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HomeMy WebLinkAbout0369 SOUTH STREET - Health 3.69 South Stmet Hyannis D o A 308 249 19 EWE K 0 R !i a 1 ! i a �� t 11/03/2015 03:04 7813375346 CLEAN SURFACE PAGE 01103 FCLEAN SURFACE DELEADING , , INC 203 Essex St. Ph: (781) 340-0816 Weymouth, MA 02188 a Fax: (781) 337-5346 FACSIMLE. COVER, SHEET DATE: Nov. 3 2015 TO: Director, Asbestos Lead Program (617) 626-6965 Director, Childhood Lead• FQisoming Prevention Program (781) 774-6700 Board of Health, ToWd of.. Barnstable (508)790-6304 FROM: Mark S. Riaiio i R RE; Notification of Dele ng Rork 369 South St- jr Uft. #11 Hyannis, MA 1 PAGES: 3 WAIVER #15004-2=Ns Please call (781') 340' 0816 of any 'problems' with transmission. F- 1103/2015 03:04 7813375346 CLEAN SURFACE PAGE 02/03 4 WA V9R#15004-2-ND COMMONWEAL)f'H OF MASSACHUSETTS Department of Labor' Industries'and Department of Public Health NOTIFICATI:ON OF DELEADING WORD All sections of this form must be completed in order to comply with the notification requirements of M.G.L.Ch. 111, § 197, 454 CMR 22.00 and 105 C11R 460,000-as most recently amended ' File Number: (AGENCY USE) Contractor performing project Mark S.l3ianw License#DC 001055 Lead Paint Inspector John MaeIsaac License#UR 3378 Date of Inspection 10/22I15 If low-risk deleading work is being pc fbrwa d,com'ple'te the following line: Property Owner: N/A _ Address of Proiect Building Name(if any) " Floor 1 Street Address 369 South St. Apt.No. 1 City H ann:is _ Zip 02601 Deleading Method: We Sc pin Heat'Gun stics Liquid Ene,apsulant Cove Demolition' Other If"Other"selected,please explain MakingIntaet .r Check One: Dwelling is multi-fancily _ X Single family Start date 1115L5 Completion date 12/1/15 When will work be done: A.M. x P.M. Weekends X Project Supervisor's name Mark Bianco License# DCQ01055 Property Owner: 369 South St:Trtc/o Garv,Maradian Address 25 Greenteal Way City_ Yarmouthport State MA Zap 02675 Telephone 5 362-2508 in case of emergency contact Mark Bianco Phone: day (617)340-0816 evenitg,_7811340-0544 (over) 11/03/2015 03:04 7813375346 CLEAN SURFACE PAGE 03/03 A/ • �. Page 2,9f 2 1a aecordtlttee with mattaaebusetts General Laws C.111 V97;454 CMR 22.00 end 105 CMR 460.000,aotice of the date and method(k)of etnevat or coveslog of riot;plaster or otlter aceessibTe nraterimla eoatalnteE dangerous levels of lead is to be provided and must be reserved by the Ibilowittg agm1ea,at.tenst (19)days prior to the heginoiag ofdeleading. NOMCATIONS-MAY HE FAXIM. 1. Departrocat oflaebar,Lead ptogram,Division of Occupational Safety 19 Stamford Street,I"Floor,Boston,MLA 02114 FLAX,619-6264%5 2. Director;Childhood L;W Poisoning Prevention Program T)epprtment of Public Health,Do navau Health BuZdin&5 Rtu"ph Streit,Canton,MA 02021 FAX,701-774-6700 3. occupants of dwelling unit 4. All otlrer oceuWt$of the residential preneises,Warty. 5. Local Board of RealthlCode Enforcement Agency 6. Massachusetts Hw tordeal Commission (if premises a're lusted on the State Register of Historic 2WMo~Mvd. Places,this notification must be made upon receipt of an Boston,MA(x202 Oster to Correct Violations or at least ail days.prior to FAX(617)727-5128 initiating preventive deleadieg) NOTI1?[GAI'IONS SHALL BE CoMpLE1'lED IN TMR I:AT�7',DATED AND SIGNED-[NCDMPLIETE NOTWICATIONS WILL NOT BE ACCEPTED AND WALL BE 1ZI7IJANED SX THE DT3J!,ARTMENT.O F LABOR&WORKFORCE DEVELOPMENT. (if owner or unlicensed owner's agentwilf be performing low-risk deleading work,complera the following): Property Owner Agent(s) ` Address Telephone Number C__)- I cortity that 1 have compMd with the training requirements of the Commonwealth of Massachusetts Lead Poisoning Prevention and Control Regulations,105 CMR 460,175,for owner/agent low-risk abatement and contain wt- I ltuthercert 6 that 1 or my agent will be performing the following low-risk activities (I have cirt;led all that apply): applying Ilgoid elscapsulant capping bastboards removing doors,cabinet doors,shatters applying orteriervinyl siding coveriag surface , I certify that all the Information oomtained in this notification is true and correct to the best of my knowledge rd belief. Dane sign L golyll e r Revised i2/20o7 Date:,6P /5/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OFBUSINESS: ,/W/c Flower ),0L nd Ck.j2 i2— BUSINESS LOCATION: 3a 2 _,(j204 INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: __ <SU� d'� �g 3 CONTACT PERSON: ram . U J 2e r EMERGENCY CONTACT EL PHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 01kM0f1_19__c cMa, INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under,the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including.chloroform,formaldehyde`, ` Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list):-- Metal polishes Laundry soil &stain removers (including bleach) O a Spot removers&cleaning fluids j (dry cleaners) �f Other cleaning solvents !� Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's gnat re Stafff's Initia �� 12/97/2017 03:01 7813375346 CLEAN SURFACE PAGE 02/03 COMMONWEALTH OF MASSACHUSETTS Department of Labor&Industries and Department of Public Health NOTIFICATION OF DFLEADING WORK All sections of this form trust be completed in order to comply with the notification requirements of M.G.L. Ch. 111, § 197, 454 CMR 22.00 and 105 CM R 460.000 as most recently amended File Number: (AGENCY USE) Contractor performing project Mark S.Bianco License#DC 001055 Lead Paint Inspector Benjamin Misch License#I/R-3984 Date of baspection 10/20/17 Z£low-risk deleading work is being performed,complete the following line: Property Owner: -NIA Agent: Address of Project Building Name(if any) Floor 2 Street Address 369 South St. Apt.No. 2 City Hyannis Zip 02601 Deleading Method: �Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement Other If"Other" selected,please expla' Check One: Dwelling is multi-family X Single family Start date 12/16/17 Completion date 12/20/17 When will work be done: A.M. X P.M. Weekends x Project Supervisor's name Mark Bianco License# DC001055 Property Owner Gaa Maradian c o 369 South St. Trust Address 25 Greenteal Way City Yarmouthport State MA Zip 02675 - Telephone (508,)367-2800 In case of emergency contact Mark Bunco Phone: day (61 34Q-0816 evening (781)340-0816 (over) 12/07/2017 03:01 7813375346 CLEAN SURFACE PAGE 03/03 Page 2 of 2 in secordsuee with Massachusetts General Laws C.111§197,454 CMR 22A0 and 105 CMR 460.000,notice of the date and method(s)or emoval or covering of paint.plaster or other accessible materials containing dangerous levels of lead is to be provided and must be received by the following agencies,at least TEN(10)days prior to the beginning of deleading. N077 ICATIONS MAY BE FAXED. 1, Department of Labor,Lead Program,Division of Occupational Safety 19 Staniford Street,l"Floor,Boston,MA 02114 FAX:417-626-696S 2. Director,Childhood Lead Poisoning Prevention Program Departmout of Public Health,Donovan Health Building,5 Randolph Street,Canton,MA 0202I FAX 791-77"700 3. Occupants of dwelling unit 4. All other occupants of the residential premises,if any S. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (if premises are listed on the State Register of Historic 220 Morrissey Blvd. Places,this notification must be made upon receipt of an Boston,MA 0=02 Order to Correct Violations or at least 30 days prior to FAX(617)727-5128 initiating preventive deleading) NOTIFICATIONS SHALL BE COMPLETED W THEIR ENTIRETY,DATED AND SICNFA-INCOMPLETE NOTIFICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORKFORCE DEVELOPMENT. PRO M OWN$A(If owner or unlicensed owners agent will be performing low-risk deleading work,Complete mho following): Property Owner Agent(s) Address Telephone Numbor�,,,_(,,_)- I certify that 1 have complied with the training requirements of the Commonwealth of Massachusetts Lead Poisoning Prevention and Control Regulations, 105 CMR 460.175,for owner/agont low-risk abatement and containment. I further certify that 1 or my agent will be performing the following low-risk activities (I have oiroled all that apply): applying liquid aneapsulant capping baseboards removing doors,cabinet doors,shutters applying exterior vinyl siding covering surfaces 1 certify that all the Information contained in this notification is true and correct to the best of m y f. �y knowledge and belie c�—'L164 Revised 1212007 ............. ............. ............. • Complete items 1,2,and 3. 5ignatufe O.Agent • Print your name and address on the reverse.... "CAddressee 1.so that we can return the card to you. 0 Attach this card to the back of the mallpiece, Received by(PrInt.6d Namo C.Dat of D Il or on the front if space permits. 1/0 71 6!1 Oy-/ D. Is delivery address different from Re,n 1? 13 Ye Michael Pacy If YES,enter delivery add.ress below. q c/o Gary Maradian x PO Box 5 I M 0 Yarmouth Port, MA 02675], 3. Service Type 13 Priority Mail Express@ 0 Adult Signature 0 Registered aj 13 Adult Signature Restricted Delivery 0 Delivery.9istred MMSRestictec 13 Certified MWIO 9590 9403 0424 5163 7488 54 El Certified Mail Restricted Delivery El Return Receipt for 0 Collect on Delivery Merchandise --Aw I nip i m In A r-transfer from-ser vide 13 Collect on Delivery Restricted Delivery. 13 Signature Confirmationm jableD—.-❑-.,�ad Mail 0 Signature Confirmation 7014, 126U, U13 '5 1 t-,..��%d Mail Restricted Delivery Restricted Delivery bit b JAk $54 ' I PS Form 3811,April 2015 PSN 7530-02-000-9053 1 V- Domestic Return Receipt i UNITED STATE$; ass'Mat PQ ?AI.S.ER1(I.CE:; ' -. .Flrst�al•• Postage Wftew{daid :uses:•; . 