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0262 LORING AVENUE - Street Files F 262 Loring Avenue S.S.C. Day Care Center Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Day Care Center Inspection. Name of faci 1 ity 622.ew. Address 6 C Name of licensee Address 3s o� '-77"a City State Zip O/ 1176 Telephone 744 Date of inspection .3 -/ -o0 Inspector: Company Responsible parties to notify in the event of an emergency: Name Address Telephone Reference: Massachusetts State Building Code Section 434.0 102 CMR 7.00 Standards for the Licensure or Approval of Group Day Care Centers NFiPA 101 Life Safety Code Form #41C (09/90) I ,alert; Fire Ce ai a%-rit 48' Lafayette Street Salem, Ma 0"970 Day Care Center Inspection • ' '-i rcle one) N 1 Is the Building Inspector's Certificate of Inspect on posted? 2. Maximum occupancy allowed: Children under the age of 2 yrs. 9 mos. r0 Children over the age of 2 yrs. 9 mos. fJ 3. Are at least two (2) separate and independent interior �./ means of .egress, remote from each other and leading directly to grade provided? iJ 4. Are two (2) means of egress, located as remoter- as v possible from each other, provided for each occupied room? tJ 5. Are all exits properly marked? tJ 6. Are all egresses clear of obstruction? J 7. Is a full fire alarm system with panel provided? • PJ 8. Is a drill switch provided? P� 9. Date most recent drill conducted:. N 10. Is a fire drill procedure conspicuously posted? r' IJ�Iq 11. Do all interior stairways have smoke detectors connected to alarms audible throughout the day care center? LII-111 12. If the total occu anc is - ;24 occupancy greater than twenty four ) children, is at least one manual alarm (pull s:atior) provided on each floor of the day care center which will sound an alarm on all floors when actuated? N 13. If the total occupancy is less than or equal to twer:y four (24) children, is a manual alarm (pull station) provided which will sound an alarm on all floors whey actuated? 14. Is the day care center occupying the same building w:v% or located within two hundred (200) feet of a high-hazard occupancy? r' ^< 15. Has an emergency shelter arrangement been fci-mu!ae for the shelter of occupants in the event of ar emergency? Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Day Care Center Inspection Name of facility ��S� ��u G r , Cep.L-.-- Address 9,�v a- C L6 0- moo, ✓ten✓e Name of licensee Address City State Zip Telephone Date of inspection I • Inspector: Company Responsible parties to notify in the event of an emergency: Name Address Telephone Reference: Massachusetts State Building Code Section 434.0 102 CMR 7.00 Standards for the Licensure or Approval of Group Day Care Centers • NFiPA 101 Life Safety Code Form #41C (09/90) �. L Lai-yetL� �treet Sale., Ma r,;G7`, • ~e Center Inspection " Circle one) N 1 Is the Building In.spectcr's Certificate of Inspection. p^'sted 2. Nlaxirrnum occupancy allowed: Children under, the age of 2 yrs. 9 mos. Children over she age of 2 yrs. 9 mos. 1 -7 ill Are at .least two (2) separate and independent interior means of egress, remote from each other and leading directly to grade provided? „ d 4. A..re t�,rc (2) means of egress, located as remotely as possible from each other, provided for. each occupied V i! Are all exits properly marked? V E. Are ail egresses clear of obstruction? iJ '. Is a full fire alarm system with panel provided? • Q 8. Is a drill switch provided? i.J 9. Date most recent drill conducted:. U� N 1C. Is afire drill procedure conspicuously posted? 