Inspection type: Quarterly This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 11/25/87 by CAPT. MILLER Inspection status: Disapproved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection' issued by the head of the Salem Fire Department certifying compliance with local ordinances in a prerequisite for an o igina1 or renewal license. The inspection of convalescent and nursing homes, rest homes,. hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Extinguishers require inspection and/or recharge. Missing door knob - fire door to boiler room. Emergency lighting - 3rd. floor stairway inoperable. cr'e • Jcyseph F. Sullivan, Chief Salem Fire Department. Form 44D (Rev. 8/87) Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: Occupancy type: Distribution: Inspection type: 10/08/87 Clinic Mass. D.P.H., Hosp. & Ambulatory Care (B) Quarterly This is to certify that Health & Education located at 162 Federal Street was inspected by the Salem by A/LT. HUDSON Inspection status: Approved Services Fire Department on 08/10/87 The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances in a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Joseph F. Sullivan, Chief Salem Fire Department. Form 44D (Rev. 8/87) SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: 1 to a L. Sal r1 TYPE OF NAME OF OCCUPANCY: t-d e o I 441 4- CC) Ci t. , �p,r/i +L o�c OCCUPANCY P.T.N. ST)lcL rc. BLDG. OWNER i4 _. f _3 ADDRESS IL; 5T S'*1.E0 ADDRESS %,% fp,ri4 J - ; PASTED TEL .76 Z2r3 TEL. ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? /0 SS 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? ire 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? ys 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? gas Y 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Yes Yc1s Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? )6'. 18. Date of last test of the interior fire alarm system? 19: Does this occupancy have a direct Fire Alarm connection? Master Instant Type :Box # ADT# Alarm # AFA# 3M* Other 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? _A4) 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an apFroved storage area? 24. Are all areas used for storage maintained in a safe manner? /sic 25. Are basement areas free of any rubbish accumulation? 26. foes the heatinc system, including the chimney, appear to be in'a safe operating condition? /c 27. Ts a current fuel oil permit posted and storage proper? X.< 28. Pre there any electrical hazards? 40 20. r-es the occupancy appear to have any structural defects? )U 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form *58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. TIN ► SS Ntl d ao )(_&)•,o b -: rr. br - T J v b' i 140 Roc) o r‘ g/9-S rig-n.t Aa_r_my , aX/` 1,5 to a s -0,--s (fl1 r, L 1 '' 4 h'/ f i-tia r S.162 ii-t-.. , ,ep P .Sd Ig r • Qaik 0►= 6/r4° Name of person to whom Form #25D was issued: Date: /lInspected by: Coif f / Company Officer Approved by: Approved by D.C. in charge of Insp. Date: rye_ S4iCziz1 Form #16 (Rev. 1/79) P.T.N. checked by F.A. r J HNSON CONTR LS ATTN: Chief Joseph Sullivan Dear Sir: Johnson Controls, Inc. Systems and Services Division 39 Salem Street Post Office Box 840 Lynnfield, MA 01940 Tel. 617/246 5500 Salem Fire Department 48 Lafayette St Salem, MA 01970 September 23, 1987 Enclosed is a cf.ey- of work. perDm and work pending - - at North. Shore Mental Health , qou ederal St., Salem. —en- A technician has' been scheduled -to complete the repairs on September 28, 19187, I. you have any questions please contact me. Sincerely yours: JOHNSON CONTROLS, TNC IARBLY-callr) kinKm Maureen Flynn Service. Coordinator cc: Paul O'Shea, North Shore Mental Health JSCHNSON :ONTR LS 10@livi H ©Ez Vame vie_ /Weitz/%, , /(,, Location , `02 P A sr ca-/ , A Quan. Code No. Description OF -,s3 o Sw,ode. 1Ie-7i om 1 A� 81h1 (6/83) Printed in U.S.A. Branch P.O. and/or Requisitions Work Authorization Title Ae Salesperson Branch % Initials Name c/ ni Salesperson Doty"^ _ 'Stock Initials Location Salesperson Initials P.O. No. Or Authority Instructions To Customer Service Rep. Branch Number Contract No. Service Order No. 953619 1 ❑ Warranty Person To • Contact !Page 1 of Labor Time & Expense Record Date Reg. of Labor Hours O.T. Hours Miles Expenses Initials 9_91/-o / 3o 7,N, 9-cv-17 01, 3o - S•A4 TOTALS Factory Orders -9999- -9999- -9999- References DMRAs/MMRAs Work complete Remarks by Customer Service Rep. 9"4`I i()rSPT iCC2la4,4111 rjaZZ,HGl Ciiyi.� (-Art L47 - er77 a "C4ri A/ I e 44i)1C C"o% % 0ea4- STD ), r - a '" Woof^ .2 ND Cho r / h i /4trni o f tc CZ figrl c ,-o-irmd ..Siw i GET. en 3 ,ie,o Floor hi 14/a i- i etfa ,;y( Taa it"o��oer. ,c, LMGQ .S'n O /#e ie 7- rrn / sT ic%12.0 . (:eeit.-c flu!/% Alo T -Cook �sedi� q' Co' frrt ( / �e�- �T °m-D /: ODi /`!.`J: ti mac> ,vn ai / sip,Je DeT 11T c/o Or /fit 1).17To/ C e i — S sT7m 1Ue ego je COPY 1 - EXECUTION DOCUMENT - BRANCH or-i-ec-re CZ(yk A, --- SALEM FIRE DEPARTMENT - INSPECTION REPORPOST[D ADDRESS; TYPE OF p�� / /� NAME OF OCCUPANCY: 1444444. F Wri-L0 5�,����c,�� OCCUPANCY I►''IQ.LJ-f_ 6 , P.T.N. foojo 14zz.a ) ADDRESS 1f7 &'0ctol S¢-, TEL. 751 C24/ BLDG. OWNER 144 „S ADDRESS f, a r k ( 5 - TEL. `7! �4y() ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? %�ZS 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Ys Y-P Y-5 y-FJs e. 5 N.� Mc. Al Form #16 (Rev. 1/79) 17.: Dos( this occupancy have an interior fire alarm system? YP,S 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? Master Instant Type :Box # ADT# Alarm 0 AFA* 3M4 Other 20. Is emergency lighting system or units provided? Ye A" 21. Are all emergency lighting units in good operating condition? /ems 22. Does the occupancy have any unusual condition which would \constitute a special fire hazard? 23. Are all flammables stored in_proper containers and/or stored in an aprroved storage area? M� 24. Are all areas used for storage maintained in a safe manner? `s 25. Are basement areas free of any rubbish accumulation? 26. roes the heatinc system, including the chimney, appear to be in'a safe operating condition? 27. is a current fuel oil permit posted and storaae proper? 28. 7re there any electrical hazards? 28. r-As the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form 025D was issued: Date: , //6 /7 Approved by D.C. in charge of Insp. Inspected by: Approved by: Date: fYr /MJ44,0I 10,4",-, au-kol"' Company Officer Form #16 (Rev. 1/79) P.T.N. checked by F.A. x * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 06/19/87 Occupancy type: Clinic Distribution: B (0)uarterly or (A)nnual: 0 * * * This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 04/10/87 by LT. CROTEAU Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances in a prerequisite for an original or renewal licenae0 The inspection of .convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Jo "eph F. Sullivan, Chief Salem Fire Department. Form 44D (Rev. 8/86) SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: //Z r�'e'z'* - 3 POSTfD TYPE OF ev7-49/7e.4 NAME OF OCCUPANCY: Afecerz 4. /.,,.iCw-,,, 5e/1aIe,OCCUPANCY fle4 fiyeci. P.T.N. A020*✓K £z2dF7 ADDRESS Ll%/4il Sr TEL.7gfK-24-/ BLDG. OWNER AY/ COS4e0.- • ADDRESS TEL. ? -C2i ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? aer ties 6/#S (1P5. yes r'c 9e S des qe? iv ti, Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? ueS 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection?" '4"0 Master Instant Type :Box # ADT# Alarm # ? AFA# 3M4 Other 20. Is emergency lighting system or units provided? PS 21. Are all emergency lighting units in good operating condition? r 2 5- 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an apVroved storage area? 24. Are all areas used for storage maintained in a safe manner? 25. Are basement areas free of any rubbish accumulation? 26. roes the heatinc system, including the chimney, appear to be in.a safe operating condition? Ts a current fucl oil permit posted and storage proper? 28. ire there any electrical hazards? 2Q. r-es the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? .vv Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file -a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: t/—ID �?-? Inspected by : G/�afek Approved by D.C. in charge of Insp. Approved by: Date: elekte ompanficer Form #16 (Rev. 1 /79 ) P.T.N. checked by F.A. * * * Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 04/04/87 Occupancy type: Clinic Distribution: B (Q)uarterly or (A)nnual: 0 * * * This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 03/24/87 by LT. LEWIS Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances in a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: Joseph F. Sullivan, Chief Salem Fire Department. Form 44D (Rev. 8/86) Administrative Offices 162 Federal Street Salem, Massachusetts 01970 (617) 745-2440 March 25, 1987 Instant Alarm Co. 303 Highland Ave. Salem, MA 01970 To Whom It May Concern: Health & A Community Partner Education of the Massachusetts Services, Inc. Department of Mental Health FILE COPy This is to inform you that our new Maintenance person is Joseph Styczko, 23 Mall St., Salem, MA., 745-2293. He will be the initial contact person to be notified should there be a problem at 162 Federal Street. If he cannot be reached, contact should be made with Frank Rizzotti, Paul O'Shea, William Madaus, in that order. Thank you for your attention to this matter. Sincerely, )--Ak z7;> Paul C. O'Shea Director of Administration and Finance /pcw CC: Salem Fire Dept. Salem Police Dept. SALEM FIRE DEPARTMENT - INSPECTION REPORT P ADDRESS: /' i% d' 7 POSTED /6� I TYPE OF off-, NAME OF OCCUPANCY: A/ ,S', (, 1J L7-/,L C A/ % A OCCUPANCY $ L4 < C 010 P.T.N. /jiW(°< / / 1Zv % %` ( ADDRESS TEL. BLDG. OWNER itJ1.5':L. z9. ADDRESS /Co 2. `FO IZ'7 - TEL. ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections / appear to be in good and usable condition? /!/ /4- 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? /i/0 Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire`'alarm system? YS 18. Date of last test of the interior fire alarm system? , 19. Does this occupancy have a direct Fire Alarm connection? V,S' Master Instant Type :Box # ADT# Alarm # AFAR 3M4 Other 20. Is emergency lighting system or units provided? 7 G 5' 21. Are all emergency lighting units in good operating conditio ?'u 22. Does the occupancy have any unusual condition which would rj constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or Vc 24. Are all areas used for storage maintained in a safe manner? VE S 25. Are basement areas free of any rubbish accumulation? vE stored in an aprroved storage area? 26. Does the heating system, including the chimney, appear to be in 'a safe operating condition? 'f ) 27. Ts a current fuel oil permit posted and storage proper? Y‘S 28. Pre there any electrical hazards? //0 20. i.hes the occupancy appear to have any structural defects? jV0 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? /i/ Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form *58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name person to whom Form #25D was issued: Date: Approved by D.C. in charge of Insp. Inspected by: Approved by: Date: Form #16 (Rev. 1/79) P.T.N. checked by F.A. Salem Fire Department Fire Prevention Bureau Fire Certificate of Inspection Date: 02/11/87 Occupancy type: Clinic Distribution: B (Q)uarterly or (A)nnual: Q This is to certify that Health & Education Services located at 162 Federal Street was inspected by the Salem Fire Department on 12/11/86 by LT. LATULIPPE Inspection status: Approved The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This fire certificate of inspection issued by the head of the Salem Fire Department certifying compliance with local ordinances in a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, hospitals, and public mental institutions are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 71. This fire certificate of inspection issued by the Head .of the Salem Fire Department is the result of an inspection con- ducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. Report of Inspection: 4 Jo -ph F. Sullivan, Chief Salem Fire Department. Form. 44D (Rev. 8/86) Administrative Offices 162 Federal. Street Salem, Massachusetts 01970 (617) 745-2440 February 2, 1987 Norman P. LaPointe Fire Inspector Salem Fire Dept. Fire Prevention Bureau 48 Lafayette St. Salem, MA 01970 Dear Inspector LaPointe: Health & A Community Partner Education of the Massachusetts Services, Inc. Department of Mental Health Below you will find the list you requested of employees to contact in case of a fire at any of our Salem fac i.l-times . 162 Federal Street: 112 Boston Street: 47 Congress Street: Andy Siaki 745-9482 Frank Rizzotti 745-6261 Paul O'Shea 745-0250 William Madaus 887-6427 Mike Doran 774-4612 Pat Crowley 598-2537 Ann Roy 334-3045 Paul O'Shea 745-0250 William Madaus 887-6427 George Semple 745-4769 Judith Boardman 887-5499 Paul O'Shea 745-0250 William Madaus 887-6427 If you have any questions regarding the above, please don't hesitate to contact me. Sincerely, Paul C. O'Shea /pcw SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: ?O$TEJ NAME OF OCCUPANCY: , (( ,,� TYPE OF /14 ,_ ,/_ ? s ��i� ¢ � � .ZC?��{,e4e4 OCCUPANCY " '`/,tee (✓cs P.T.N. / , ADDRESS 3a0,9,,L, i�- TEL. ?E%--... BLDG. OWNER/ial S! ante /4 , 'ADDRESS / �' Ze• .- e) /fV TEL. ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches ,to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of,rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 37O-14- 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? Vekvt-c_. 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" "system? Form #16 (Rev.- 1/79) 4,4 Form #16 (Rev. 1/79) 4 17..Does this occupancy have an interior fire alarm system? U 18.-Date of last test of the interior fire alarm system? 19.- Does this occupancy have a direct Fire Alarm connection? Master / Instant r Type :Box # .f/ ADT# Alarm # AFA* 3M4 Other_ 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? 24. Are all areas used for storage maintained in a safe manner? fit, 25. Are basement areas free of any rubbish accumulation? 26. Does the heating system, including the chimney, appear to be in'a safe operating condition? 27. Ts a current fuel oil permit posted and storage proper? 28. Pre there any electrical hazards? 2Q. F-es the occupancy appear to have any structural defects?_ 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for :.his inspection? Y-t4 -)7„ %Z) Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form *58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: Inspected by: /=% Approved by: Approved by D.C. in charge of Insp. Date: P.T.N. checked by F.A. ez"6„;(4.,� Company �r SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: ll2 fed' AL �- NAME OF OCCUPANCY: AlO . _5404 F rc),tiLr ya i f `! P.T.N. 4,, / 0 ' i e ADDRESSo©0 BLDG. OWNER 9oc ADDRESS ileA ar o. TYPE OF OCCUPANCY t- (24Vz-rT-TP PJSTEflJ Sl`TEL.7yf=•2o5"a TEL�y�2y'L ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? l LDS 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? )t cS 3. Are facilities provided for the safe disposal of rubbish? 'Y 0-S 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? N 0,f t 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? y,c-s 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? YL'.s yes 9. Are all necessary Licenses and Permits posted & dated? y �� 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? y-S 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? A/ O Nv A 0 4v 0 Form #16 (Rev. 1/79) 17.. Does this occupancy have Form #16 (R.ev. 1/79) an interior fire alarm system? ydes 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? y4..5 Master Instant Type :Box # ADT# Alarm # AFA* 3M4 Other_ 20. Is emergency lighting system or units provided? V 42-3 21. Are all emergency lighting units in good operating condition? )/P- 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? v 4 O 24. Are all areas used for storage maintained in a safe manner? yS 25. Are basement areas free of any rubbish accumulation? \/ e-S 26. Does the heatinc system, including the chimney, appear to be in'a safe operating condition? 27. Ts a current fuel oil permit posted and storage proper? 28. Pre there any electrical hazards? 20. r-es the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made yemJ and issued for this inspection? Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form *58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. __La 4XTJJ 1," G4.0161ot. 7'4[aa /=/oan w7-0 d e frt0v.vte..„() f2all �iA/lvv �Aw o f e-1/n-�' 1 Ad e ^al/et • /= A. a, r, ,e l,b l e D Ai/4- re( 1, D c) if' r .c q- Flu! [J 4 , " , , c' P- cS To !l r.. ,- Name Df person to whom Form #25D was issued: A4S p4?rliCtA Date : 4- 02 s.4. Approved by D.C. in charge of Insp. Date: ,{-- 6,—d C P.T.N. checked by F.A. Inspected b y : (.4, f• ei alto fA k o e_ ti �QC Approved by: 0.0f' iglc Gi4, Company Officer SALEM FIRE . DEPARTMENT SERVICE. INSPECTION COMPLAINT RECQMMENDATION #. ',,Name- /I1-/- °:.:t:. 1a.isr.. (ia�.cr,c_ .' .44400 G.�=L.r r 'Address i l,:,'9 r i ` ' ,�? -v ' As • a result of an inspection this ,date of the premises<an owned d/or -occupied by - you,;' the; following. recommendations are submitted which should receive serious consideration: These recommendations are'made in the. interest, of fire prevention and:to correct conditions that are or may become• dangerous as: a' fire•haard, may be. required for legal occupancy of the premises or otherwise are in,violation of the law. ,l ry , ,. - .a%? i '2 t - ;. /., n x • - n .,4 A. 714 t i F'R: f"y"rf'' % ..- ra Tr a� , r' ra t`r• .. I . f „r e • kr,1 ,n 4.r_.44"tA .,.-+.•^n '•t.a i. c..r'i A r' c.f %'-I 4d r Reinspection date': 'Form _25D r (Fire Dept. Copy>- In`spector In -Service Cand itions � AS`A iris � • i'. .. y,},+:F ,+ •� .Re-TnspeCtion'jteports . =1 f 4, , 1,7.9. t #, foundto,; exist pat- timeto s. < Name .;of ;pe� t P sonF -, ",Dates it '* e Inspection:' / ,:. / ,,, , , i.� 0�•=% ram "%?.2..�///���', -,.ac-d' whom recommendation' .follow-up.,Was discussed'.' �• �.lY�•t. t: IC' qt'!�. K. T,w ?.h sot d+R•9 ?ly,Z�t } S� - +F• w. easons,.,' lif ;any., for failure y4tof:complyrwith: original,, recommendation; t. , • .•Complaint, has.:, been corrected.''e . E . Forward this 'form4 to ;Eire Prev. Bureau 'for--follow-u az-t-ti.Le t c,t.a .ii.' "ie y • + T J^ p-'ctor aa.A'Coll SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS : /4,0Z / •9 -. -L.. cs- TYPE OF NAME OF OCCUPANCY: /VL4-4.7 EI4/C..*77041 cSE/?//, OCCUPANCY PiiTED P.T.N. /74-11L o S ADDRESS <30o F.9 `JCT7'< J/ TEL.%V -Oa So BLDG. OWNER hik/M.7/1 .FDI/CI7-70,41 ADDRESS /6 a /4-D.4L s/- TEL.75/3 02Y4' A ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? DES 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? YGS 3. Are facilities provided for the safe disposal of rubbish? Y6-s 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? Y616 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? .`DES' 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? YES' 11. Are all vertical shafts and stairwells properly safe- YtS 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? / 6S guarded and provided with self closing devices? 13. Does this occupancy have a fixed fire extinguishing system? /J 0 Date of last inspection? 4 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Form #16 (Rev. 1/79) � � F It 17..Does this occupancy have an interior fire alarm system? Y&S r 18. Date of last test of the interior fire alarm system? fP/ tL 3, 15i=4. 19. Does this occupancy have a direct Fire Alarm connection? ,,0 a Master Instant 0-0/44/S0A/ Type :Box # ADT# Alarm # AFA# 3M4 .Othera6W7Z4..S 20. Is emergency lighting system or units provided? 5/A-S 21. Are all emergency lighting units in good operating condition? ___ 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? ilia 23. Are all flammables stored in proper containers and/or stored in an approved storage area? 24. Are all areas used for storage maintained in a safe manner? i6' 25. Are basement areas free of any rubbish accumulation? y� 26. Does the heatinc system, including the chimney, appear to be in'a safe operating condition? 21. Is a current fuel oil permit posted and storage proper? 29. 7,re there any electrical hazards? 20. r-es the occupancy appear to have any structural defects? ybs )'6-s Ai 1, O 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? v Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name ,f person to whom Form #25D was issued: Date: 9 - 29- J'4 Inspected by: f-F 44t3o,J7-6 - 2 f 0,77E .S Approved by: Approved by D.C. in charge of Insp. Date: company Officer Form #16 (R.ev. 1/79) P.T.N. checked by F.A. SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS : / s.2 rcq/e'/' /gL / /T/t U TYPE OF /Ar."-i-rw NAME OF OCCUPANCY: X11 9 ��dC/ ?W Sty, CCUPANCY $erv,cer P.T.N. jc;s4vk 23'z26,7-r/ BLDG . OWNER U / Q fleAt ADDRESS 4/7 /3t' i j/ TEL .795 =6.z6 ADDRESSa76(O�•w*/ 4( TEL.V//D ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a saf condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells, properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy\have a fixed fire extinguishing system? Date of last inspection? 14. Does this' occupancy- have•a standpipe system? Are all pressures satisfactory? Are standpipe ,hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Ves \ley Yes js c ^ S N -4 n /Z f.� -v m CO eS Lie 5 eS tle5 Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? .e S 627,i /,#y Form #16 (Rev. 1/79) 18. Date of last test of the interior fire alarm system? Fj 19. Does this occupancy have a direct Fire Alarm connection? 4lb Master Instant Type :Box # ADT# Alarm # AFA# 3M# Other 20. Is emergency lighting system or units provided? 14e s 21. Are all emergency lighting units in good operating condition? A4 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or A/O stored in an approved storage area? 24. Are all areas used for storage maintained in a safe manner? d/,? 25. Are basement areas free of any rubbish accumulation? A/d poes the heating system, including the chimney, appear to be in a safe operating condition? :,27. Is a current fuel oil permit posted and storage proper? t 1 28. Are there any electrical hazards? 29'. Does the occupancy appear to have any structural defects? -Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? geS Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file..a Form•#58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark With item number for identification. 4. Lrel 70,kr,PM. — �/D iGGiap hv. /,e tirrAe.1/ �f/O 1;4ips',_ L e/4w— DAev /O4 C /'Oi) pkYes) ?Gb /l4 9,4-S c'4 4 s, L.4w+,u Aloes erS•, c) r*/e (fi.l e7s' . . / / £pert A&/ 44TCe1 i/e.f A/ex/l 9�ife-n, Gtu�vic/ e ��nb r` �ir,lru.�i� vLsi .� "1��r .li ,Ga�Cl.Ce su!-4 --,2ftlIJAkif Z5;/€76VedY /4e)a:t3- dred,..44.4 Weil j'5",e,i4w AkIvio. Avw:Ir;r-,1 i7/1;/9#41 A r 0.5 f Name of person to whom Form #25D was issued: P -C // /S' q Date: Inspected by: /47,4r ,9? on) .N- 23:z.c4, Approved by: Com Approved by ►.nv Officer D.C. in charge of Insp. ( Date: 41a.i/rf P.T.N. checked by F.A.,7'/1 'SALEM FIRE DEPARTMENT — INSPECTION REPORT ADDRESS ; . /6.2 At"cri 4+L NAME OF OCCUPANCY %AV. �7/i 9` ��dC�%�, i JPrv, TYPE OF f�E•4cr., CCUPANCY Servi'ctC P, T.N. /C11-41k 7;'z26,7-7'/ ADDRESS,7.tersD c T TEL .7YS=6.ZG/ ' OWNER ADDRESSA764:Li/AP/lei/, TEL. •.f.3/- 5///D ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE".. Are the approaches to the building free and clear? •f. ra i,• i > Does the area adjacent to the building, appear to be free "of rubbish accumulations, or other fire hazards? Are -facilities provided for the safe disposal of rubbish? Are 'all%outside- egress paths free from any obstructions `that may interfere with the safe exit of the occupants? -Do porches and fire escapes, appear to be in a safe "condition and-free:of'obstructions? ▪ Do outside sprinkler and standpipe F.D. connections . appear to be :in:'good and usable condition? . Are entrances and hallways clear of any obstructions that .may interfere with the emergency exit of occupants? • Are all interior occupied spaces clean and consistant with -: good. housekeeping practice's? .;.Are all necessary :Licenses .And . Permits posted, & dated? t Are,.the,occupantscomplying,.with all regulations and condi.tions ,. asw prescribed. on the Licenses and Permits? Are all vertical,shafts and stairwells properly safe - with' self closing devices? • . Are all. portable fire extinguishers readily accessable • and' have •they. been-: inspected `and, properly tagged? 13.:.:Does`:thi's occupancy'have a fixed fire extinguishing system? Date ofs-last''inspection? ` '.Does this occupancy!have-a-standpipe system? `.Are''all pressures"`'satisfactory?., Are .standpipe hoses provided?` . Is- agauge, provided.. at' top of system? . Does, this. occupancy' have. a, sprinkler system? 'Are:all-pressure'gauges showing satisfactory readings? Are all :0.S.&Y.- valves open and -padlocked? - Is- a gauge` provided 'at 'the 'top .of the system? 16 : Is this a "WET" .or "DRY" . system?, Ves s Lees �cS N//9- ties t-ies yc5 eS e5 V Je ,f "94 ti/il 4)/49 y/Ai-- Form #16 (Rev...1/79) 24. Are a11: areas used for storage maintained 17.. Does this occupancy, have an' -interior fire alarm system? 18.- Date of: last test of the interior fire alarm system? 19.; Does. this` occupancy have .a' direct Fire Alarm connection? Master Instant Type;, :Box # ° ,ry` ,'`ADT# Alarm # AFA# 3M# Other Ne S emergency. -lighting ,system or units provided? 