7;7- • Sender: Please print your name, address, and ZIP+4®in this box- " 4 Town of Barnstable Health Division ° 200 Main Street Hyannis,MA 02601 USPS TRACKING# 9590 9403 0424 �,f3 8�: s �; a�i:t:sF��' 3�:''m j3 OFZHE r, Town of Barnstable Regulatory Services BARNSTABLE, 4 Richard Scali,Director MASS. �Aren 59. All Public Health.Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: .508-862-4644 Fax: 508-790-6304 October 23, 2015 Michael Pacy c/o Gary Maradian PO Box 5 Yarmouth Port, MA 02675 A lead paint determination was conducted at the home you own at 22 Pine Avenue (aka) 369 South Street Hyannis, MA. This determination was conducted by Timothy B. O'Connell, R.S.. ' The determination found lead paint in violation of the Lead Law,Massachusetts General Laws, chapter 111, section 197, and the Massachusetts Department of Public Health's (DPH's)Lead -Poisoning Prevention and Control Regulations, 105 Code of Massachusetts Regulations(CMR) 460.000. The law requires owners of homes or apartments built before 1978 to have lead paint violations deleaded for full compliance or brought under interim control when a child under six years old lives there. A private risk assessor has to do a risk assessment and give you a lead inspection/risk assessment report before you can go ahead with interim control. A private lead inspector has to do a comprehensive lead inspection'and give you a lead inspection report before you can go ahead with deleading for full compliance. If you already have a Letter of m Compliance for this property,please complete the last,,page of the Order to Correct and send it to me within 14 days. The Order that comes with this letter has important information telling you: • what you have to do • what deadlines to meet • what documents you have to send to this agency • who can do the necessary work • what the penalties are for not meeting the Order's requirements • what your options are if the property has been previously deleaded. Please call me at this office at(508) 862-4646 as soon as possible to discuss this Order and how to meet it. The following information explains the deleading process, if the property has not been deleaded previously. Hiring a Lead Inspector To help you take the first step—getting a full inspection or risk assessment—a list of lead inspectors is enclosed. We recommend that you check references.and make sure that the inspector is still licensed. You can check on the license by calling the state Department of Public Health's Childhood Lead Poisoning Prevention Program (CLPPP)before hiring an inspector. To BOH Cover Revised 1-05 Page 1 of 3 " get a list of risk assessors for interim control, call CLPPP's central office at 1-800-532-9571. You can also get other helpful materials from CLPPP, including brochures explaining the choices of full compliance deleading and interim control. Again,you can get these by calling CLPPP at the number above or by checking our website at www.state.ma.us/dph/clppp. Requirements for Doing Deleading Work High-risk deleading: If you need to or choose to have high-risk deleading work done, such as having lead paint stripped or scraped,you have to hire a deleading contractor. A list of deleading contractors is also enclosed. Just as in the case of inspectors, we recommend you check references and make sure that the deleader is still licensed. You can check on the license by calling the state Division of Occupational Safety(DOS) at 1-800-425-0004. Moderate-risk deleading:'Before you or your agent can do moderate-risk deleading work, such as removing windows and woodwork,you have to take a course,pass it and get an authorization number from CLPPP. These courses are given by a number of groups and organizations at various places,times and prices. For a list of approved moderate risk training providers, call CLPPP at 1-800-532-9571 or check our website(address above). Remember that you still have to meet the deadlines in the Order.-If a course for owners to do moderate-risk deleading is not available at a convenient time or place for you to meet the deadlines of this Order, you won't be able to do moderate-risk deleading work yourself. You then have to use other methods to delead, or hire a licensed lead-safe renovation contractor. To get a list of these contractors, or to check their licenses, call DOS at 1-800-425-0004. Low-risk deleading: Before you or`your agent can do only low-risk deleading work, such as covering surfaces,you have to read the CLPPP low-risk booklet,take a self-corrected exam that you send in to CLPPP, and get an authorization number from CLPPP. If you want to encapsulate, you must first have a full lead inspection done on the property and then contact CLPPP to go over your inspection report and discuss surfaces that may be good for encapsulation. If encapsulation is a suitable option,you have to read CLPPP's encapsulation booklet,take a self- corrected exam that you send in to CLPPP, and get an authorization number from CLPPP. To get a free copy of the low-risk booklet, or the encapsulation training handbook, call CLPPP at 1-800- 532-9571. A Interim control work: If you or your agent will be doing other work for interim control, such as structural repairs and cleaning of leaded dust,you have to take safety steps and clean up in the way described in the CLPPP booklet for interim control. To get a copy of this interim control booklet, call CLPPP at the above number. Deleading work has to be carefully done to be safe. To protect the people who live in the home or apartment,you have to keep them out of the home or apartment, or area being worked on, in these ways: • All people and pets have to be temporarily moved from the home or apartment for the whole time that high- or moderate-risk deleading work is taking place inside the home or apartment. You have to provide the residents with a reasonable alternative place to live for this period. People and pets who have been temporarily moved from their home or apartment can only come back after a licensed private lead inspector or licensed private risk assessor says it is safe for them to return. The inspector or risk assessor does this after reinspecting the home, BOH Cover Revised 1-05 Page 2 of 3 including taking dust samples to assure that lead dust levels meet approved standards. This reinspection will be done at least three hours after deleading work.is all done. • People and pets have to stay out of the work area while you or your agent does most low-risk deleading work or structural repairs or cleaning of lead dust. They also have to stay out of the work area while there's any deleading work in common areas outside the home or apartment, as long as they have another regular way(not a fire escape)to go in and out of the building. In these cases,people and pets can use the area once the work is done in the area and cleaned UP. • People and pets have to stay out of the home or apartment for the workday while you or your agent apply encapsulants with an airless sprayer. They also have to stay out for the day during deleading in common areas when they do not have another regular way (not a fire escape)to go in and out of the building. When people and pets are out of their home or apartment for the day, it means they can come back to the home or apartment after cleanup at the end of the workday, and don't have to be out overnight. All work for deleading and interim control has to be neatly and properly done, in a professional way, and the home or apartment has to be returned to a condition that meets the requirements of the State Sanitary Code. Deleaded surfaces cannot be repainted until after they have passed reinspection by a licensed private lead inspector or risk assessor. You have to give written notice about common area lead paint violations to all other residents of the building. "Notice to Tenants of Lead Paint Hazards" is enclosed for that purpose. You also have to send a copy of the lead inspection report or lead inspection/risk assessment report and any reinspection reports to all mortgagees and lienholders of record. If your property has been previously deleaded, you may be eligible for a 30-day maintenance period. Please fill out the last page of the Order to Correct and return it to me within 14 days to take advantage of this option. ' If you have questions about the Department of Public.Health's Lead Poisoning Prevention and Control Regulations,you can ask me, or call the CLPPP central office (1-800-532-9571 or 617- 284-8400). If you have questions about the Division of Occupational Safety's (DOS)Deleading Regulations, call the DOS central office (1-800-425-0004 or 617-727-7047). Remember to refer to the attached Order for more information about what you have to do. 5rn ORDER F THE BOARD OFHEALTHas A.McKean, S., CHO ' Director of Public Health Town of Barnstable BOH Cover Revised 1-05 Page 3 of 3 I Town of Barnstable r � ;$"MMAMA`"B`E� Regulatory Services jDtEo Mp(6 Richard Scali,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA'02601 Office: 508-862-4644 Fax: 508-790-6304 October 23, 2015 Michael Pacy c/o Gary Maradian PO Box 5 Yarmouth Port, MA 02675 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION - The property owned by you located at 22 Pine Avenue(aka) 369 South Street Hyannis, MA was inspected on October 23, 2015 by Timothy O'Connell,R.S.,Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. Be advised that certain portions of