11 11. Do all interior stairways have smoke detectors connected to alarms audible throughout the day care center? " iJ 12. If the total occupancy is greater than twenty four (24_) children, is at least one manual alarm (pull station; provided on each floor of the day care center which will sound an alarm on all floors when actuated? PJ 1 If the total occupancy is less than or equal to twenty four (24) children, is a manual alarm (pull station) provided which will sound an alarm on all floors when actuated? 1+. Is the dal care center occupying the same building wcti". or located within two hundred (200) feet of a high-hazard occupancy? i 15. Has an emergency shelter arrangement been 1_ mule._.. for the she!ter of occupants in the event of an emergency? Salem Fire Department 48 Lafayette Street Salem, MA 01970 "y Care Center Ins on Name of facility. S'S Address: c C �� A vs- Name of licensee: Address: ��`�-� a,r,n��C o`�6c�► �,A;�� ✓� City State:/1'l A- Zip: O I 7 d Telephone: Date of inspection: - a O 'O Company.- Inspector L a Division: v� Responsible parties to notify in the event of an emergency: Name Address Telephone Ampy Location of emergency shelter arrangement. ` 41//h 140 us 4P Reference: Massachusetts State Building Code • 102 CMR 7.00 Standards for the Licensure or approval of Group.Day Care Centers NFPA 101 Life Safety Code Form #41 C (02198) Salem Fire Department 48 Lafayette Street Salem, MA 01970 Day Care Center Ins "on Circle One) Y N Is the Building Inspector's Certificate of Inspection posted? Maximum occupancy allowed. Children under the age of 2 yrs. 9 mos. " Children over the age of 2 yrs. 9 mos. / 7 LY N Are at least two (2) separate and independent interior means of egress, remote from each other and leading directly to grade provided? N Are two (2) means of egress, located as remotely as possible from each other, provided for each occupied room? i �Y N Are all exits properly marked? N Are all egresses clear and unobstructed? • N is a full fire alarm system with a panel provided? Y N Is a drill switch provided? Date most recent drill conducted: N Is a fire drill procedure conspicuously posted? �Y N Do all interior stairways have smoke detectors connected to alarms audible throughout the day care center? N if the total occupancy is greater than twenty four(24) children, is at least one manual alarm (pull station)provided on each floor of the day care center which will sound an alarm on all floors when actuated? nA N If the total occupancy is less than or equal to twenty four(24) children, is a manual alarm (pull station)provided which will sound an alarm on all floors when actuated? Y (N Is the day care center occupying the same building with or located within two • hundred (200) feet of a high-hazard occupancy? Y N Has an emergency shelter arrangement been formulated for the shelter of occupants in the event of an emergency? Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 • Day Care Center Inspection c i l i t ((q�- =G — Q Name of facility o Address Name of licensee S Address �cT, !'C' City State _ Zip O Telephone ,--.Date of inspection • Inspector: �t o ' Company L o= I Responsible parties to notify in the event of an emergency: Name Address Telephone : J Reference: Massachusetts State Building Code Section 434.0 102 CMR 7.00 Standards for the Licensure or Approval of Group Day Care Centers NFiPA 101 Life Safety Code Form 041C (09/90) Salem Fire Department 48 Lafayette Street Salem, Ma 01970 Day Care Center Inspection (Circle one) N 1 Is the Building Inspector's Certificate of Inspection posted? 2. Maximum occupancy allowed: Children under the age of 2 yrs. 9 mos. Children over the age of 2 yrs. 9 mos. N 3. Are at least two (2) separate and independent interior means of egress, remote from each other and leading directly to grade provided? i� 4. Are two (2) means of egress, located as remotely as ..possible from each other, provided for each occupied room? f N 5. Are all exits properly marked? Y� N 6. Are all egresses clear of obstruction? N 7. Is .a..fuII..fire alarm system with panel provided? N 8. Is a drill switch provided? C/ N 9. Date most recent drill conducted: G YO N 10. Is a fire drill procedure conspicuously posted? 6 N 11. Do all .interior stairways have smoke detectors 1co'nnecte'd to alarms audible throughout the day care center? Y N 12. If th otal occupancy rester than twenty four (24) cK!lld'r " is at I one_ .manual alarm Cpull station) provided floor of the day care center which wiLP so d an alarm.o :=all floors when actuated? N 13. If the total occupancy is less than or equal to twenty four (24) children, is a manual alarm (pull station) provided which" WVW sound- an alarm on all floors when actuated? Y ( N/ 14. Is the day care center occupying the same building with or located within two hundred (200) feet of a high-hazard occupancy? • Y N 15. Has an emergency shelter arrangement been formulated for the shelter of occupants in the event of an emergency? City of Salem, Massachusetts Fire Department 'gyp 48 Lafayette Street Robert W Turner Salem, Massachusetts 01970-3695 Fire Prevention Chief Tel 978-744-1235 Bureau 978-744-6990 FaX 978-745-4646 978-745-7777 DAY CARE CENTER INSPECTION NAME OF FACILITY ADDRE S S NAME ON LICENSEE ADDRESS o Z C CITY STATE ZIP o�g z3 TELEPHONE 2 Z - 6�(O q �u. • DATE OF INSPECTION 2 /C)7— INSPECTOR: GI l i+-n COMPANY- RESPONSIBLE PARTIES TO NOTIFY IN THE EVENT OF AN EMERGENCY: NAME ADDRESS'; TELEPHONE G REFERENCE: MASSACHUSETTS STSTE BUILDING CODE SECTION 434.0 102 CMR 7.00 STANDARDS FOR THE LICENSURE OR APPROVAL OF GROUP DAY CARE CENTERS. r NFPA 101 LIFE SAFTY CODE • FORM #44C 12/05/2001 i DAY CARE CENTER CHECK LIST (CIRCLE ONE) • N 1. IS THE BUILDING INSPECTOR'S CERTIFICATE OF INSPECTION POSTED? Y N 2. MAXIMUM OCCUPANCY