4lb • Are'all .emergency- lighting -units in good operating condition? Alp Does theoccupancy. have any' unusual condition which would constitute.a special' fire. hazard?. ./ 0 • Are all flammables.stored in proper containers and/or WO _stored in an.approved storage area? Jr��/ in a safe manner? � .Are basement areas free of any 'rubbish accumulation? °.. Does .the heatingsystem; including the chimney, appear to be in a safe operating condition? Is, a,.current fuel,oil permit posted and storage proper? Are there any electrical'hazards? Does the occupancy appear to have A/a it/0 G%s e.S any structural defects? /vp 30.. Has a Form 25D-(Inspection Recommendation Form), been made ° r and issuedfor this inspection? geS ../ Write a brief description of any •violations discovered during this 'inspection.' If the -violation requires an early Fire Prevention Bureau •notification, file..,a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. ;List each remark with item number for identification. ,yce_ cam,( ,,,/Cr Ai. geo ,,,p4raed J e: _ZY, /'e arrtLe,ve 1. s. (e/4 oAeU /u.vcf i,u kite s� iDead, 4.4-s o<~r, L.44,od mowers, c$ rome (,;. .veir,. sf„zol T. Name of person pproved:, by :p; C;. in charge, of Insp. 7 e An Air( �9t'4eivG L. i J/r �JQeil Flier �Gar,d , ti/z4: ;t 9 i/1/1/ &. obi to whom. For' #25D was issued: 02 %, /f,V Inspected by: fC I I 'ao Sade,; 4ia Approved by: C,'�,< 4 Form'#16 (Rev.. 1/79) Com ny Officer Date: 41a-i/ilf P.T.N. checked by F.A. :v. •• COMMONWEALTH OF MASSACr[UsETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES " CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed hy and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department .of. Public Health on forms provided hy the Department of Public Health. In accordance with the statutory mandate, the nTnr Fli Chnrr " a d9 n noni.or Marti i L 1 Lfl1c • A/Lt.'•Robert Jellison Name of Inspector REPORT OF INSPECTION APPROVED DISAPPROVED .Tuna 27. 1 Q84' Cate Building Inspector Health, Dept. (Salem_ ) Occupant Dept. of Public Health file Please Return This Report To; Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities' Room 940, 80 Boylston Street Boston, Mass. 02116 SEE ATTACHED REPORT ire Chief • Signal and Titi June '27. 1984: • tote ONE COPY SHOULD BE SENT TO CLINIC:: 1 ' O. itg cillassacillt5dt5 ROBERT J. CROWLEY A/Chlet :.North Shore Guidance Center 162 Federal Street =Salem, Ma 019.70 Dear Sirs Aire lepurt:ur::t ji-1cubquurtera. 48 ' lids ettc ,i,trcct Salem, Pa. 019711 June. 27, 1984 As a result of the quarterly inspection conducted this date, the following conditions were found'to exist: (1) The chimney, as seen from the attic, is in need of repair. .(2) Electrical deficiencies in the basement area, ie: live. wires exposed, open junction boxes, fuse box bypassed. Storage of lawn mowers, gas cans, storage cabinets in the basement area. (3) (4) Heat detectors hanging from the ceiling in room 6 and in the conference room. (5) Smoke detector missing in the office area on the second floor. (6) Emergency light inoperable - second floor stairwell. ..(7) Temporary wiring to a light in room 29. As a result of the conditions found during this inspection,. your quarterly inspection for the second quarter of 1984 has been dis- approved. A follow-up inspection will be made within the next thirty days. Cordially, Robert W. Turner, • Salem Fire larshal • SALM..-FIRE DEPARTMENT- ._INSPECTION REPORT ADDRESS; 2CITE.,/9L s/.1 TYPE OF NAME OF OCCUPANCY: �1�: ` i 1�" ' �— C 0 c' f OCCUPANCY P . T . N . /(®S4t,9/ 2 LA' i%%i// ZF ADDRESS / L/ (?'cI7A1e//G.sea S;` TEL . jys -02 BLDG. OWNER 17P, L,q-m,i -er ADDRESS ,�CJa a,fe/J2- Si-, TEL . 7 - ?Od a' ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"l OR "NONE". 1. Are the approaches to the building free and clear? 2 Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? '\/6S v 67-2s 3. Are facilities provided for the safe disposal of rubbish' St," &'S 4. Are all outside egress paths free from any obstructions;, that may interfere with the safe exit of the occupants?.-S 5 Do porches and fire escapes, appear to be in a safeu/fie, ' 0uo condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions,as prescribed on the Licenses and Permits?, 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? y� S WE Form #16 (Rev. 1/79) 17.. Does this occupancy have 18. Date of last test of the 19. Does this occupancy have Master Type :Box # ADT# an interior fire alarm system? interior fire alarm system? a direct Fire Alarm connection? \/T.i Instant Alarm # AFA# 3M# Other / 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in V 625 good operating condition? YCS 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? 24. Arg all areas used for storage maintained 25. Ares basement areas free of any rubbish accumulation? eps .tt. 26.,m Dogs the heating system, including the chimney, appear "- toybe in a safe operating condition? ate. 27I a current fuel oil permit posted and storage proper? 28. Are there any electrical hazards? '29. Does the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? No in a safe manner?' G=S TS Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: ,Date: 7/rY Inspected by:(1/4C Approved by: Approved by D.C. in charge of Insp. Form #16 (Rev. 1/79) Date: l ?>a o - G i-6 i mpany Of 'icer ao itE3 / P.T.N. checked by F.A. ttg of $�xlem, rzssttcipmet#s Jire siepartment pettbquarters 48 Pfirgeite gifrret Salem, ga. 13197D 'FIRE INSPECTION REPORT ( ) Hospital (a). (X ) Clinic (b) ( ) Convalescent or Nursing Home (a) ( ) Rest Home (a) ( ) Public Medical Institution (a). Charitable Home (a) Group Care Facility (c) Day Care Facility (c) • This is to certify that Health & Education Services, Inc. Name of Facility located at 162 Federal Street was inspected on 3.4.86 Date Address (X ) APPROVED ( ) DISAPPROVED by Lieutenant Robert Jellison - Name of Inspector REPORT OF INSPECTION Smoke detector missing - second floor office area. ief, Salem Fire Department Form 44D (March 1985) (City of $alent, a5sachuactis jitePepartmEnt3Gabquarters 48 rialagette Street Salem, cilia. 01978 FIRE INSPECTION REPORT ( ) Hospital (a) (X ) Clinic (b) ( ) Convalescent or Nursing Home (a) ( ) Rest Home (a) ( ) Public Medical Institution (a) Charitable Home (a) Group Care Facility (c) Day Care Facility (c) This is to certify that Health & Education Services, Inc. Name of Facility located at 162 Federal Street Address was inspected on 4.29.86 by Lt. Poitras Date Name of Inspector_ (X ) APPROVED ( ) DISAPPROVED REPORT OF INSPECTION Chief, Salem Fire Department Form 44D (March 1985) - N., ROBERT J. CROWLEY AlChief a of $itlem, 4xc1ivaetts girt department peuhquarters 48 ' iufttgeiie 5freet $uIem, 4ttt. D1970 FIRE INSPECTION REPORT ( ) Hospital (a) (X ) Clinic - (b) ( ) Convalescent or Nursing Home (a) ( ) Rest Home (a) () Public Medical Institution (a) Charitable Home .:(a) Group Care Facility (c) Day Care Facility (c) • This is to certify that Health & Education Services Name of Facility located at 162 Federal Street was inspected on 8.26.86 Date Address ( ) APPROVED (X ) DISAPPROVED by Capt. Poehler Name of Inspector --- REPORT OF INSPECTION Fire extinguishers in cellar and third floor area require mounting. One gallon container of gasoline in cellar. Flammable fluids (paint thinner, duplicating fluid, & paint) stored improperly in cellar. rf , Salem Fire Department Form 44D (March 1985) SALEM FIRE DEPARTMENT IN—SERVICE INSPECTION COMPLAINT RECOMMENDATION Name ' ` c . rA I. TA/ 7 /51; '/ ,'; G . ..,. r 1; , r ie . Address (a --.-r-''r/;r_",r.t�) _.—) �, t ,As '.'a resiilt of an -inspection `this date, of the prems ise• owned and/or occupied by you, the following recommendations are submitted, which should receive serious' consideration. These recommendations are made in the interest of ,fire prevention and to correct conditions that are, or may become dangerous as a fire hazard, may be required for. legal occupancy of the premises or otherwise are in violation of the law. ,• � Date r` /i t-,1'! f 1 9/ • ,G 'J j;J Inspector• Wr3}e'1'7r,,1Nwn In -Service Re -Inspection Report: Date: 3h/gC Conditions found to exist at time of Re -Inspection: 57912?-e 6m/ - "7f n oPc ' a D V Gtie'S 74 o /ice/ I'e r� At Name of perswith whom recommendation follow-up was discussed. /91- 0 //5OM Reasons, if any, for failure to comply with original recommendation. tZia NONE Complaint has been corrected. /0 Fo ward t form to Fire 3fi cP-1 Aguta Prev. Bureau for follow-up. 06_a_zeol 470./fi Eng. Co. Lad, Co.# SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: 12,2 f-ederA! 54- NAME OF OCCUPANCY: E/51-Z.TY d Eckeii TMw .GYL/, e P.T.N. f r, znrT7 BLDG. OWNER/90/ is`,„,. POS TYPE OF ,/ ,UC.000UPANCY WeAvTfz Sru,c.s ADDRESS '/7 er S71 S.0Ct7EL • 7V -loa 6/ ADDRESS 30D /41ge/ �/TEL. 7 ®a2S0 4,4 ANSWER ALL QUESTIONS: EITHER "YES"J "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? e S 2. Does the area adjacent to the building, appear to be free yes 3. Are facilities provided for the safe disposal of rubbish? Ves 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? ye 5 5. Yes of rubbish accumulations, or other fire hazards? Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6.. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? Ve 5 8.'Are all interior occupied spaces clean and consistant with good housekeeping practices? ye s 9. Are all necessary Licenses and Permits posted & dated? Vf s 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? _ 15. Does this occupancy have a sprinkler system? Are all, pressure gauges showing satisfactory readings? Are all O.S..&Y<-valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Form #16 (Rev. 1/79,), 17..Does this occupancy have an interior fire alarm system? 'e S ' 18. Date of last test of the interior fire alarm system? , 44/VG- 19. Does this occupancy have a direct Fire Alarm connection? i/D Master . Instant Type :Box # ADT# " Alarm # AFA* 3M4 Other 20. Is emergency lighting system or units provided? 1405' 21. Are all emergency lighting units in good operating condition? k 22. Does the occupancy have any unusual condition which would AI constitute a special fire hazard? /Va. 23. Are all flammables stored in proper containers and/or �� stored in an apFroved storage area? 24. Are all areas used for storage maintained in a safe manner? YeS 25. Are basement areas free of any rubbish accumulation? P%` 5 26. Does the heating system, including the chimney, appear 1/ to be in .a .safe operating condition? e 5 permitposted and storage proper? Ye'S 2 Ts a current. fuel oil p p 28. Pre there any electrical hazards? /V 2Q. ryes the occupancy appear to have any structural defects? 30. Has a Form 25D •(Inspection Recommendation Form), been made and issued for this inspection? YeS Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form 058 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Smo�P �eee4r o2-- 4-41.7 Name person to whom Form #25D was issued: Date: ,%%'/W/ //9 't Inspected by: Approved by: Approved by D.C. in charge of Insp. Date: 7 d v Com ny Officer Form #16 (Rev. 1/79) P.T.N. checked by F.A. • ROBERT J. CROWLEY A/Chief City of ,? aient, aazad1uzctt Aire pepatintritt Xenbquarters 48 Pfagette ,Street Salem, Ala. 131970 FIRE INSPECTION REPORT ( ) Hospital (a) (X ) Clinic (b) ( ) Convalescent or Nursing Home (a) ( ) Rest Home (a) FILE Cti'Py Public Medical Institution (a) Charitable Home (a) Group Care Facility (c) Day Care Facility (c) This is to certify that Health & Education Services, Inc. Name of Facility located at. 162 Federal Street Address was inspected on 10/16/85 Date ( X ) APPROVED ( ) DISAPPROVED by Lt. Raymond Gregoire Name of Inspector REPORT OF INSPECTION C ief, SA-1'em Fire De artment Form 44D (March 1985) DISTRIBUTION (a) Department of Public Health Division of Health Care Quality 2nd floor, 150 Tremont Street Boston, Ma 02111 (b) Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Ma 02116 (c) Office for Children The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This Fire Certificate of Inspection issued by the Head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, charitable homes, hospitals, and public medical institutions are in accordance with the requirements of Massachusetts Geheral Laws, Chapter 111, Section 71. This Fire Certificate of Inspection issued by the Head of the Salem Fire Department is the result of an inspection conducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. 1\ SALEM FIRE DEPARTMENT —INSPECTION REPORT IPISTEJADDRESS: / ‘ �,c�- / 6 f%4/r �-L- ) T • 4. TYPE OF /vje.... r-4-1 NAME OF OCCUPANCY : f. LT// e aC i G c4-%/o ^► i OCCUPANCY, Tay1:6 :, ,2 r �.,c. v�"v 4 1 / ,N.- c . P.T.N.J/'A7,0."--1$r f /Z?-,r/7 ADDRESS/jC7,dirt04/f ,c- t. TEL._ Li,l BLDG. OWNER /,€,. f-, J•:it..G., ADDRESS/ ,2-f ,I4 A G .17`` . TEL W t fo4 ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be .free of rubbish accumulations, or other fire hazards? ' If 3. Are facilities provided for the safe disposal of rubbish? //.'Ef 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? (5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? A10 /1/4-11. 14.-Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? /b .4 ND., £ Form #16 (Rev. 1/79) ,Date: 17.. Does?this occupancy have an interior fire alarm system? p,�,f r 18. Date''o'f last test of the 'interior- fire alarm system? ' Mon. j )jLY 19. Does this occupancy have a direct Fire Alarm connection? /l/ti Master 'Instant' Type :Box # ADT# Alarm # AFA# 3M# OtherI0r04. t - 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? krf' 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? /t/r0 23. Are all flammables stored in proper containers and/or stored in an approved storage area? AA, # C 24. Are all areas used for storage maintained in a safe manner? kik( 25. Are basement areas free of any rubbish accumulation? 26. Does the heating system, including the chimney, appear to be in safe operating condition? j4f 27. le a current fuel oil permit posted and storage proper? 28. Are there any electrical hazards? /Vrb 29. Does the occupancy appear to have any structural defects? //i 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? Write brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) o If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: r . g 41..E -� , 0 ri;t ' Inspected by: ,Q :. fl . � '%i%, 4, i',P i� 7" J Approved by D.C. in charge of Insp. Approved by: Date: Comparfy dlficer Form 116 (Rev. 1/79) P.T.N. checked by F.A. ROBERT J. CROWLEY acnief ( ) ( X) Clinic (b) ( ) - Convalescent or Nursing ;Home :(a) ( ) Rest Home (a) IgL1f $alem, ttssttchusE##s girt pepartment PeaDjuarters 48 712I{?xgette gtreet $atem, Azt.0197D .FIRE INSPECTION REPORT Hospital (a) • Public Medical? FILE COPY Institution Charitable;Home (a) G'roupCare ;Facility (c) Day Care Facility (c) This is to certify that North Shore Guidance Center:. Name of Facility, located at 162 Federal Street was inspected on Address 7/17/85 by Lt. Bruce. Silva Date Name of Inspector ( X ) APPROVED ( . ) DISAPPROVED REPORT OF INSPECTION ef, Sa m Fire De. rtment (a) Form 44D (March 1985) -DISTRIBUTION 46,6 (a)..Department of Public.Health Division of Health Care`:Quality 2nd.floor,-.150 Tremont Street Boston, Ma 02111 (b) Carolyn Zavarine, M.D. ,Department of Public Health 'Hospitals and''Ambul atory Care Facilities Room 940, 80.Boylston Street Boston, 'Ma 3 '02116 (c) Office for Children 83 Pine Street... Peabody, Ma `01960 Building Inspector Health Department Occupant File • The inspection of hospitals, clinics, and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This Fire Certificate of Inspection issued by the Head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, charitable homes, hospitals, and public medical institutions are in accordance with the requirements of Massachusetts Geheral Laws, Chapter 111, Section 71. This Fire Certificate of Inspection issued by the Head of the Salem Fire Department is the result of an inspection conducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. ADDRESS: •SALEM FIRE DEPARTMENT - INSPECTION REPORT / 2- Ai /7r_ Rki S NAME OF OCCUPANCY : /4411 /, ,-. Elacdriou P.T.N.L Nk l�i y9 o%' '. flSFip TYPE OF eqa fre011,Tf— S67f 9/e?L OCCUPANCY ' /1r4/1,74 ADDRESS y 7 B,penn s- BLDG. OWNER 3u/ 0'S/,�� ADDRESS 2.4 C.%n/,4/ �oJ TEL . 26- '►A TEL.-53)-4;Mb ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2 Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 7Y514 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free 'from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consista with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12., Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a.gauge provided. at the top of the system? 16. Is this a "WET" or "DRY" system? a4 n pug - Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? 18. Date of last test of the interior fire 19. Does this occupancy have Master Type :Box # ADT# a direct Fire Instant Alarm # alarm system? Alarm connection? AFA# 3M# 20. Is emergency lighting'system or units provided? Other 21. Are all emergency lighting units in good operating conditi)(44 on? 22_. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? y-04 !%ne- 24. Are all areas used for storage maintained in a safe manner? 25. Are basement areas free of any rubbish 'accumulation? 26. Does the heating system, including the chimney, appear -.fo be in a safe operating condition? '27.cIs a current fuel oil permit posted and storage proper? 28.-Are there any electrical hazards? ca 29..aDoes the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? 1 Write a brief description of any violations discovered during this inspection. If the violation requires an.early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: ,Date: 7-/7- 9- Approved by D.C. in charge of Insp. Inspected by: Approved by: ' '�tl Compa `Officer Date: -1- ( Form #16 (Rev.; 1/79) P.T.N. checked by F.A. 1/14 8� • ROBERT J. CROWLEY A/Chief Ctu tf $alem, ?X88MtlT1tSetB Aire pepariment Xeadquarters 48 Pfaveite ,treet $afem, AL01970 FIRE INSPECTION REPORT Hospital (a) Clinic (b) Convalescent or Nursing Home (a) Rest Home FILE Cipy Public Medical Institution Charitable Home (a) Group Care Facility (c) Day Care Facility (c) This is to certify that North Shore Guidance Center Name of Facility located at 162 Federal Street Address was inspected on May 22, 1985 by Lt. Peter Ronan Date. Name of Inspector (X ) APPROVED (. ) DISAPPROVED Form 44D (March 1985) REPORT OF INSPECTION Chief, Salem Fire Department (a) DISTRIBUTION (a) Department of Public Health Division of Health Care Quality 2nd floor, 150 Tremont Street Boston, Ma 02111 (b) Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Ma 02116 (c) Office for Children 83 Pine Street Peabody, Ma 01960 Building Inspector Health Department Occupant File The inspection of hospitals, clinics,'and dispensaries are in accordance with the requirements of Massachusetts General Laws, Chapter 111, Section 51. This Fire Certificate of Inspection issued by the Head of the Salem Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. The inspection of convalescent and nursing homes, rest homes, charitable homes, hospitals, and public medical institutions are in accordance with the requirements of Massachusetts Geheral Laws, Chapter 111, Section 71. This Fire Certificate of Inspection issued by the Head of the Salem Fire Department is the result of an inspection conducted by the Salem Fire Department on the date indicated. Inspections conducted by the Salem Fire Department are in accordance with the provisions of Massachusetts General Laws, Chapter 148, Section 4. SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: I TYPE OF coow %L NAME OF OCCUPANCY: /%,L A c�{�Ol2Lc Meer -AL l4-ew + OCCUPANCY sep4�e P. T . N . 11" /2134J/ Zo77 ( ADDRESS 4 ? gp,oe, s a—. TEL:7 ---,,2L / BLDG. OWNER Z257APAI ADDRESS,V, (ALyt ;d. • al TEL53/-4J/D ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of oc----_nts? 8. Are all interior occupied spaces clean and consi with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dat 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? )1,0c )/P Ord 3c per cs yP c Form #16 (Rev. 1/79) an interior fire alarm system? interior,fire,alarm system? 19. Alarm connection? , J 0 3M# Other 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? e ' 22. Does the occupancy have any unusual condition which would j constitute a special fire hazard? e 17, Does this occupancy have 18. Date of: last test of the ,Does this occupancy have Master Type :Box # ADT# a direct Fire Instant Alarm # AFA# 23. Are all flammables stored in proper containers and/or 'stored in an approved storage area? 24. Are all areas used for storage maintained in a safe 25. Are basement areas free of any rubbish accumulation? 26. Does the heating system, including the chimney, to be in a safe operating condition?. 27,., I•s- a current fuel oil permit posted and storage 2$. Are there any electrical hazards? appear proper? 29. Does the occupancy appear to have any structural defects? 4 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? yes manner? }' P Jc —7\471- yec /1)n A)) Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each. remark with item number for identification. Name of person to whom Form #25D was issued: Date: Inspected by: Approved by D.C. in charge of Insp. Approved by: ( Date: - QOJUT/11.- tl!n J Company Officer Form #16 (Rev. 1/79) • P.T.N. checked by F.A. W°". 6- �Q/8 ROBERT J. CROWLEY AlChief Cri#g II£ $t1em, MSStILI11iSPftS girt ieJrartment peabz3uarters 48 Prfirgette 5truut Salem, ciTia. 01970 FIRE INSPECTION REPORT ( ) Hospital (a) (x ) Clinic (b) ( ) Convalescent or Nursing Home (a) ( ) Rest Home FILE C�py Public Medical .Institution (a) Charitable Home (a) Group Care Facility (c) Day Care Facility (c) This is to certify that North Shore Guidance Center Name of Facility located at 162 Federal Street was inspected on _March 20. 1985 Address by A/Lt. Bruce Silva Date Name of Inspector (x) APPROVED ( ) DISAPPROVED REPORT OF INSPECTION 0-6,1/4* ' De tme Chef, Sal`i�m Fire p nt Form 44D (March 1985) SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS; /6e7. NAME OF OCCUPANCY: Aw6411u/C�� ate✓ d'Cdv�E 47„. P.T.N. B/ �iQj4�//Z 4P/L.2d'�t/ ADDRESS �`% Aeo.9 0 BLDG. OWNER Pad. /'sAi:04 TYPE OF OCCUPANCY 11 S TEL 7/4 -G2// ADDRESS C®/.efi/fiu_ ten P049 TEL.5.3/-%//® ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and •free of obstructions? 6-0 0 6. •Do outside sprinkler and standpipe F.D. connections �,� appear to be in good and usable condition? /z� 7. Are entrances and hallways clear of any obstructions `"" that may interfere with the emergency exit of occupants&/ 740 w ,.. 8. Are all interior occupied spaces clean and consis with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dat 10. Are the occupants complying_with all regulations and conditions, as prescribed.on the Licenses and Permits? 11. Are all vertical shafts and staiiwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is.a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? Aeio Master Instant Type :Box # ADT# Alarm # AFA# 3M# Other 20. Is emergency lighting system or units provided? 411/✓ r 21. Are all emergency lighting units in good operating conditio-.?d 22. Does the occupancy have any unusual condition which would y�� constitute a special fire hazard? ��'l1 23: Are all flammables stored in proper containers and/or stored in an approved storage area? 24. Are all areas used for storage maintained in a safe manner? 25. Are basement areas free of any rubbish accumulation? Ctf.e 26. Does the heating system, including the chimney, appear to be in a safe operating condition? 27. Is a/current fuel oil permit posted and storage proper? h% 28. Ate there any electrical hazards? 29. Does the occupancy appear to have any structural defects? / 1.O' 30. Has a Form 25D (Inspection Recommendation Form), been made 'and, issued for this inspection? ,Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List y�each r49 �e®mark with item number for identification. )40t.e, r- , ' Fv �.- .. I/ . 4(.A i t X chi lid Name of person to whom Form #25D was issued: Date: Approved by D.C. in charge of Insp. Form #16 (Rev. 1/79) Inspected by:, 4,L4,_ Approved by: da S / Company 6f icer Date: 3 - Yoevir P.T.N. checked by F.A. Name Address I • 1 / SALEM FIRE DEPARTMENT IN—SERVICE INSPECTION COMPLAINT RECOMMENDATION 1-1,1ok: tr•il a,/ /L t i-.2 I F1)fr'fiL 57- / - Date III- /l / 19 i'Q As a result of an inspection this date of the premises owned and/or occupied by you, the following recommendations are submitted which should receive serious consideration. These recommendations are made in the interest of fire prevention and to correct conditions that are or may become dangerous as a fire hazard, may be required for legal occupancy of the premises or otherwise are in violation of the law. e/70 /0 / N e. A-L L .7? .4.7 I /ch/ T 5 s'%/�o-C4.4-_/> ?A-77-4-47 Reinspection date: +J �1-• V //, 19F%r) 1 Form 25D (Revs 1/79) (Fire Dept. Copy) (` Inspector In -Service Re -Inspection Reports nditio s 7 ound to eaUst a i time off Re -I spection: C�Q� cO .. 111.1.0 Name of person with whom recommendation follow-up was discussed. Jf Reasons, if any, for failure to comply with original recommendation. Complaint has been corrected. . St� Forward this form to Fire Prev. Bureau for follow-up. Date: r a'U Inspector -`` COMMONWEALTH OF ,,,1ASSACr-r if.TTS 1)EPAR"TN1 N'C OF P'tiilLTC HEALTH HOSPITALS AND AMI;UL 1ORY CARE', FACILJTIES CLINIC QUARTER LY FIRE, INSPECTIONAL REPORT In accordance with the regrli.renlcnt:s of General Laws, Chapter la, Section 4, the Marshal or the head of a fire delkl.rlment, to whom he toay delegate authority shall make an inspection every three rnr)nths of institutions licei,Gr:(I by and under the supervision of the Departmenr. of ;),Iblic I-Ieal.;h, and sha.i! make a report of such inspection to the Department of I't(biic Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Cor)ter l\ar'1c ot. l;link 162 Federal Street, Salem, Mass. 01970 was inspected on January 16, 1980 Care 01 t 1 ;peeiuon by Lt. David J. Goggin, Fire Marshal Name-o.fl.inspector APPROVED C/ DISAPPROVED Jan. 17, 1980 Date R F PORT OF INSPECTION Inspection conducted for Fire Certificate of Approval this date, in conjunction with the Quarterly Inspection. All conditions found satisfactory at time of inspection. cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass. ) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facitilies Room 940, 80 P3oylst on Street Boston, Mass. 02110 Fire Chief Sigrxlture and 'Title Jan. 17, 1980 Date • ONE COPY SHOULD BE SENT TO CLINIC Form #39 FIRE CERTIFICATE OF IINSPECTION In accordance with the.requlrements of General Laws, Chapter III, Section 51, this Fire Corti icate of Inspection issued by the head of the local fire deparL- ment certifying compliance with local ordinances is a prerequisite for an original or renewal license. North Shore Guidance Center (Health & Education Services, Inc.) Name of Clinic (r--- 162 Federal Street, Salem, Mass. 01970 \ jress of Clinic was inspected on Jan. 16, 198gy Fire Marshal, Lt. David J. Goggin Date Name of Fire Inspector I HEREBY CERTIFY THAT THIS INSTITUTION COMPLIES WITH THE LOCAL ORDINANCES. YES X NO If answer is "NO", indicate violations and recommendations. violations: Reconmandations: All conditions found satisfactory at time of inspection. ISSUED BY Signature Head of Local Fire Depart INSTRUCTIONS: EIRE DEPARTMENT TO RETURN TW0 COMPLETED COPIES TO CLINIC CLINIC TO RETURN ONE C0PY TO: Edna Smith Director Clinic Program PO Boylston Street Room 940 Boston, Mass. 02116 itrif aiettt, glafisachusetts 3irr £arpartment ?dexbqusrtrrs games of..rcnt�xn (Miief Address of Occupancy Name of Occupancy Occupant P.T.N. #1 Address . NEW OCCUPANCY INFORMATION Date CJan._28,,,.