this residential property to be in violation of the State Sanitary Code, 105 ; Code of Massachusetts Regulations (CMR) 410.750(J). This violation also constitutes a violation of the Lead Law,Massachusetts General Laws (MGQ) chapter 111, section 197, and the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000.If you already have a Letter.of Compliance, please look to the last page of this Order and fill out the appropriate information. Conditions exist in this residence that may endanger and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Massachusetts Department of Public Health Childhood Lead Poisoning Prevention Program'declares that the presence of this violation of the Lead Law and the Regulations for Lead Poisoning Prevention and Control constitutes an emergency pursuant to the Lead Law,MGL chapter 111, section 198 and within the meaning of the Sanitary Code, 105 CMR 400.200(B). CORRECTION OF LEAD VIOLATION(S) BOH OTC Revised 1105 i li Page 1 of 8 v," The Lead Law,MGL c. 111, §§189A-199B, and the Department of Public Health's Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000,require the owner of a residential premises or dwelling unit built before 1978 in which a child under the age of six lives have lead paint violations either abated or contained(referred to as "deleading")for full compliance or brought under interim control. The steps that you must follow are in the"Order" section. The Lead Law,the Department of Labor and Workforce Development's Deleading Regulations, 454 CMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that residential deleading work be done by authorized people. The type of authorization will determine the method of deleading that can be done. There are three levels of deleading: High Risk Deleading Only licensed Deleaders can do high risk deleading activities. These activities include scraping, stripping, demolition, and making large amounts of loose paint intact.If this type of work is done on the interior of a unit,then the occupants must be temporarily relocated until the work is complete and has passed a reoccupancy reinspection. Moderate Risk Deleading Moderate risk authorized owners/agents and licensed lead safe renovators can do moderate (and low risk) deleading. These activities include removal and replacement of building components such as windows, and making a small amount of loose paint intact.If this type of work is done on the interior of a unit,then the occupants must be temporarily relocated until the work is complete and has passed a reoccupancy reinspection. Owners interested in becoming trained and authorized to do moderate risk deleading should contact CLPPP for more information. Low Risk Deleading Low risk authorized owners and agents can do some minor deleading activities such as covering surfaces with approved coverings and encapsulating approved surfaces. Owners interested in becoming trained and authorized to do low risk deleading should contact CLPPP for more information. These rules on who is authorized to perform what kind of deleading work apply whether the work is being done for full compliance or for interim control. An owner or owner's agent may -also make structural repairs, as defined in 105 CMR 460.020, and clean leaded dust, as may be required for interim control. ORDER You are hereby ordered to remedy all violations of MGL c. 111, §197 and 105 CMR 460.000, as identified by a licensed private lead inspector. If you wish to pursue interim control,you must remedy all urgent lead hazards identified by a licensed private risk assessor. Whether you pursue full compliance or interim control,you must correct the relevant violations in accordance with the following schedule: BOH OTC Revised 1/05 Page 2 of 8 Within sixty (60) days of your receipt of•this Order, you must provide proof of the following: 1. A complete analysis of the property for lead hazards. Proof consists of one of the following: • A comprehensive initial lead inspection report done by a licensed private lead inspector. The inspector must inspect the interior of the unit and the common areas of the unit, including the exterior. • A comprehensive initial lead inspection and risk assessment done by a licensed private inspector who is also licensed as a risk assessor. This is only necessary if you have decided to pursue the option of Interim Control. For more information on the Interim Control program,please contact CLPPP. • For previously deleaded properties, a post compliance assessment determination done by a CLPPP code enforcement inspector. If you have a previously complied property and failed to return the last page of this Order.within 14 days,then you may no longer be eligible for a maintenance period;however,you must still have the assessment done. Only a CLPPP code enforcement inspector can do this assessment. 2. An established deleading plan for who will be deleading and when the work will be done. Proof consists of at least one of the following: A contract with a licensed deleader, licensed lead-safe renovator, or low risk authorized agent. To check_on the license for deleaders and lead safe renovators, contact the Division of Occupational Safety at(617) 727-7047. To check on the authorization for low risk agents, such as vinyl siders or carpet layers, contact CLPPP at 800-532-9571. • If you or your agent will be doing the work, a copy of the authorization letter and a completed`-`Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct"form verifying that all work will be done within required timelines(see 90 day and 120 day requirements). This form is included in this package. '< Contracts with licensed/authorized people as well as an authorized owner or agent's a completed"Documentation of Training to be an Authorized Owner/Agent And Intention to Comply with the Order to Correct''must also specify that the unit will meet acceptable lead dust levels under 105 GMR 460.170, as determined by the licensed lead inspector or risk assessor's dust wipe sampling. Should any of the dust samples fail to meet acceptable standards,the last authorized person who performed F high- or moderate-risk work will be required to reclean the entire unit until all dust samples meet acceptable levels. If a low.or moderate risk authorized person did the deleading and dust samples fail three times, a licensed deleader will be required to reclean the entire unit until all dust samples meet acceptable levels. BOH OTC Revised 1105 V Page 3 of 8 Within ninety (90) days of your receipt of this Order, you must provide proof that the following work was completed and reinspected (including passing dust wipes if required): 1. All high and moderate risk deleading on the interior of the unit must be done and must have passed reinspection, including dust wipes. Please note that if high or moderate risk activities will be done on the interior,then encapsulation cannot be done until after all'of this high and moderate risk work has been reinspected and passed dust wipes. 2. Removal and replacement of doors, if chosen as,the method of deleading,must be done and have passed reinspection. 3. Loose surfaces in the interior of the unit must have been made intact by the appropriately authorized person,been covered, or otherwise deleaded and reinspected. This includes loose surfaces being prepared for encapsulation(but DO NOT encapsulate these surfaces until after a successful reoccupancy reinspection). Making paint intact on the interior of a unit requires dust wipes at the reinspection. There cannot be any loose paint in the unit by the ninetieth day. 4. For those owners pursuing the Interim Control option,rules 1- 3 still apply; however only "urgent"lead hazards are required to be corrected.In addition, all required safeguards and structural repairs relevant to the interior of the unit must be complete and have passed reinspection and dust wipes, if required. Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor and copies of passing dust wipe results,if dust wipes were required. Copies of these documents must be provided to this agency by the 90th day. Within one hundred and twenty (120) days of your receipt of this Order, you must provide proof that the following work was completed and reinspected (including passing dust wipes if required): I. Any low risk activities on the interior of the unit that were not done by the 900'day deadline must be complete. This includes encapsulation of interior surfaces that were previously made intact. 2. All required deleading in the interior common areas and on the exterior is done and has been reinspected, including passing dust wipes if they were required. 