ALLOWED: CHILDREN UNDER THE AGE OF 2YRS. 9 MOS. CHILDREN OVER THE AGE OF 2YRS. 9 MOS. S N 3. ARE AT LEAST (2) SEPERATE.AND INDEPENDENT INTERIOR MEANS OF EGRESS, REMOTE FROM EACH OTHER AND LEADING DIRECTLY TO GRADE PROVIDED? � Y ) N 4. ARE TWO(2) MEANS OF EGRESS, LOCATED AS REMOTELY AS POSSIBLE FROM EACH OTHER, PROVIDED FOR EACH OCCUPIED ROOM? Y N 5. ARE ALL EXITS PROPERLY MARKED? N 6. ARE ALL EGRESSES CLEAR OF. OBSTRUCTION? (�y N 7. IS A FULL 'FIRE ALARM SYSTEM�WITH PANEL PROVIDED? N 8. IS A DRILL SWITCH PROVIDED? � fy ) N 9. DATE OF MOST RECENT DRILL CONDUCTED: _._ Y N 10. IS A FIRE DRILL PROCEDURE CONSPICUOUSLY POSTED? N 11. DO ALL INTERIOR STAITWAYS HAVE SMOKE DETECTORS CONNECTED TO ALARMS AUDIBLE THROUGHOUT THE DAY CARE CENTER? Y / N IF THE TOTAL OCCUPANCY IS GREATER THEN TWENTY-FOUR (24) CHILDREN, IS AT LEAST ONE MANUAL ALARM (PULL STATION) PROVIDED ON EACH FLOOR OF THE DAY CARE CENTER WHICH WILL SOUND AN ALARM ON ALL FLOORS WHEN ACTIVATED? : N 1 IF THE TOTAL OCCUPANCY IS LESS THAN OR EQUAL TO TWENTY FOUR (24) CHILDREN, IS A MANUAL ALARM (PULL STATION) PROVIDED WHICH WILL SOUND AN ALARM ON ALL FLOORS WHEN ACTIVATED? Y ) 14. IS THE DAY CARE CENTER OCCUPYING THE SAME BUILDING WITH OR LOCATED WITHIN TWO HUNDRED (200) FEET OF A HIGH-HAZARD OCCUPANCY? N 15. HAS AN EMERGENCY SHELTER ARRANGEMENT BEEN FORMULATED FOR THE SHELTER OF OCCUPANTS IN THE EVENT OF AN EMERGENCY? WHERE M T-- *gLO 0:42 ��60 2 • Salem Fire Department Fire Prevention Bureau 48 Lafayette Street Salem, Ma 01970 Day Care Center Inspection Name of facility SC Address a u,e.in J C Name of licensee S C Address 3Sa k&-y City &jc' State NIA Zip Telephone 9 000 Date of inspection Inspector: ���d l �s� Company rM Responsible parties to notify in the event of an emergency: Name Address Telephone &UtV1 Gev-son Reference: Massachusetts State Building Code Section 434.0 102 CMR 7.00 Standards for the Licensure or Approval of Group Day Care Centers NFiPA 101 Life Safety Code Form #41C (09/90) Salem Fire Department 48 Lafayette Street Salem, Ma 01970 Day Care Center Inspection (Circle one) N 1 Is the Building Inspector's Certificate of Inspect?on posted? 2. Maximum occupancy allowed: Children under the age of 2 yrs. 9 mos. Children over the age of 2 yrs. 9 mos. 17 N 3. Are at least two (2) separate and independent interior means of egress, remote.from each other and leading directly to grade provided? 1J 4. Are two (2) means of egress, located as remotely as possible from each other, provided for each occupied room? N 5. Are all exits properly marked? N 6. Are all egresses clear of obstruction? QY 7., Is a full fire alarm system with panel provided? Y 8. Is a drill switch provided? J Y N 9. Date most recent drill conducted:. Y 10. Is a fire drill procedure conspicuously posted? Y N 11. Do all interior stairways have smoke detectors connected to alarms audible throughout the day care center? Y N .12. If the total occupancy is greater than twenty four (24) children, is at least one manual alarm (pull station) provided on each floor of the day care center which will sound an alarm on all floors when actuated? N 