=1980 162 Federal Street Floor # all North Shore Guidance Center Eleanor Norman 3 Ticehurst Lane, Marblehead, Ma. Phone # for Emergency Use 631-3123 Occupant P.T.N. #2 Frank Rizzotti Address 47 Broad Street, Salem, Mass. Phone # for Emergency Use Other P.T.N. Information Owner of Building 745-6261 Health & Education Services, Inc. Address of Owner 162 Federal Street, Salem Owners P.T.N. Phone # for Emergency Use. See above information Keys available Engine Co. # 4 Ladder Co. # Box 434 Place information on inspection records. cc: Fire Alarm Office Deputy Chiefs Office Police Department Fire Prevention file Form #84 ( Rev.1/77) Lt. David. J. _ :Goggin. Salem Fire Marshal CO.\L\-1UNWI1•;ALL Ul MASSACI[U:)i;TTS Di PARTMEN:'1' OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE E INSPECTIONAL REPORT In accordance with the requi.renicnts of General Laws,, Chapter. 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority sha11 make an inspection every three months of .institutions licensr:d hy-andunder-the supervision of the Department of.?iblic Health, ancl..sha.11 make. a report of such .inspection to the Department of Public 1=lealth on forms provid€d-by the Department_ of Public Health. In accordance with the statutory mandate, the,.. was inspected on North Shore Guidance Center l\arnc ol. �;inuc 162 Federal St Salem Mass 01970 . Address et L:11111C May aiw of yaw inspection by Raymond T Dansreau Name -of Inspector iz EPORT OF INSPECTIQN APPROVED I� DISAPPROVED Conditions satisfactory at tiro* of inspection: Date cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To; Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 8.0 Boylston Street Boston, Mass. 02116 /�Fire Chief Sigrnture and 'title `57d3/ p Date ONE COPY SHOULD BE. SENT TO CLINIC a a,.xstar .nw�e.:..,,.cs:.s�....�oevvw..n.,»sJa�wnwea.,.�:.,,.,a^.,.: zt3xirs/ai::.w..e.+mw.x>..t...,..,.�u...w_s•z..ry=..e..r.,sue.....a.......a,c;�.4aaw�.<;......s;.o r .u.. .,u...,e .aaaG .,,•• NOTICE: This Certificate of Approval shall be available for inspection.,,, on the premises listed below. Fee $5.00 games r- prennttn. flit ief :Occupancy _Address_:' /% 7 / sf %? e Occupant: d Sf if?C� Occupancy Use Group Classification: Area of Uses-/T/ 7s'►4 4-&- Product Name : �1'l' �4' rn 4-1 Type of Padding: t/o Al 4cf efm p Carpet Manufacturer: Testing Laboratory: Laboratory Address: Carpet Installer: (City n# ,Salent, assttchusetts ire !epxrtment PeaDquttrters 48 1,Eafagette Street $ah m, Cu_ U11970 .CERTIFICATE OF CARPET .APPROVAL Clinic Approx. Sq. footage 9:2-car° R06ERT :•1r'I & SON CARPET CO 335 BRIDGE STREET! SALEM. dYIASS, 0197Q !Name Aciciress ,Qertified Testin Laboratores Inc. rr Color:Cjrte %3ei C-C Average Critical Radiant Flux 'watts/cm2 p7, r(s_ , //VC 0,477teQ, -=# 4 Address %-U ir, rrf 4A.C/4.-4_ .e. u. box '1u41 Dalton, UA. J072u Dalton, Ga. ®•�' b41X ] C lot/.j y* 6-2A .3%1FJ • Date of Test: - ? 9 —4? d Laboratory Approval # 1551908034 Applicant certifies that the carpet designated above, was prepared from the same formulation and has the same characteristics as listed on the Radient Flux Profile and Test Data Log Report, as submitted with this application for approval. Date _ Applicants ,a C Submitted: 4" /e�- `' Signature (/ Ll c- Applicants Address�'�S -6.LA Salem Fire Prevention Bureau Approval: Approval Date April 16, 1981 Certificate of Approval # Conditions of Approval Expiration April 16, 1991 Date cc: Salem Building Inspector State Fire Marshal G041681A Use Group As per Mass. State Building Code Approved by: Clinic (B) aeVi Cafit. David J. Go; "n Salem Fire Marshal P.,,,•,,, A Rne (Pntr_ i iRn) SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: / 6 $t NAME OF OCCUPANCY: P.T.N.,fLe/lea/. Afhpiii414 ADDRESS BLDG. OWNER /4,4/37-774/ 7.4 ( ADDRESS TYPE OF a vrpp rTEATT— OCCUPANCY 6=-4G1-6/. ev, (,- 3% is 1iviesr L/g /& TEL.63/- 34)3 � 6,2 f jt -re ( c TEL .?J VYp ANSWER ALL QUESTIONS: EITHER "YES% "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for -the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? VPS VS 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? A/ 1- 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10.. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses 'provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and. padlocked? Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? /t/ A - Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? 18. Date of last test of the interior fire alarm system? 19. boes this occupancy have a direct Fire"Alarm connection? Master Instant Type :Box # ADT# Alarm # AFA# 3M# Other ,/q- 20. Is emergency lighting system or units provided? y_e.y (re 21. Are all emergency lighting units in good operating condition? 22.'Does the occupancy have any unusual constitute a special fire hazard? 23. Are all flammables stored in proper stored in an approved storage area? 24. Are all areas used for storage maintained in a safe manner? 25. Are basement areas free of any rubbish accumulation? 26. Does the heating system, including the chimney, appear to be in a safe operating condition? condition which would containers and/or 27. Is a current fuel oil permit posted and storage proper? 28. Are there any electrical hazards? 29. Does the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form•#58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. �,►�: - ,fa -A— v Name of person to whom Form #25D was issued: 4C74A (it- ,VD,? AMA( Date: Approved by D.C. in charge of Insp. Inspected by: Approved by: 4/ Date: Company Officer l P.T.N. checked by F.A. Form #16 (Rev. 1/79) CERTI E I E D ' LABoRATORIEs,;Inc. PHONE ;404) 226-1400 • 1105 RIVERBEND DRIVE • P 0 BOX 2041 • DALTON, GEORG:A 36720 CLIENT: Howard Carpet Mills P. 0. Box 1782 Dalton, GA 30720 REPORT OF TEST NUMBER 19443 July 16, 1980 Lab. Test No. 1551908034 of Plc/VAT— SUBJECT: One (1) sample of carpet submitted and identified by client as "LANATEX, Saddle, Roll # 6541-B". RADIANT PANEL.FLAMMABILITY TEST br Specimens of the sample were ,tested for critical radiant flux in accordance with ASTM Test Method E-648. The value reported is the average of three specimens. Test Assembly: Specimens were mounted on cement asbestos board using Webtex 80 adhesive. TEST RESULTS Average Critical Radiant. Flux Standard Deviation Coefficient of Variation 0.48 Watts/Sq. Cm. ± 0.07 13.5% Detailed data are attached hereto. For CERTIFIED TESTING. LABORATORIES, Inc. fr n'k, resident OUR LETTERS AND REPORTS APPLY ONLY TO THE SAMPLE TESTED AND ARE NOT NECESSARILY INDICATIVE OF THE DUALITIES OF APPARENTLY ICENY+CAL CP SIMILAR PRODUCTS. THESE LETTERS AND REPORTS ARE -FOR THE USE ONLY OF THE CLIENT TO WHOM TH ARE ADDRESSED AND T,I.EIR COMMUNICATION TO ANY OTHERS OR THE USE OF THE -NAME OF CERTIFIED TESTING 'LABORATORIES, INC. ST RECEIVE OUR PRIOR WRITTEN APPROVAL. THE REPORTS AND LETTERS, AND'OUR,' NAME. OR OUR SEALS, OR OUR INSIGNIA ARE NOT UNDER C+RCUM• STANCES 'TO RE USED IN ADVERTISING TO THE GENERAL PUBLIC,: .` C E RTI Fi E D 7 LABORATORIES, inc. PHONE 404) 226-1400 • 1105 RtvERBEND DRIvE • P. 0 BOX 2041 ^ DALTON, GEORG:A 30/20 ATTACHMENT TO REPORT NUMBER 19443 Critical Time Distance Radiant Flux Specimen 1 75.0 minutes 44.0 centimeters 0.42 watts/sq. cm. Specimen 2 45.2 minutes 37.0 centimeters 0.55 watts/sq. cm. Specimen 3 40.4 minutes 40.5 centimeters 0.48 watts/sq. cm. AVERAGE: 0.48 watts/sq. cm. Standard Deviation ± 0.07 Coefficient Of Variation- 13.5% OUR LETTERS AND REPORTS APPLY ONLY TO THE SAMPLE TESTED AND ARE NOT NECESSARILY INDICATIVE OF THE QUALITIES OF APPARENTLY IDENTICAL OR SIMILAR PRODUCTS. THESE LETTERS AND REPORTS ARE FOR THE USE ONLY OF THE CLIENT TO WHOM. THEY ARE ADDRESSED' AND THEIR COMMUNICATION TO ANY OTHERS OR THE USE OF THE NAME OF CERTIFIED TESTING LABORATORIES. INC. MUST RECEIVE OUR PRIOR WRITTEN APPROVAL. THE REPORTS. AND LETTERS, AND OUR NAME. OR OUR SEALS, OR OUR INSIGNIA ARE NOT UNDER ANY CIRCUM• STANCES TO DE USED IN ADVERTISING TO THE GENERAL.FUOLIC.. CONIMONWALTH OF MASSACrIt.IjETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE. INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter. 148, Section 4; the Marshal. or the lead of a fire department, to whom he may delegate authority shall make an inspection every three months of.institutions licensed by and under the supervision of the Department of .Public Health, and sha.i.l make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center l\dmc of L;1III 1C 162 Federal St Salem Mass 01970 Hucress et Clinic was inspected on 09-30-80 �7_ vac of inspection by APPROVED DISAPPROVED (OD 1.r,0 Date Raymond T. Dansreau, Inspector Narne-of inspector REPORT OF INSPECTION Reported to person in charge that stairwell; doors ar.e not to be chocked in open position., cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 ONE COPY SHOULD BE SL'N'T_TO CLINK= Form #39 SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: ,e4w/ cl-�r� / S7 � TYPE OF Ok t" Dr eSkix-,Alf occUPANCY/11iw.A1-4: P.T.N. �fJt? Y ,/ ADDRESS 456/ e/!042.-g 51'. TEL.7 ' ' 2CL NAME OF OCCUPANCY: BLDG. OWNER Apy' ADDRESS y ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"j`OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations_ and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? 16. Is -this a "WET" or "DRY" system? /J/� Form #16 (Rev. 1/79) 17.. Does this occupancy have an interior fire alarm system? Yef 18. Date of last test of the interior fire alarm system? /„Z- fl wiz' \1 19. Does this occupancy have a direct Fire Alarm connection? ,011.c2 Master Instant Type :Box # ADT# Alarm # AFA# 3M# Other 20. Is emergency lighting system or units provided? `)/.c�S' 21. Are all emergency lighting units in good operating condition? 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? Ad, 23. Are all flammables stored in proper containers and/or stored in an approved storage area?�-1 24. Are all areas used for storage maintained in a safe manner? fr 9 25..Are basement areas free of any rubbish accumulation? 26. Does the heating system, including the chimney, appear to be in a safe operating condition? 27. Is a current fuel oil permit posted and storage proper? 28. Are there any electrical hazards? 29. Does the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? y yeRJ hJ/> Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form•#58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: /'/ Approved by: Approved by D.C. in charge of Insp. � Date: / J/ Inspected by : vi�i8< hJ ' �,'cCompany Officer — 1 Form #16 (Rev. 1/79) P.T.N. checked by F.A. 40(.54 is COAL\4ONWEALL1H OF MASSACrIU:.)13TTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMFULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal. or the. head of a fire department, to whom he may delegate authority shall slake an inspection every three months of..institutions licensr.d by and under the supervision of the Department' of Public Health, and sha.tl make a report of such inspection to the Department of Public -Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center Name of l:link 162 Federal Street, Salem, Mass. 01970 i ucress et utiniC was inspected on 12/9/80 i}ate of inspection by Act. Lt. Hugh Dickson Name -of Inspector APPROVED DISAPPROVED 12/12/80 Date X REPORT OF INSPECTION cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 All conditions found satisfactory - at time of inspection. - Fire Chief,: 'Sig -rat ,re and "Title Dec. 12, 1980 Date ONE COPY SHOULD BE SENT TO CLINIC COMMONWEALTH OF MASS A,CrIUb1,TTS DLpARTMENT Oi'' PURL:IC IIEALTI1 HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY 'FIRE INSPECTIONAL REPORT In acc'or.dance with- the reglti.remeRts of General Laws, Chapter 148, Section 4, the Marshal: -or the head of a ;[.ire dcpn rtme nt.. to whom he may delegate authority shall make an inspection every three months of inst.itutinns licensed by anti under the supervision of the Department. of Public Health, and shall make a report of such inspection to the Department of. Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center 162 Federal Street, Salem, Mass. 01970 /.(tC°.1CsS ("t t.;I1iUc was inspected on by APPROVED DISAPPROVED 3/30/79 Date March 30, 1.979 Ua.ic 01 11SpectLOu Inspector Raymondr T. Dansreau Name -of Inspector REPORT OF .INSPECTION See report on reverse side. Please Return This Report To: Carolyn Zavar.ine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street: Boston, Mass. 02116 c).--4-41Z-;71A �Fire Chie'f .re at 3/30/79 U:ite ONE COPY SHOULD BE SENT TO CLINIC` 2nd floor 2nd floor 3rd floor Report of inspection Emergency lights notwOrking (dead batt.) Hallway lack of receptacles has created an extention problem,with cords running overcasings to desk in hallway. Emergency lights have some sort of short circuit:. problem The renovation work that had been submitted with plansetc. has once again been delayed. This occupancy in my opinion is seriously in need of some immediate fire protection, such as Sprinklers and or snake 1;). detectors. CONL'-fONWEALTH OF MASSACt-IUs}3TTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMI;ULATORY CARE FACILITIES CLINIC QUARTV,RL,' FIRE INSPECTIONAL REPORT In accordance with the requirements• of General LaV s, Chapter 148, Sectlon 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensr:d by and under the supervision of the Department of Public health, and shall make a report of such Inspection to the Department of Public Health on forms provided by the Department of Public Health. - In accordance with the statutory mandate, the Health 8: Education .Services Inc. Name of tonne 162 Federal St Salem Mass 01970 / UCress Ot Cllnic was inspected on 'APPROVED DTSA PPR OVED Date June 21 1979 pate of .inspection Inspector Raymond T Dansreau Name•nf.Inspector R EPORT OF INSPECTION Emergency lights third floor not operatingi. Remodeling of building has been started. Updating, .0f current cedes is now in progress. Pr.,e,vious, complaints will be. taken of. whe ...b.. b.... i,sa.compl,s ted. re and Tit ONE COPY SHOULD BE SENT TO Ct Please Return This Report To: Carolyn Zavar.ine, M.D. Department of Public Health Hospitals.ancl Ambulatory Care Facilities Room 940, • 80 Boylston Street Boston, Mass. 02116 orm #39. COMMONWEALTH OF MASSACHU)ETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapier 1,10. Section 4, the Marshal. or thc head of a fire department,- to whom he may delegate. authority shall make an inspection every three months of institutions licensr:d by and under the supervision of the Department of Public Health, and shall. make a report of. such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, thc was inspected on by North Shore Guidence Center l\amc ot Irnic '1A2 Salem Mass 01970 tkoeress ufin.ic 09-07-79 iJatc 01 utspeciion Raymond T Dansreau Name -of Inspector APPROVED DISAPPROVED 9 ' (Date REPORT OF INSPECTION enovation of this occupancy is still in progress,and work is being done to correct past complaints. On a temporary basis we could accept this inspec.,, tion. Please Return This Report To: Carolyn Zavarine, M.D. , Department of Public Health Hospitals and Ambulatory. Care Facilities Room 940, 80 Boyl..stbn Street . Boston, Mass: 02116 - LL Jgrature and 'fine io 7 17-ite ONE COPY SHOULD BE SENT TO CLINIC Form #39 •dames Aircznutti QIIef Location _System- Accepted X System:NOT Accepted Litt of ,-atent, ila55arliusetts Hirt Ilizpartinent Headquarters FIRE ALARM TEST REPORT Date: /51/7f Owner of Building Occupant of Building Master Fire Alarm Box Local Alarm Only .,44/vuL) Private Other Classification of Detectors: Rate of Fixed Duct v, Rise K Temp. A Unit Flame or Pneumatic Gas Tubing Local Manual Pull Stations Water Flow Switch - Control Panel: Name of System: Number of Zones on Panel Annunciator: Number of Zones Primary Power Test Procedure: Manual Stations Heat Detectors Smoke Detectors Water Flow Switch Tested on Standby Power Tested through to Master Fire Remarks: Signal Protection Service 74/0"-" Photo- Ioniza- Electric A tion Comb. RR&FT Other Door Release Devices Trouble. e,./4 By -Pass Dr ill Switch 74A-- iv, (k,e RM(1,0P/0711_01n: 64 0 0 fi--/C)10A7r 1/11 / Number of Zones cs. Being Used 1,(is prod _1 ZirT.. Plate p oved S t and by Power AtAl(A4e,L AlarBox r7/tA---1/---(-----• P0..,i7n0.4 8 '7.B‘ (g/77) Inspected:by COM1.,MONWLALTH OF MASSACrIU 17,-'C' ' DEPARTMENT OF PUBLIC HEAL'P-1 . i. HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FMt I.NSPECT ONAL'REPOR'T' t In accordance with the regni.l.emcnts of General Laws, Chapter 148, Section, Marshal. or the head ()Sol fire cicl',a.t'tme nt:, to whom he (tiny cicl.e:�Iate atitho it 1 i 11aU . ll:e make an inspection ev y three months of institutions licensed ley and taaidelr,�tla.eA-t-' supervision of the Dcpartrncnt, of Public I-Iealth, and shall, Make a a rcrib t otXifch inspection to the De.partrnent'of Public Health on forms p:rovidecl by the,T)-6f)trittiien of Public Health. In accordance with the statutory mandate, the North Sho e''Guidance Center N irr c of t;llrllc 162 Fedora Street, Salem, Ma88. 01970 was inspected on November 1979 LAIC 01 111S1)CC .0t1 by 'Lt. David J. Goggin, Fire Marshal Name -of ?Typectnr APPROVED DISAPPROVED Nov, 6, 1979 Date Please Return This Report To: Carolyn Zavari.nc, M.D. Depart:mcnt of. Pnbl.i,c Health Hospitals and Ambulatory Care P'aclli les Room 940, 80 Royl. ,ton Street Boston, Mass. 0211.( REPORT OF INSPECTION All conditions :found sai;ibfa:64 of inspection. Fire Alarm `:sy, . approved. Emergency approved. lgn itr:re ancl.'.I;Itie Nov. 6, 197 ONI. COPY SI-dUULb TIT i James - prcruixn Chief litg 1 �ttPm, f' assadiugrft5 �Airt El4Iartmrnt lirabgiuirtrrs CERTIFICATE OF COMPLETION FOR A FIRE ALARM INSTALLATION The undersigned installer of a Fire Alarm System, plans of which were previously approved, hereby certifies that the installation (or alteration) of said. Fire Alarm System has been installed in compliance with the guidelines and provisions of the Salem Fire Department and the State. Building Code. Furthurmore, this installation has been tested in accordance with the requirements of the Salem City Electrician and is now ready for a final test by the Salem Fire Prevention Bureau. Tests are conducted by appointment only.: .A representative of the installer must be present for the test. Complete instructions as to the use and maintenance of the system have been furnished to the person (or persons) for whom the installation (or alteration) was made. Date l%/..511 Installer Locr:ti onj e ed12 Jignatures License North Shore Guidance Center AND HEALTH & EDUCATION SERVICES, INC. 162 FEDERAL STREET, SALEM, MASSACHUSETTS 01970 TELEPHONE: 745-2440 RONALD C. KACZYNSKI PRESIDENT NORMA H. ROOKS FIRST VICE-PRESIDENT PAMELA HUESTED SECOND VICE-PRESIDENT ERIC B. LOTH TREASURER TRACY I. FLAGG SECRETARY Lt. David Goggins 48 Lafayette Street Salem, MA 01970 Dear Lt. Goggins:. December 17, 1979 WILLIAM C. MADAUS, ED.D. CLINIC DIRECTOR ELEANOR I. NORMAN EXECUTIVE DIRECTOR I have discussed your holding a set of keys for Health & Education Services, Inc., 162 Federal Street, Salem, MA., with the President of the Board and he has given his approval. I am enclosing a set of keys for the main entrance. It is my understanding that the keys will not be marked so that unauthorized persons will not have access to our building. If the need arises, I have listed my home phone below. Mr. Frank Rizzoti works for us on a part-time basis. I have listed his home phone also. Thank you for helping us out in this way. We appreciate your assistance. Si erely, ealt,thyds notwAtA____ Eleanor I. Norman Executive Director EIN:hf Enclosure 631-3123 - Eleanor Norman 745-6261 - Frank Rizzoti North Shore Guidance Center is jointly sponsored by Moss. Department of Mental Health and Health & Education Services, Inc. COMMONWEALTH OF MASSACtrUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC OUART).;RLY FRE INSPECTION.AL REPORT Tri accordance with the regnirements of General Laws, 018 pt.cr I/18, Section 4, the .•f:,! Marshal. or the head of fire cleFlartrrent, to whom he may delegate. authority shallmOse an inspection every three 1110)1tIlS of ill SI itutions licensed by and under the • supervision of the Department: of I'nblic nnd shall make a report of such • inspection to the Department of Public Health on forms provided 'by the Department . — of ,Pablie Health. In accordance with the statutory mandate, the ,61;').L M C of UlinIc I b:r aress of ‘V of17--/n. was inspected on by •-%:// APPROVED DISAPPROVED Dale 7 _7_- •__,_7(/ ualc of hispection Name,of Inspector R Epoin- or INSPECTION Please Return This Report To: Carolyn Zavarine, M.D.. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 .----a--71-gTi1ture.Tand Title / 3//7 1 r 7-Cie ) ; • ONT.!: COPY SHOULD BE SENT TO-dia.uNIC-7•yy_ ..P1// `tit d /v7=1:,--// />i ( el17- (j4;-/-/ /2 j 4) • / ?-A- SA-, vie: 6)_cs -64 • (`' )),27/ zev /5t7i-/Ci /4.)r ,--- /1' P / -c 7/"P , ./- 43,-)-71 4-- • " COMMONWEALTH OF MASSACrIUSETTS DEPARTMENT OF PUBLIC IHEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY. FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, . the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall'inake a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the Health Education Services Inc. Formerly N.S.Guidence Center Name of unpile 162 Federal ...t aalenn Nass 01970 Aucress oc was inspected on June 15,1978 .trace of inspection by Inspector'Raymond T Dansreau Name -of Inspector APPROVED ��- DISAPPROVED r Dat REPORT OF INSPECTION New owners having ::xtentive remodeling performed. Complaints of previous inspections being worked on. gr>atuntu G(�re and4 it tfr a,12e l Date ONr COPY SHOULD BE SENT TO CLINIC Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940,. 80 Boylston Street Boston, Mass. 02116 Jztrize �- Pre tttYt cyJ (Iiitv of tkm, iR-65uci zse1t . ;V irr Elz. artm:msn2 yip L� ; rtrra • NEW OCCUPANCY INFORMATION Address of Occupancy Date 162 Federal St Salem Mass 01970 June 15,1978 Name of Occupancy Health & Education Services Inc. N.S.Guidence Center. Occupant P.T.N. #1 Mrs Elenor Norman Address 3 Ticehurst Ln. Marblehead Mass Phone # for Emergency Use 631-3123 Occupant P.T.N. #2 William Madous Address Linebroof Rd Topsfield Mass Phone #for Emergency Use 887-6427 Other P.T.N. Information Owner of Building Address of Owner Health & Education Services Inc. Th2 Federal St Salem Mass Owners P.T.N. Phone # for Emergency Use. Keys available None Engine Co. t Ladder Co. # 1-4 1 Place infoi ation on inspection records. cc: Fire Alarm Office AGr Deputy Chiefs Office Police Department Fire Prevention file Director of Constituent Services. Fnr;r r F?L' ( 9:-v. l /77 1 • r 1 qiitu .of 11•-r - ..-5 "4-I2z(Z151,2,:trterzi iv,Tw OCCUPANCY TiCFORATION Address of Occupancy Ileaj-tb--&-liervics . CN. S.CruidEnace) Name of Occupancy Occupant P.T.N. #1_ Address 162 Federa1 St tc 06-15-;78 3 - Ticehurst Ln T.%rblehead Mass Phone # for Emergency Use Occupant P.T.N. #2 1.1iii Lia.dous Address Lino -brook Irl Topsfield tk.ss - Phone # for Emrgency 887(-427 Other P. T. N. Information Owner of Building Health & Services Inc 11:, Federal alcm Address of Owner Owners P.T.N, Phone #,fOr Emergency Use. Keys available Engine Go. It .L.: Ladder Co. Tr Place information on inspection records,' ' ' :--,_,,,•,,i._ ,,, :-,. :.•,,,._„ _241,-441,111 P\...117,34.41-4,ZCe.4.4 cc: Fire Alarm Office Deputy Chiefs Office Police Department Fire Prevention file fi84 (1.,ov i/vv\ CITYOF SATEM Fee Due $5.:b0 FIRE DEPARTMENT - FIRE PREVENTION BUREAU '48 Lafayette St., Salem, Massachusetts 01970 LICATION F ',I . s HEAD OF FIRE DEPARTMENT ?,.'4 . • , 1 ; In accordance with the;provisions of Chapter 148, G. L. as provided in Sec application is hereby made •.it for permission to install a fire alarm system, per plans submitted. Plans shall.be in: -compliance with provisions of Mass. State -Building Code and Salem Fire Prevention Regulation #15A or #158. Plans will be stamped approved for type and location of alarm devices. Restrictions: Subject to approval of_anv other authority having iurisdiotion. Subject to a Form #82, (Certificate of Completion) being filed. Owners / �% Name: lit -A 1iFdP(Ca7iafk(s�d'�ltres-fA�cAddress : /6'Z / @ci/°A 1 / frs PEAMIT To: State clearly purpose for which permit is requested Date issued- Date of expiratiorL /%/'‘,S/ INSTALLS Re: Installation of Fire Alarm System t 10A (Give location by street cad 7 6/no , or describe is such a Incliner as to provide adequate identification of location) ?c Do9 aA.,&/;71 r. (Signature ofapplicant) /,4 L 4iJ (Addreaa) ki 7 LICENSE #' 0, CO byDavid Rust of Jaquith. 7/6/78-Plans presented to Rust approved.Lt•G _ Three sets returned royal. 2/1 Revised plans submitted for approval. 2/1 V79Plansa roved with two notes on plans.Lt. pla�is rolled in closet. RECEIVED SALEM FIFE DEPT. FEB 1 5 1979 F17 B APPROVED Subject to approval by authority having jurisdi CITY of SALEM, MAS FIRE P ,,EVE NT ON By .• 16 1979 any other ction. S. READ BUR PLANS ARE APPJED SOLCLY °?'T;=1;1TION OF T/PE AND LOCA ION OF FL',,. ..10T:CT';;.1 ' I.F.S. ALL FIRE PROTECTION DEVICES CIE SJ.S'.CT -3 A. FINAL TEST AND INSPECTION, rOR _.• ANCE WITH fHE FIRE COOE. COMMONWEALTH OF MASSACHUSI✓TTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL DEPORT In accordance with the requirements of General Laws, Chapter. 