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28 GOODHUE ST - BUILDING INSPECTION (8) �er 4d 0 5 �' ffiSNtISPiEfMtfisNND WHOM OY im • ��`f+ re�ewflt cIIwRANT�D CITY OF SALEM No.��J� a,s o 2 w.rd 1 .J zo"fAMdm Is PAY LoorYd In I. TAGStIm of t� ft �f]kow VM No aAf� n (OOtOI/�-Nirl M Plomq Loafed in file Cm1eWaSo 1 Awe9 Yw NO_ Permit to: NO SUILDI PERMIT APPLACATIDN FOR: Pols wlfblwm apply) Rod. Raroof. instill SMft Coftww DooK Shed, Pool, Repaidilloplow OtMc PQPrIb PLEASE PULL.OUR LSOMILY a COIAPLETELY TO AVOW DELAYS N PROCEirNO TO THE INSPECTOR OF BUILDING& ' The Whereby applies for a permit to build aoomdftto dw.lmlln Mng Owaa:'s Name &Of LGC Address a Phorw 22 9-ggoA Z 75�r (P Jpl q Amhksot's Nti no ?4 haPOAAa 4- Address a Plum 6 Lf'rcow�p �T' MaoftartI= Name Address a Ph" ( 1 whet It er PmPeM of eulsne?mom d hwom! i Ibo'll/ N s dwe- R for how wary fm dery wN kNd"omdam fo feerr T�S — AL/r� T✓ A Bard Emftmw oat Cp uomw r► aft Ul • 0111111111111111 tNO "a PENALTY OP PNMRW D T1oN oP v�lilc TO mom r�� `ti MAIL PEFWIT TO. F r' i i • � t ar �2 t otLv l 40) ow NgV=Iddr � � i 0/06/2004 07:05 7815927641 Al EXTERMINATORS PAGE 03 Al A•1 Exterminators pest[Ontrot prpfessionals DATE: TO: BOARD OF HEALTH SALE, AT THE REQUEST OF: r T 291 ArTDOVER CT A RODENT CONTROL DEMOLITION SERVICE WAS PERFORMED AT --------------- THE PROPERTY SERVICED WAS. " IF YOU HAVE ANY QUESTIONS, PLEASE DO NOT HESITATE TO CALL. SINCERELY, A-1 Ek F"INATORS 183 Shepara Streel ^ L"..M$ 07$029557 781-542-2731 •$00-525.4625 78L-5S2-7641 Fax SITE COPY A F� BACKFLOW PREVENTION DEVICE TEST STATUS INSPECTION AND MAINTENANCE Initial [ ] "-/� REPORT FORM Retest [ 1 N R`Vp( ` Print Clearly Supplier Annual (y, CA—YU/�-L LC,C- Sup`==--- sem:ann..a- . inspection Date 7 ' © T DEP Owner ID # Owner of Device � Tester' s Name C Contact Person. Y"T e _ Q� DEP Tester Certificate a I� 258156160 Phone # Ste' � (J P Device ID # Mailing Address 28 Goodhue Street Device Type: [ ) RPBP [X ] Dcw.. Salem, MA. 0197?Qk [ ] Bronze (X ) Iron. Device Address 28 Goodhue Street Make Ames Model 2000SE Salem, MA. 01970 Size 61, Serial # 2DLO445 Exac- Device -zca:ior. nn the fire Contaiment Device: [ ) Yes X J NC sprinkler system Secondary Supply or Syst. 3y-Pass : [ Yes X; No Device # 1 /aloe Type: [ ] Ball ( ] NRS ( ) OS&Y ( X ) Butterfly [ ) otner Check. Valve No. 1 Check Valve No. 2 Differential Pressure � Relief Valve Leaked ( Y Leaked [ ) Test Before I Closed Tight [ .5/1 Opened at Psi Repairs Pressure p cr ss Closed Tight ( Reduced Pressure First Check Psi i • Describe Repairs Final Test Closed Tight [ ] I Opened at Psi Pressure drop across Closed Tight ( ] Reduced Pressure Date First Check / Psi .nspection Result: PASS ('VJ FAIL [ ] :itnes`sseed by: (Si ature) If device failed, describe the problem, iwner's Represen alive o PWS 0 f.ci • List^ Parts & material used: 1A-DEP Certified Te ter -EP/DWS Official _G/DL'S (05/10/96)