13. If the total occupancy is less than or equal to twenty four (24) children, is a manual alarm (pull station) provided which will sound an alarm on all floors when actuated? Y" 14. Is the day care center occupying the same building with or located within two hundred (200) feet of a high-hazard occupancy? N 15. Has an emergency shelter arrangement been formulated for the shelter of occupants in the event of an emergency? SALEM FIRE DEPARTMENT Ins Date pec. INSPECTION AND VIOLATION REPORT ! � In p14r8� Z Reinsp.Date: Occupa5ooc,yfName Occupa fay Typ J a. Addr ss 1 Bldg.#'s Floor/Sq ticln Phone •, C �Cti w Yes No ❑ ? Jr� '�1091 Ins ector N e C p y# Notifications ❑ Health ❑Bldg. ❑Electrical ❑Police 1. Exterior 6. Heating Systems 9,N/A fire escapes/decks Z Pass ❑ Fail ❑Warn ❑ N/A combustibles ❑ Pass ❑ Fail ❑Warn ❑ N/A proper storage [4 Pass ❑ Fail ❑Warn ❑ N/A within 5 feet proper access A Pass ❑ Fail El 'Warn ❑ N/A defective chimney ❑ Pass ❑ Fail ❑Warn ❑ N/A KNOX BOX VJ Pass ❑ Fail ❑Warn ❑ N/A defective system ❑ Pass ❑ Fail ❑ Warn ❑ N/A 2. Exits other ElPass ElFail ❑Warn ElN/A open properly Pass ❑ Fail ❑Warn ❑ N/A 7. Electrical exit blocked Pass ❑ Fail ❑Warn ❑ N/A defective wiring EK Pass ❑ Fail ❑Warn ❑ N/A exit signs working Pass ❑ Fail ❑Warn ❑ N/A panels accessible Pass ❑ Fail ❑ Warn ❑ N/A adequate lighting 9 Pass ❑ Fail ❑Warn ❑ N/A extension cords: door(s) locked E9 Pass ❑ Fail ❑Warn ❑ N/A proper use [ Pass ❑ Fail El-Warn ❑ N/A signs needed 64 Pass ❑ Fail ❑Warn ❑ N/A cover plate mis§ing Ll Pass ❑ Fail ❑Warn ❑ N/A in need of repair [j .Pass ❑ Fail ❑Warn ❑ N/A proper fusing Pass ❑ Fail ❑Warn ❑ N/A emergency lights M Pass ❑ Fail ❑Warn XN/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A 8. Fire Extinguishers ❑ N/A 3. Fire Alarm System ❑ N/A signs needed ❑ Pass [9 Fail ❑Warn ❑ N/A operative C Pass ❑ Fail ❑Warn ❑ N/A properly mounted ❑ Pass KFail ❑Warn ❑ N/A properly labeled fA Pass ❑ Fail ❑Warn ❑ N/A proper type 9 Pass ❑ Fail ❑Warn ❑ N/A accessible ►K Pass ❑ Fail ❑Warn ❑ N/A obstructed ❑ Pass ❑ Fail g Warn ❑ N/A trouble indication Pass ❑ Fail ❑Warn ❑ N/A need recharging ❑ Pass J4 Fail ❑Warn ❑ N/A defective devices [4 Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A • missing devices ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A 9. Sprinkler & Standpipe System 4. Kitchens KN/A 10 lb.ABC extinguisher ❑ Pass ❑ Fail ❑Warn 4 N/A valves labeled ❑ Pass ❑ Fail ❑Warn ❑ N/A at hazard valves accessible ❑ Pass ❑ Fail ❑Warn ❑ N/A ext.system operat. ❑ Pass ❑ Fail ❑Warn m N/A pressure reading ❑ Pass ❑ Fail ❑Warn ❑ N/A roof collect.clean ❑ Pass ❑ Fail ❑Warn N/A FDC clear/capped ❑ Pass ❑ Fail ❑Warn ❑ N/A system inspected ❑ Pass ❑ Fail ❑Warn N/A valves open ❑ Pass ❑ Fail ❑Warn ❑ N/A hood/duct clean ❑ Pass ❑ Fail ❑Warn L N/A valves secured ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑ Fail ❑Warn [t_N/A spare head avail. ❑ Pass ❑ Fail ❑Warn ❑ N/A heads obstructed ❑ Pass ❑ Fail ❑Warn ❑ N/A 5. Storage other ❑ Pass ❑ Fail ❑Warn ❑ N/A proper labeling K Pass ❑ Fail ❑Warn ❑ N/A proper storage A Pass ❑ Fail ❑Warn ❑ N/A PTN Form#84-Completed Yes ❑ No ❑ legal storage &Pass ❑ Fail ❑Warn ❑ N/A Form#58-Filed Yes ❑ No ❑ other ❑ Pass ❑ Fail ❑Warn ❑ N/A 10. Violations Found • Form#16-(Rev.11/93) Copies: White-Fire Prevention Yellow-Inspecting Company Pink-Building Owner/Manager Ref.No:G 104502373 SALEM FIRE DEPARTMENT Inspec. ate: Insp.Number INSPECTION AND VIOLATION REPORT Reinsp.Date: ti ' r e;Occupancy Name Occupancy type S 5 Cc Bldg. Ws Address rr__ Floor/Section a Phone y V c ^✓Y��i Yes❑ No❑ + Inspector Name Company# Notifications D Health ❑Bldg. ❑Electrical ❑Police v, q - 1. Exterior 6. Heating Systems _❑ N/A fire escapes/decks �Pass D Fail ❑Warn ❑N/A combustibles D Pass D Fail ❑Warn D N/A proper storage O Pass ❑ Fail ❑Warn ❑ N/A within 5 feet proper access O Pass D Fail ❑Warn ❑ N/A defective chimney D Pass ❑ Fail ❑Warn ❑ N/A KNOX BOX ©Pass ❑Fail ❑Warn ❑ N/A defective system O Pass O Fail ❑Warn ❑ N/A other ❑ Pass D Fail D Warn ❑ N/A 2. Exits open property El Pass D Fail D Warn O N/A 7. Electrical exit blocked . O Pass 'D Fail ❑Warn O N/A defective wiring .❑ Pass D Fail ❑Warn D N/A exit signs working O Pass O Fail O Warn ❑ N/A panels accessible i Pass ❑ Fail ❑Warn ❑ N/A adequate lighting O Pass ❑ Fail ❑Warn ❑N/A extension cords:* i 'door(s)locked 0 Pass D Fail D Warn ❑ N/A proper use 01 Pass D Fait ❑Warn ❑ N/A signs needed 0 Pass ❑ Fail ❑Warn D N/A cover plate missing DIPass D Fail ❑Warn ❑ N/A in need of repair Pass ❑ Fail D Warn ❑ N/A proper fusing OlPass D Fail ❑Warn ❑ N/A emergency lights D Pass 0 Fail ❑Warn PQ N/A other ❑'Pass ❑ Fail D Warn ❑ N/A other D Pass D Fail ❑Warn ❑ N/A 8. Fire Extinguishers ❑ N/A 3. Fire Alarm System D N/A signs needed,, ❑ Pass 'D Fail ❑Warn ❑ N/A operative O Pass ❑ Fail ❑Warn ❑ N/A properly mounted 17 Pass ❑ Fail ❑Warn ❑ N/A properly labeled D Pass 0.fail ❑Warn ❑ N/A proper type O Pass D Fail O Warn ❑N/A accessible O Pass ❑ Fail ❑Warn D N/A obstructed(2 ❑i Pass ❑ Fail ❑Warn ❑ N/A s 'trouble indication 17 Pass ❑ Fail ❑Warn ❑N/A need recharging Pass ❑ Fail D Warn ❑N/A 5 fective devices © Pass ❑Fail ❑Warn ❑N/A other Pass ❑ Fail D Warn ❑ N/A missing devices Pass D Fail D Warn ❑ N/A other ❑Pass ❑ Fail ❑Warn ❑ N/A 9. Sprinkler&Standpipe System N/A 4. Kitchens valves tabled ❑ Pass D Fail ❑Warner❑ N/A 10 lb.ABC extinguisher ❑ Pass ❑ Fail ❑Warn © N/A valves.accessible ❑ Pass ❑ Fail '❑Warn ❑N/A at hazard I pressure reading O Pass ❑ Fail O Warn D N/A ext.system operat. D Pass ❑ Fail D Warn 13 N/A FDC clear/capped ❑ Pass D Fail D Warn ❑N/A roof collect.clean ❑Pass D Fail ❑Warn O N/A Valves open ❑ Pass D Fail D Warn O N/A system inspected ❑ Pass ❑ Fail O Warn 0 N/A valves secured ❑ Pass D Fail D Warn ❑ N/A hood/duct clean ❑ Pass ❑ Fail D Warn 0 N/A spare head avail. ❑ Pass ❑ Fail D Warn ❑ N/A other ❑ Pass D Fail_ D Warn C1 N/A heads obstructed ❑ Pass ❑ Fail ❑Warn ❑ N/A S. Storage I other ❑ Pass ❑ Fail ❑Warn D N/A proper labeling . - D Pass O Fail O Warn O N/A proper storage ❑ Pass ❑ Fail D Warn N/A PTN Form *84-Completed Yes❑ No❑ legal storage ❑ Pass ❑ Fail ❑Warn IL-1 N/A other O Pass D Fail ❑Warn O N/A Form #58-Filed Yes❑ No❑ 10. Violations Found I i i ,. f, ,,;pin I^u1;/i1.f�.! �iG ?