148, Section 4,.the Marshal. or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department.of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the Health & Education SerVicesInc Formerly N.S.Guidence Center (Name Or Lamle tiueress o.t l.Lu11G 14.3 F+'cricr9l C.17 was inspected on September 11,1978 lace of inspection by Inspector Raymond T Dansreau Name of Inspector REPORT OF INSPECTION APPROVED Approved plansfor remodeling of. build.i;rig and updating current codes have been delayed. DISAPPROVED Previous complaints will all be corrected Y/'q/7f Date Please Return This Report To: Carolyn Zavarine, M.D. Department of. Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 021k with proposed remodeling.. Si.gr.tuf2 and 'Title ,77 /7? / Date • ONE COPY SHOULD BE SENT TO CLINIC COMMONWEALTH OF MASSACrfUs}TTS I:)EPARTMENT OF. PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT • In accordance with the requirements of. General Laws, Chapter 148, Section 4, the Marshal_or the head of a fire department, to whom he nay- delegate authority shall make an inspection every three months of .inst.itutinn.slicensed by and under the supervision of the Department of lAthlic Health, and shall make a report of such inspection to the Department of Public Health on forms provides; by the Department of Public Health. • In accordance' with the statutory mandate, the Health & Education Services Inc. Formerly N.S.Guidence Center t\amc of Ua111lc 162 Federal St Salem Mass 01970 A icress et 1;11n1C -• was iirspected on ` December8 1978 Ua{c cm inspection by Inspector Raymond T Dansreau Name of Inspector - APPROVED4,, ,-.0i DISAPPROVED /0/7/f Date • Please -Return This Report To:.. Carolyn Zavarine, M.D. Department of Ribl.ic Health Hospitals and Ambulatory Care Facilities Room 940, 80 '3oy1ston Street Boston, Mass..02116 R EPORT 'OF INSPECTION Emergency lights third floor not Working. 'Approved.' plans for remodeling of building and updating current •codes has been delayed again.. Previous complaints will be all corrected with .proposed new°work when completed. Sigi t. re and '.little Late ONE COPY SHOULD BE SENT TO CLINIC • GO\l-\,IONVv'EAI.,; .1 Oi' MASSACrfiJ_)l'TTr� 1)F,PARTMZ,NT OF alP•LIC HEALTH HOSPITALS AND A;r11;LJLATORY CARE FACI:,ITI S CL[NIC QUARTI-T.L:' FIRE INSPECTIONAL IZFIk)R( ALE copy In accordance with the requirement. of. General Laws, Chapter 148. Section 4, the Marshal or the head of a fist: department, to whom he way clt lec;ate authority shall make an inspection every three months of .institutions licr . :d by nnd.under the supervision of the Department.. of ;Public Health, and shai.l make a report of such inspection to the Departmect of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the was inspected on �Juor SJ�ore- G dan_ce Center ui l 2.n 1c 162 Federal Street AUress c>f Ulhue • DEC 1984 Date of Intspec.tion y� by .lk) :c c A) E Name -of Inspector REPORT OF NSPECTION APPROVED %` DISAPPROVED • DEC 1984 Date cc: Building Inspector Health Dept. (Salem). Occupant Dept. of Public Health (Mass. ) file Please Return This Report To: Carolyn- Zava r. in e , M .0 . Department of Pcthlic Health • Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 011ie igrr ttyire and Tit DEC 1984 Fire Chief ONE COPY SHOULD BE SENT TO CLINIC Form #39 Robert J. Crowley P/Chief 0.1itu AISSZICIII-I5elta talent, ire Pepsrtment �iea�,�.i�rtcrs 4S liLafagette Street cam_ 0.1070 INSPECTION REPORT 1. Building Inspectors Certificate Of Occupancy: Posted Expiration Posted • Expiration 2. Health Dept. License: 3. Maximum Number of Occupants per License: 4. Fire Alarm: Drill Switch provided: Drill Conducted: Full System with panel provided: Battery Power: Local Manual Pull Station on.A.C. Power only: 5. Fire Extinguishers: Number of Extinguishers: 6. Exits clear and unobstructed: 7. Emergency lighting tested: 8. Two separate means of egress from each room used: 9. Fire Drill procedure posted: Date last tested: 10. Emergency shelter agreement available: Location of Emergency Shelter: 11. Boiler Room enclosed: 12. ASprivnailable er System Remarks: city Pressure Pressure at Top of :system Date: Inspector: Company or F.P.B. (OVER) • • :',1ASSACt-11.1:)17,i1-73 1)1-!•PAR'-rN./1131s-:T01 P1--HII-[C1-1EKL7FE.1..:: • HOSPITALS AND A.;.„rifill-LA-TOTIT CAR :".. - • 7.-z- • QUAR*TER 1 1,•TR!?, u,r,(p.T • , . .. ., . . . ., In accordance with the requiren,terits of General. La.ws,. ChaP.Ye. r 148', SeCtiOn 4.;the-- , . . Marshal. or the head of a fire au depa.rt.rne ni-,,, to whorn he idfiy:i,-.101.e--a.P. ttk:Orityslia-11-' make an inspection every threc months.'of,ins.ition titis licOn-sr:d liy ri rid:under'the-,_,--` _. . : supervision of the Department. of niblic tIe.a.l.th-; And shai.1arke..a.report`..6f.-Sti.ch . , . ...., inspection to the Department o( Publie.Health on formS. provided .1-)y- thei:DePartTnent, -of Public Health., : • ' • „1.., In accordance with the statutory rrianclate, •the: • - was inspected on . by APPROVED DISAPPROVED X Date • I Center.: • 1N4111(.: fl 1C 162 'Federal. Street _ ATICrres s. (..1 hi) C. • 1 . CC 3 Building Inspector Health Dept. (Salem)_:- • Occupant Dept. of Public file . • Please Return This Report To:, Carolyn- Zavarine, M.1). Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 ONE'MPY,'SHOUL,D BE SENT TO CI INIc Form #39 RobertJ. Crowley A/Chief pep'rtitcent ea'l1i:i::Iter5 48 " xf e}te ` irzei tzlem,: c {u. 014.7a. INSPECTION., REPORT 1. Building Inspectors Certificate Of .Occupancy: Posted Exp iratIor"t. ": Posted. 2. Health Dept. License: 3. Maximum Number of Occupants per'LicenseV 4. Fire Alarm: Drill Switch provided: Drii1;'..Conducted : Expiration Full System with panel`f-provided Local Manual Pull Station-on..:A. C. . 5. Fire Extinguishers: Number of Extinguishers:. 6. Exits clear and unobstructed: 7. Emergency lighting tested: 8. Two separate means Of -egress from each`.room::used:'. Battery Power:. only: ate last tested:. 9. Fire Drill procedure posted: 10. Emergency shelter:agreement .available: Location of .Emergency -Shelter. 11. Boiler Room enclosed:- 12. Avainnlable'System Remarks: Date: r- CO:ELMONWHALTH Or MASSACriUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal. or the heal of a fire department, to whom he may delegate authority shaU make an inspection every three months of institutions licensrcl by and under the supervision of the Department of Public I-Ieal.th, and shall make a report of such - inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, .the North Shore Guidance Center Name of Uiinic 162 Federal St :.Salem Mass`- '01970 rtucress et Lluiuc. was inspected on 1-24.-81. Late .oi inspection by Raymond T.Dansreau' Name -of Inspector APPROVED DISAPPROVED Date cc: Building Inspector Health -Dept. (Salem) Occupant Dept. of Public Health Mass.) file. REPORT OF INSPECTION Excessive„use of-.ext4nhion cords°Tr; n'bidg provide electric -heaters should-,-; e..: stopped_:; 'Second floor extention cord running from ;one_..; room to .another will have to 16.:7 d °;sconne t:e : C•0-2 :extin uisl erS in .bldg :w l°l a e to: beg Ven- Hy drostat'ic't�est and` `ca4ngsR swamped.` Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 ONE, COPY SHOULD BE SENT TO CLINIC ClIitg of lei , gassacluiseita- , Fire peiizrtmectt Peabipartcrs 43 T..af ette tr2et ,Soigm, cam- IIt,47II 1. Building Inspectors Certificate 0f Occupancy: Posted Expiration 2. Health Dept. License: Posted Expiration 3. Maximum Number of Occupants per License: 4. Fire Alarm: Drill Switch provided: Full System with panel provided:.... Battery Power: Local Manual Pull Station on A. C. Power only: 5. Fire Extinguishers: Number of Extinguishers: 6. Exits clear and unobstructed: 7. Emergency lighting tested: Date last tested: 8. Two separate means of egress from each room 9. Fire Drill procedure posted: 10. Emergency shelter agreement available: Location .of Emergency Shelter: 11. Boiler Room enclosed: 12. Available System City Pressure used: .y' Pressure at Top of System Inspector: Company or F.P.B. (OVER) CONL\zONWEALTH OF MASSACr[iJsETTh DEPARTMENT OF PUBLIC HEALTH • HOSPITALS AND AMhULATORY CARE FACILITIES CLINICQUARTFRLY FIRE INSPECTJONAL REPORT In accordance with the requirements of General Laws, Cnaprer 148, Section 4, the Marshal. or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions Ticensr:d by and under the supervision of the Department of Public I-iealt:h, and shall make a .report of such inspection to the Department of Pubic Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the was inspected on North Shore Guidance Center t\arac ot: ut n.Ic 162 Federal St Salem :Mass 01970 Address et !.Lime 11-15-83 !.late; .ot inspection by Raymond: T" Dansreau Name -of Inspector REPORT OF INSPECTION APPROVED C/ DISAPPROVED Date ,cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file .Please Return This Report To: Carolyn Zavarine-; M.I. Department of 'Public Health Hospitals a ncl.Arrrbutatory Care Facitities Room 940, 80 Boylston Street Boston, Mass..02116 See Report on reverse- side.. Ttre and 1 itle. / / % Da t e Fire Chief ONE COPY SHOULD BE SENT TO CLINIC 2. Health Dept. License: 3. Maximum Number of -occupants per -License: 4. Fire Alarm: Drill Switch provided: ves .Drill Conducted: 1► DttJ of $alern, ',; ! assuc TCP pepxrtr:Tettt Pe;ttitj_T::rtc.5 43 ^f rrreite tree aLrr, C _ 31570 • INSPECTION REPORT. , Building inspectors Certificate of•„Occupancy: Posted Expiration Posted Expiration Full -System with.panel provided: Battery Poorer:yes Local'. -Manual Pull Station on A. C.Power only: 5. Fire .Extinguishers: Number of Extinguishers O.KeDate last tested: 6. Exits clear and unobstructed: 7. Emergency lighting tested Rear first floor Unit not working. 8. Two separate means of egress from each room used: O.K. Yes 9, Fire Drill•procedure posted: 10. Emergency shelter agreement available: Location of Emergency Shelter: 11. Boiler Room enclosed: 12.- Available System City Pressure .Pressure at Top of System Remarks: On Going report of corridor door at reception desk being triggered open on last3 reports does not seem to reach responsible parties. This lack of having Megnatic door holders inotBelled.may result ih someon9 beipg over come in event of a fire ccuri g' Date: i/ / / ;�" / S'-� Inspector: f» -�'"aiceAL4 ,cam." (OVER) CO\L\IONWEALT'l[ O'r MASSACrfJ 133•TTS Di7,PARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CL[NIC QUARTF;P.C.Y FIRE INSPECTIONAL REPORT In accordance with the r.eclrii.ienrenty,of Gone.ral.Laws, Chapter I118,,Scction 4, the Marshal gr. the- head o.f a fire clelia..rtment:, to whom he rhay r!ul.egatP at.ithority,sball make an inspection every threc,months of .inst,i.tution.s•li.c�ns :�.1 hy,and.under the supervision of the Department: cif Public Health, and shall make a ,report of such inspection to the Departrnei t of Public Health on forms pcovided by the Department of Public Health. In accordance with the ;statutory mandate, the North Shore Guidance Center kani nl: l li.rltC 162 Federal St Salem Mass 01970 was inspected on 8-30-83 APPROVED (.ern DISAPPROVED Date Raymond T Dansreau Name-o.11nspeetnr R T.:PORT OF INSPECTION See other side. cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Dt partment of Public Health Hospitals and Arnl5ulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Fire Chief Sigrnture a.nd 'Fide 6P/3/./3 Dite ONF COPY SHOULD BE SENT TO CLINIC •. • Form #39 Report Of Inspection. Basement: That part of basement that is used for storage of Equiptment, Mowers and any type tools that can be used with electrical outlets will have to be kept locked and out of reach of the patients that do enter this area. 1St Floor: Main Floor corridor door at reception desk will have to be closed or magnatic door holders installed to allow door to be kept opened. _SALEM FI- E``DEPARTMEN INSPECTION REPORT ADDRESS NAME OF OCCUPANCY: 7---6/ 57, 0,e6- t� p¢,.cF �c✓ P.T.N. (lG/a� Gfl7`.44-352 BLDG. OWNER TYPE OF ,u�.0 1 1 SF� OCCUPANCY 3 XKcaS ADDRESS o2(e CC o iv/TEL .s 3 /4/// ADDRESS TEL. ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? �P S 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? ye s 3. Are facilities provided for the safe disposal of rubbish? v e 4. Are all outside egress paths free from any obstructions ,.,: that may interfere with the safe exit of the occupant?ie S 0 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connectio appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? /v 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is a gauge provided at the top of the system? y YES ye 77 , N �cvar 16. Is this a "WET" or "DRY" system? Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? ,v/d Master Instant Type :Box # ADT# Alarm # AFA# 3M# Other — 20. Is emergency lighting system or units provided? yP� 21. Are all emergency lighting units in good operating condition?y2 f 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? S 24. Are all areas used for storage maintained in a safe manner? yes 25;4Aret basement areas free of any rubbish accumulation? ' s tn 26, Does the heating system, including the chimney, appear V`.;to''be in a safe operating condition? 2715Is a current fuel oil permit posted and storage proper? 28.FA w there any electrical hazards? ,vd 29. Does the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? �d Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form•#58 (Complaint Form) o If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: , Date: 7/,7/7� Inspected Approved by: Approved by D.C. in charge of Insp. Date: 740 pany Offcer c3 Form #16 (Rev. 1/79) P.T.N. checked by F.A.C. COMMONWEALTH OF MASSACrrUsETTS DEPARTMENT OF PUE3LIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLNIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three ,months of institutions IicenG^d by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of..Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North ShcrP CT► ida ce Center tea c. 01 Lilnic 162 Federal,+StSalem 'Ma'ss '01970' ricicress o.c was inspected on 6-10- Late of inspection by •Raymond:.T'FDarisreau • Name -of Inspector REPORT OF INSPECTION APPROVED 1St Floor Corridor door to be;:._provided_'.with "Electro-Magnate door holder. DISAPPROVED x It is now required to provide :,yore.' Al arm< panel with a silent alarm `switch Square D `90011csi11c3. that will allow' our .responding ,cor'ipany'.s; to silent ExtenguisheT ist, Floor needsa faulty alarm, condition. ° recrgn.= =-5::_ a:`' Late cc: Building Inspector Health -Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Form #39 ,.cure and 'i'itle ONE COPY SHOULD BE SENT TO CLINIC: 2. Health Dept. License • 3. Maximum Number of Occupants per License: 4. Fire Alarm: Drill.: Switch provided: Full System with panel provided: F' Local. Manual Pull Station on A. C. 5. Fire Extinguishers: Number .of Extinguishers: 6. Exits clear and unobstructed: 7. Emergency lighting tested: C tg .of atETT[, 41aassactp.133eita lire Peps.rtnient jieabquarters 48`T..'afagette trzet SaLent. ffizz., uigzu INSPECTION REPORT . Building Inspectors Certificate Of Occupancy: Posted Expiration Posted Expiration 8. Twoseparate means of egress from each room used: 9. Fire Drill procedure posted: 10. Emergency shelter agreement available: Location of Emergency. Shelter: 11. Boiler Room enclosed: 12.- Available- System City Pressure Pressure at Top of System Inspector: Company or F.P.B. (OVER) FIRE CERTIFICATE OF n ccordance•with the requirements of General La.ds, Chupter 111, Section El tnis Certificate of Inspection issued by the head of the local Fire Department fVirc ccmpliance with local ordinances is a prerequisite for an original or t-f-.:!alicense. North Shore Guidance Center Name of Clinic 162 Federal Street, Salem, Mass. 01970 Address of Clinic ir.srectec .on -2/9/83 Date by F—R. Insp. Raymond T. Dansreau Name of Fire Inspector !1E;:EEY CERTIFY THAT THIS INSTITUTION COMPLIES WITH THE LOCAL ORDINANCES. CONDITIONAL APPROVAL YES X NO If anser is' "NO", indicate violations and recommen,:tions. Violations: Recc .;.endations: Provide better housekeeping in work shop area. Mattresses and furniture shall.be stacked neatly or removed. All electrical panels shall be kept closed. Gasoline lawn mower shall be kept in a separate approved area. Excessive use of extinsion•cords. All areas should have approved electrical outlets provided for needed uses. Fire` ext i n-g•u i she rs .•(espec i al l y. non-ava i l ab a units) shall be kept in ar,remote area, awaiting refilling. Arr nge to have at least two charged extinguishers on brakets I.S5tIED BY: v 7 r�y -- located in basement. Signature First floor corridor door to be provided Head of Local Fire Dept. IISTRUCTIQ S: with electro-magnetic door holder. p Emergency lighting ,at side entrance not working. 'RE DEPT. TO RETURN TWO CCt•:PLETED COPIES TO CLINIC °; I C TO RETURN ONE COPY TO: Division of Health Care Quality Eoylston Street, Room 945 8os ton , t'.:, 02116 was inspected on APPROVED • CONLMONWEALTHH.Or MASSACriUsirTT7 . DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE. FACILITIES CLINIC QUARTERLY' FTR'E INSPECTIONAL REPORT`- • • In accordance with the requirenients of...General Laws.'.Chaptcr NB...Section 4, the. Marshal. or the head of a f redepa.rtment.,, to whorri,he ulay,c+el-ec . to authority shall make an inspection every three months of.institutions licenscd.hy and under. the supervision of the Department of F hlic Health, and shalt make a report of such inspection to the Department of Public Health on forms provide 1 by the Department of Public Health.. :Y '• In accordance with the statutory mandate, the North Shore Guidance Center Name of Cr11111C • 162 Federal St'Salem Mass 01970 Acicress oc �i�ullc 02-09-83.... UaLC 01 mspecllull by Raymond Dansreau Name -of Inspector DISAPPROVED Date cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file REPORT OF NSPECTIO 'See :'.:Other side. Please Return This Report To: Carolyn Zavarine, M.D. • Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Si.g;iture antj.nil� hate Fire Chief -• ONE COPY SHOULD BE SENT TO CLINIC Form #39 Report Of Inspection. Basement; Work shop cluttered Mattresses and furniture will have to be stacked in area provided or removed. 2. Electrical panels to be kept closed. 3. Gasoline lawn mower should have fuel removed from tank and stored away from this type area. 4. Wiring and extention cords now in use or not connected to any units should be removed and recommend more outlets be installed to service equiptment in this room. 5. A number of extinguishers on floor. Either hang on brackets or remos 6. Entrance, to basement should be kept locked to keep unauthorized ersonei from entering this area 1st Floor. main corridor door at reception desk will need Electro Magnatic holders installed or door is to be kept closed. Emergency lights in side entrance not working. w COMMONWEALTH OF MASSACr[U:)F,TTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES . CLINIC QUARTZ R L :' FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter. I48, Section 4, the Marshal. or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensrx1 hy and under the supervision of the Department of Public 1-health, and shall make a report of such inspection to the Department of Public Health on forms provided hy the Department of Public Health. • In accordance with the statutory mandate, the North Shore Guidence Center. Name of t.,i:nlc 162 FederaLa St. Salerri Mass 0197.0- Auc:ress Ci < irnJC • was inspected on 12-15-82. uatc .ot inspection by Raymond T Dansreau Name -of Inspector APPROVED Conditional DISAPPROVED Dec. 16, 1982 Date • REPORT OF INSPECTION 1St Floor:Corridor door at desk area is kept- in: open position.This has been reported. on- last 2- inspectionsand nothing has been corrected. This could result in a serious irncident,and:.should be corrected with rnagnatic door holders if doors is to be kept open,other wise keep tl>iis corrid6r arose cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Healrh Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Fire Chief- -- Signature and Title Dec. 16, 1982 Date ONE COPY SHOULD BE SENT TO CLINIC - Form #39 (11.itt em s Pejrrtruerct fez��u�rte 48 ^ f rette ,tree ,aLerc, Cam_ U1S78 'INSPECTION REPORT_ 1. Building Inspectors Certificate Of Occupancy: Posted Expiration ;Posted Expiration 2. Health Dept. License: 3. Maximum Number of occupants per _License: 4. Fire Alarm: Drill Switch provided: Drill Conducted: Full System with panel provided: Battery Power: Local Manual Pull Station on A.C. Power only: 5. Fire Extinguishers: Number of Extinguishers; 6, Exits clear and unobstructed: 7..Emergency lighting tested: 8. Two separate means of egress from each room used: Date last tested: 9, Fire Drill procedure posted: 10. Emergency shelter agreement available: Location of Emergency Shelter: 11. Boiler Room enclosed: 12c Available-kler System Remarks: Date: City Pressure Pressure at Top of System Company or F.P.B. (OVER) • • Health & Education Services, Inc. North Shore Community Mental Health Center 162 FEDERAL STREET, SALEM, MASSACHUSETTS 01970 AREA CODE: 617-745-2440 RONALD C. KACZYNSKI PRESIDENT NORMA H. ROOKS FIRST VICE-PRESIDENT PAMELA HUESTED SECOND VICE•PRESIOENT ERIC B. LOTH TREASURER TRACY I. FLAGG SECRETARY Memorandum January 6, 1981 To: Capt. David J. Goggins Salem Fire Department From: Re: Eleanor I. Norman Director of Planning, u7tation� a and S vial Projects P J Fire Certificate of Inspection WILLIAM C. MADAUS, Ed.D. CLINIC DIRECTOR ELEANOR I. NORMAN EXECUTIVE DIRECTOR I spoke with Fire Chief Brennan this morning and he advised me to send these forms directly to you for completion. Since the building has just been inspected on December 12, 1980, he indicated that the forms could be completed immediately. The Department of Public Health has requested that we return the form as soon as possible. I would appreciate anything you can do to expedite. I am enclosing a stamped, self-addressed envelope for your convenience. /hf Enclosures A Community Partner of the Massachusetts Department of Mental Health. FIRE CERTIFICATE OF INSPECTION In accordance with the requirements of General Laws, Chapter 111, Section 51, this Fire Certificate of Inspection issued by the head of the local Fire Department certifying compliance with local ordinances is a prerequisite for an original or renewal license. Health & Education Services Inc. & N.S. Community Health Center Name of Clinic 162 Federal Street, Salem, Mass. 01970 Address of Clinic was inspected on 1/7/81 by Fire Marshal David J. Goggin Date Name of Fire Inspector I HEREBY CERTIFY THAT THIS INSTITUTION COMPLIES WITH THE LOCAL ORDINANCES. YES X NO If answer is "NO", indicate violations and recommendations. Violations: Recommendations: All conditions, found satisfactory at time of inspection. ISSUED BY INSTRUCTIONS: FIRE DEPT. TO RETURN TWO COMPLETED COPIES TO CLINIC CLINIC TO RETURN ONE COPY TO: Clinic Regulation Program 80 Boylston Street, Room 940 Boston, MA 02116 Signature Head of Local Fire Dept. ^-is^w.uwx]'N;!'a• •rn�,s :+>n�PY �Yi1F+�^•ai; CO .MONWIYALTH OF MASSACHUI)}ITT,S ' • 1.)EPARTMEis OF PUf1LIEC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY TIRE, INSPECTIONAL REPORT • In accordance with the requirements of. General Laws, Chapter. 148, Section 4, the Marshal. or. ,the head ofa fire department, to whom he ropy delegate authority shall make an, inspection every threc•months of.institutions licenGnd hy and under the supervisiorracrf_the Department of. fiblic: HeaIxh...and shall make a. report. of such inspection to the Department of Public Health on forms provided hy the Department of Public Health. In accordance with the statutory mandate, the Health & Education Services, Inc. and N.S. Community Health Center. 1.`amc or L:ianic 162 Federal Street, Salem, Mass. 01970 Aucress et L.ltu)c was inspected on Jan. 7, 1981 .uaLe of inspection Fire Marshal David J. Goggin Name -of Inspector by APPROVED DISAPPROVED Jan. - 7, 1981 Date REPORT OF INSPECTION Conducted inspection for 'Fire Certificate in conjunction with Quarterly Inspection.._." All conditions found satisfactory at_tL,ime-- of inspection., cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health, Hospitals and Ambulatory Care Facilities Room 940,80 Boylston Street Boston, Mass. 02116 Form #39 Fire Chief Sigrriture and Title January 7, 1998.1 (.)ate ONE COPY SHOULD BE SENT TO CLIN COMMONWEALTH OF .MASSACHUsETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS. ANDAMBULATORY CARE FACILITIES: - CLNIC'QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148-, Section 4, the . .-.. .. _. . .. .. . - ...... Marshal. or the head of a fire department, to whom he may delegate authority shaU ----- -::::-.7:1''. -..•.-.. make an inspection- every three- months of institutions licensed by and under the ..--..„-.,—.,-„,-...- . superrision..of,the,..Departrnent-,a.„ai-b-iic.-Health.,-a-ncLsliall-rnake.•,&_.reporz of sue`a- ---,,,r,t;.;:.-.•-i:f---.:.-:-1.r.spettiori-;;-t07the.•Departmett-t,OF-rptchlicil-realtire.onjerrnS--provided-hyther,Departme.rit.±',-,;;:•.-:-',.3,4-'.-i±,±------t-.--.::- of Public Hea-lth. - -... . - - - Ill-, - - - -- • - - • • - • ,• APPROVED In accordance with the statutory mandate, the North Shore Guidance Center iNa.M.0 01: u!inic 162 Federal Street •Saieml: Plass. 01970 Address et Uila)C .• :.; was inspected_on _ June . : .ua.tc at inspection ; • by Firefigh-ter L. Jalbert • - • • DISAPPROVED CC: Date _ . Building_ Inspector Health-. Dept. (Sa.lem) Occupant-, •-• -- Dep. of Public Health. file • Please Return This Report To: Carolyn Zavarine, Department -of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street - Boston, Mass. 02116 Narne-pf Inspector REPORT OF INSPECTION AlL-,COriditions found :satiSi4c-tOrr': time of inspection. :f• Form #39 • • Fire Chle- , Signature and Title Jun'''1. 1981 • - Date •=s ONE COPY SHOULD BE SENT TO CLINK • • ADDRESS: SALEM FIRE DEPARTMENT - INSPECTION REPORT ,.-. =. TW4 /� ' TYPE OF NAME OF OCCUPANCY: /� S (r� / /)/�/)/Gi-- OCCUPANCY j,0a' ,f 4'•%%. P.T.N. c174" ADDRESS ,c/ (oA'/V//// 1 TEL. 9/ Z/ BLDG. OWNER ((js- 620i0ly, ce"- ,ADDRESS e- 4 ( TEL.'S 2.