3. :For those owners pursuing the Interim Control option, all of the "urgent" lead hazards must be corrected on the interior, common areas, and the exterior. Also, all required safeguards and structural repairs relevant to the interior common areas and the exterior must be complete and have passed reinspection. For Interim Control, a final set of dust wipes is required to be taken at the final reinspection. BOH OTC Revised 1/05 Page 4 of 8 r Proof of this work consists of a copy of a reinspection report from a licensed lead inspector or risk assessor, copies of passing dust wipe results, and a copy of a compliance document. Copies of these documents must be provided to this agency by the 120t' day. PROSECUTION AND CIVIL PUNITIVE DAMAGES Failure to comply with any of the deadlines set out above will require this agency to initiate criminal or civil proceedings against you within seven(7)business days. Compliance with this Order will be determined by this agency's receipt of the appropriate documents within the specified deadlines. Documents should be sent to my attention at 200 Main Street Hyannis,MA 02601. Inspection documents required by the 60th day deadline. One of the following: ❑ Initial Lead Inspection report by a licensed private lead inspector; ❑ Inspection report and risk assessment report by a licensed private risk assessor; ❑ Post Compliance Assessment Determination done by a CLPPP code enforcement inspector. Deleading documents required by the 60th day deadline. At least one of the following;although there may be a combination of documents: ❑ A contract with a licensed deleader,licensed lead-safe renovator, or low risk authorized agent; ❑ A copy of an owner/agent authorization letter from CLPPP and a completed"Documentation of Training to bean Authorized Owner/Agent And Intention to Comply with the Order to Correct;" ❑ If you or your agent will only be doing structural repairs and lead-dust cleaning for interim control, a signed written statement attesting that this work will be completed in accordance with the required timelines. Documents required by the 90th day deadline: ❑ A Letter of Lead Paint(Re)occupancy(Re)inspection Certification issued by a licensed lead inspector or risk assessor,in cases where high- or moderate-risk deleading work occurred, requiring occupants to be relocated from the unit for the duration of the work; ❑ Copies of results of all dust samples.taken by the licensed lead inspector or risk assessor, and copies of all reinspection report(s)issued by a licensed lead inspector or licensed risk assessor; Documents required by the 120th day deadline. Only one of the following: ❑ A Letter of Full Deleading Compliance issued by a licensed private lead inspector. BOH OTC Revised 1/05 Page 5 of 8 ; i . ❑ A Letter of Interim Control issued by a licensed private risk assessor. ❑ For previously deleaded properties, a Certification of Restored Compliance (an addendum,to the original letter of compliance) issued by a CLPPP code enforcement inspector. A copy of the deleading notification(s)must be sent to this agency at least ten(10) days before the start of any deleading, no matter who is performing the work, and whether it is for full compliance or interim control. The law provides penalties of up to $500 for each day of noncompliance.In addition,you may become liable for civil punitive.damages equal to three times any actual damages for failure to comply with this order if a child becomes poisoned. CORRECTION OF VIOLATION BY CODE ENFORCEMENT AGENCY If within the time periods stipulated above this residential property is not brought into full compliance or interim control,this agency may contract with an authorized person or authorized n persons to correct the violation(s) and obtain a Letter of Full Deleadi g Compliance or a Letter of Interim Control, and bill the owner, or initiate court action to reimburse itself. RIGHT TO A HEARING You may request a hearing pursuant to 105 CMR 460.900 of the Regulations for Lead Poisoning Prevention and Control, in conjunction with the procedures of 105, CMR 400.200(B),the Sanitary Code provision for hearings in emergency public health matters. As already noted,the aforementioned violation constitutes an emergency. (See"Declaration of Emergency" section.) As such,you may request a hearing only if you have complied with this Order. The hearing will be provided within ten days of your request. This agency shall issue a written decision within seven days after the hearing. FEDERAL REGULATIONS Some federal financial assistance programs require additional environmental investigation. If you are planning on or have applied for a federal loan program,please contact me as soon as possible in order to discuss further requirements. Please have the name of the loan program and the local agency administering the program when you call. You may request a hearing before the Boafd of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations,please contact speak with the inspector who the Town Health Division and ask to performed the inspection. p P&,as ER O THE BOARD,OF HEALTH , r . cKean, R. ., CHO ,. Director of Public Health— Town of Barnstable BOH OTC Revised 1/05 Page 6 of 8 If your property already has a letter of compliance, you must fill out this form and return it to me within 14 days. Please include copies of ALL your lead related paper work for this address. I will review the paper work for this address and contact you to schedule a post compliance assessment determination. Upon this review and a site visit, you may be eligible for a 30-day maintenance period, during which you maybe able to fix the hazards yourself and your letter of compliance remains valid. Failure to return this form to me within 14 days may disqualify you from this option, requiring you to follow all of the rules and timelines outlined in this Order To Correct Violations. Only a CLPPP code enforcement inspector can do the required inspection work for previously complied properties. The inspection and reinspection services are provided for free. Please complete and return this form immediately in order to take full advantage of this 30-day maintenance period. . Please print clearly: NAME: DATE: ADDRESS: ZIP CODE TELEPHONE NUMBER ADDRESS OF THE PROPERTY CITED: ZIP CODE: OCCUPANT(S)NAME: OCCUPANT'S TELEPHONE NUMBER: Please check off which documents you have attached to this form: ❑ Lead Inspection Report BOH OTC Revised 1/05 Page 7 of 8 ' ❑ Risk Assessment Report ❑ Letter of Full Initial Inspection Compliance ❑ Letter of Abatement Compliance ❑ Letter of Full Deleading Compliance ❑ Letter of Interim Control ❑ Certificate of Maintained Compliance : ❑ Certificate of Restored Compliance Other: This is an �imporcanc noticc_ Plra.se•havc-it cranslatcd_ Este e umav'm impormrite. Queira manda-Io uaduzir_ Este es un aviso importance. Sirvase mandarlo =ducir. -D& LA MOT BAN THONG CAW QUAN TRONG XIN VUI LONG CHO DICH LAI THONG CAC AY Ceci est imporcant. Veuillez faire traduire. S o �S i1 tltl tt� eS TJ T3' N1 u N V 4LTJ V4 S t; 15 r-� u In At IIPOEOXH, AYTO EINAI EHMANTIKO. IIA.PAKAAO META(DPAETE Questo e un 'awiso importante. Si pregadi farlo tradurre. BOH OTC Revised 1/05 ' Page 8 of 8 Town of Barnstable Regulatory Services Richard Scali, Director + SARtVSPABL& qMASS. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REQUEST FOR DETERMINATION OF LEAD HAZARDS 'AND ENFORCEMENT OF THE LEAD LAW k I Date: 20 `�kh G , request the Fwlj �� Department print name of occupant of Public Health to inspect my residence or dwelling unit for lead paint. The address of this residence or unit: Street and Apartment Number Massachusetts. Cit or Town Zip code The telephone number to reach me there is: O Phone Number The child (ren) under the age of six (6) years who reside(s) in this household is/are: ,En Was the residence built before 1978? Yes No I understand that the lead determination requested may include all rooms of the.dwelling unit or residential premises, common areas, porches and accessible exterior areas, as well as other buildings within the property lines. I further understand that if there is a child under six (6) years of age in residence, and the determination hereby requested identifies lead hazards in violation of Massachusetts 1 BOH Request for Determination Revised 11/04 General Laws, chapter 111, section 197, and Regulations for Lead Poisoning Prevention and Control, 105 Code of Massachusetts Regulations 460.110 and .750, such violations must be either deleaded for full compliance, or the unit must be brought under interim control, at the property owner's expense. The property owner must correct all violations, whether for full compliance or interim control, within 120 days of the receipt of an Order to Correct Violations. The property owner must also submit within 60 days of the receipt of such an Order, a copy of a signed contract with a.licensed deleader, if one will be necessary for the required work. If the owner or his/her agent is going to perform owner/agent deleading work, the owner must also submit a special form within 60 days. If the owner fails to comply with the Order to Correct Violations, the Health Department shall initiate judicial proceedings against the owner to enforce the Order. The Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention Program conducts random audits of inspections conducted by private inspectors and risk assessments conducted by private risk assessors following lead determinations. Such monitoring is performed to assure the quality of services being provided to the public. By requesting this determination, you agree to allow CLPPP access to your residential premises or dwelling unit after the initial determination and prior to your returning once any deleading, whether for full compliance or interim control, is completed. Not all private inspections or private risk assessments will be audited, so you may not hear from CLPPP requesting access for these additional visits. Signature o Occupant > e 2 BOH Request for Determination Revised 11/04 I � �oFtHE r Town of Barnstable } Regulatory Services 9$"xM ' AES � Richard Scali,Director •s639 �� prE1639 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 LEAD DETERMINATION REPORT FORM Date of Determination: 10-23-15 Inspector: Timothy B O'Connell R.S. License#: .D3796 Method Used: X Sodium