� ! it Vl)d re jT6; iA�;Vv�'G Form#16-(Rev.11/93) Copies: White-Fire Prevention Yellow-Inspecting Company Pink-Building Owner/Manager a SALEM FIRE DEPARTMENT nspec. ate: Insp.Number INSPECTION AND VIOLATION REPORT Reinsp.Date: :,,Occupancy Name s S J {i'�SC�A U( Occupancy Type Address ll"� Bldg. #'s Floor/Section Phone. /�_ � Yes O No❑ � Inspector Name Company# Notifications ❑Health O Bldg. ❑Electrical O Police 1. Exterior (�.6. Heating Systems ❑ N/A fire escapes/decks ®Pass O Fail O Warn ❑ N/A combustibles ❑Pass ❑ Fail O Warn ❑ N/A proper storage [11 Pass O Fail O Warn O N/A within 5 feet p proper access ® Pass ❑ Fail ❑Warn ❑ N/A defective chimney O Pass O Fail ❑Warn ❑ N/A KNOX BOX O Pass O Fail ❑Warn ❑ N/A defective system ❑ Pass ❑ Fail O Warn ❑ N/A other ❑ Pass ❑Fail ❑Warn ❑ N/A 2. Exits open property 17 Pass ❑ Fail ❑Warn O N/A 7. Electrical exit blocked . O Pass ❑ Fail ❑Warn O N/A defective wiring 0 Pass ❑ Fail ❑Warn ❑ N/A exit signs working Pass ❑ Fail ❑Warn ❑ N/A panels accessible Pass ❑ Fail ❑Warn ❑ N/A adequate lighting O Pass ❑ Fail O Warn ❑ N/A extension cords: door(s) locked O Pass ❑ Fail ❑Warn ❑ N/A proper use IDPass Pass ❑ Fail ❑Warn ❑ N/A signs needed 4 Pass O Fail ❑Warn ❑ N/A cover plate missing Pass ❑ Fail ❑Warn ❑ N/A v in need of repair O Pass ❑ Fail ❑Warn ❑ N/A proper fusing ❑ Fail ❑Warn ❑ N/A emergency lights ❑ Pass ❑ Fail ❑Warn �Q N/A other ❑ Pass ❑ Fail ❑Warn O N/A other ❑ Pass O Fail ❑Warn ❑ N/A 8. Fire xtinguishers ❑ N/A 3. Fire Alarm System ❑ N/A signs needed,r ❑ Pass ❑ Fail ❑Warn ❑ N/A operativeO Pass Fail ❑Warn ❑ N/A properly.mounted O 11 Pass ❑ Fail ❑War n ❑ N/A properly labeled ® Pass ❑ Fail ❑Warn O N/A � proper type ❑ Pass ❑ Fail ❑Warn D N/A a xry accessible O Pass ❑Fail ❑Warn ❑ N/A , obstructed _ Pass O Fail ❑Warn ❑ N/A ti,. • trouble indication O Pass ❑ Fail O Warn ❑ N/A need recharging Pass ❑ Fail ❑Warn ❑ N/A y 'defective devices © Pass ❑ Fail ❑Warn ❑ N/A other Pass ❑ Fail 0 Warn ❑ N/A missing devices Pass O Fail ❑Warn O N/A other O Pass ❑Fail ❑Warn ❑ N/A 9. Sprinkler&Standpipe System 4. Kitchens N/A valves tabled O Pass O Fail ❑Warn ❑N/A, 10 lb.ABC extinguisher ❑ Pass ❑ Fail ❑Warn ED N/A valves accessible ❑ Pass ❑ Fail ❑Warn ❑ N/A' at hazard pressure reading ❑ Pass ❑ Fail ❑Warn ❑ N/A. . ext.system operat. ❑ Pass ❑ Fail ❑Warn ©N/A FDC clear/capped ❑ Pass ❑ Fail O:Warn ❑ N/A roof collect.clean ❑ Pass O Fail ❑Warn © N/A Valves open ❑ Pass ❑ Fail '❑Warn 0 N/A system inspected O Pass ❑ Fail O Warn O N/A valves secured ❑ Pass ❑ Fail ❑Warn ❑ N/A hood/duct clean ❑ Pass ❑ Fail ❑Warn ❑ N/A spare head avail. ❑ Pass ❑ Fail ❑Warn ❑ N/A. other El Pass ❑Fail ❑Warn ❑N/A heads obstructed ❑ Pass ❑ Fail ❑Warn ❑ N/A S. Storage other ❑Pass. ❑ Fail 0 Warn ❑ N/A I proper labeling O Pass O Fail ❑Warn © N/A , proper storage ❑ Pass ❑ Fail ❑Warn © N/A PTN Form *84-Completed Yes❑ No❑ legal storage ❑ Pass ❑ Fail O Warn 1p N/A other. > ❑ Pass ❑Fail ❑Warn V N/A Form *58-Filed Yes O No❑ 10. Violations Found tr1 r to i,u SI.�a+ (A►, 11A ! ePA) 6 VA&) D V'& € 1s UI � 1� relnS �c�' � hQv ' ��arm it 0VUA4 Form#16-(Rev.11/93) Copies: White-Fire Prevention Yellow-Inspecting Company Pink-Building Owner/Manager �r!"w"ke� ��"C�' 'S��.