�0e0 ANSWER ALL QUESTIONS: EITHER "YES".L "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear'of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are,all necessary Licenses. and Permits posted .6, dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable • and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date.of last inspection? /VA% 14. Does this occupancy 'have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure'gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked? Is -a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? vs c yes 1 / Iv 1 Form #16 (Rev. 1/79) 17..Does this occupancy have an interior fire alarm system? 18. Date of last test of the interior fire -19. Does this occupancy have Master Type :Box # ADT# a direct Fire Instant t Alarm # alarm Alarm AFA# system? connection? 3M# Other 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? t/ff 22. Does the occupancy have any unusual condition f constitute a special fire hazard? 23. Are all flammables stored in proper containers stored in an approved storage area? 24. Are all areas used for storage maintained in a 25. Are basement areas free of any rubbish which would and/or safe accumulation? 26. Does the heating system, including the chimney, appear to be in a safe operating condition? 27. Is a current fuel oil permit posted and storage proper? 28. Are there any electrical hazards? 29. Does the occupancy appear to have any structural defects? 30. Has a Form 25D (Inspection Recommendation Form), been made and issued for this inspection? Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form #58 (Complaint Form) . If the violation appears to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form #25D was issued: Date: Approved by D.C. in charge of Insp. Form #16 (Rev. 1/79) Inspected by: Approved by: Date: P.T.N. checked by F.A. COMMONWEALTH OF MASSACr-IUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FrACIL,ITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148. Section.4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed hy and under the supervision of the Department of Public health, and shall snake a report of such inspection to the Department of Public Health on forms provided hy the Department of Public Health. In accordance with the statutory mandate, the /1/ rcr-A y 4 o ac? Ce,v re amc oL lainlc Re, Pee S was inspected on by APPROVED 'DISAPPROVED Sepy. 30, 1981 Date X ttacress et Ltlnip Sept. 29, 1981 ease ox Inspection \�a Lieut. P1d11ace Miller Name -of Inspector R EPORT OF NSPECTION • .A1conditions found satisfactory time of inspection. cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass. ) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Fire Chie Signature and Title Sept..30, 1981 Late ONE COPY SHOULD BE SENT TO CLINIC 2ttmes g. arennnn Qll;ief Oig .af Natezn, ASSachu‘ 4eifia Mire Department Peailrluartcrs 48 Tafagette tr2et tem, C z_ II iII 7II 1. Building Inspectors Certificate Of Occupancy: 2. Health Dept. License: 3. Maximum Number of Children, per License: 4. Fire Alarm: Drill Switch provided: !� 0 Posted J'i Expiration-3 i 43 Posted YQS Expirationr�/)- .cL4R . Drill Conducted: Full System with panel provided: !/0,3 Battery Power: (4,3 Local Manual Pull Station on A.G. Power only: YQ S 5. Fire Extinguishers: (� Number of Extinguishers Date last .tested: j 6. Exits clear and unobstructed: `)/e 7. Emerguncy lighting tested: 02..S 8...Two -_._sr.parate-. means of egress • from each room used: °P " C, re ®Nv 9. Fire Drill procedure posted: IJt 10. Emergency shelter agreement available: ( IA: I - I"�?"i'Q Il/' Location of Emergency Shelter: 11. Boiler Room enclosed: Additional Report: Dates • Inspectors i 7 ' /IO/i.'£ "4 Company or F.P.B. (OVER) . COMMONW EA LTH OF MASSACrIUs ETTS DE PARTMLNr OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACIL,ITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to .whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public health, and shall make a report of such - inspection to the Department of. Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center wamc OL <ainlc 162 Federal Street, Salem, Mass. 01970 rtuc Tess uunic was inspected on by APPROVED DISAPPROVED 12/8/81 Date Dec. 7, 1981 uaLC of mspeciioa Insp. Raymond T. Dansreau Name of Inspector REPORT OF INSPECTION Clinic is still in the process of alterations New Certificate of Occupancy has not been. signed, until items noted by Capt. Goggins on construction are corrected.. Most important is the 1st floor. front .ha:l:l.. door 1 ft open. This may be .h.eld open wi. an ele tro-magnetic door holder only... �,,, ,,� ,�i A Fire Chief - Sigrntiire and Title cc: Building Inspector Health Dept. (Salem) Occupant Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 12/8/81 Date ONE COPY SHOULD BE SENT TO CLINIC Form #39 ,lammes J. Iartruian C ief (Gig of lent, Fire pepurtment Peaoquarter5 48 Pfagette trzet ,aIrn,c u_01971J INSPECTION REPORT 1. Building Inspectors Certificate of Occupancy: Posted .Expiration Posted Expiration 2. Health Dept. License: 3. Maximum Number of €occupants per License: 4. Fire Alarm: Drill Switch provided: Drill Conducted: Full System with panel provided: Battery Power: Local Manual Pull Station on A.C. Power only: 5. Fire Extinguishers: Number of Extinguishers: Date last tested: 6. Exits clear and.unobstructed: 7.-Emergency lighting tested: 8. Two separate means of Heo ess from each room used: 9. Fire Drill procedure posted: 10. Emergency shelter agreement available: Location of Emergency Shelter: 11. Boiler Room enclosed: 12e Availaber le System Remarks: Date: City Pressure Pressure at Top of System Inspector: Company or F.P.B. (OVER) . 1 ! • CONNONWEALTWOF MASSACHIJSBTTS- • •k . • DEPARTMENT.OF•MLIC HEALTH' _ • • HOSPITALS AND AMI3ULATORY CARE FACILITIES,. CLINIC QUARTERLY -FIRE INSPECTIONAL REPORT • In accordance with the -requirements of General Laws, Chapter 148, Section.4,the Marshal or the head of a fire department, to whom he may delegate authority shall .; • *--....• * make an inspection every three months of institutions licensed hy and under the .-..• - supervision of the Department of Public. Health, and shall make a report of such inspection to the Department of Public Health on forms provided hy the Department of Public Health. In accordance with the statutory mandate, the. • North Shore Guidence Center -1 NarTIC 01. Mints 162 Federal St Salem Mass 01970 Aueress of L11111C was inspected on 03-30-82 'AAA.: 01 inspection by Raymond T Dansreau' Name -of Inspector APPROVED DISAPPROVED 3/3/it Date REPORT OF NSPECTION See Report on reverse side. cc: Building Inspector Health Dept. (Salem) Occupant • Dept. of Public Health (Mass.) file Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Mite/,‘ Date - . • ow: COPY SHOULD BE SENT TO CLNK-::::." Form #39 Basement; Remodeling going on.It appears offices are being built Building Inspector will have to approve this type of remodeling as to second egresses etc. 1st Floor: Corridor door at desk area if left in open position will need of installing a magnatic door holder or kept closed. 2nd Floor: Emergency lights in corridor not working. COMLMONWEAL T H OF MASSACrfUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148. Section 4, the Marshal. or the head of a fire department., to whom lie may delegate authority shall make an inspection every three months of.institutions license 1 by and under the supervision of the Department of Public Health, and shall ►hake a report of such - inspection to the Department of. Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Centber Name of Uilnic 162 Federal St Salem Mass 01970- AGtcress t?.i tunic was inspected on by APPROVED x DISAPPROVED 07-21-tit Date 07-21-82 - uate .oi zuspeeiion Raymond T Dansreau Name -of Inspector cc: Building Inspector Health• Dept. (Salem) Occupant Dept. of Public Health (Mass.) file REPORT OF INSPECTION The° corridor Exit doors on some-.°'floorswe're kept open withdoor stops This`:practice-':.c'ould become serious in event of a;fire :: the, spread. of flame would travel very fast:;:-in-thi-type- structure . Core ,doors -tobe ke it closed:; Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Form #39 a-, Signature and Title 07-21-82 . t)ate ONE COPY SHOULD BE SENT TO CLINK 2. Health Dept. License: 3. Maximum Number of Occupants per License: 4. Fire Alarm: Drill Switch provided: Full System with panel provided: atez , ;tascIu2th fire Department Peabiturters - 48 Tafagette ,Street Adem,Pa.U1S713 INSPECTION REPORT. . Building Inspectors Certificate Of Occupancy: Posted Expiration Posted Expiration Drill Conducted: Local Manual Pull Station on A.C. Power 5. Fire Extinguishers: Number of Extinguishers: 6. Exits clear and unobstructed: 7. Emergency lighting tested: 8.. Two separate means of egress from each 9. Fire Drill procedure posted: 10. Emergency shelter agreement available: Location of Emergency Shelter: 11. Boiler Room enclosed: 12e Avail able Remarks: Remarks: Date: City Pressure Battery Power: only: Date last tested: room used: Pressure at Top of System Inspector: Company or F.P.B. (OVER) 1 t, • x ,�..MMONWE .LTH.(.OF MASSACHUSETx` ('DEPARTMENT HEALTHOF;PUBLIC':`. OSp f MBULATORY,,CARE' FACILITIE C n•ITALS,AND Ai ^ ,; , . ,-,,, CLINIC QUARTERLY FIRE INSPECTIONAL REPOR t j'-n-•(Y^- Mri. •' --.Ci4./, . ;y..- m a.. i 'A1.: ^Y :.�.^ y Y .x y'.: Rey: '.•h`�. .1 .'yy��•. -In accordance with the requirements of -General' dra.ws, Chapter 148 'Section 4;;;the -Marshal or the head of a fire department;"to whomhe may delegate', authority ehal]'q make an.inspection every three months of institutions•licensed'by and underahe :"•_ :supervision,of the Department of Public Health, and •shall make a report of, such', ,,inspection to the Department of,Public Health on forms' provided by the Department' of Public Health. In accordance with the statutory mandate, the.-. 71, North Shore Guidance Center Name or 162 Federal St Salem Mass 01970 naaress or uimrc was inspected on 1-31-77 Late or inspection by Inspector Raymond Dansreau Name of Inspector APPROVED DISAPPROVED �ilo=0•t/ �l 0-47S 7 40144 d D . REPORT OF INSPECTION 1.Emergency lighting is of old plug in type with other type epuiptment plugged into same receptacle. 2.1 st floor unit dead batteries( not working)' 2nd floor exit signs are located about 36 inches high.Th's is much to ow and cou1> be torn down (over) Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Signature land Title // /Dee 7? ONE COPY SHOULD BE SENT TO CLINIC 1 , . .. f-...... ;',... ..4,4,-...-,. • 4 '''' '''' ' - ' ' ,,, 3 ,, • . . '1: 1,... o ,,,, '' ` ' ' • ..,..,,‘..,,,6.,Tkt, ,' , •,,t'' ' * i42,, '.. ' ... '., 4 t ......f...?: '-i- , ...:.,,..• ' • ,.!...,:,,.:-..,•., ., ot••0•-', ',..^' ',-7•• : ' • - ' 1. -' —° -•'.'','..-. •,:•, • • ' - ''''.'' ''''," '"•74... ..", °' • . ' , ' • -..0- • , -0", .•-• -. t. "' ..'' • '40! • ,, , , . •, ,, ., , •,..,, .,- ,,,,,,, _ - , "fk i• , • , • -i•• ,^{,,i 4,4,.,. •-''•,, - --; ' ,, ' , . --''.°,.; --, ..:,::• .'-7..? , r'.• -, - - .r- .1 . ,.i. 1. • . o. .. . "I' , • • ° - , W Jr• • • 7' ‘ i - • . ---4,- - • 7°'4 0 •• ' 0 - ' .. ° • 1 : '7! ' • ,,,, ?IA! --.c, 2 .% by "children as :.:.thpy move about. i-q, . , ,41,,y•-••;--,,,,,,,,, k.- , '',1 • . y I; :,:..s., ..: , 1', trif f,.. :3'.3rd floor .Emergency light s areloce.ea much.' to ' loW , about ,. 140inche S arid.-' irr 1 !..,'; :.,,t, s,,,..„,4,,,, , .,g, . , ,. case lights w.ere not .cworking'; unti V- it was nOticed,' tampeiiing hb.dC.'been'rk,i, , •,• • : , -, ., ,, . i• ,. , d.., ...yt . ', I le,,,i:f., ,„/ 4. done ' with fuse nob and on switch; was on' of f.,.--;?•,i •', '''' ' ' '''''' ' •'" • ' ''''''''' .."''' 9 ' ,. ,... ,01 f„' P." • t" '1 ' ",,k,L,,104, It t Re.c omMend fire alarm sounding device located.. on-lst• floor.be',-.•hai:iged''tr,o„ritif.i. .1«. , .. • i . 4, ' . an ordinary light •'. switch to a regular pull .-station`;,......-;..,' ' ‘,',.1••••••H:`;y,t,,,4:,•.-3.,•1?..,c•141,;.,,t;-iy.:::: Ifr.,--. • . , . - . . • • . . .. . . - - - • ' . '..,..4-',", / 5.. Recommend hangers be orovided for two exitingnd, sextinguishers,aany new,'„-_• )P . ..• extinguishers should be of tri-Class ABC type . • ' ' , -M,',- •,.. , , .1. .• • . ; ...• •.,.. , ., , 1 . . _ . • W.+ • ' e „ 1.• , , . . . I • • . . • - 4 1' • t. 4. o 73,4 -44/1 • 45`, r •':7 o :41 4 (.4:1 ; • ". ". • ` • • !.'.•, : ,...` .:::.... ..:: ' . . 1.. • ' '''''•,- T.F •,-,.' .••• '• . • , " r " • Por . ' * COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIESU CLINIC QUARTERLY FIRE INSPECTIONTAL REPORT Fz • In accordance with the requirements of General Laws, Chapter 148" Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center Name or Llinic 162 Federal St Salem Mass 01970 tiaaress or Lilnlc was inspected on 1- 31-7 7 iiate or inspection by Inspector Raymond Dansreau Name of Inspector APPROVED ati DISAPPROVED REPORT OF INSPECTION 1.Emergency lighting is :of old plug in type with other type epuiptment plugged into same receptacle. 2.1 st floor unit dead batteries( not working) 2nd floor exit signs are located about 36 inches high.Th°s is much to ow and couljbe torn down (over) °'-►_ Signs uye and Title //97?Date ONE COPY SHOULD BE SENT TO CLINIC Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 2. by children as the move about. 3.3rd floor .Emergency lights are located much to low,about 40 inches and in this case lights were not working,until it was noticed tampering hadbeen done with fuse nob and on switch was on off. 4. Recommend fire alarm sounding device located on 1st floor be changed from an ordinary light?switch to a regular pull station 5. Recommend hangersbe provided for two existing extinguishers,and any new extinguishers should be of tri-Class ABC type. COMMONWEALTH OF MASSACtivaa i lb DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT. i 4 In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the .supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center (Health & Education Services) Name or Liinic 162 Federal Street, Salem, Mass. 01970 Aaaress or uiuiic was inspected on March 1, 1977 Late or inspection by APPROVED DISAPPROVED March 7, 1977 Date Lieut. David J. Goggin Name of Inspector Please Return'This Report To: 'Carolyn Zavarine, M.D. Department of Public Health a Hospitals and Ambulatory Care • Room 940, 80 Boylston Street ,Boston, Mass. 02116 cc:'Building Inspector' r Electrical •Inspector REPORT OF INSPECTION Report on reverse side. sf Fire Chief Signature. and Title March 7, 1D77 Date ONE COPY SHOULD BE SENT TO CLINK Report of inspection conducted on March 1, 1977 at 10:00 A.M. As a result of an inspection made this date it. has been deter- mined if that this occupancy is being.,conducted.:in an';R-2 District, without a Certificate _of Occupancy. -. , , M.d.'� • r; •F•.' .'r ,. ,'r-t. k '• 4 It 'is therefor imperative•that.said Certificate,.of Occupancy -,be obtained for continued occupancy. Violations to be corrected for approval by the'_Saletn Fire Preven- tion Bureau are as follows:-. ..:�ks A. Basement Area: Build ing'Code.DER t - 1. If the rear basement room is to be used for conference -purposes 'tthe egress door shall ,be changed 'to' swing in''the direction of,' egress. 'A The boiler shall'be enclosed in an approved boiler room per Section 1113 of the` Mass. State Building Code. ' 3. Exit signs shall be placed over -each means of egress. '4. Emergency lighting shall be provided to properly light the • egress door and the stairway to the first floor. '' ' 5. The Electric service box is presently being used as a quick disconnect for the range, because of a defectiverange switch. This practice shall be stopped and the. electrical box shall be placed 'out of service by removal of all fuses. 6. The oil burner shut off switch in the stairs shall be repaired. B. First Floor Area: 1. Rear egress door shallhave exit sign placed properly over center- of door. 2. Rear egress door shall have dead bolt removed from same. 3. Rear egress directional sign shall be moved up to at least ° 60 inches in' height. 4. Rear emergency light continues to be inoperative, and the lights shall be aimed toward the door and the corridor. This unit shall also be permanently wired. (Plug in units are not acceptable.) 5. Emergency lighting at front egress is not operating and requires . a permanent wireing for' compliance. 6. Stairway to second floor is open and. ..creates a flue all the way, to the third floor. C. Second and third floors:. 1. Emergency lighting needed at all egresses from both floors. 2. 'bpen, stairway to third` floor `shall be enclosed in 'fire partition.. 3.-. Proper Red on White or; White on Red Exit signs'shall beposted.; ;' - F'4 4. Continued use of the third floor shall cease until -a second, means of. egress is provided from the third floor. D. General:, Additional fire ex tinguishers of the Ten Pound Tri-Class"ABC: type .shall be provided, so• as' to :have_ ,one '' near(each° egress on. each floor.., . An approved -fire alarm ,system shall• be required -if three floors are occupied as per 'Sect -ion .1218.217 :of the Mass.t State , lly subitt�d G avid,� J6/Gogg - • Report of inspection conducted on March 1, 1977 at 1O100 A.M. As a re::nl t of an inspection made this date it has been deter- mined that this occupancy is being conducted in an R-2 District, without a Certificate of Occupancy.' It is therefor imperative that said Certificate of Occupancy*be obtained for continued occupancy. Violations to be corrected for approval by the Salem Fire Preven-' •tion Bureau are as follows: - A. Basement Areas 1. If the rear basement room is to be used for conference purpoaess the egress door shall be changed to swing in the direction of, egress. 2. The boiler shall be enclosed in an approved boiler room per Section 1113 of the Mass. State Building Code. 3. Exit signs shall be placed over each means of egress. •4. Emergency lighting shall be provided to properly light the egress door and the stairway to the first floor. 5.' The Electric service box is presently being used as a quick disconnect for the range, because of a defective range switch. This practice shall be stopped and the electrical box shall be placed out of service by removal of all fuses. 6. The oil burner shut off switch in the stairs shall be repaired. B. First Floor Area: 1. Rear egress door shallhave exit sign placed properly over center of door. 2. Rear egress door shall have dead bolt removed from same. 3. Rear egress directional sign shall be moved up to at least 60 inches in height,. 4. Rear emergency light continues to he inoperative, and the lights shall be aimed toward the door and the corridor. This unit shall also be permanantly wired. (Pluck in units are not acceptable.) 5. Emergency lighting at front egress is not operating and requires' a permanant wirein: for compliance. 6. Stairway to second floor is open and create:: a flue all the way to the third floor. C. Second and third floors: 1. Emergency lighting needed at all egresses from both floors. 2. Open stairway to third floor shall be enclosed in fire partition: 3. Proper Red on White or White on Red Exit signs shall be posted. 4. Continued use of the third floor shall cease until a second means of egress is provided from the third floor., . D. General: 1.. Additional fire extinguishers of the Ten Pound Tri-Class ABC .. type shall be provided,, so as to have one near each"egress`on each floor. ...An approved fire alarm system shall be required if three floors are occupied as per Section 1218.217 of the Mass.' Stat Building Code. Re .. ... .. i'X C�t lly subitt eut. avid.7OGogg a�a COMMONWEALTH OF MASSACtHUSm ate DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT Iii accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head ofa fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision- of the Department of Public Health, and -shall make a report of such inspection to the Department of Public Health on forms provided by the Depaxudient of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center (Health & Education Service) Name or uimic 162 Federal Street, Salem, Mass. 01970 naaress or uunrc was inspected on . March 1, 1977 .uate or inspection by• APPROVED DISAPPROVED March 7, 1977 Date Lieut. David J. Goggin» - Name of Inspector REPORT OF INSPECTION Report on reverse side. Fire Chief 'Signature. and Title March» 7, 1977 Date ONE COPY SHOULD BE SENT TO CLINIC Please Return' This Report To: Carolyn Zavarine, M.D. Department,of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 cc:' Building Inspector Electrical .Inspector Si • . 1 Report of inspection conducted on March 1, 1977 at 10:00 A.M. As a result of an inspection made this date it has been deter- mined that this occupancy. is .being,conducted in an,,R-2 'District, Without) . Certificate of Occupancy. , - ' , , •f. It is therefor.imperative that said. Certificate i of- Occupancy,be obtained for -continued occupancy.. • ,? Violations to be corrected for approval by. the Salem Fire Preven- tion Bureau are as follows: A. Basement Area: 1. If the rear basement room is to be used for conference purposes; the egress door shall be changed to swing in the direction of egress. 2. The boiler shall be enclosed in an approved boiler room per Section 1113_ of the Mass. State Building Code. _ 3. Exit signs shall be placed'over'each means of egress. 4. Emergency lighting shall be provided to properly light the egress . door and_ the. stairway. to the first. floor. ' - ' �-- 5. The Electric service box is presently being used as a quick disconnect for the range, because of a defective range switch. This practice shall be stopped_ and .the .electric',, box shall be placed out of service by' -removal of all fuses. 6. The oil burner shut off switch in the stairs shall be repaired. B. First Floor Area: 1. Rear egress door shall have exit sign placed properly over center of door. ' 2. Rear egress door shall have dead bolt removed fr.om.same. 3. Rear egress directional sign shall be moved up -to at least 60 inches in height. 4. Rear emergency light continues to. be inoperative, _and the lights shall be aimed toward the door and the corridor. This unit shall also be permanantly wired. (Plug in units are not acceptable.) 5. Emergency lighting at front egress is not operating and requires a permanant wireing for compliance. 6. Stairway to second floor is open and creates a flue all the way to the third floor. C. Second and third. floors: 1: 'Emergency, lighting needed at all egresses from both floors. '2. Open stairway to third floor shall be enclosed in fire partition. 3. Proper Red on White or White on Red Exit signs shall be posted. 4. Continued use 'of the third floor shall cease until a second means of egress is provided from the, third floor.„ :..: f, T ; D. General: 1. Additional fire extinguishers of the Teri -.Pound .Tri-Class ABC type shall be provided, so as ito have onef•near.= eachfi egress on each floor. ) f ." Fr. 2. An approved fire alarm system shall be requiredaif three floors are occupied as per Section 1218.217 of the Mass.. State Building Code. KZ Re pect lly subittt � . O ie��uut. avid Jl/Gogg Salem Fire Marshal COMMONWEALTH OF MASSACtiUbETTS DEPARTMENT OF PUBLIC HEALTH. HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT • In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public'Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In'accordance with the statutory Mandate, the Noy7%H SAfeeE %r�r2�nr� Ce,ie ,/ (tIiLi71 44.- ?o i lvame or uiinic G' A ce' F,e"4 S' 7 S4 , Criss o/ ' 7 d riac.ress or Liinie was inspected on 6//‘ 1 Ce or inspection by ( T Nam Inspector APPROVED DISAPPROVED X idi?/77 Date REPORT OF INSPECTION Report on reverse side. "Signature and Title /i /77 Wit. Date ONE COPY SHOULD BE SENT TO CLINIC Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 - n Report of inspection conducted on June 16, 1977 by Capt. D. Francis. at 162 Federal 'Street, Salem, 'Mass. All conditions listed on inspection report of Lt. David J. Goggin on March 1, 1977 'continue'to exist with 'the,.exception" of. the following items. Y- ' A. 6 Basement -Oil burner shut off .switch` has lbeen repaired. i T �f.a.�' r " i ` rl . B.4 First Floor: Rear emergency light is working but still does not KaN±aNNRx have permanant wiring as required by code. B.5 First floor: Front egress emergency light`is working but still does not comply with code for permanant wireing. It appears that the owners_ .are_:obtaining bids for starting.work to bring the occupancyc up to ode''requirements. l4 • 1 61' :tw 9' ti .. 06' • _ `t `l „•.. :344i r-1 • •1/r. . COMMONWEALTH OF MASSACHUSETTS •. DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the /1�i,/IA SA„ dam' L r� n ,ie- c(1eaJf4 ,e Edo Go n Nanie or iimxc /ice 7.. Fe c/e✓cV/ S 7 ,5 q%;71 ii.7c7 © jc9 7 e Aaaress or uimic was inspected on by APPROVED •� DISAPPROVED 'Date (2 1 Late bt inspection gNarne ,9f Inspector REPORT OF INSPECTION Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and 'Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 re and Title � v ig� te? 1 ba Set .sJ ONE COPY SHOULD BE SENT TO CLINIC co/41 11;2 (..A-2' d /b�j1 „1/I _ k )4AA'. /. pe,0-9 a Eilw,a-e-er' "i_yvic; • 0/b-r- ar)-IP *(1),,,17 ,j,„ 9 is :.. • SALE/M/ FIRE DEPARTMENT INSPECTION REPORT BUSINESS : G� XXADDRESS :AZ Fe��' TEL: / "2"'d� /eG��s..44 //e4, y--/GlGrcc ✓J�. /� 3/- /.tJ P . T . N .: ADDRESS: o r,.TEL: .,'7.2 `�' 9 ?,.? �-�T`� BLDG. OWNER : I ( WrtADDRESS : . c7Agnt TEL: ANSWER ALL QUESTIONS EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building appear to be free from rubbish accumulations, ary vegetation or anything of a combustible nature tending to create a fire hazard? 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside means of egress free from any obstruction that may interfere with the safe exit of the occupants? . 5. Do porches and fire escapes appear to be tion, and free of obstructions? 6. Do outside sprinklers and standpipe connections appear to be in good and usable condition? 7. Are the entrances and hallways clear from any obstructions that may interfere with emergency exit, of occupants? $. Are all interior spaces consistant with good housekeeping practices? 9. Are necessary lic. & permits posted, & currently dated? 10. Are the occupants complying with all regulations and con- ditions as prescribed on the licenses or permits? 11. Are all vertical shafts and stairwells properly safe, guardedself-closing and rovid d with devices? a-&6aQhed rr" -6 12. Are all fire extinguishing appliances readily accessable, and have they been inspected, weighed or recharged? ' See a-&&ab-/ 13. Does this occupancy have an interior alarm system? 