Sulfide Expiration date: 10-29-15 Lot#062915 X-Ray Fluorescence Model: Serial#: Property Address: 22 Pine Ave. (AKA)369 South Street Hyannis MA 02601 Description of Property: Single family X, Multi-family #_units Garage Fence Other structures Age of Property: X Pre-1978 Post-1978 - Occupant: Cleidimar Campos Occupants under six year of age: Enzo Paula DOB: 10-03-2011 Occupant's Telephone: 508-360-1199 Property Owner(s): Michael Pacy Owner's Address: PO Box 5 Yarmouthport MA 02675 Owner's Telephone: Lead Hazards found? Yes X No An X-ray fluorescence reading greater than 1.0 mg/cm2 or a gray or black reaction to sodium sulfide indicates a dangerous level of lead and constitutes a positive determination. Deleading should not be undertaken based on this report. A licensed lead inspector must do a full inspection in order for you to qualify for a Compliance Letter. Deleading of lead painted surfaces must be performed by an appropriately authorized person, including a licensed deleading contractor, a licensed lead-safe renovator, and an owner/agent who is trained to perform specific work as required under the Lead Law. Contact the Childhood BOH Determ Form Revised 1-05 Page 1 of 2 Lead Poisoning Prevention Program for additional information regarding deleading and training. LOCATION SOURCE Pb 1. Child's bedroom Window Interior sill INC 2. Child's bedroom Base board INC 3. Mother's bedroom _ Trim board of closet Door Pos 4. Mother's bedroom Window Interior sill Pos 5. Mother's bedroom Baseboard under windows Pos 6. Mother's bedroom Bedroom door trim on hall way side Pos 7. Living room Window Interior sill Neg 8. Kitchen Door Jamb, non-hinged side Neg 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. ' 24. 25. BOH Determ Form Revised 1-05 Page 2 of 2 Town of Barnstable ��z rti Regulatory Services Richard Scali,Director 5AYINsr SLF. 4 Public Health Division Alf°""p'rA Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: '508-862-4644 Fax: 508-790-6304 REQUEST FOR DETERMINATION OF LEAD HAZARDS AND ENFORCEMENT OF THE LEAD LAW Date: 20 1 1 ),'tA A- C 0, (-A request the 1 ac"lj ��b �� Department print name of occupant of Public Health to inspect my residence or dwelling unit for lead paint. The address of this residence or unit: Street and Apartment Number Massachusetts: Ci or Town Zip code t _ The telephone number to reach me there is: ( 150 Phone Number The child(ren) under the age of six (6)years who resides) in this household is/are: �)-l7r tk ) Was the residence built before 1978? Yes No. I understand that the lead determination requested may include all rooms of the dwelling unit or residential premises, common areas,porches and accessible exterior areas, as well as other buildings within the property lines. I further understand that if there is a child under six(6)years of age in residence,and the determination hereby requested identifies lead hazards in violation of Massachusetts - 1 I General Laws, chapter 11 l,'section 197, and Regulations for Lead Poisoning Prevention and Control, 105 Code of Massachusetts Regulations 460.110 and .750, such violations must be either deleaded for full compliance, or the unit must be brought under interim control, at the property owner's expense. The property owner must correct all violations, whether for full compliance or interim control,within 120 days of the receipt of an Order to Correct Violations. The property owner must also submit within 60 days of the receipt of such an Order, a copy of a signed contract with a licensed deleader, if one will be necessary for the required work. If the owner or his/her agent is going to perform owner/agent deleading work, the owner must also submit a special form within 60 days. If the owner fails to comply with the Order to Correct Violations,the Health Department shall initiate judicial proceedings against the owner to enforce the Order. The Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention Program conducts random audits of inspections conducted by private inspectors and risk assessments conducted by private risk assessors following lead determinations. Such monitoring is performed to assure the quality of services being provided to the public. By requesting this determination, you agree to allow CLPPP access to your residential premises or dwelling unit after the initial determination and prior to your returning once any deleading, whether for full compliance or interim control, is completed.Not all private inspections or private risk assessments will be audited, so you may not hear from CLPPP requesting access for these additional visits. i r r , O Signature o ccupant t October 28,2015 • 'fir Mr.Thomas McKean, Director Public Health Division 200 Main Street ;a Hyannis, Ma.02601 Dear Mr. McKean, I am in receipt of your letter and order of conditions dated October 23,2015 regarding lead paint at 369 South St. Hyannis and including 22 Pine Ave. Immediately upon learning of the situation I had the tenants moved out of the apartment and have found temporary housing for them.They will not return until the situation has been fixed. On October 27,2015 Mr.John Maclssac of ASAP Environmental did a lead paint inspection of the property. I received the report by email on October 28,2015. 1 have already contacted three licensed de-leaders as provided in the information packet I received: Hopefully,my first appointment is on October 29th. Enclosed is the comprehensive initial lead paint inspections. . ; Date stamp will indicate that this letter and reports were received by the Town of Barnstable I intend to remedy this problem as quickly as possible- Yours Truly, Gary Maradi n 50.8-367-2800 cell s Lead Inspection / Risk Assessment Report Main Office: _ Page t Of ASAP 1`Arcadia Street Dorchester,MA 02122 Toll Free: 800-349-7779 ENVIRONMENTAL,INC. Phone:617-288-8870 Fax 617-282-7783 WWw-asapenvironmental.com St.# Street Name t r�a r Z 2 �N Street Type Unit I C.ty Zip Code1-41 L Number of Rooms in Unit -�,. l i_"4 Owners Name: 7 V D l// /� �q,�t� Property Type: Owner Address: E (� OZ(e7 ❑ Single Family Contact Information: M- d e,,L ® Multi Family #of Units Client Name(if different from owner): 4 :_21LL � El Condominium #of Units Client Address: El Day Care ❑ Other Key Lead Column Key IDelead/1C Method Column Key Delead/IC Method Column Laundry in Basement? El Yes No COV Covered CAP Capped SCR Scraped x Finished Space in Basement- Yes No VB Vinyl Baseboard COV Covered DIP ` Dipped MET Metal . ENC Encapsulated REM Removed VR Vinyl Rep.Window MI Made Intact REP Replaced MR Metal Rep.Window PRE Prepared for Enc. REV ; Reversed Testin�Metbod Used NA Not Accessible VR/MR Vinyl/Metal Rep Window INT Intact NC No Coating SFR Storm Frame Removed a M Tile Tile(testing suggested) [�:;;j Component Does Not Exist Na,S Expiration Date: DC Dropped Ceiling X-Ray Fluorescence Model: LPq —1 Serial# i Commc,is/Notes: Submitted for Co m liance Evaluation❑ l+loor# L (level within building of unit being inspected) Floor# Property Diagram/Unit Labels C 1� I•f tt c f M L4+ B B ; D D r 4 ELL --------- ---------------- �22 - A(Street Side) Start Here A(Street Side) Start Here A(Street Side) Pb(lead)equal to or greater than 1.0 nVczn2 with x-ray fluorescence or positive with Na,S is Dangerous. XRF Calibration Recorded In Log Book (�' ✓-Checkoff when complete Address verified through LISPS Research on Lead Related History for Address -Check off when complete www.state-ina.us/dph/cln or 800-532-9571 -Che nn ck off when Complete John 1VMadsaac 2378 0 lz� Inspector's Name License# —Signature Date LI/RA revised 09/14 'ADDRESS: Page 2 0f22 INSPECTION HI INTERIM CONTROL Determination Risk Assessment Y Inspector Name: Lic# Y R.A.Name. ,Lid N Signature Lead Hazards? Urgent Pb.Hazards? N Signature Comprehensive Inspector Na ' 0&4e Lic#Z,&Zk Dust Taken for Risk Initial Inspection Assessment P R.A.Name: Lic#_ '' 1 0 N Signatu e F Signature Lead Hazards? Visual Portion of Comp Initial Inspector Name: Lic# Reinspection for P w/Partial PCAD Y ' interim Control F R.A,Name: Lid4 _ N Signature Lead Hazards? .1 t Signature Addendum add on Dust Taken for Risk P Mm.,.w„t. Inspector Name: Lic# Assessment Reins , ;+ to Initial Inspection) 77MY F Signature NN Signature Lead Hazards? Visual Portion of Remspection for R.A.Name: r Lick Addendum as Full • - "' Interim Control P Inspect y Inspector Name: Lid Signature F TT N Signature -T Lead Hazards? Dust Taken for Risk P PA.Name: Lic# - Assessment Reinsp. Walk Through for F Signature Ed/Consultation Inspector Name: Lic# Signature Risk Assessment Recertification ' Y .Lic# REINSPECTION HISTORY' RA.Name:. d, x, Visual Portion of N Reocc.Reinspection IF Inspector Name: Lic# Urgent Pb.Hazards? Signature Signature Dust Taken for RA R.A.Name: Lic# Recertification Visual Portion of [Fq Signature Reocc.Rein ection P Inspector Name: Lid Signature POST COMPLIANCE ASSESSMENT DETERMINATIONS PCAD Dust Taken for Inspector Name: Lid Reocc.Reins motion P Inspector Name: Lic# y F - N Signature Signature• Lead Hazards? Dust Taken for [Fq Full Inspection Reocc.Reins ection Inspector Name. Lic# Acting as PCAD Signature' y Inspector Name: Lid 1 Visual Portion of Lead Hazards? N Signature Final Reirispection P Inspector Name: `,Lic# F Visual Portion of P Inspector Name: LidSignature rPCAD Rein lion Visual Portion of F Signature Final Reins ection P Inspector Name: Lick 8 µ Dust Taken for p Inspector Name: ,Lid Signature PCAD Reins ection Dust Taken for Final P Signature Rein .