+�-h+..+an.+r�s�;ys , / ' .n.ef-N.ri.+•+f �,�:,�i r � � :......�' * 1 SALEM FIRE DEPARTMENT Inspec. ate: Insp.Number .` ° INSPECTION AND VIOLATION REPORT Reinsp.Date: Occupancy Name Occupancy Type t� Address tt__ A G ti Bldg. #'s Floor/Section Phone _ `: v�. s✓ z�� )' Yes❑ No❑ �-- Inspector Name Company# Notifications ❑Health ❑Bldg. ❑Electrical ❑Police I., Exterior (-� 6. Heating Systems ❑ N/A fire escapes/decks M Pass ❑ Fail ❑Warn ❑ N/A combustibles ❑Pass ❑ Fail ❑Warn ❑ N/A proper storage Q Pass ❑ Fail ❑Warn ❑ N/A within 5 feet proper access. Cl Pass ❑ Fail ❑Warn ❑ N/A defective chimney ❑ Pass ❑ Fail ❑Warn ❑ N/A KNOX BOX O Pass ❑ Fail ❑Warn ❑ N/A defective system ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A 2. Exits open property El Pass ❑ Fail ❑Warn ❑ N/A yI- 7. Electrical exit blocked Pass ❑ Fail ❑Warn ❑ N/A defective wiring ❑Pass ❑ Fail ❑Warn ❑ N/A exit signs working ©Pass ❑ Fail ❑Warn ❑ N/A panels accessible ❑ Pass ❑ Fail ❑.Warn ❑ N/A adequate lighting D Pass ❑ Fail ❑Warn ❑ N/A extension cords: door(s)locked 0 Pass ❑ Fail ❑Warn ❑ N/A proper use ❑ Pass :. 0 Fail ❑Warn ❑ N/A signs needed O Pass ❑ Fail ❑Warn ❑N/A cover plate missing ❑ Pass O Fail ❑Warn ❑ N/A in need of repair Pass ❑ Fail ❑Warn ❑ N/A proper fusing ❑ Pass ❑ Fail ❑Warn ❑ N/A emergency lights ❑l Pass ❑ Fail ❑Warn Z N/A other ❑ Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑Fail ❑Warn ❑ N/A 8. Fire Extinguisher: ❑ N/A 3. Fire Alarm System ❑ N/A signs needed,,, ❑ Pass ❑ Fail ❑Warn ❑ N/A operative U1 Pass ❑ Fail ❑Warn ❑ N/A properly mounted ❑ Pass ❑ Fail ❑Warn ❑ N/A s roper) labeled ® Pass ❑ Fail ❑Warn ❑ N/A properly a proper type ❑ Pass ❑ Fail O Warn ❑ N/A accessible ® Pass ❑ Fail ❑Warn ❑ N/A obstructed/:Z' ❑ Pass ❑ Fail ❑Warn ❑ N/A ` trouble indication ❑ Pass ❑ Fail ❑Warn ❑ N/A • fi;: Y need recharging Pass ❑ Fail ❑Warn ❑ N/A 'defective devices O Pass ❑ Fail ❑Warn ❑ N/A other A ❑ Pass ❑ Fail ❑Warn ❑ N/A missing devices 0 Pass ❑ Fail ❑Warn ❑ N/A other Q Pass O Fail ❑'Warn ❑NIA 9. Sprinkler&Standpipe System ❑� N/A 4. Kitchens valves tabled ❑ Pass ❑ Fail ❑Warm•❑ N/A 10 lb.ABC extinguisher ❑ Pass ❑ Fail ❑Warn 0 I N/A valves accessible ❑ Pass ❑ Fail ❑Warn ❑ N/A at hazard pressure reading ❑ Pass ❑ Fail ❑Warn, ❑ N/A ext.system operat. ❑ Pass ❑ Fail ❑Warn 0 N/A FDC clear/capped ❑ Pass ❑ Fail ❑Warn ❑ N/A roof collect.clean ❑ Pass ❑ Fail ❑Warn 0 N/A Valves open ❑ Pass ❑ Fail ❑Warn, ❑ N/A system inspected ❑ Pass ❑ Fail ❑Warn 0 N/A valves secured ❑°Pass ❑ Fail ❑Warn ❑ N/A hood/duct clean ❑ Pass ❑ Fail ❑Warn ❑ N/A spare head avail. ❑Pass ❑ Fail ❑Warn ❑ N/A other ❑ Pass ❑Fail ❑Warn ❑N/A heads obstructed ❑Pass ❑ Fail ❑Warn ❑ N/A <<-S. Storage ,P other ❑jpass ❑ Fail ❑Warn ❑ N/A � proper labeling Ej Pass ❑ Fail ❑Warn JN/A ,. proper storage ❑ Pass ❑ Fail ❑Warn N/A PTN Form *84-Completed Yes❑ No❑- �. legal storage ❑ Pass ❑ Fail ❑Warn N/A other ❑ Pass ❑ Fail ❑Warn Q N/A Form *58- Filed Yes ❑ N670 "--- 10. Violations Found k OA I Form*16-(Rev.11/93) Copies: White-Fire Prevention Yellow-Inspecting Company Pink-Building Owner/Manager q�s �wa Aso Q-3 .j", A�l