14. Has the interior alarm system been tested recently? 15. Is an_emergency lighting system provided? yv s, if so, is it in good operable condition? 16. Does this occupancy have any manufacturing process which would constitute a fire hazard? Aro , if so, are the pro- per fire extinguishers provided? 17. Is this occupancy pfotected by a sprinkler system? 18. Are sprinkler gauges showing proper pressures? in a safe condi- CJ Y�J yes 20. Are all areas used for storage or piling of products maintained in a safe and orderly manner? 21. Is the basement free of any rubbish accumulation and maintained in a safe manner and consistant with good housekeeping practices? 22. Does the heating system, including the chimney, appear to be in a safe operating condition? 19. Are all flammables stored in proper containers and kept in an approved storage area? ei9 7�S yes 23. Does this eccupancy have a current fuel oil permit posted,f/e s and the storage appear in good condition? 24. Does the premises appear to be free of any electrical f/_ hazards? 25. Does the occupancy appear to have any structural defects? Ve-_s 26. Has a Form #17 complaint form follow-up been made for this inspection? Write a brief description of any violations discovered during this inspection? 0,4,6Q 4,„4-,44,4 „e, i aia Natne of person to whom verbal recommendations were made: Date: // FORM 16 (Rev. 2/70) Inspected by: i cz NJ92. Approved by: . We/11/ Company Officer COMMONWEALTH OF MASSACrIU'ETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONTAL REPOR In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of _Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore GIAIC.ance Centr Name of ulnlic 162 Federal Street, Salem, Hass. 01970 iiacress o.t U!inxc was inspected on November 23, 1977 Jaw of inspection by APPROVED DISAPPROVED t/ Dec. 6, 1977 Lt. Wallace 1\9 i.11 r Name of Inspector REPORT OF INSPECTION Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Signature and Title Dec. 6, 1977 Date Fire Chief ONE COPY SHOULD BE SENT TO CLINIC ga.5e, Alt 1rl ctel�L•- n , Nd 3 rci .A( .1-21; . / J4, 444/4 ,#tAPY•.) r61,L el -ill- At • 3 J —'4*/ elt14;61/ AMI / 64) 4, 1/ � = w COMMONWEALTH OF MASSAOrdUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center Name or u nnic 162 Federal Street, Salem, Mass. 01970 raaress of uunic was inspected on by APPROVED DISAPPROVED November 23, 1977 care or Inspection iz Dec. 6, 1977 Date Lt. Wallace Miller Name of Inspector REPORT OF INSPECTION R,,�f CJ.�1�ti•..�a.� Fire Chief Sigrature and Title Dec. 6, 1977 Date ONE COPY SHOULD BE SENT TO CLINIC Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 „y,40-v-ed 41 /4M-e&, f . V V .. %!- e mac.. .zierr?‘) 1:4t,t.wmtle)77, ie-kAlet-a) 09, aJ If eZzel /0 . Orr (stet 65 "467C ` F •aiv ;,.ez/vin).•d)i,, •/Ifti-t;1-4, 71 64''! . a.tset, lat.vut _46/ /cod, zz _<& • i4/ Zzietace, CO:i'tOt;TE hLTit O AssAc losuf'TS DL•:P71IIT`tE:1T cr PUELTC iti:AI: E t)IVISION OF MEDICAL C2RE BlIgl:AU OF HEALTH FACXLITIES FIRE CERTIFICATE OF IOSPECICN In accordance with the requirements of General Laws, Chapter 111, Section 51, this Fire Certificate of. I ;pect::on issued by the head of the local fire de-, partmn.nt certifying cclpliance with local ordinances is a prerequisite for an on ginal or rei,.,•:ral license. fr.. North Shore Guidance Center frame--oi_Cli.n is • Federal Street, Salem, P+bass. 01970. '. Address of C"lime was inspected on 4/1/74 by 'ieut. David J. Goggin Date Nate of, ;`ire Inspector. ' •I nn'PDY CErtrIrY THAT THIS INSTITUTION CO'"4PLIES WITH.THE LOC Yes GL/7(44,0-- -G ' If anse'er is "No", indicate violations and recommendations. .'Violations: hcccrcmendations: ' Provide Exit signs over egress doors complying with'.proper.,�`': five inch size per code. Provide hangers for fire extinguishers, and,; any new extingu.rsh'er. are recommended to be Tri-Class ABC type. J Issued by: NSTRUCTI Oi":S: I/ ' FIRE DEPIUU -1ENT TO RpTUPN TgO COAPLETF,D COPIES TO CI.IMIC' CLIiNIC TO R: PU^1I C1.9E COPY TO: Carolyn Zavarinc, M.D. Division of Medical fare Room 940; 80 Boylston Street' Boston, t:assachusetts 02116 . orm 30 COMMONWEALTH OF MASSACHQSETTs DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center Name or uunic 162 Federal Street xaaress or Limit was inspected on August 6, 1974 pate or inspection by APPROVED DISAPPROVED v2p. Date Insp. T.J. Hull Name of Inspector REPORT OF INSPECTION Recommended to leave rear EXITLOOlit Recommended to repair test button o emergency light on third floor. Recommended to hang extingusher in area so t-'hat it would be visible, Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 ' ' Date unlocked.. n kitchen Title . ONE COPY SHOULD BE SENT TO CLINIC COMMONWEALTH OF MASSACHUS ETTS DEPARTMENT OF PUBLIC HEALTH -HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTF,RLY FLRE ENSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire departr e nt, to whom he may delegate authority shall make an inspecticn every three months"cf institutions licensed by and under the supervision of the Department of Public Health, end shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the Short G!Verne �, tcianoaxrtr anAuuc 162 Federal St. Salem, mass. 01970 xacress of Uiinic was inspected on by APPROVED DISAPPROV F,D Date November26, 1974 pate of Inspection T ,J. Hull Name of Inspector Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Room 940, 80 Boylston Street Boston, Mass. 02116 REPORT OF INSPECTION Recommend to leave rear EXIT DOOR Recommend to repair test button on light on third floor. Also on sec Facilities Signa.ttire and Title Date ONE COPY SHOULD BE SENT TO CLINIC unlocked. emergency and floor. • COMMONWEALTH OF MASSACtiUbETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE ..FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore 162 Federal was inspected on by APPROVED DISAPPROVED 7 Date Guidence Center Name or manic St. Salem Mass® 01970 t�,aaress otf uianac Febrjiary 1.Inspection 1975 to or Tngr R _R Etn1 l nran Sr,. Name of Inspector REPORT OF INSPECTION Rec: Repair emergency lighting on third floor. Remove exposed wire in stage area. Larger EXIT signs on third floor. ONE COPY SHOULD BE SENT TO CLINK Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 - 1• 11 y{t COMMONWEALTH OF MASSACt1USETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with `the statutory mandate, the was inspected on by APPROVED X DISAPPROVED ./23 75 Date North 4"re c td ace Canter 162 Federal St. Salem, Mass. tiaaress or utmac J -P ispection R n+.0 1 1 • R_ Rnl l nwa n Narne of Inspector REPORT OF INSPECTION All conditions found satisfactory. Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Chief t "re an• it e 4 3/'3 /Date ONE COPY SHOULD BE SENT TO CLINK, COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public Health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center Name of Llmle 162 Fedral Street Salem, Hass. 01970 was inspected on by A P PR O V E DD Actc'i.ress or Lii.nic August 8, 1975 Date or inspection Insp. T . J. Hull Name of Inspector DISAPPROVED August 8, 1975 REPORT OF INSPECTION a Rear Exit light does Rear EXIT door still being left in locked position. When left unlocked Door sticks and is difficult to open. Remove loose wire altogether from auditorium Date areas Signature and Title u " ill I9%,c Date ONE COPY SHOULD BE SENT TO CLINIC Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 • i COMMONWEALTH OF MASSACHU TITS DEPARTMENT OF PUBLIC HEALTH HOSPITALS AND AMBULATORY CARE FACILITIES CLINIC QUARTERLY FIRE INSPECTIONAL REPORT In accordance with the requirements of General Laws, Chapter 148, Section 4., the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department of Public health, and shall make a report of such inspection to the Department of Public Health on forms provided by the Department of Public Health. In accordance with the statutory mandate, the North Shore Guidance Center Name or Manic 162 Federal Streeb Salem, Mass. 01970 Aaaress or uimic November 5, 1975 was inspected on vate or inspection Insp. T.J,, Hull by - APPROVED t/ DISAPPROVED )g/ Date Name of Inspector REPORT OF INSPECTION 1. Rear EXIT door still being left in locked position. When left unlocked door sticks and is difficult to open. 2. Remove goose wire altogether from auditorium. Please Return This Report To: Carolyn Zavarine, M.D. Department of Public Health Hospitals and Ambulatory Care Facilities Room 940, 80 Boylston Street Boston, Mass. 02116 Signature and Title Date mil of Fire Dep ONE COPY SHOULD BE SENT TO CLINIt Conditional, subject to correction of above #1 and #2 as noted. HEALTH AND EDUCATION SERVICE, INC. 162 FEDERAL STREET SALEM, MASS. 01970 SHORE BANK AND TRUST COMPANY LYNN, MA 01901 53-251/113 CHECK NO. 3497 DATE i'11/01/89. One Hundred Twenty -Two Dollars*****************************00/100 PAY TO THE ORDER OF The Knox Company ORDERED BY: Company Street. City/State. Contact person: 1100311971P 1:0LL3025L91: 000L LOSE" C.AKtF-ULLY t;UMI'Lt I t .t Mt 1-ULLUWINU Type or Print Clearly PO. # N/A Order Date' November 1, 1989 Health and Education Service, Inc. 162 Federal Street Salem, MA Paul C. O'Shea Phone. 508-745-2440 SHIP TO: (Do NOT use P.O. Box) Inspector Norman P. LaPointe Salem Fire Prevention Bureau Attention of. Company zIP- 01970 street- 48 Lafayette Street City/State- Salem, MA zIP. 01970 OINSTALLATION ADDRESSES: (This is an agency requirement.) Purchasers must list all actual installation addresses in the space below. This fist is necessary for agency security records and is confidential. BUILDING NAME STREET ADDRESS Health & Education. 162..Federal. Street.. ATTACH ADDITIONAL PAGES IF NECESSARY. .:.bY.0W1111ww...1.. . Id. WIi11 .YYWI Maw. i., IS . I.,I. IY n.I i II in.4.1.11111 Ihl milk.. alM.l ilia ATE DEVICE KEY OPERATED SWITCH MODEL KS-2 -Key removable in either position. For override control of electric doors, gates, equipment, etc. Includes simple mounting kit. KS-2 With Dust Cover -- — KS-2 Without Dust Cover - KEY OPERATED SWITCH MODEL KS-2P t with Mounting Plate and Fire Department Operation Decal. Plate - 27/8"Wx 49/16"H x Vs" thick aluminum with Fire Department Operation Decal. Fits standard single gang electric switch box. Includes gasket and mounting screws. Finish color: aluminum. (For decal only, see below.) KS-2P With Dust Cover KS-2P Without Dust Cover Fire Department Keyswitch Decal only- FlinEPT For use on custom installation panels. Decal is 222/32"Wx121/32"H. Constructed of the finest 3-M reflective material. Weatherproof Heavy Duty MODEL PL-1W PADLOCK-3/4" diameter hardened steel shackle with solid cast brass body and pull resistant shrouded key hole. EPDM Elastimeric body case and solid brass keyway cover offer substantial weather resistance. CITY Salem, MA AMOUNT 7tA122.00 UTHORIZED SIGNATURE .I -: - I' -II 1 ' 7 ;:,TIKCT ULIGC?•r. AGENCYUSE:ONL Issuing Agency OT.VALIDUNLESS SIGNED THORIZED.: J 1..ru 11 ills i6A.1In . . I. I I1 Y J114I 1 I I :1I.4 .In.1I lY11 . LI .1 11 Yli KNOX CO. USE ONLY REC'D. RETURNED i VERIFY O/N I = REJECT s z n. n.11.1001111.....S1a y„'✓. 1 1 MA y1 li .'I IS WWII. 11111.IA11 .1,•. Ili. -, .1 .11. Olf IIIN19r• ° 11.1.0l.f "'" - iY1W1YI...oWW..lwy..11l WAWA ® PRODUCT SECTION OTY. PRICE TOTAL 38.00 29.00 48.00 39.00 1.00 56.00 35-D --35 35P-D 35P 48 36-W CESS • FIRE DEPARTMENT ALERT DECAL - Decal should be placed on all exterior doors to alert firemen that the building is equipped with a KNOX-BOX device. Decal is 2" square and made with the finest 3-M reflective material. One decal included with each unit. -KEY-TAGS-White fiber- - Package of 10 tag with spring clip Package of 25 Package of 100 Package of 250 TAMPER SEALS - Package of 50 Consecutively numbered. KEYRINGS-1" diameter, durable solid brass rings. Package of 100 4 keyrings 25 keyrings l.fls� OTY. PRICE TOTAL 1.00 2.50 37 6.00 18.00 40.00 8.00 12.00 37-T 37-T 37-T 33 34 1.00 39 5.00 398 Heavy Duty MODEL PL-1 PADLOCK- 3/e" diameter hardened steel shackle with solid cast brass body and pull resistant shrouded key hole. CARRY TOTALS TO OTHER SIDE IF 42.00 36 A CARRY TOTALS TO OTHER SIDE ` r • �7."Y•Mu. .''r.15.r u: k.i'A h.*�,.,'S'v.4s ti-^1. :, k.. .i"Y. J.*..a:�c . R' tMODEL 4400• U Surface Mount Extra Heavy Duty KNOX-VAULT-5/8" thick steel door. Large Capacity. Outside dimensions: 7"Wx7"Hx5"D. Approx. wt. 23 lbs. Surface mount Model 4400 without tamper switches Black Aluminum Dark Bronze Surface mount Model 4400-TS with tamper switches Black Aluminum Dark Bronze tMODEL 4400-R* O Recessed Mount Extra Heavy Duty KNOX-VAULT-5/8" thick steel door. Large Capacity. Outside dimen- sions: 7"Wx 7"H x 5"D with 91/2"x 91/2" flange. Approx. wt. 24 lbs. Recessed mount Model 4400-R; no tamper switch Black Aluminum Dark Bronze Recessed mount Model 4400-RTS with tamper switch Black Aluminum Dark Bronze RECESSED MOUNTING KIT - MODEL 4400-RMK-Greatly simplifies mounting in new concrete or masonry. For use with Models 4400-R and 4400-RTS ONLY. Kit contains shell housing which is cast -in - place during new concrete or masonry construction. KNOX-VAULT then mounts inside shell housing with hardware provided. NOTE: Special Application. t For areas in which salt air, acid rain, and other extreme environmental conditions increase the threat of corrosion, we recommend aluminization of all 4400 Knox -Vaults. D,EL 3200 K W LOCKBOXE tMODEL 3200 0 Surface Mount Heavy Duty KNOX-BOX-1 "solid steel plate door, 1/4" steel case. Outside dimensions: 4"Wx 5"H x 31/4"D. Approx. wt. 9 lbs. OTY. PRICE TOTAL Surface mount Model 3200; no tamper switches Black Clne Aluminum Dark Bronze Surface mount Model 3200-TS with tamper switches Black Aluminum Dark Bronze tMODEL 3200-R O Recessed Mount Heavy Duty KNOX-BOX-1/2" solid steel plate door, 1/4" steel case. Outside dimensions: 4"Wx 5"H x 31/4"D with 7"x7" flange. Approx. wt.10 lbs. Recessed mount Model 3200-R; no tamper switch Black. Aluminum Dark Bronze Recessed mount Model 3200-RTS with tamper switch Black Aluminum Dark Bronze RECESSED MOUNTING KIT - MODEL 3200-RMK-Greatly simplifies mounting in new concrete or masonry. For use with Models 3200-R and 3200-RTS ONLY. Kit contains a shell housing which is cast -in - place during new concrete or masonry construction. KNOX-BOX then mounts inside shell housing with hardware provided. NOTE: Special application. t For areas in which salt air, acid rain, and other extreme environmental conditions increase the threat of corrosion, we recommend aluminization of all 3200 Knox -Boxes. • A11 4400 series vaults have 5/9" thick solid steel doors with drill resistant hard plate and a special relocking feature. MAIL COMPLETED FORM TO: THE KNOX COMPANY 6 7 1210-WH WEATHER HOUSING - Constructed entirely of 3/16" aluminum for extra life. Use with 1300 and 1220 Key & HAZ. MAT. Vaults when an outdoor installation is required. Outside dimensions: 23"H x 20"Wx 14"D. Add 23.00 Add 34.00 298.00 304.00 Add 23.00 Add 34.00 227.00 275.00 42 43 A B 46 47 A B 32E 32F MODEL 1100 DATA STORAGE BOX -For use by small businesses. Holds information, MSDS and floor plans, interior capacity of 13"Wx11"Hx2"D holds a 11/2"thick binder. 187.00 .. 38 All steel construction. Tan polyester powder coat finish. Outside dimensions: 14"Wx14"H x41/4"D. Approx. wt. 20 lbs. IAEDIU 0 8 MEDIUM DUTY° Surface Mount MODEL 1650 KNOX-BOX-All 1/4" heavy plate steel. Tamper switch not available on this model. Olive brown polyester powder coat finish. Outside dimensions: 4"W x 5"H x 17/e"D. Max. 3 key capacity. Weatherproof. Approx. wt. 5 lbs. 9 10 11 12 13 14 186.00 201.00 201.00 216.00 231.00 231.00 16 17 18 19 20 21 MAT` DA'f MODEL 1300 HAZ. MAT. DATA STORAGE AND KEY CONTROL CABINET ®-This model Is designed to fill high -security, on -site MSDS storage and key control needs. Use in highrises, large industrial complexes, and office buildings when security is a major concern. Beige polyester powder coat finish. Includes tags and hook panel for 27 keys. To weatherproof, use 1200-WH or 1210-WH weather housing shown below. 141/2"W x 18"H x 5" D, Approx. wt. 60 lbs. 383.00 141/2"Wx 18"H x 7" D, Approx. wt. 62 lbs. 391.00 OTY. PRICE TOTAL Option "TS" - Dual Tamper Switches Option "2A"-2 locks: Key to either lock will open vault Other lock options available. Please contact factory. MODEL 1220 HAZ. MAT. DATA STORAGE AND KEY CONTROL CABINET -This model is designed to fill medium -security, on -site MSDS storage and key control needs. Use 221.00 22 for highrises, large industrial complexes, and 236.00 Y3 office buildings. Beige polyester powder coat finish. Includes tags and hook panel for 9 keys. Single fire 236.00 24 department lock and tamper seal are standard. To weatherproof, use 1200-WH or 1210-WH weather housing shown below. 236.00 251.00 251.00 49.00 40.00 each 25 26 27 28 141/2"Wx 18"H x 5"D, Approx. wt. 47 lbs. 141/2"W x 18"H x 7"D, Approx. wt. 50 lbs. Option "TS" - Dual Tamper Switches Option "2A"-2 locks: Key to either lock will open vault Other lock options available. Please contact factory. 1200-WH WEATHER HOUSING - Constructed entirely of 10 gauge steel; for use with 1300 and 1220 Key & HAZ. MAT. Vaults when an outdoor installation 50 is required. Outside dimensions: 23"H x 20"Wx 14" D. 114.00114.00 129.00 4 1.29.00 5 144.00 159.00 159.00 142.00 157.00 157.00 157.00 172.00 172.00 MEDIUM DUTY Surface Mount MODEL 2900 KNOX-BOX-This model is designed for lower level security (e.g. utility doors, gates, boat docks, parking structures). Tamper switch not available on this model. Black polyester powder coat finish. Outside dimensions including baseplate: 4"Hx4"Wx21/2"D. Approx. wt. 5 lbs. B Total from right column: 39.00 15 * Total from left column:. Total from front page: -- -- v California deliveries add correct 49 each state sales tax (60/0or 6.50): Shipping & processing charge: Alaskan & Hawaiian shipments: $12.00 total 78.00 99.00 114.00 ADD $8.00 TOTAL la ®El ®®$ 122.00 SEND WITH ORDER o Form must bear "Authorized Signature" -Section 5® ® Full payment must accompany this order • Make check payable to The Knox Company 45 2 P.O. Bb 2684, Newport Beach, CA 92663 (714) 650-2885 © The Knox Company, 5/88 cAzaaadatizetta, .9atai& Warnrithsathn. ROBERT O. CRANE CHAIRMAN CHARLES V. BARRY WILLIAM KILMARTIN FREDERICK S. PILLSBURY, Esq. DENNIS R. TOURSE, Esq. 15. garicelak Meet gka:ezi,ee,, diazwarizaaal 0,218.,E �eL (67) 849 - 5555 FAX: (617) 849-5546 CITATION NAME OF ORGANIZATION ID# St. James Church 161 Federal Street Salem, MA 01970 4 0 6 1 8 JAMES E. HOSKER EXECUTIVE DIRECTOR HEAD OF ORGANIZATION MEMBER -IN -CHARGE Reverend Francis Delaney Clarence Chaklos DATE OF VIOLATION(S) REPORTED BY INVESTIGATORS) July 24, 1990 Vincent Fabucci VIOLATION(S) SECTION 3.04:(3)(c) - ACCOMMODATIONS TO BE FURNISHED PLAYERS "...Under no circumstances may the public be admitted to a building which does not have the required occupancy permit." Certificate of Inspection Expired July.18, 1990 REPLY TO THIS CITATION WITHIN FIFTEEN (15) DAYS WITH A WRITTEN EXPLANATION OF CORRECTIVE AND PREVENTIVE ACTION TAKEN. MASSACHUSETTS STATE LOTTERY COMMISSION BEANO CONTROL DIVISION. JO'EPH INGEMI, JR REGIONAL MANAGER PHOTOSTAT COPY TO MUNICIPAL CODE OFFICERS: BUILDING INSPECTOR William Monroe FIRE CHIEF CHIEF OF POLICE Joseph Sullivan Robert St Pierre SALEMFIFIRE DEPARTMENT - INSPECTION REPORT ADDRESS: /5 (� `f`)�P F- S T, � TYPE OF NAME OF OCCUPANCY: .Sl . syym s ('i 0_L OCCUPANCY P.T.N. re, 1 e)4niey ADDRESS %�jc% / G/),p4/ Y JTEL BLDG. OWNER /4,0 , QFgQ6-7L0 ADDRESS /6/ lqi2r3P411/ s' f TEL POSTED ANSWER ALL QUESTIONS: EITHER "YES", "NO", OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free of rubbish accumulations, or other fire hazards? yyP5' 3. Are facilities provided for the safe disposal of rubbish? \/'P �j' 4. Are all outside egress paths free from any obstructions o' that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and 'free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.&Y. valves open and padlocked?_ Is a gauge provided at the top of the system? 16. Is this a "WET" or "DRY" system? yeos ntoiu, y es PS )) Ain Form #16 (Rev. 1/79) 17..Does this occupancy have.an interior fire' alarm system? 18. Date -of last test of the interior fire alarm system? - a 19. Does this occupancy have a direct Fire Alarm connection? • yp '' Master Instant Type :Box 4 437 ADT4 Alarm 4 AFA* 3Mfl Other 20. Is emergency lighting system or units provided? yPc 21. Are all emergency lighting units in good operating condition?yP3' 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23.-Are all flammables stored in proper containers and/or stored in an apFroved storage area? 24. Are all areas used for storage maintained in a safe manner? ) P.,5 25. Are basement areas free of any rubbish accumulation? 26. roes the heating system, including•the chimney, to be in'a safe operating condition? 27. Ts a current fuel oil permit posted and storage 2B.- ?re there any electrical hazards? 2a. r -,pc the occupancy appear to have any structural 30. Has a Form 25D (Inspection Recommendation Form), and issued for this inspection? appear proper? 4 defects? been made Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau notification, file a Form *58 (Complaint Form) . If the violation appemrs to require immediate action, notify the Deputy Chief on duty. List each remark with item number for identification. Name of person to whom Form *25D was issued: Date: 0/145:/afen ,9 spected by: Approved by D.C. in charge of Insp. Approved by: Date: ly1 �t ��� ik Company Officer Form 416 (Rev. 1/79) P.T.N. checked by F.A. Ftviti 82 , CERTIFICATE OF COMPLETION — FIRE ALARM INSTALLATION POD City u# ,SAICTC[, 4tactiusettz girt Ptpartrand Pabquarters 48 'zftrgette*rut *lent, AL 01970 Dee: August 30, 1990 The undersigned installer of a fire alarm system, plans of which were approved, and a Form 81F is on file; hereby certifies that the installation (or alteration) of said fire alarm system has been completed in compliance with the guidelines and provisions of the Salem Fire Department and the Massachusetts State Building Code. Furthermore, this installation has been tested in the presence of an inspector of the Salem Fire Pre- vention Bureau, and complies with the provisions of the Massachusetts Electrical Code. Complete instructions as to the use and maintenance of the system have been furnished to the person(or persons) for whom the installation was made. Installer's Location: 160 Federal Street Company Name: Crannev Electric Owner or Installer's Occupant: Federal Street School Signature: License No. A 11918 Type of Occupancy: Commercial x Residential Signature of Date of Certification 8.30.90 Fire Prevention Insp. No. of Residential units Capt. Turner Salem FJ e DepaA tment FtAe Pn.even t,con &.vtPfv,z 48 Lafayette S t zee-i Sa.Cem, Ma 01970 (617) 745-7777 FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR 13UILDING PERMIT In accon.da.nce w-tth the pnov-t aion-s o4 the Mates-5achuzettts State Buttdtng Code and the Salem F-vz.e Code, app-aLca i.on -tis hen.eby made 4on_ appn„ova-e o4 p-ea.nz and the -to-suance of a ceAtt.4.icate o4 appAova.. 4on. a bu-iJ4Ln9 penm,it by the Sa-eem F-vz.e Department. (Re4. Section 113.3, Ma-s-s. State S-My. Code) Job Loca t-Lon: Owneir./ O ccu pant : E-eectAtcat Conr,acton.: F-vr.e Suppn.ezzton Con tac tor.: S-Lgnatun.e o Appt.tcant: Addn.e-a-s o6 A p p-e-Lean. : l (a V'-eckr S � ST G ?Cc v Ctrav‘„, ciKt Appn,ova.0 date: _ C/ O Phone #: C-ity vn Town: Sde h %Z?- l4l) Cen t 4tcate o4 appnovat -ice hen.eby gn.anteil , on appn.oved p-ean- on, zubmt ta-e o- pn,oject deta..irez, by the Salem FJ e Depan meat. A-2C pear- an.e appn.oved -oZe-Cy .6on..-i.den,#t4 t.co Lon o4 type and .coca t-Lon o6 4tAe pn.otec tJ.on dev-i.ce5 and equ-t.pment. AZe p=Ca.n-s are -subject to a.ppn.ova.e o4 any othen. a.tthon.tty hav-ing juAtzd-t ction. Upon comp-Cet.Lon, the appfi cant on. zta Uen (ems) -shah n.eque-t an tnz pec t t.on and/on. test o4 the 4tAe pn.otec t i.on devtcez and equipment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) d New corvstiLucti.on. '. .-i' P..openty .eocatton ha-s no compt.t.ance w-tth the pn.ov-i-is-i.ona 04 Chapter. 148, Section 26 C/E, M.G.L. , n.eZative to the -i.nv ta,Ca tt.on. o4 appn.oved 4tAe a.&vun device-. The owner. o4 th-t-s pn.o pen ty -t-s n.equ-vt'i1 to obtatn compZi.cance az a condttLon o4 obtatn.tng a Suttd ing Pe'um t. Pn.open y £oca t i,on -tom -in comp2.iance wi th the pn,ov-i.a-Lono o4 Chapter. 148, Sect -Lon 26 C/E, M.G.L. ExptAatLon date: C �rTh Rct-l„_ Fee due: undeA 7,500 Sq. Ft. ` $1 0. 00 ..7, 500 Sq. Ft. on. -ean.gen. - $25. 00 S-igna-un_e o- F-vz.e 04. tcta2 Fonan #81 (Rev. 9/87) (1titu of *aim, iJ to zac.jusettL FIRE DEPARTMENT - FIRE PREVENTION BUREAU 48 Lafayette Street Salem, Massachusetts 01970 Fee Due $10.00 Ck. # Cash Rec'd by: (Date) APPLICATION FOR PERMIT To: HEAD OF FIRE DEPARTMENT In accordance with the provisions of the Mass. General Laws and/or the Salem Fire Code, application is hereby made for a permit to install approved fire alarm devices. Location: I (o d C' oe TQ,— - S-Owner: i.^! V 1 o Ci e se Or t2 J 0 S) A A) Installer: eV-is-N rUre C(Q. cT' Tel # S 2 % ^ S' rn ((-) Installer's Address: 3 C o-Th 5 ,--c c i ST License # i ((5 ( Type of Occupancy: 5 C 4 0 0 4- - LIST TYPE AND LOCATIONS OF DEVICES ON REVERSE SIDE, OR PROVIDE PLANS. - Installation subject to final inspection and filing of Certificate of Completion, taller. In 0 Iler must be present. Date of ap proval: pproyal: Date of expiration: Form #81F (Rev. 12/88) DO NOT WRITE BELOW THIS LINE (Signature of Applicant) (Address) G.V.W., INC. HOME QFFICE ACCOUNT„ ' 256 MARGINAL ST. -h E. BOSTON, MA ..02128 A /,7/Pg14 DATA TOTHE ORDE � r� ee CD FIRST MUTUAL OF BOSTON a tv 010E 1- r 1', _ DESCRIPTION 11'00 19 1411■ I: 2 1 LO 7008 LI: 9 L 00 36 16 L11' In, us. I MI. nu• •• WOW i 11 a 1n. .n. d oa ni eu 1,111. .I. ni O ORDERED BY: Company. Street' City/State: Contact person: 1 . 11 1 n ...1,1,.,... I� CAREFULLY COMPLETE THE FOLLOWING Type or Print Clearly P.O. # N/A GOVT USE ONLY) August 10, 11990 Order Date. G. V. W., Inc. 7Si, Marrji na1 gtmat East Boston, NTA Edward Curtin SHIP TO: (Do NOT use P.O. Box) Attention of. Company: Street: City/State: ZIP:_0717R Phone: ( 508 745-9300 Inspector Norman P. LaPointe Sa1Pm P1rp Prevention Bureau 4R T.ifayettP Street Salem, MA ZIP: 01970 INSTALLATION ADDRESSES: (This is an agency requirement.) Purchasers must list all actual installation addresses in the space below. This list is necessary for agency security records and is confidential. BUILDING NAME STREET ADDRESS • CITY St: -James School .'