(No Reocc Inspector Name: Lic# F Signature Dust Taken for PCAD Reins ection P Inspector Name: Lic# Dust Taken for Ffiial F Reins o Reocc ` P Inspector Name: Lic# Signature F Signature ADDRESS: Page 3 off REOCCUPANC ATE HISTORY . :COMPLIANCE E (CONT.) Certificate of Certificate of Reoccupancy Inspector Name: ,Lic# Maintained Inspector Name: .Lic# Co,m liance Signature Only after Signature High/Mod Risk No Work--No Dust (#rooms rule) Work=7 Dust Certificate of Certificate of Reoccu ancy Inspector Name: Lic# Restored Com fiance Inspector Name: Lic# Only after Signature Signature High/Mod RiskDust wipes and auth, g (#rooms rule people Certificate of Inspector Name: Lic# Certificate of ` Reoccu anc Maintained Inspector Name: Lid Signature Compliance Only after Signature High/Mod Risk #morns rule) No Work—No Dust Work=7 Dust COMPLIANCE HISTORY Letter of Full Initial Certificate of Restored Com fiance Inspector Name: Lid Compliance inspector Name: Lic# No prior history/ Signature :D Signature y ' Dust wipes and auth. No signs of UD eople Letter of Interim . ' OTHER HISTORY: WAIVERS/lUD Control Inspector Name: Lic# , Approved CLPPP Waiver No prior Comp. Signature Inspector Name: Lid Expires in 1 yr. Attach to Camp Docs Signature Recertification of €. , Approved Interim Control Inspector Name: Lic# CUPP Waiver Inspector Name: Lick Expires 2 yrs from Signature original Interim Attach to Comp Signature Control Does Letter of Full " } Deleading UD/DES Visual Inspector Name: Lid' k Compliance Reins ection Inspector Name: Lic# Signature I I I 19F Si nature Dust wipes if No No LOC Issued g Reocc. Certificate of UD!DES Dust Maintained . Inspector Name: Lid i Taken Inspector Name: Lid Compliance Signature' q g Si nature No LOC Issued I N' No Work—No Dust Work=7 Dust UD/DES Dust . Taken- Certificate of a Lid Name: Restored Compliance Inspector Name: Lid Si nature No LOC Issued g Signature Dust wipes and auth. _ UD/DES Final eo le Reins ection Inspector Name: Lid No LOC Issued F Signature Page 4 of EXPIAN.QTIOIY OF LEAD INSPECTION/RISK ASSESSMENT RE "COLUMNS 22 This page provides general information needed to understand the.lead inspectionhisk assessnZent report However,you should speak with the inspector/risk assessor before.you start to do any work on your home. SIDE Refers to A,B,C,or D side of the building or room. See the diagram on the cover sheet.The"A"side of the building or room is the side facing the street that gives the property its address(usually,it is the front of the building).Keeping your back to this street,from the"A"side move clockwise to the"B"side on your left,the"C" side opposite you,and the"D"side to the right. Numbering is from left to right. LOCATION/ Refers to the building component(s)being tested.Some surfaces may be made up of more than one part.For SURFACE example,`Baseboard"may refer to four separate pieces of wood(one on each wall),but is still considered one surface. LEAD The actual lead result.Each surface tested must have a result recorded in the "Lead"column. • A number shows that the surface was tested with an XRF analyzer.A number(or average number)equal to or greater than 1.0 mg/cm2 is a dangerous level of lead. • A"pos"or"neg"shows that the surface was tested with sodium sulfide. "pos"means that there is a dangerous level of lead. • "N/A"means that the inspector was not able to test the surface.Unless the owner can get a sample to test,the inspector must assume the surface contains lead and require it to be deleaded,if necessary. • "MET"or"MR"means that a metal surface was not tested and only needs to be intact,even if it is a leaded surface. However,metal handrails;metal window sills,and metal railing caps,need to be deleaded if they test equal to or greater than 1.0 mg/cm2,or is marked"N/A." • For key to abbreviations like"COV","VB","VR"or"MR","NC","Tile","DC",see the cover page. ® When a component box is slashed and there are test results above and below the diagonal line,the result on the "bottom"represents results below 5 ft.and the"top"result indicates the test result above 5 ft. TYPE OF Not all lead paint must be deleaded.This column tells you IF and WHY a surface needs deleading.The deleading - HAZARD standards below may not apply for Interim Controls.Speak to your risk assessor for more information. • "M/1"circled means that the surface is a moveable/impacted surface and must be deleaded in its entirety. • "SF''circled indicates that there is a storm.frame present which requires the blind stop and exterior sill be deleaded as interior moveable/impacted surfaces. • "AIM"circled means that the surface is"accessible'mouthable"and must be deleaded to a minimum of five feet high,four inches in from the edge or corner. • "L"circled means that the surface'is loose and must,at minimum,be made intact. • If more than one choice is circled„the rules for deleading may change depending upon what method of deleading you choose.Speak to the inspector for more information. • "N/A"means the inspector was unable to determine if the surface was a lead hazard.The person doing the. deleading must check this surface and follow all the rules for deleading. Speak to the inspector for more information. • If nothing is circled in the column,then it is likely the surface does not need deleading. Speak to the inspector for more information. Remember,this does not mean the entire surface is lead free,it just does not require deleading in its current condition. URG HAZ? This column is only completed during a risk assessment.A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment,not all inspectors are risk assessors. If"Y"is circled,then this surface is considered an"Urgent Lead Hazard"and some type of deleading work is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim Control. IC METH The deleading method or structural repair done to qualify the surface for Interim Control.Refer to the deleading codes key on the cover page. DELEAD The date that the lead inspector reinspects the surface and finds that it has been successfully brought back into DATE " compliance. DELEAD The method used to bring a surface into full compliance.Refer to codes in the Key on the cover page of the PCAD METH EXCLUDED The amount of loose paint on a surface as measured by the lead inspector."N/A"means that the inspector was not SURFACES able to measure the loose paint,but has determined it is more than the cut-off for moderate risk making intact. LIRA Exp.8/08 John Maclsaac IIR-2378 10/27/15 2 11 Page—Of— Inspector(print) Lic# re Date John Maclsaac I/R-2378 Risk Assessor(print) 22 PINE AVLic# 4Aignature, Dat YANNIS Address of Pro e • A t.# City: HALLWAY: terio or Common Hallway: 'Front Rear Floor# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD'DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Up Walls A/M L NIA Y A Closet Door AN L NIA Y A B Low Waits AIM L NIA Y B Cl Casing AIM L NIA Y A o Baseboards Q. AIM L N/A Y + C Closef Jamb AlM L N/A Y A 8 Chair Rail A/M L NIA Y D Closet Walls AN L NIA Y AB a . CD Radiator AIM L NIA Y Cl Baseboard AIM L NIA Y Floor A/M L NIA Y 1 Closet Pole AIM L NIA Y Ceiling o AIM L NIA Y 2` Closet Shelf A/M L NIA Y B Door A/M L NIA Y 3 Cl Supports A/M L NIA Y C D Door Casing (J(} AIM L NIA Y 4 Closet Floor AIM L NIA Y 12 DoorJamb AIM L NIA Y Closet Ceiling AIM L NIA Y 34 Threshold A-j AIM L N/A Y A Window Sill MA AIM L NIA Y A& Door AIM L N/A Y B Win Apron AAuI L NIA Y C D Door Casing p AIM L NIA Y C Win Casing A/M L N/A Y 12 Door Jamb dy AAvI L NIA Y D Header Stop MA A/M L NIA Y 34 Threshold AIM L NIA Y Int Stops MA A/M L NIA Y A B Door D AIM L NIA Y •1 " Wio Int Sash M/1 A/M L N/A Y Door Casing 6 AIM L INA Y 2 Exterior Sill M/I SF L N/A Y 12 Door Jamb d.� AIM L NIA Y 3 Part Bead M/I L N/A Y 34 Threshold AfM L NIA Y 4 Blind Stop M11 SF L NIA Y A B Door A/M L N/A Y Win Ext Sash MA L NIA Y C D Door Casing AN L NIA Y A Window Sill MA A/M L N/A Y 12 Door Jamb AIM L N/A Y B Win Apron AIM L N/A Y 3 4 Threshold AIM L NIA Y C Win Casing AIM L NIA Y Pffl A/M L NIA Y T} D Header Stop MA AIM L NIA Y J AIM L N/A Y Int Stops Mil AIM L N/A Y Door Jamb AN L NIA Y 1 ` Win Irit Sash MA AIM L WA Y Threshold AIM L NIA Y 2 Exterior Sill . MA SF L NIA Y A Closet Door AIM L N/A Y 3+ Part Bead Mn L N/A Y B Ci Casing A/M L N/A Y 4 Blind Stop MA SF L N/A Y V Closet Jamb A/M L N/A Y Win Ext Sash MIl L NIA Y D Closet Walls 03 AIM L N/A Y ' y Mil AIM L NIA Y CI Baseboard 02, A1M L NIA Y :' �, �, M/I A/M I I& Y 3/ 1 Closet Pole AIML NIA Y ZZ,MA AIM L NIA Y '2 Closet Shelf 06 6)NIA Y `f F�.. MEN /SjRUCTURAL DEFECTS�tJ 3 Cl Supports ;t L NIA Y L �����-v�°'eve/VZ� 4 Closet Floor A/M L N/A Y •l oI.? A t r✓ it - Clo§et Ceiling 1X(CLUDED •A/M L NIA Y SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT, IC IC (MORE THAN 288 SQ.IN.) DATE METHOD ED' Check the box If this ROOM IS RULED OUT for encapsulation because there are 3 or more surfaces with adhesion y. problems and/or 3 or more loose A/M surfaces r.URA RenHall 6/15. John Maclsaac IIR•2378 46 10/27/15 Pagof 22 Inspector(print) Lic# turi Date John Maclsaac VR-2378 Risk Assessor(print)22 PINE AV Lil Signature DatHYANNIS Address of Property: Apt.