--- �_:160-...Federal-° Street:. Salem. • MA - - ni. 1 ..m• u . il. 1 11 ¢ d,1 1 . n ATTACH ADDITIONAL PAGES IF NECESSARY. .I I Id III. I I .„ . 11, 11 • 11 ►TEDEVIG KEY OPERATED SWITCH MODEL KS-2 i®-Key removable in either position. For override control of electric doors, gates, • equipment, etc. Includes simple mounting kit. KS-2 With Dust Cover KS-2 Without Dust Cover KEY OPERATED SWITCH MODEL KS-2P with Mounting Plate and Fire Department Operation Decal. Plate - Tie" Wx49/,e"Hx'/a" thick aluminum with Fire Department Operation Decal. Fits standard single gang electric sw'tch box. Includes gasket and mounting screws. Finish color: aluminum. (For decal only, see below.) KS-2P With Dust Cover KS-2P Without Dust Cover FIRE DEPT Fire Department Keyswitch Decal only - For use on custom installation panels. Decal is 222/32"Wx121/32"H. Constructed of the finest 3-M reflective material. Weatherproof Heavy Duty MODEL PL-1W PADLOCK -We" diameter hardened steel shackle with solid cast brass body and pull resistant shrouded key hole. EPDM Elastimeric body case and solid brass keyway cover offer substantial weather resistance. Heavy Duty MODEL PL-1 PADLOCK- 3/4" diameter hardened steel shackle with solid cast brass body and pull resistant shrouded key hole. PRODUCT SECTION OTY. PRICE TOTAL 43.00 34.00 52.00 41.00 35P 35-D 35 35P-D 2.00 48 66.00 36-W 52.00 36 1/410102, tad SuEri- 1 5-7008 : 2110 CHECK N9, FIRE%POLIC GENCYUSEONL Issuifig Agency OTAyALID:UNLESS••SIGNED TEM `CO.DE:NUMBER I1rd NruII 11.6d b .., n 1 6.,. n.:46 111.111. ...AA sun 1 ..i, ,S„ 1 n .1 1.... 1 .d11 S.I a .111..1 I S,I m...e; .Lr KNOX CO: USE ONLY - REC'D. RETURNED_ • VERIFY. REJECT SSORIE O/N FIRE DEPARTMENT ALERT DECAL • - Decal should be placed on all exterior doors to alert firemen that the building is equipped with a KNOX-BOX device. Decal is 2" square and made with the finest 3-M reflective material. One decal included with each unit. S' MA A KEY TAGS -White fiber •Package of 10 tag with spring clip Package of 25 Package of 100 Package of 250 TAMPER SEALS- Package of 50 Consecutively numbered. Package of 100 KEYRINGS-1"diameter'-4 keyrings durable solid brass rings. 25 keyrings CITY. PRICE TOTAL 1.00 1 2.50 37 6.00 18.00 40.00 8.00 12.00 1.00 5.00 37-T • 37-T 37-T 33 34 39 I 398 CARRY TOTALS TO OTHER SIDE `' CARRY TOTALS TO OTHER SIDE lir 4400tKEYA�LOCKBOXI t+441.bi?:rlo Alr QTY. PRICE TOTAL DATA'& K STORE QTY. PRICE TOTAL tMODEL 4400* J Surface Mount Extra Heavy Duty KNOX-VAULT-5/e" thick steel door. Large Capacity. Outside dimensions: 7"Wx 7"H x 5" D. Approx. wt. 23 lbs. Surface mount Model 4400 without tamper switches Black Aluminum Dark Bronze Surface mount Model 4400-TS with tamper switches Black Aluminum Dark Bronze tMODEL 4400-R* Recessed Mount Extra Heavy Duty KNOX-VAULT -/8" thick steel door. Large Capacity. Outside dimen- sions: 7"Wx7"Hx5"D with 91 "x91/2" flange. Approx. wt. 24 lbs. Recessed mount Model 4400-R; no tamper switch -- _ Black Aluminum Dark Bronze Recessed mount Model 4400-RTS with tamper switch Black Aluminum Dark Bronze RECESSED MOUNTING KIT - MODEL 4400-RMK-Greatly simplifies mounting in new concrete or masonry. For use with Models 4400-R and 4400-RTS ONLY. Kit contains shell housing which is cast -in- . place during new concrete or masonry construction. • KNOX-VAULT then mounts inside shell housing with hardware provided. NOTE: Special Application. l t For areas in which salt air, acid rain, and other extreme environmental conditions increase the threat of corrosion, we recommend aluminization of all 4400 Knox -Vaults. DEL-3200,KEY• LOCKBOX tMODEL 3200 Surface Mount Heavy Duty KNOX-BOX -1/2" solid steel plate door, 1/4" steel case. Outside dimensions: 4"Wx 5"H x 31/4"D. Approx. wt. 9 lbs. Surface mount Model 3200; no tamper switches n (fine. Dark Bronze I Surface mount Model 3200-TS with tamper switches Black Aluminum Black Aluminum 1 Dark Bronze 1 tMODEL 3200-R O Recessed Mount Heavy Duty KNOX-BOX-1/2" solid steel plate door, 1/4" steel case. Outside dimensions: 4"Wx 5"H x 31/4" D with 7"x 7" flange. Approx. wt.10 lbs. Recessed mount Model 3200-R; no tamper switch Black Aluminum Dark Bronze Recessed mount Model 3200-RTS with tamper switch ;e"t"e� Black Aluminum Dark Bronze 1 RECESSED MOUNTING KIT - MODEL 3200-RMK-Greatly simplifies mounting in new concrete or masonry. For use with Models 3200-R and 3200-RTS ONLY. Kit contains a shell housing which is cast -in - place during new concrete or masonry construction. KNOX-BOX then mounts inside shell housing with hardware provided. NOTE: Special application. t For areas in which salt air, acid rain, and other extreme environmental conditions increase the threat of corrosion, we recommend aluminization of all 3200 Knox -Boxes. • All 4400 series vaults have 5/8" thick solid steel doors with drill resistant hard plate and a special relocking feature. MAIL COMPLETED FORM TO: 191.00 206.00 206.00 221.00 236.00 236.00 16 17 18 19 20 21 231.00 22 246.00 23 246.00 24 246.00 261.00 261.00 59.00 25 26 27 MODEL 1300 HAZ. MAT. DATA STORAGE AND KEY CONTROL CABINET 0-This model is designed to fill high -security, on -site MSDS storage and key control needs. Use in highrises, large industrial complexes, and office buildings when security is a major concern. Beige polyester powder coat finish. Includes tags and hook panel for 27 keys. To weatherproof, use 1200-WH or 1210-WH weather housing shown below. 141/2"Wx 18" H x 5"D, Approx. wt. 60 lbs. 14V2"Wx 18"H x 7"D, Approx. wt. 62 lbs. Option "TS"-Dual Tamper Switches Option "2A"-2 locks: Key to either lock will open vault Other lock options available. Please contact factory. MODEL 1220 HAZ. MAT. DATA STORAGE AND KEY CONTROL CABINET -This model is designed to fill medium -security, on -site MSDS storage and key control needs. Use for highrises, large industrial complexes, and office buildings. Beige polyester powder coat finish. Includes tags and hook panel for 9 keys. Single fire department lock and tamper seal are standard. To weatherproof, use 1200-WH or 1210-WH weather housing shown below. 141/2"Wx 18"H x 5"D, Approx. wt. 47 Ibs. 141/2"Wx18"H x 7"D, Approx. wt. 50 Ibs. Option "TS"- Dual Tamper Switches Option "2A"-2 locks: Key to either lock will open vault Other lock options available. Please contact factory. 1200-WH WEATHER HOUSING - Constructed entirely of 10 gauge steel; for use with 1300 and 1220 Key & HAZ. MAT. Vaults when an outdoor installation 50 is required. Outside dimensions: 23"H x 20"Wx 14" D. 28 119.00h lc_( 135.001 4 135.001 5 149.00 6 165.00 7 165.00 8 r 152.001 9 167.001 10 167.001 11 167.001 12 182.00 13 182.00 14 49.00 30.00 each 1210-WH WEATHER HOUSING - Constructed entirely of 3/1e" aluminum for extra life. Use with 1300 and 1220 Key & HAZ. MAT. Vaults when an outdoor installation is required. Outside dimensions: 23"11 x 20"Wx 14"D. MODEL 1100 DATA STORAGE BOX -For lrs` use by small businesses. Holds information, MSDS and floor plans, interior capacity of 13"Wx11"Hx2"D holds a 11/2"thick binder. All steel construction.Tan polyester powder coat finish. Outside dimensions:14"Wx14"Hx41/4"D. Approx. wt. 20 Ibs. ijM; DUTTKEY'LOCKBOXES MEDIUM DUTY Surface Mount MODEL 1650 KNOX-BOX-AII 1/4" heavy plate steel. Tamper switch not available on this model. Olive brown polyester powder coat finish. Outside dimensions: 4"Wx 5"H x17/a"D. Max. 3 key capacity. Weatherproof. Approx. wt. 5 Ibs. MEDIUM DUTY Surface Mount MODEL 2900 KNOX-BOX-This model is designed for lower level security (e.g. utility doors, gates, boat docks, parking structures). Tamper switch not available on this model. Black polyester powder coat finish. Outside dimensions including baseplate: 4"H x 4"Wx 21/2"D. Approx. wt. 5 Ibs. B Total from right column: 15 '* Total from left column: 49 Total from front page: California deliveries add 6.25% state sales tax. Shipping & processing charge: Alaskan & Hawaiian shipments: $16.00 total 433.00 441.00 Add 23.00 Add 34.00 334.00 340.00 Add 23.00 Add 34.00 254.00 335.00 199.00 85.00 119.00 119.00 ADD $8.00 TOTAL ®®®a®1EH $ 127..00 SEND WITH ORDER THE KilOX COMPANY C oduction Place, Newport Beach, CA 92663 (714) 650-2885 • Form must bear "Authorized Signature" -Section ® • Full payment must accompany this order • Make check payable to The Knox Company © The Knox Company, 2/90 ca)1 a4--t (13,7LAz (The/i Lot,-ca 6 / -36 ?- 3C 7o 62120L Ltf u?/6745.z2z.,., t 2 April 1990 EXISTING CONDITIONS STATUS REPORT SAINT JAMES SCHOOL FEDERAL STREET SALEM, MASSACHUSETTS EARL R. FLANSBURGH + ASSOCIATES, INC. Architects, Landscape Architects & Interior Designers • SALEM SCHOOLS - ST. JAMES SCHOOL OBSERVATION OF EXISTING CONDITIONS INTRODUCTION The project consists of the probable remolding and alteration of St. James School, built in 1906. The following is an existing conditions review based on site visits. On 22 March 1990, Hagai Dvir (ERF+A, Architect) and Paul Gross (ERF+A, Architect) visited the site. On 28 March 1990, Bob Hendrick (Lottero & Mason Associates, Electrical Engineer), Rich Noce (TMP Consulting Engineers, HVAC Engineer), Hagai Dvir (ERF+A, Architect), and Paul Gross (ERF+A, Architect) visited the site. The scope of work outlined in this report is contiguous upon: 1. Site inspection by Asbestos Consultant; 2. Site inspection of Inspector LaPonte of the Salem Fire Department; 3. Additional engineering review in regards to the structural and plumbing issues. SUMMARY I. GENERAL A. Asbestos An asbestos survey performed by Hygeia, Inc. (Attachment A) in August 1987 detected no asbestos in the ceilings; this was the limit of scope of the survey as requested by St. James Parish Church. A complete asbestos survey is recommended. ERF+A's attempts to contact Hygeia, Inc. were unsuccessful. B. Architectural Access Board All construction, reconstruction, alteration, remodeling and changes of use of public buildings shall conform to the Architectural Access Board's regulations to the extent dictated by the following formula: If the work being performed amounts to less than 25% of the equalized assessed value of the building, and: 1. The cost of the work is less than $50,000, only that portion of the work being performed shall comply with the regulations. 2. The cost of the work is $50,000 or more, then that portion of the work being performed shall comply with these regulations, and an accessible entrance and toilet usable by a person in a wheelchair also shall be provided. Salem Schools - St. James School Observation of Existing Conditions Page 2 If the work being performed amounts to more than 25% of the 100% equalized assessed value of the building, the entire facility shall comply with the regulations. The current assessed value of the St. James School is $1,106,400. Therefore, the Architectural Access Board regulations must be implemented as follows: 1. If the cost of tenant fit -up is less than $50,000, only that portion of the work being performed shall comply. 2. If the cost of the tenant fit -up is between $50,000 and $276,600, and accessible entrance and toilet usable by a person in a wheelchair shall be implemented into the design. 3. If the cost of the tenant .fit -up exceeds $276,600 ($1,106,400 assessed value x .25 = $276,600), the entire building shall be brought up to code. C. Historic District 1. Federal Street in Salem is a historic district. 2. For registered historical buildings, the Architectural Access Board may allow alternate accessibility. II. EXISTING CONDITIONS A. Architectural The building was constructed in 1906 and used as a school serving the Saint James Parish. The existing 3-story structure is exterior masonry wall construction and heavy timber framing; the floors, roofs, and interior framing are wood. The facility consists of 4 levels with a total area of 34,600 S.F. 1. Basement: 8,600 S.F. student bathrooms, mechanical, 2 classrooms 2. 1st Floor: 8,600 S.F. 6 classrooms, 2 private toilets 3. 2nd Floor: 8,600 S.F. 6 classrooms, 2 private toilets 4. 3rd Floor: 8,600 S.F. 6 classrooms, 2 private toilets The emergency egress capacity of the building is satisfied with 3 enclosed egress stairs serving all levels and exiting directly to grade. Salem Schools - St. James School Observation of Existing Conditions Page 3 B. Structural Structural analysis has not been done yet. No structural work is anticipated. C. Mechanical See Attachment B. D. Fire Protection See Attachment C. The attached report is subject to the Salem Fire Department approval. E. Plumbing 1. Replace toilet fixtures on first floor with handicapped toilets. 2. Replace any damaged or unoperable toilet fixtures as required. 3. See Attachment B. F. Electrical See Attachment C. III. PROPOSED MINIMAL RENOVATIONS A. Site 1. Provide a handicapped accessible ramp at Main Entrance. B. Vertical Circulation 1. Architectural a. Provide a handicapped accessible ramp from Main Entrance in stairhall no. 1 to first floor. b. Remove existing stairs from Main Entrance in stairhall no. 1 to first floor. c. Properly remove and dispose all damaged floor tiles in all stairhalls and install new VCT to match existing tiles. d. Repair all damaged sub -flooring as required. e. Provide new entrance doors at exterior of building fully complying with Architectural Access Board regulations. Salem Schools - St. James School Observation of Existing Conditions Page 4 2. Fire Alarm System a. Provide fire alarm signal (audible) with flashing light signal in all stairhalls. b. Provide manual pull stations at entrances to all levels. c. Provide illuminated exit signs with self-contained batteries for emergency operation at entrances to all egress stairhalls at all levels and at all exterior egress doors. d. Provide emergency lighting in each classroom on all floor levels. C. Basement 1. Architectural a. Properly remove and dispose of all floor tile and install new VCT in the following rooms: Administration 001 Faculty 002 Sink Room 004 Corridor 003 b. Epoxy paint existing concrete floor in the following rooms: Boys Toilet Girls Toilet 005 006 c. Clean and inspect that the toilet fixtures are functioning properly. Replace all non-functioning fixtures. 2. Plumbing a. Verify with the Plumbing and Building Inspectors the continued use of the open unisex sink room 004. b. Verify with the Plumbing Inspector the continued use of the stall urinals in boys' toilet 005. 3. HVAC a Verify that the exhaust ducts are operable in boys' toilet 005 and girls' toilet 006. Replace if required. Salem Schools - St. James School Observation of Existing Conditions Page 5 D. First Floor 1. Architectural a. Renovate toilet rooms 107 and 108 to fully comply with Architectural Access Board requirements for private toilet rooms, including new HP water closets and HP sinks. b. Provide smoke doors in corridor 109. c. Provide new door openings (for second means of egress) in the following locations: Between Classrooms 101 and 102 Between Classroom 103 and Closet 103A Between Classroom 106 and Closet 106A To Toilet Room 107 To Toilet Room 108 d. Properly remove and dispose of all existing damaged floor tile or floor tile required to be removed due to renovation work. Install new VCT to match existing. E. Second and Third Floors 1. Architectural a. Provide smoke doors in corridors 209 and 309.\ b. Provide new door openings (for second means of egress in the following locations: Between Classrooms 201 and 202 Between Classrooms 301 and 302 Between Classrooms 203 and Closet 203A Between Classrooms 303 and Closet 303A Between Classrooms 206 and Closet 206A Between Classrooms 306 and Closet 306A NOTE: All new doors shall fully comply with the Architectural Access Board Regulations. F. Additional Work ITEM Architectural Interior Paint - Ceilings Interior Paint - Walls Interior Carpet Remove Asbestos Floor Tile New Doors and Hardware COST Salem Schools - St. James School Observation of Existing Conditions Page 6 ITEM COST Private HD Bathroom (4 required) HP Toilet Stall (2 required) HP Sink (2 required) Demolish Stair no. 3 and Install New Hydrolic Elevator in Stairshaft No. 3 Fully Complying with Elevator Code Plumbing Demolish Existing Urinals and Provide New Urinals in Boys Toilet 005 Replace Valves Serving all Toilets Upgrade All Water Using Devices, Flush Valves, Faucets, Etc. to Meet Code Provide Backflow Prevention in Water Make-up to the Boilers and Service Sinks Drinking Fountains (7 required) Sprinklers Sprinklers Add Sprinkler Heads HVAC New Ventilation System Electrical Upgrade Electric Service and Distribution Upgrade Clock and Program Bell System SALEMII/lc/stjames ATTACHMENT A I ' HYGEIijINC. August 14, 1987 Reverend Francis Delaney St. James Parish Church 156-162 Federal Street Salem, MA 01970 Subject: Industrial Hygiene Services, Asbestos Survey, St. James Parish Church and School, Salem, MA HYGEIA INC. Project No. 5418 REF: STJAMES-Rept5 Dear Father Delaney: On August 13, 1987 HYGEIA INC. was requested to conduct an asbestos survey of the ceilings of St. James Parish Church and School, Salem, Massachusetts. The ceilings surveyed were the church and sanctuary basements, the basement, 1st floor, 2nd floor and 3rd floors of the church school. As requested, only the ceilings of these areas were surveyed. The samples results are as follows: HB-4520; Boiler Room, ceiling Asbestos, None Detected; Cellulose Fiber and Hair, Trace; Calcite and Clay, 80%; Quartz, 20%; Feldspar, Trace. HB-4521; Basement. classroom ceiling Asbestos, None Detected; Cellulose Fiber, 5%; Calcite and Clay, 80%; Quartz, 15%. HB-4522; 1st Floor. hallway ceiling Asbestos, None Detected; Cellulose Fiber and Hair, 20%; Gypsum/ Andydrite, 65%; Quartz, 15%; Talc, Trace. HB-4523: 3rd Floor, ceiling Asbestos, None Detected; Cellulose Fiber and Hair, 10%; Calcite, Clay and Micas, 60%; Quartz and Feldspar, 30%. HB-4524: Church basement ceiling Asbestos, None Detected; Cellulose Fiber, Trace; Calcite, Clay and Micas, 75%; Quartz, 10%; Opaques, 15%. The bulk samples were analyzed by polarized light microscopy at magnifications ranging from 100x to 400x. The estimated phase abundances are provided in weight percent and are accurate to within 10 to 15 percent of the amount reported. This method, which is recommended by the US Environmental Protection Agency Guinan Street \\altliani. Massachusetts (1?15 ► lcicplu.'nc (61-16-1; -9i-5 Reverend Francis Delaney August 14, 1987 Page 2 (EPA), is sensitive to the detection of asbestos to less than one percent by weight. The HYGEIA INC. laboratory is accredited by the American Industrial Hygiene Association for asbestos analysis (AIHA #272) and participates in the US Environmental Protection Agency (EPA) Quality Assurance Program for bulk asbestos samples administered by Research Triangle Institute, Research Triangle Park, North Carolina, and the National Institute of Occupational Safety and Health (NIOSH) Proficiency Analytical Testing Program for air asbestos samples. As can be seen with the sample results, no asbestos was detected in any of the ceiling samples. Based on these sample results, none of the ceilings at the Church and School are asbestos -containing. During the survey I observed the general condition of the ceilings in the school building to be good, with the exception of certain areas where there has been water damage. The trowled-on plaster ceilings in the basements of the church and sanctuary were found to be in in fair to poor condition. The worst conditions were found around the perimeter of the building, where there appears to be constant water leaks. Although the ceilings were found not to be asbestos - containing, a significant amount of potential asbestos -containing pipe insulation was noted throughout the buildings. Therefore, I recommend that a complete asbestos survey be performed at some time, in order to document the existing conditions and identify any potential hazards. Yours sincerely, HYGEIA/INC' MA Thomas F( Wasson Senior Industrial Hygiene Technician TFW:at cc: Jim Jenkins Approved by ig %� - l `/ 2 L 4"1''7 Mark R. Arriens, MS Senior Industrial Hygienist ATTACHMENT B pf V pi Consulting A A Engineers Inc. Boston/Toronto/Calgary Julius C. Olsen Richard S.Noce 2 April 1990 Michael C. Spence Richard G. Zaccone Roger D. Wardwell Mr. Paul Gross Earl R. Flansburg Associates, Inc. 77 North Washington Street Boston, MA 02114 RE: St. James School Feasibility Study Our File: 5954-90 Dear Mr. Gross: 52 Temple Place Boston, Massachusetts 02111 617 357-6060 FAX 357-5188 torne S. Mitchell Robert WShute James D. Magarian Kevin J. Caddie This letter lists the items we noted during TMP's visual inspection of this facility on 3-29-90. Our inspection was arranged to con- sider on an overview basis the existing mechanical systems and com- ponents regarding functionality and code compliance. We also con- sidered possible minor and major revisions to the systems that might be considered. HVAC SYSTEM The user reports that the system provides heat without major overheating or cold areas. Some of the radiation control valves appear inoperative. Some basement area spaces do not have con- trols on the heating devices. The piping is reportedly sound. We could see no evidence of major leaks. The boiler room piping and trench condensate piping were replaced in 1980. The boiler, oil tank and condensate pump are reported to be oper- ating properly. The equipment appeared to be in good condition. The buried 5000 gallon number 2 oil tank, low pressure steam boiler and condensate pump were installed in 1980. There are exhaust ducts in the basement toilet rooms. It is believed the exhaust fans are not operational. There is no classroom ventilation system. Outdoor air for the classrooms must be brought in thru the operable sash. While code would require mechanical ventilation there is a large avail- able operable area at the windows. Considering the planned short term use of the school we suggest the code officials be asked to accept the windows as the source of fresh air. Should a long term solution be desired we would recommend a new venti- lation system be added. Some of the pipe coils that are used to heat the classrooms have an open wire cover. Some pipes have no cover. The pipes get hot. With desks away from the pipes this may not be considered Mr.•Peter Gross 2 April 1990 Page Two a problem. The existing covers may not be acceptable. We sug- gest your office and the City of Salem review this matter. Much of the piping is not insulated. Some of the insulated pip- ing may be covered with asbestos. In general for a short term use of two (2) years the HVAC system is sound, except for the previously noted lack of classroom ven- tilation air and other minor deficiencies. PLUMBING SYSTEM It is reported that the fixtures all work. The valves serving the toilets however reportedly need to be replaced. The lava- tory valves are reportedly functional. There is a separate gas fired domestic water heater in the boil- er room that reportedly is functioning properly. The piping is a combination of brass and copper. All the fix- tures need cleaning. We recommend they be tested to verify there are no blockages. Stall urinals would not be allowed by the present code although we'd assume that they would be allowed to remain on a temporary basis. They also develop leaks around the base/drain very easily as time goes on. The existing fixtures are not suitable for handicapped acces- sibility. The water using devices, flush valves, faucets, etc., are not water conserving or metering types (as required for public rest - rooms) . Backflow prevention is not present on the water make-up to the boilers or on service sinks. SPRINKLER SYSTEMS There is a dry sprinkler system serving the building. The heads would not meet present new codes. Some of the piping runouts are 3/4 inch. The present code requires a minimum pipe size of 1 inch. There are no standpipes or fire hose cabinets which would be required by present codes. We are not aware if the available water pressure is sufficient to meet the present building code. Mr. Peter Gross 2 April 1990 Page Three It is possible the code official may accept the system as is. It is possible that officials may request the system be con- verted to a wet system. Since the system serves the large open unheated attic the exact method of accomplishing the code offi- cials desires would require further review. Heat may have to be added in the attic or the attic may remain as a dry system with the remainder of the building being converted to a wet system. Considering the fact that many buildings of this type are not sprinklered at all the code officials may accept the system as is. We are aware that the Fire Department has recently inspected the system and given approval for its continued use under the cur- rent building usage. However, the system should probably be tested to 200 psig if the school is temporarily reopened. Please advise should you have any questions. Very truly yours, TMP CONSULTING ENGINEERS, INC. Richard S. Noce, P.E. President RS N/ j em cc: RDW - TMP RN5#595490-A ATTACHMENT C Lottero + Mason Associates, Inc. Consulting Engineers 132 Lincoln Street Boston, MA 02111 (617) 423-7367 FAX: (617) 423-6381 30 March 1990 Mr. Hagai Dvir E.R. Flansburgh and Associates, Inc. 77 North Washington Street Boston, Massachusetts 02114 Re: Existing Conditions Report St. James School Salem, Massachusetts Dear Hagai: Please find herein, attached, our report of existing electrical systems conditions and recommendations to bring existing electrical systems to a reasonable condition for possible use by the Salem School Department. We understand that the City of Salem is considering leasing this building as a temporary classroom facility during the period of renovation to other existing school buildings. This report will focus on equipment adequacies, as they pertain to code requirements, and general operating conditions. Present age and projected life of existing equipment is elementary to this report. If there are any questions, please call. Very truly,you s, LOTT R0, D SON SSIATES, INC. Robert H Brick kr EXISTING CONDITIONS REPORT ST. JAMES SCHOOL SALEM, MASSACHUSETTS A. Electric Service and Distribution Eauioment 1. Existing Conditions a. Existing electric service is 120/208 volts, single phase, 3 wire with a capacity of 300 amps. This calculates to about 2.5 watts per square foot of capacity. b. Service distribution equipment consists of individual mounted circuit breakers and fuse pull out units mounted on a wiring trought. Power is distributed from these devices to one panel at each floor. Area panelboards are edison screw shell type with fusing for each circuit. 