# City: KITCHEN - JF LOCATION/ LEAD TYPE OF URG !C IC- DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? "DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH p Walls AIM L N/A Y Window Sil! M/i AIM L N/A Y ow Walls AIM L NIA Y Win Apron A1M L NIA Y aseboards AIM L NIA Y C Win CasingAAN L N1A Y hair Rail AIM L NIA Y D Header Stop MA AIM L N/A Y adiator AAU1 L N/A YInt Stops MA AIM L NIA Y loor pt/ AIM L NIA Y 1 Win Int Sash V Mll AIM L NIA Y eiling AIM L NIA Y 2 Exterior S11 MA SF L NIA Y oor AIM L N/A Y 3 Part Beaddi Mll L NIA Y C D Door Casing Qgj A/M L NIA Y 4 Blind Stop M/1 SF L NIA Y 12 Door Jamb AIM L NIA Y Win Ext Sash A L NIA Y 34 Threshold ,(j(J AIM L NIA Y A. Window Sill MA AIM L N/A Y A B Door 0 AIM L NIA Y- B Win Apron AIM L N/A Y Door Casing Z L NIA Y C Win Casing AIM L NIA y 2 DoorJamb AIM L N/A Y D Header Stop MII AIM L NIA Y 3 4 Threshold AIM L NIA Y Int Stops MA AIM L NIA Y A B Door A/M L N/A Y 11 Win Int Sash MA AIM L N/A Y C6 Door Casing 5 AIM L NIA Y 2 ExteriorSill_ Mil SF L N/A Y 1 Door Jamb AIM L N/A Y 3 Part Bead M!I L NIA Y 3 Threshold AIM L NIA Y 4 Blind Stop MII SF L NIA Y A B Door AIM L NIA Y J Win Ext Sash M/i L NIA Y C D Door Casing AIM L NIA Y B Up Cab Frame j AIM L NIA Y 12 DoorJamb AIM L NIA Y C D Up Cab Door 65 AAUI L N/A Y 34 Threshold AIM L N/A Y Up Cab Walls AIM L N/A Y , A Closet Dow 6,3 AIM L NIA Y 12 Up Cab Shlvs o AIM L N/A Y B Cl Casing 2 NIA Y ) 34 Supports .t AIM L NIA Y C Closet Jamb AIM L NIA Y Low Cab Fram AIM L NIA Y Closet Walls a. Al IA Y Low Cab Door. a7 AIM L NIA Y CI Baseboard AIM L NIA Y CID Low Cab Walls AIM L NIA Y 1 Closet Pole AIM L N/A Y Low Cab Shly AIM L NIA Y 2 Closet Shelf AIM L NIA Y 12 Supports AIM L NIA Y 3 Cl Supports 60 AIM L NIA Y 34 Drawers Z— AIM L NIA Y A8 4 Closet Floor 2. NIA Y c p Win Above 5' MII AIM L NIA Y Closet Ceiling Z A/M L,N/A : Y M/I AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS:0 � MA AIM L NIA Y MII AIM L NIA Y M/I AIM L NIA Y M/I AIM L NIA Y EXCLUDED SURFACES:Surfaces fisted in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC ED Check the box if this`ROOM is RULED OUT for (MORE THAN 288 SO.IN.)` DATE METHOD encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces LIRA RepKitchen,6/15 John Maclsaac VR-2378 10/27/15 Page7of2� Inspector(print) Lic# nat Date John Maclsaac IIR-2378 Risk Assessor(print) Lic# Signature Date Address of Pro rt :22 PINE AVE. Apt.# .-City: HYANNIS ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls AIM L NIA Y A Window Sill �! MB AIM L NIA Y A B Low Walls A/M L NIA Y B Win Apron AIM L NIA Y A p Baseboards AIM L NIA Y C Win Casing AIM L NIA Y A B Chair Rail AIM L WA Y 'D Header Stop Ma AIM L N/A Y AB Radiator AIM L NIA Y 1 4 1nt Stops 00 MII A/M L NIA Y Floor AIM L NIA Y Win Int Sash MII A/M L NIA Y Ceiling AIM L NIA Y 2 Exterior Sill M/I SF L NIA Y A B Door AIM L NIA Y 3 Part Bead t/ A L NIA Y C Door Casing A/M L N/A Y 4 Bfind Stop MI! SF L N/A Y ' 1 Door iamb AIM L NIA Y ' Win Ext Sash MII L NIA Y 34 Threshold AIM L NIA Y Window SM MA AIM L NIA Y A 8 Dooral Z2L AIM L NIA Y Win Apron (, ( A/M L NIA Y D Door Casing 60 AIM L N/A Y C Win Casing � A/M L NIA Y 10 Door Jamb AIM L N/A Y D Header Stop Mil A/M L NIA Y 3 4 Threshold AIM L NIA Y Int Stops MII A/M L NIA Y A B Door L NIA Y 1 Win Int Sash J Mil A/M L NIA Y C 6 Door Casing 01 A/M L N/A Y 2 Exterior Sill V Mll SF L NIA Y Ut 2 Door Jamb 6,31 AIM L NIA Y � Part Bead Wl L NIA Y 34 Threshold A/M L N/A Y 4 Blind Stop Mli SF L NIA Y A B Door A/M L N/A Y Win Ext Sash MII L N/A Y Door Casing D. AIM L NIA Y A Window Sill M/i A/M L NIA Y 10 Door Jamb (�.Q AIM L NIA Y B Win ApronIL M L NIA Y . 34 Threshold AIM L NIA Y C Win CasingM L NIA Y A Closet Door 1. AIM L N1A Y 'D' Header Stop L NIA Y B CI Casing AIM L NIA Y Int Stops L N/A Y ® Closet Jamb A/M L NIA Y 1 Win Int Sash L NIA Y D 1 Closet Walls AoG1 AIM L NIA Y 2 Exterior Sill L NIA Y C1 ! Cl Baseboard AIM L NIA Y 3 Part BeadL N/A Y 1 Closet Pole A/M L NIA Y 4 Blind Stop L N/A Y 2 Closet Shelf AIM L N/A Y Win Ext SashL NIA Y 3 Cl Supports A/M L N/A Y B • Fireplace L N/A Y 4 Closet Floor AIM L WA Y C D Mantle L N/A Y AB Closet Ceiling AIM L N/A Y c o Win Above 5' L N/A Y COMMENTS/STRUCTURAL DEFECTS�j} '// Ceiling Moldin AIM L N/A Y AIM L NIA Y AIM L N/A Y AIM L NIA Y Surfaces listed in these boxes can only be made intact by a Deleader SIDE LOCATION e MEASURE:LOOSE PAINT +c lC (MORE THAN 288 SO,IN.) DATE METHOD Check the box if this ROOM is RULED OUT�for encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces Ll/RA RegRoom,6115 John Maclsaac t/R•2378 10/27/15 Page 01`22 Inspector(print) Lic# atuoEL�G Date John Maclsaac VR-2378 Risk Assessor(print) Lic# Signature Date Address of Property:22 PINE AVE. Apt.# City: HYANNIS _ ROOM# Z SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Wails AIM L NIA Y A Window Sill 7—( MA L NIA Y A B Low Wails AIM L NIA Y B Win Apron L N/A o A B Y A B Baseboards �t D WA Y C Win Casing NIA Y A B Chair Rail AIM L NIA Y D Header Stop L MA A/M L NIA Y A Radiator G AIM L NIA Y Int Stops Mtl AIM L NIA Y Floor A/M L N/A Y� /M Win Int Sash �/ M/I A L NIA Y Ceiling AIM L WA Y 2 Exterior Sill (l MA .SF L WA Y Door AIM L NIA Y 3 Part Bead V L N/A Y OD Door Casing q. N/A Y 4 Blind Stop Mil SF L NIA Y 12 Door Jamb .(f /A Y Win Ext sash MII L N/A Y 34 Threshold Z ZI &L WA Y Window Sill M/I &Y L NIA Y A B Door b A/M L NIA Y Win Apron L NIA Y Door Casing L N/A Y C Win Casing L N1A Y 1 2 Door Jamb /A Y D• Header Stop MA A/M L NIA Y 3 4 Threshold AIM L NIA Y Int Stops MA A/M L N/A Y A B Door AtM L NIA Y 1 . Win Int Sash %/ MA AIM L N/A Y C D Door Casing AIM L NIA Y Exterior Sill V MA SF L N/A Y 12 Door Jamb AIM L NIA Y 3 Part Bead II L NIA Y 34 Threshold A/M L WA Y 4 Blind Stop NUI SF L NIA Y R A B Door AAN L NIA Y Win Ext Sash 11 L NIA Y C D Door Casing AIM L NIA Y A Window sill_ Mll L N/A Y 12 Door Jamb AIM L NIA Y B Win Apron L NIA Y 3 4 Threshold AIM L N/A Y Win Casing L NIA Y A Closet Door AN L NIA Y D Header Stop Mil AIM L NIA Y B Cl Casing AAA L NIA Y Int Stops MII L NIA Y Lv; Closet Jamb L N/A Y 1 Win fntSash MA AIM L NIA Y D Closet Walls -0 A!M L NIA Y 2 Exterior Sill M/l SF L NIA Y Cl Baseboard A/ AAvt L Y 3' Part Bead /� MA L NIA Y 1 Closet Pole A/M L NIA Y 4', Blind Stop MA SF L NIA Y 2 Closet Shelf �., A/M L WA Y Win Ext Sash A L WA Y 3 CI Supports ./ AIM L NIA Y AB Fireplace �, AIM L WA Y 4 Closet Floor_ AIM L / Y C Mantle -7 � L WA Y AS Closet Ceiling AIM L N/A Y c p Win Above 5` AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS: Ceiling Moldinc t4> AIM L NIA Y cf! D AAut L N/A Y AIM L WA Y 11M L N/A Y Surfaces listed in these boxes can only be made Intact by a Deleader SIDE LOCATION MEASURE:LOOSE PAINT IC IC, � Check the box if this ROOM IS RULED OUT for (MORE THAN 288 S0.IN.) DATE METHOD encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces LURA RepRoom,6115 John Maclsaac l!R-z378 10/27/15 22 � Page/Of_ inspector(print) Lic# *ignature re Date 6 John Maclsaac IIR-2378 4& Risk Assessor(prin022 PINE AVE:ic# DafdYANNIS Address of Pro A t.# City: HALLWAY: #2, or Common Hallway: Front Rear Floor#_ SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEAD,DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD. SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A D Up Walls A/M L N/A Y A Closet Door AN L NIA Y A B Low Walls AIM L NIA Y B Cl Casing AIM L NIA Y SLD-A B Baseboards AIt�NIA Y C Closet Jamb AIM L NIA Y A B Chair Rail AIM L N/A Y D Closet Walls A/M L N/A Y AB CD Radiator AIM L NIA Y CI Baseboard A/M L N/A Y Floor AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling AIM L NIA Y 2 Closet Shelf AIM L NIA Y A Door NIA Y f 3 CI Supports A/M L N/A Y D Door Casing AIM L N/A Y 4 Closet Floor A/M L NIA Y 12 Door Jamb A Loy A/M L NIA Y Closet Ceiling AIM L NIA Y 34 Threshold A/M L NIA Y A Window Sill M/I A/M L NIA Y "Door (J A/M L NIA Y B Win Apron. AJM L NIA Y C D Door Casing N/A Y C Win Casing A/M L N/A Y 12 DoorJamb L WA Y D Header Stop M/i A/M L NIA Y 34 Threshold A/M L N/A Y Int Stops MI! A/M L NIA Y 1 Win Int Sash MnA B Door N/A Y A/M L NIA Y 6 Door Casing N/A Y 2 Exterior Sill MA SF L NIA Y 12 Door Jamb N/A Y 3 Part Bead Mil L NIA Y 34 Threshold AIM.L N/A Y 4 Blind Stop MA SF L NIA Y A B Door AIM L N/A Y Win Ent Sash MA L N/A y Door Casing JA Y A Window Sill M11 AIM L NIA Y Door Jamb N/A Y B Win Apron A/M L NIA Y 3 4 Threshold A/M L N/A Y C Win Casing AJM L N/A Y A B Door A/M L NIA Y D Header Stop M/1 AN L N/A Y C D Door Casing A/M L NIA Y Int Stops MA AIM L NIA Y # Door Jamb A/M L N/A Y - 1 Win Int Sash MA AIM L NIA Y Threshold AIM L NIA Y 2 Exterior Sill M1I SF L N/A Y A Closet Door A/M L NIA Y 3 Part Bead MJI L NIA Y CI Casing A/M L N/A Y 4- Blind Stop M/I SF L NIA Y C Closet Jamb L N/A Y Win Ext Sash MA L WA Y D Closet Walls AIM L N/A •Y AB c o Win Above 5' 11 AN L NIA Y AB Cl Baseboard NIA Y c D Ceiling Moldin M/I AIM L N/A Y 1 Closet Pole AIM L NIA Y MI1 AIM L NIA Y 2 Closet Shelf '� �}y A/M L NIA Y �>� COMMENTS!STRUCTURAL DEFECTS` ) I 3 CI Supports ,Z: 03 AIM L NIA ,Y - 4 Closet Floor ft AIM L N/A Y ' Closet Ceiling A/M L N/A Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. - SIDE LOCATION MEASURE:LOOSE PAINT IC lc ED Check the box if this ROOM is RULED OUT.#or (MORE THAN 288 S0.!N} DATE METHOD encapsulation because there are 3 or more surfaces with adhesion ' problems and/or 3 or more loose A/M surfaces. _ fx I1.URA R .nHail 6/15 John Maclsaac IIR-2378 10/27/15 22 Inspector(print) Lic# re Date John Maclsaac I/R-2378 Risk Assessor(print)22 PINE AVE!c# *in.Wre Da YANNiS Address of Pro Apt.