2. Comments and Recommendations a. The electric service and most of the distribution equipment, including area panelboards are more than 35 years old. However, present condition of same indicates equipment that is well maintained and not under condition of overload. b. We believe that the existing electric service and distribution can operate reliably without modifications for at least 3 years. Adding electrical load is not recommended. B. Fire Alarm System 1. Existing Conditions a. The existing Gamewell fire alarm system consist of master box tie to city fire department, control panel, pull stations (one each floor), signal horns (one each floor), heat detectors in attic only, and flow supervision of sprinkler system main water pipe. System appea*s to be about 25 years old. b. Operation was not tested during visit. 2. Comments and Recommendations a. Existing system does not meet present code requirements for fire alarm systems in school buildings. Although system is operational, its reliability because of age may be questionable. b. We recommend replacement of the fire alarm system with new equipment in compliance with existing building codes. The new system would provide added signal coverage (audible) to - 2 - stairwells, classrooms and attic space and flashing light signal for hearing impaired students. Manual pull stations would be added at all building exits. New control panel would increase system reliability. (1cd ] Estimate cost $20,000. C. Lighting 1. Existing Conditions a. All existing lighting equipment is about 20+ years old. However, lighting fixture are well maintained, good quality construction and in good operating condition. b. Footcandle levels appear to be in line with recommendation by IES for classroom use. 2. Comments and Recommendations a. We believe the lighting system to be functional and suggest no work other than cleaning. D. Emergency Lighting and Exit Signs 1. Existing Conditions a. Emergency lighting for exit egress from the building is provided from new 6 volt battery units with adjustable heads. System appears to comply with code. b. Illuminated exit signs do not exist. 2. Comments and Recommendations a. Emergency lighting complies with code except that coverage extending into classrooms does not exist. We recommend additional equipment be added to provide one head per classroom. Estimated Cost $3,000. b. Inmost egress corridors exit signs do not exist. We recommend the installation of illuminated exit signs in egress paths complete with self contained batteries for emergency operation. Estimate Cost $3,500. E. Sound and Intercommunication System 1. Existing Conditions a. This existing system appears to be operational. Speakers are located in all corridors and classrooms. One central handset 3 is provided at each floor for two way communication with central console. Central console equipment has zone switching and microphone for broadcast announcements or zone calling. 2. Recommendations a. Total system operation need to be conducted to determine exact condition of equipment. System is about 25 years old and appears to be well maintained. We recommend no action. F. Clock and Program Bell System 1. Existing Conditions a. This existing system appears to be at least 25 years old. We observed about 20% of indicating clocks to be inoperational. Program bell system central equipment for automatic operation does not function. 2. Comments and Recommendations a. Work is required to return this system to a total functioning status. Estimated Cost $3,000. G. Circuitry 1. Existing Conditions a. The existing branch circuitry consists of a variety of methods but in most cases is type "AC" (BX) cable or EMT. General condition appears to be good and functioning properly. 2. Comments and Recommendations a. We believe the existing circuitry to be suitabel and of good condition and suggest no work. - Esrl R. FIansburgh + Associates, Inc. 77 North Washington Street Boston, Massachusetts 02114 Telephone (617) 367-3970 Date: Project: Project No.: Location: Present: Distribution: MEETING NOTES 4 April 1990 Salem Public Schools St. James School 8929.00 St. James School Salem, MA I`specto.r—Norman—LaP-ointe-+t -Salem Fire Dept. Paul Gross -ERF + A All Attendees Beth Debski Joseph Salerno Edward Curtin David Soleau Hagai Dvir Bob Hendrick -Salem Planning Dept. - Salem School Board -Salem School Board - ERF + A -ERF + A - Lottero & Mason A. After site observation of the existing facility, Inspector LaPointe presented the following comments: 1. The existing sprinkler system appears satisfactory. A flow test would be required to determine the condition of the system. 2. The sprinkler system should have both flow & tamper connections to the fire alarm. 3. The fire alarm annuciator panel should be located in a conspicuous location to be determined by the Salem Fire Department. 4. The fire alarm system shall be equipped with a square "D" switch. 5. A fire drill switch is required for the fire alarm. 6. A Knox rapid entry -box shall be installed outside the main entrance. Meeting Notes Salem Public Schools 4 April 1990 Page 2 7. Inspector LaPointe reviewed the existing condition status report dated 2 April 1990 and was in agreement with all issues pertaining to the fire alarm and sprinkler systems, except as previously noted. The preceding meeting notes represent our interpretation of the information exchanged. Please notify us of misunderstandings or required interpretations ASAP as we will proceed on the basis that these items are as agreed to by all parties concerned. Earl R. Fiansburgh + Associates, Inc. 77 North Washington Street Boston, Massachusetts 02114 Telephone (617) 367-3970 Date: Project: Project No.: Location: MEETING NOTES 1 August 1990 Salem Public Schools/St. James School 8929.15 Salem Fire Department Present: Chief Turne-r Beth Debski Bob Gauthier Brian Cranney Mike Massey Robert Hendrick Doug Murray Distribution: All Attendees Joseph Salerno Edward Curtin Hagai Dvir File - Salem Fire Dept. -Salem Planning Dept. -Clerk of the Works -Cranney Electric -G.V.W. -Lottero & Mason -ERF+A -Salem School Board - Salem School Board - ERF+A A. Cranney Electric provided new submittals to Electrical Engineer. Contained were: 1. Fire-lite alarms installation manual. 2. Pull stations (resubmittal). 3. Rechargeable batteries. B. Chief Turner noted the following items: 1. Beacon at exterior to be horn/strobe, non -rotating. 2. Annunciator and Master box locations are acceptable. C. Fire Department had reviewed these plans before and had found them acceptable. They are on file at the Building Department. It was noted that the plans are generally not at issue (exceptions, see item #D below), but the type of items specified (see item #E). Meeting Notes Salem Public Schools 1 August 1990 Page 2 D. Revisions to Plans: 1. Drawing E-1 a. Sprinkler flow zones for each floor are deleted. Sprinkler flow will be monitored at existing pressure switch at sprinkler main valve. City of Salem Fire Department does not required flow indication for each floor level. b. Tamper switches for sprinkler system valve monitor has been reduced to actual number of system valves (1). c. Fire alarm system zones have been reduced to coordinate with flow switch and tamper switch zone deletions. E. Revisions to Specifications 1. Voice communication features have been deleted from fire alarm system specifications. Such features are not required by code for this building occupancy classification. F. Chief Turner noted number of tamper switches to be provided at sprinkler main and quality of backflow preventors. Doug Murray stated that the system had been reiewed on site with the Fire Department previously and nothing had been noted concerning the backflow preventor. No new work is included under this contract. The preceding meeting notes represent our interpretation of the information exchanged. Please notify us of misunderstandings or required interpretations ASAP as we will proceed on the basis that these items are as agreed to by all parties concerned. Prepared by: Doug Murray- STJAMES1/lc/mndm0801 3. Are facilities provided for the safe disposal of rubbish? 4. Are all outside egress paths free from any obstructions that may interfere with the safe exit of the occupants? 5. Do porches and fire escapes, appear to be in a safe condition and free of obstructions? 6. Do outside sprinkler and standpipe F.D. connections appear to be in good and usable condition? 7. Are entrances and hallways clear of any obstructions that may interfere with the emergency exit of occupants? 8. Are all interior occupied spaces clean and consistant with good housekeeping practices? 9. Are all necessary Licenses and Permits posted & dated? 10. Are the occupants complying with all regulations and conditions, as prescribed on the Licenses and Permits? 11. Are all vertical shafts and stairwells properly safe- guarded and provided with self closing'devices? 12. Are all portable fire extinguishers readily accessable and have they been inspected and properly tagged? 13. Does this occupancy have a fixed fire extinguishing system? Date of last inspection? 14. Does this occupancy have a standpipe system? Are all pressures satisfactory? Are standpipe hoses provided? Is a gauge provided at top of -system? 15. Does this occupancy have a sprinkler system? Are all pressure gauges showing satisfactory readings? Are all O.S.Y. valves open and padlocked? Is a gauge provided at the top of the system? 16 Is this a "WET" or "DRY" system? ,vA- SALEM FIRE DEPARTMENT - INSPECTION REPORT ADDRESS: a/d',2 od -a I c.74 NAME OF OCCUPANCY: P.T.N. /2c ScPr(6 oldfoomiere BLDG. OWNER f, Pi /Q TYPE OF OCCUPANCY ADDRESS /e/ Ceria/U)eu) 57Li ADDRESS •e0$,,,er I ,S7/. • POSTED TEL. % yf z2`1-5- TEL .7Ys 106.C) ANSWER ALL QUESTIONS: EITHER "YES"1 "NO"1 OR "NONE". 1. Are the approaches to the building free and clear? 2. Does the area adjacent to the building, appear to be free r/ of rubbish accumulations, or other fire hazards? Ye-S I v�L� 476 /VA Form #16 (Rev.. 1/79) 17..Does this occupancy have an interior fire alarm system?% Ve 5 18. Date of last test of the interior fire alarm system? 19. Does this occupancy have a direct Fire Alarm connection? ' 0.4 Master,,, Instant Type :Box # 7_ ? ADT#' Alarm N AFA* 3Mf Other 20. Is emergency lighting system or units provided? 21. Are all emergency lighting units in good operating condition? 22. Does the occupancy have any unusual condition which would constitute a special fire hazard? 23. Are all flammables stored in proper containers and/or stored in an approved storage area? 24. Are all areas used for storage maintained in a safe manner? i4e< 25. Are basement areas free of any rubbish accumulation? / 26. roes the heatinc system, including the chimney, appear / to be in'a safe operating condition? I%. Ts a current fuel oil permit posted and storage proper? Ket 29. Treesthere any electrical hazards? 20. �A the occupancy appear to have any structural defects? /UO 30. Has a Form,25D (Inspection Recommendation Form), been made and issued for this inspection? _76 Write a brief description of any violations discovered during this inspection. If the violation requires an early Fire Prevention Bureau nctification, file a Form *58 (Complaintorm) . If the violation appears to require immediate action,. F notify the Deputy Chief on duty. List each remark with item number for identification. Name of. person to whom Form *25D was issued: Date: Inspected by:____ Approved by: " Approved by D.C. in charge of Insp. Date: 2sVany Officer' Form #16 (Rev. 1/79) P.T.N. checked by F.A. Ap Atlas Alcrrm Corp. 1239 WASHINGTON STREET, WEYMOUTH, MA 02189 (617-337-8866) FIRE ALARM INSPECTION REPORT PAGE #1 TO: ( J h , C. v_I.-s i 6.-- A, S F A L 5; 4 v1 ;-aJrl v ATT: MASTER/TRANSMITTER BOX NO. I/ :5 7 T- INSPECTION LOCATION: 5 A CUST. # ._-' FREQUENCY?:' u'f ► f�`s' ' �f. 9 # ALARM CIRCUITS 44 AHJ < 14 4- V',\ /" i AI e t-i p T" - Inspector's Section (All responses reference current inspection) N.A. = NOT APPLICABLE 1. Control and Supervisory Panels f a. Did all controls,and annunciator panels test satisfactorily? ❑'Yes 0 No 0 N.A. b. Did system trouble signals test satisfactorily? ❑'Yes 0 No 0 N.A. 2. Secondary (stand by) power supply ,•" a. Are batteries in satisfactory condition? ❑'Yes 0 No 0 N.A. 3. Alarm Indicating appliances a. Did audible alarms test satisfactorily? OeYes 0 No 0 N.A. b. Did visible alarms test -satisfactorily? 0 Yes 0 No 0,'N.A. 4. Automatic fire detectors a. Did heat detectors test satisfactorily? - ❑,'Yes ❑ No 0 N.A____) Loop Resistance of b. Did smoke detectors test satisfactorily? 0 Yes ❑ No ❑ N.A. Line Type Heat Detection c. Did flame and/or gas detectors test satisfactorily? 0 Yes 0 No 0 M.A. 5. Sprinkler waterflow and supervisory devices a. Did waterflow switches test satisfactorily? 0 Yes 0 No 0 N.A. b. Did pressure switches test satisfactorily? 0 Yes ❑ No O'N.A. c. Did supervisory switches test satisfactorily? 0 Yes 0 No EN:A. 6. Manual fire boxes and two way telephone a. Did manual fire boxes test satisfactorily? ❑'Yes 0 No 0 N.A. b. Did two way telephones test satisfactorily? 0 Yes 0 No 0-N.A. 7. Emergency Ca11 a. Did emergency call system test satisfactorily? 0 Yes 0 No 0 N.A. S. Miscellaneous a. Did miscellaneous devices.test satisfactorily? 0 Yes 0 No O'N.A. 9. Master box or other connection a. Did master box or other connection test satisfactorily? E'Yes 0 No 0 N.A. 10. System left in service .........Yes ❑ No 11. Remarks: ^ r / .ri -T' 1 :r- . 7—i- - • tJ . ._._ 1 — 7 --, .r- t i 7. ►- r A t., ., . / .7'''.... . -7--- W L v -, a/ ❑-N.A. :ems S 74-4.i. rt / I // J v 12. Adjustments or Corrections Made ri f'VV �- Y 13. Parts Replaced • 14. The Inspector suggests the following necessary improvements, repairs, or replacements. These suggestions are not the result of an Engineering Survey. t ✓� 15. Inspector suggested improvements, repairs, replacements were discussed with the undersigned owner or owner's representative 0 Yes 0 No ❑„N:A. 16. Explanation of "No" Answers �- Ew CONTINUED PAGE #2 0 Yes 0 N.A. SIGNATURE INSPECTOR DATE SIGNATURE OWNER OR OWNER'S REPRESENTATIVE (PRINT NAME) DATE In accordance with NFPA guidelines, you the subscriber must retain a copy of the report on the premises for at least 5 years. InV Nugl� OEc� ncy Name Address Inspectay Na'i 2.t fire escapes/decks proper storage proper access KNOX BOX open property exit blocked - exit signs working adequate lighting door(s) locked signs needed in need of repair emergency lights other operative properly labeled accessible trouble indication defective devices missing devices other SALEM FIRE DEPARTMENT INSPECTION AND VIOLATION REPORT ,ice,IQ ,�T, I Bldg. WsYes I Company; I Notifications 1. Exterior ❑ Pass 0 Fail Pass ❑ Fail Pass ❑ Fail ❑ Pass tail 2. Exits Bass IcPass aPass (&Pass I&Pass Pass J2tiPass RtPass 0 Pass ❑ Fail ❑ Fail ❑ Fail ❑ Fail ❑ Fail ❑ Fail ❑ Fail O Fait ❑ Fail 3. Fire Alarm System Pass ❑ Fail Pass 0 Fail 'Pass 0 Fail 11 Pass ❑ Fail Pass ❑ Fail 1'Pass ❑ Fail ❑ Pass ❑ Fail r„ 4. Kitchens 10 Ib. ABC extinguisher 0 Pass 0 Fail at hazard ext. system operat. 0 Pass 0 Fail roof collect. clean 0 Pass 0 Fail system inspected 0 Pass 0 Fail hood/duct clean 0 Pass 0 Fail other 0 Pass 0 Fail 5. Storage proper labeling Pass 0 Fail proper storage filzPass 0 Fail legal storage tirPass 0 Fail other 0 Pass 0 Fail r/�j1 wiit' % ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn 0 ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn j'N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A 0 N/A ❑ Warn )N/A ❑ Warn 0 N/A ❑ Warn ❑ N/A ❑ Warn ❑ N/A ❑ Warn ❑ N/A ❑ Warn ❑ N/A 0 Warn 0 N/A ❑ Warn 0 N/A ❑ Warn ❑ N/A ❑ Warn 0 N/A valves Tabled valves accessible pressure reading FDC clear/capped Valves open valves secured spare head avail. heads obstructed other No 0 0 Health Occupancy Type Fall);C 0 Bldg. combustibles within 5 feet defective chimney defective system other Inspec. ate:- Reins`p. Dare: )uT 1\ zosex 0 Electrical ❑ Police 6. Heating Systems 0 N/A ,tPass 0 Fail 0 Warn 0 N/A defective wiring panels accessible extension cords: proper use cover plate missing proper fusing other 8. signs needed properly mounted proper type obstructed need recharging other L. DPass ,4 Pass ❑ Pass ❑ Fail ❑ Fail ❑ Fail 7. Electrical Pass 0 Fail 0 Warn 0 N/A ss 0 Fail 0 Warn 0 N/A ❑ Warn ❑ Warn ❑ Warn ❑ N/A ❑ N/A ❑ N/A 0 Pass 0 Fail )Pass 0 Fail "Pass 0 Fail ❑ Pass 0 Fail ❑ Warn ❑ Warn ❑ Warn ❑ Warn Fire Extinguishers 0 Pass $1 Pass C Pass J-Pass Pass ❑ Pass ❑ Fail ❑ Fail ❑ Fail ❑ Fail 0 Fail ❑ Fail ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn ❑ Warn 9. Sprinkler & Standpipe System jie N/A 0 Warn 0 N/A ❑ Pass 0 Fail ❑ Pass 0 Fail 0 Warn 0 N/A ❑ Pass 0 Fail 0 Warn 0 N/A ❑ Pass 0 Fail 0 Warn 0 N/A 0 Pass 0 Fail 0 Warn 0 N/A ❑ Pass 0 Fail 0 Warn 0 N/A ❑ Pass ❑ Fail ❑ Warn ❑ N/A ❑ Pass 0 Fail 0 Warn ❑ N/A ❑ Pass 0 Fail 0 Warn 0 N/A N/A ❑ N/A ❑ N/A ❑ N/A N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A ❑ N/A PTN Form #84 - Completed Form *58 - Filed 10. Violations Found g-2'1G Yes 0 NoE Yes 0 Now Op/ ,/71 P t. v 7)0- ???7 Form * 16 - (Rev. 11/93) Copies: White - Fire Prevention Yellow • Inspecting Company Pink -Building Owner/Manager 46 Salem F-vice Depan.tment Ftite Prevention Bunolru 48 La4ayette Street Salem, Ma 01970 (617) 745-7777 FIRE DEPARTMENT CERTIFICATE OF APPROVAL FOR BUILDING PERMIT In acco-'rr/ance w-c th the pn.ovt4 Loris o4 the Ma-s-sachtvse t- State Buttd ing Code and the Salem FJ e Code, appt-Lcation -vs hereby made Son approval o4 p&ana and the 4.44u.a.nce o3 a cent.44.cate 04 appn.ova.2 4on a. buttd ng pe.-vm t by the Sat -ern Ftne Department. (Re%. Secti.on 113.3, Ma,aa. State Bldg. Code) Job Loca t Lon: Owner/Occupant: E2ec44.ca,2 Contn.a.cton: F-t to Suppne-64ton Contnacton: Stgna tune o4 Ap pttca.nt : Addnvis-a o4 A p p2-i,ca.nt : Approval date: a/1. Uie-y 2 tidwft f cz adze. &4444,4vi t 7 7 l Cf l� 6/ &j .2-Af.L//c/,q!,4. J (>/52I Phone #: dS _d 99s C-ct y on Town: ,OJwIG%f Cent.L¢Lcate o4 approval 4.4 hereby granted, on approved p&an4 on zubm-i ttaZ o4 project deta42 , by the Salem F-vre Department. A22 plans are approved 4o2e2y 4on 4.dent4.4 .cwti.on o4 type and location o4 4-Lite protection dev-i.ce4 and eqw pment. A22 pParvs are -subject to approval o4 any othen authon,i ty ha.v-Lng jun-i.ad-LctLon. Upon comp2etLon, the appP-Lca.nt on tn4tatte4(4)-aha2.2 request an -i.n-spec t Lon and/or test o4 the 4 L' protection device a and equ-i.pment. ( ** FOR ADDITIONAL REQUIREMENTS, SEE REVERSE SIDE ** ) X New construe ti,on. Property 2ocat-Lon ha-e no comp-C.-Lance with the pnov .-tows o4 Chapter 148, Section 26 C/E, M.G.L., reJati.ve to the Lrvstata ti.on o4 approved 4-Lite alarm d.evtceis. The owner o4 thus property 4.4 4.equtned to obtain compliance a.,s a condition o4 obtaining a Buttd ing Pe -'um t. Property 2ocatton .t-o -i,n comp2 trtnce w-c th the pn.ovt,s-Long o4 Chapter 148, Section 26 C/E, M.G.L. f xp-vuz tLon date: V'12-(1- 1 r ' S-ignatune o4 F-i e 044.Lcia,2 Fee due: under 7,500 Sq. Ft. - $10.00 7,500 Sq. Ft. on-2cvtgen - $25.00 Foram #81 , (Rev. 9/87) 5 QumRf - 9 S�S�fvt'1 Si rL- 5 tfr' 1I OT'e-0 () S\JL (S v u 0 QvA iLE.S tto V r F %c' 6 2Av sf ow' Cowt p Ct ivc a ki F f \Eq.1M i` i A NJ i C 92e-D c24)'ri'k_Q . CITY OF SALEM FIRE DEPARTMENT - FIRE PREVENTION BUREAU 48 Lafayette St., Salem, Massachusetts 01970 APPLICATION FOR APPROVAL OF PLANS: 'Ft): HEAD OF FIRE DEPARTMENT 1'ee Due $5.00 Re c' d by4ry/l .3—'/ 19frl (Date) Fire Prot. Equip. &-F.P.Code Inst. Fire Alarm System: Fire Extinguishing System ;,;:;*** In accordance with the provisions of the Massachusetts State Building Code and the Salem Fire Code, application is hereby made for approval of plans for the install- ation of Fire Protection devices. ` LOCATION: /6 /�" e D rE' i/ Jc 71 �r�4J 3y7 OWNER OR OCCUPANT: N%v/' INSTALLER:_ - INSTALLERS ADDRESS „2 6.6 6 j LICENSE 11 c5 V T E L . it 7'/L/ , Plans are approved solely for idefiitification of type and location of devices. Installation subject to final inspection and filing of Certificate of Completion. Date approved: March 4, 1981 Date of expiration _Sept. 4,1981 PLMIT TO INSTALL: (Slgnatu CITY OF SALEM FIRE DEPARTMENT - FIRE PREVENTION BUREAU Salem, Massachusetts 01970 Fire Extinguishing System 1 Addie,q) Fee Paid $5.00 Date March 4, 1981 Fire Protection Equipment and Fire Prevention Code Fire Alarm System X Required Installations. X Owners Name North Shore Mental Health Services Installers Name Bernard Mitchell, Contractor Permit is hereby granted based on approved plans, to install the system designated above. All plans are approved solely for identification of type and location of fire protection devices. All plans are subject to approval of any other authority Diving jurisdiction and issuance of a permit by said authority. Upon completion, the 11,.l..iIHr :;)nail request a test and file a Certificate of Completion or lnsnection. LOCATION:_ 162 Federal Street,. Salem, ...1,_..__ _ (Give location by street and no., or describe in such manner as t fovtdof loeatian) (St4iSature or o gnacnting permit) This permit will expirA 9/4/81 Salem Fire Marsha (Title) 1 (THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES.) Form //81 (Rev. 7/78) /g) r:van. SECTION 9R - CARPETING PART I - GENERAL 1.1 RELATED DOCUMENTS A. Drawings and general provisions of Contract, inclu-_ ding General and Supplementary Conditions and other Division 1 Specification sections, apply to work of this section. 1.2 DESCRIPTION OF WORK A. Extent of work is shown on drawings as schedules. 1.3 RELATED WORK SPECIFIED ELSEWHERE A. Subflooring and underlayment B. Resilient Flooring C". Rubber base 1.4 QUALITY ASSURANCE Carpet Flammability: Pass pill test, ASTM D 2859 (DOC FF-1-70). 1. Radiant Panel Test: Rating of'0.22 for corridors, circulation spaces, and rooms larger than 400 sq. ft.; ASTM E 648. 2. Smoke Test: Density of 450 or less; NFPA No. 258, 1.5 A. See Division 1 for amount and procedures for purchase and payment (overrun or underrun). The costs of. handling and installation are covered by the allowance. 1.6 SAMPLES A. Submit 18" x 27" samples of each required type, color, pattern and texture of carpet. PART II - PRODUCT 2.1 PILE YARN A. Mill's standard denier, ply count and twist, as re- quired for color, pattern, texture. 2.2 MISCELLANEOUS MATERIALS AND CARPET ACCESSORIES A. Metal Edge Guard: Black anodized aluminum bend -down type, with integral gripper teeth and nailer flange. CARPETING 9R-1 14/1/'„v„GtX/W/MLW-(/ 'VG4.l. YJW/TVLI/JYri'J' ;\ , 0 gg .-orgy -o o° ee 1\ APPLICATION and PERMIT IFee:$50_00 J for storage tank removal and transportation to approved tank disposal yard in accordance with the provisions of M.G.L. Chapter 148, Section 38A, 527 CMR 9.00, application is hereby made by: ank Owner Ginna Diamonca Tank Owner Name (please print) 173 Federal St. Address Removal Contractor Salem Signature or apilying for permit) Ma. 01970 Street City State ZIp Company Name H & S Tank Cleaning, Inc. Print Address 101 Foster St. Peabody . MA 01960 (978)531-6433 Pm't • Signature ' applying for permit), . / ❑ CI Certified Other 0 IFCI Certified 0 LSP # Other Contamination Assessment Tank Location Tank Capacity (gallons) Co. or Individual Address Signature (if appl ring for permit) Print Print 173 Federal St. Salem Ma. 01970 275 Gal. Aboveground Tank Dimensions (diameter x length) Remarks: i posalInfor-rnation" City Substance Last Stored Fuel Oil Firm transporting waste H & S Tank Cleaning, Inc . State Lic. # MA 3 7 6 E.P.A. # MP9784572069 Tank yard # 0(12 N/A Tank yard address 225 Commercial Street Lynn. MA 01905 Hazardous waste manifest# Approved tank disposal yard Turner Salvage Type of inert gas • ,_Approvals. City or Town •d ChAfi\ Date of issue ,s7/0 11,o Dig safe approval number: Signature / Title of Officer granting permit �i ll After removal(s) send Form FP-290R signed by Local Fire:�ept. to UST Regulatory CorIlpliance Unit, One Ashburton Place, Room 1310, Boston, MA 02108-1618. FDID# Ci? Permit# Date of expiration \I )0I C D I I Dig Saf Toll Free Tel. Number - 800-322-4844 l FP-292 (revised 9/96) City of 8alem,Ma88aehu8ett8 FIRE DEPARTMENT - FIRE PREVENTION DIVISION 29 Fort Avenue Salem, Massachusetts 01970-5232 APPLICATION FOR CERTIFICATE OF COMPLIANCE To: HEAD OF FIRE DEPARTMENT ❑ One Family Dwelling ❑ Two Famlily Dwelling XCondominium Unit # Application is hereby made for inspection of smoke detectors and carbon monoxide alarms as required by Massachusetts General Law. Chapter 148 Sections 26F, 26F1/2 and 527 CMR 31. et seq. C HHECK--e Fee Due Inspe/io Y .2 Time C/a,'0 Closing Date: Type of Smoke Detector Battery Hardwire Hardwire w/Bat. back-up Heat Combination Type of Carbon Monoxide Detectors Battery Plug-in W/ Bat. Back-up Combination Location of Property Owner of Property 6.94, e rA _o_ Date of ification: �/9,a7 r By o Owner or Agent Phone • Note Any certificate issued in accordance with provisions of M.G.L. Chapter 148 Sections 26F. 26F1/2 expires sixty (60) days after issuance by head of the Fire Department. ' ^ [A THE KNOX COMPANY � ` puBOX zmm^mcw"onrBEACH, o^9266^Jn*vm`xov � FEDERAL uu#9m-3vnvn SOLD TO: HEALTH & EDUCATION 8ERV. ATTN: PAU` O'SHEA 102 FEDERAL ET �STRE GALEoN, MA 01970 ,ODE ,+ P5-4�-044-09-86 1 � Salesman Tenn PREPAiD ` GALBM FIRE [}EPT 3200 BLACK SHIPPING & PROCESSING: TOTAL: P/\|[}{:K#: 3497, $122.00 Invoice Date | i1/06/8@ SHIP TO: Shipped —Zone UPS *ZONE 8m �|^ INVOICE NO. 56579 Your Order No. SALBM F-IRE PREV. BUREAU, ATTN: INSP. NORMAN LaPO|NTE 48 LAFAYETTE STREET . SALEM, MA 01970 FOR NEWPORT BEACH ' �Unit Price INSTALLATION ADDRESS' HEALTH & EDUCATION — 162 FEDERAL STREET —.BALEKn / CUSTOMER } � —~.~~_^ ' ^ ° 122.00 '