# City: HALLWAY: nterio #--Z- or. Common Hallway: Front Rear Floor# SIDE LOCATI W LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A a Up Walls AIM L NIA Y A Closet Door AJM L NIA Y r.A n Low Walls AIM L NIA Y B Cl Casing AIM L N/A Y A 11 p Baseboards of AIM L NIA Y C Closet Jamb AN L NIA Y A B Chair Rail AJM L N/A Y D Closet Walls AJM L N/A Y AS _ CD Radiator AIM NIA Y, Cl Baseboard AIM L N/A Y Floor 1 AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling t7 AIM L N/A Y 2 Closet Shelf AIM L NIA Y A Door AIM L NIA Y 3- Cl Supports AIM L NIA Y C D Door Casing AIM L NIA Y 4 Closet Floor AIM L NIA Y 12 Door Jamb (} AIM L N/A Y Closet Ceiling AJM L N/A Y 3 4 Threshold AIM L NIA Y A Window Sill MA AIM L NIA Y -AU Door AIM L NIA Y B Win Apron A/M L N/A Y C D Door Casing N/A Y C Win Casing AML NIA Y 12 Door Jamb N/A Y D Header Stop M/t AIM L NIA Y 34 Threshold AIM L NIA Y Int Stops MAA!M L NIA Y A B Door O&A Y 1" Win Int Sash M/I AIM L NIA Y Poor Casing . &0 AIM L N/A Y 2, Exterior Sill MA SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead MA L NIA Y 34 Threshold AIM L NIA Y .4 Blind Stop MA SF L NIA Y A B Door AIM L NIA Y 4 Win Ext Sash MA L NIA Y C D Door Casing AIM L NIA Y A Window Sill Mli AIM L N/A Y 12 Door Jamb AIM L NIA Y B Win Apron AIM L N/A Y , 34 Threshold AIM L NIA Y C Win Casing AIM L NIA Y A B Door AIM L NIA Y D Header Stop MA AIM L N/A Y C D Door Casing AIM L NIA Y• Int Stops MA AIM L NIA Y _ r Door Jamb AIM L NIA Y 1 Win Int Sash MA AIM L NIA Y Threshold AIM L NIA Y 2 Exterior Sill MII SF L NIA Y A Closet Door AIM L NIA Y 3" Part Bead M!! L NIA Y B Cl Casing AIM'L NIA Y 4 Blind Stop MA SF L NIA Y C Closet Jamb AIM L N/A Y Win Fact Sash MA L N/A Y D Closet Walls AIM L WA Y AS CD Win Above b' Ml1 AIM L NIA Y AS Cl Baseboard AIM L NIA Y - C p Ceiling Moldin M!I AIM L NIA Y 1 Closet Pole AIM L NIA ,Y MII AIM L NIA Y 2 Closet Shelf AIM L'NIA Y COMMENTS/STRUCTURAL DEFECTS: 3 Cl Supports AIM L NIA Y 4 Closet Floor AIM L N/A Y ; Closet Ceiling AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT lc tc ED Check the box if this ROOM is RULED OUT for (MORE THAN 288 SQ.IN.) DATE METHOD encapsulation because there are 3 or more surfaces with adhesion `problems and/or 3 or more loose AIM surfaces IVRARenHan All 10/27/15 22 John Macisaac ilR-2378 �i o Inspector(print) Lic# n ture Date Page Of John Maclsaac I/R-2378 RiskAssessor (pdnt)22 Q(NEAVELic# Signature Da ~ Address of Property: Apt # City: BATHROOM# FQ LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH r. Up Walls A/M L N/A Y Low Cab Fro AM L NIA Y Low Walls A/M L NIA Y A Low Cab Door AIM L NIA Y A B Baseboards A/M L NIA Y C D Low Cab Walls AIM L WA Y A 8 k2D ir Rail A/M L NIA Y Low Cab Shly AIM L NIA Y iator AM L N/A Y 12 Supports A/M L NIA Y r 3 ( AM L NIA Y 34 Drawers, AM L NIA Y ng AIM L N/A Y A Window Sill M/I AIM L NIA Y r L N/A Y B Win Apron b AM L NIA Y r Casing AIM L NIA Y Win Casing A/M L N/A Y r Jamb AIM L NIA Y D Header Stop MA AIM L NIA Y 3 4 IThreshold Ati,, AIM L NIA Y Int Stops MA AM L NIA Y A B Door A/M L WA Y 1 Win Int Sash . M/I AIM L N/A Y C D Door Casing AM L NIA Y 2 Exterior Sill MA SF L NIA Y 12 Door Jamb A/M L N/A Y 3 Part Bead L42,WI L N/A Y 34 Threshold AIM L NIA Y 4 Blind Stop MA SF L NIA Y A Closet Door AIM L N/A Y Win Ext Sash /1 L N/A Y B CI CasingAIM L NIA Y An c D Win Above 5' M!I AIM L NA Y C Closet Jamb A/M L N/A Y AB CD Ceiling Molding M/I AM L NA Y AB D Closet Walls AIM L NIA Y CC) Medicine Cab M/I AIM L NA Y CI Baseboard AM L NIA Y C p Wall O/C M/I A/M L NA Y 1 Closet Pole AIM L NIA Y M/1 A/M L NA Y 2 Closet Sheit AIM L NIA Y MA AAv! L NA Y 3 Cl Supports A/M L NIA ;Y r . MA AIM L NA Y 4 Closet Floor A A/M L N/A Y ,. M/I A/M L NA Y Closet Ceiling A/M L N/A Y Mil AM L NA Y A Up Cab Frame A/M L WA Y MA AM L NA Y C D Up Cab Door 0 AIM L N/A Y M/I A/M L NA Y Up Cab Waifs Iff AM L N/A Y MA A/M L NA Y 12 Up Cab Shlvs AIM L N/A Y Mll AIM L NA Y 34 supports AM L N/A Y MA A/M L NA Y Mli A/M L NIA Y M/I A/M L NA Y MA AM L NIA Y W AM L NA Y MII AIM L N/A Y M/1 AM L NA Y COMMENTS?STRUCTURAL DEFECTSOJ COMMENTS I STRUCTURAL DEFECTS: 'EXCLUDED SURFACES: Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC Check the box"rf this ROOM is RULED OUT for (MORE THAN 288 SO.IN.) DATE METHOD encapsulation because there are 3 or more surfaces With adhesion problems and/or 3 or more loose AIM surfaces LIRA RepBath,6115 T John Maclsaac IIR•2378 10/27/15 Paget 'Inspector(print) Lic# at RG Date John Maclsaac IIR-2378 Risk Assessor(print) Lic# Signature Da e Address of Pro :22 PINE AVE. Apt.# city: YANNIS ROOM# SIDE LOCATIOIw 'LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A n Up Walls Ij A/M L NIA Y A Window Sill M11 AIM L N/A Y r.A n Low Walls AIM L NIA Y B Win Apron Q. AIM L NIA Y A p Baseboards A/M L N/A Y Win.Casing AM L NIA Y A s Chair Rail AIM L NIA Y D Header Stop M/i AIM L N/A Y AS Radiator L AIM L NIA Y Int Stops' d a MI1 A/M L N/A Y Floor A/M L N/A Y 1 Win Int Sash ✓ WI A/M L NIA Y Ceiing AIM L N/A Y 2 Exterior Sill L/ Ml1 SF L NIA Y Door AIM L N/A Y 3 Part Bead4WgA L NIA Y C D Door Casing AIM L NIA Y 4 Blind StopL NIA Y 12 Door Jamb AN L N/A Y Win Ext Sash L N/A Y 3 4 Threshold AIM L NIA Y A Window Sill L NIA Y Door aa NIA Y B Win Apron AIM L NIA Y C D Door Casing A/M L N/A Y C Win Casi n9 A/M L NIA Y 12 Door Jamb AtM L N/A Y Header Stop M/I A/M L NIA Y 34 Threshold A/M L NIA Y Int Stops Mli A/M L NIA Y A B Door AIM L NIA Y 1 Win Int Sash Vk M/l A/M L N/A Y C D Door Casing A/M L N/A Y 2 Exterior Sits uZt WI SF L N/A Y 12 Door Jamb A/M L N/A Y - 3 Part Bead Mil L N/A Y 34 Threshold A/M L NIA Y 4 Blind Stop MA SF L NIA Y AB Door AIM L NIA 'Y Win Ext Sash MA L NIA Y C D Door Casing A/M L NIA Y A Window Sill M11 AIM L NIA Y 12 Door Jamb AIM L NIA Y B Win Apron AN L N/A Y 34 Threshold AIM L NIA Y C Win Casing' AIM L N/A Y Closes Door AIM L NIA Y D Header Stop MM AIM L NIA Y CI Casing AIM L NIA Y • Int Stops Mil AIM L N/A Y C Closet Jamb 66r AIM L NIA Y 1 Win Int Sash Mll AIM L N/A Y D Closet walls ( /U4'A/M L NIA Y - 2 Exterior Sig Mil SF L N/A Y CI Baseboard AJA A/M I & Y `3 Part Bead Mil L NIA Y 1 Closet Pole A/M L N/A Y r4 Blind Stop M/1 SF L NIA Y 2 Closet Shelf AIM L N/A Y Win Ext Sash M/1 L NIA Y 3 Cl Supports AIM L N/A - Y AB Fireplace AIM L WA Y 4 Closet Floor /f1 A/M L& Y CD 'Mange AIM L NIA Y Closet Ceiling, A 8 Qi✓. AIM L NIA Y c D win Above 5' AIM L NIA Y rMENTS/STRUCTURAL DEFECTS: Ceiling Moldin A/M L NIA Y AN L N/A Y AIM L NIA Y AIM L NIA Y Surfaces listed in these boxes can only be made intact by a Deleader SIDE LOCATION MEASURE:LOOSE PAINT IC IC(MORE THAN 288 SQ.IN.) DATE METHOD Check thebox if this ROOM is RULED OUT for encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces LYRA 11.epRoom,6115 John Maclsaac VR-2378 10/27/15 22 Inspector(print) Lic# ig Page�Of— 4 i Daie John Maclsaac I/R-2378 Risk Assessor (pnntl� E V c# Signature Address of Pro ert : ` CaHYANNIS A #.# Ci : EXTERIOR A Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ I LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH 'A SURFACE HAZARD HAZ? DATE METH DATE METH Siding L N/A Y Window Sill A/M L N/A Y Comer Boards 4 NIA Y A Win Casing AIM L NIA Y A Lower Trim L N/A Y Window Sash A/M L NIA Y Upper Trim (�N/A Y Cellar Win Siil AIM L N/A Y Win Above 5' Q) NIA Y rA Cel Win Sash AJM L N/A Y Porch Above 5' L N/A Y Cel Win Fram AIM L N/A Y Stone Door A!M L N/A Y ' Screen Frame AJM L N/A y Door AIM L NIA Y Cellar Win Sill A/M L NIA Y A Door Casing A/M L N/A Y c A Cel Win Sash A/M L N/A Y 1 2 Door Jamb AIM L NIA Y Cel Win FrameA/M L NIA Y 3 4 Threshold AIM L N/A Y Screen Frame A/M L N/A Y Kickplate AIM l N/A Y Gellar Win Sill A/M L N/Al Y Storm Door AIM L N/A Y A Cel Win Sash A/M L NIA Y Door AIM L N/A Y # Cei Win Frame A/M L N/A Y A Door Casing AIM L N/A Y Screen Frame A!M L N/A Y 1 2 Door Jamb A/M L NIA Y Cellar Win Sill A/M L NIA Y 3 4 Threshold AIM L N/A Y A• Cel Win Sash A/M L NIA Y Kickpdate AIM L NIA Yff Cel Win Frame A/M L N/A Y Door A1M L NIA Y Screen Frame AIM L NIA Y A Door Casing AIM L NIA Y Foundation L N/A Y 1 2 Door Jamb A/M L N/A Y s A Bulkhead A/M L N/A Y 3 4 Threshold AIM L WA Y Fences A/M C N/A Y Window Sill Z L NIA Y Shutters A/M L N!A Y A Win Casing AIM( N/A Y Newel Apt AIM L NIA Y . # Window Sash /,A j L N/A Y Railing Gap AIM L NIA Y Window Sill NIA Y Handrail A/M L NIA Y A Win Casing j AI NIA Y A Balusters A/M L N/A Y #Z- Window Sash (}� X� M L N/A Y lower Rat AIM L NIA Y Window Sill A1M L N/A Y Treads AIM L NIA Y A Win Casing AIM L N/A Y Risers AIM L N/A Y # Window Sash AIM L NIA Y Stringer AIM L N!A Y B Lamp Post L N/A Y ` lattice AJM L N/A Y COMMENTS I STRUCTURAL DEFECTS:' Drain Pipes t N!A Y F A Elec Conduit L N/A Y r Oil Fill Pipe �LN/A Y Overhang Tri J:� Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 pprn for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SQ.IN.) DATE METH F (Square Feet) (PPM) DATE METH A Play Area . A Bare Soil P A Comments: A tL[/RA RepExtA,6/15. John Maclsaac IIR•2378 10/27/15 22 Page Of Inspector(print) Lic# tur Date ` �s John.Maclsaac VR-2378 Risk Assessor (pri12 E AVEuc#• ' Signature D4H' ANNiS Address of Property: Apt.# City: EXTERIOR B Side --- SIDE LOCATION/ LEAC TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD HAZ? DATE METH DATE 'METH B SURFACE HAZARD HAZ. DATE METH DATE METH Siding L NIA Y' j Window Sill AIM L N/A Y Comer Boards 60 ®N/A Y B Win Casing AIM L NIA Y B Lower Trim L NIA Y Window Sash A/M L NIA Y Upper Trim 41 L lA Y Cellar Win Sill A!M L NIA Y Win Above 5' L A Y B Cel Win Sash AIM L NI Y Porch Above 5' L N/A Y # Cel Win Fram AIM L N/A Y Storm Door AIM L NIA Y Screen Frame AM L NIA Y Door AIM L N/A Y Cellar Win Sill AIM L NIA Y B Door Casing j AIM L N/A Y B Cel Win Sash AIM L N/A Y 1 2 Door Jamb A/M L NIA Y # Cel Win FrameAIM L NIA Y 3 4 Threshold A!M L NIA Y Screen Frame AIM L NIA Y Kickplate AIM L NIA Y Cellar Win Sill AIM L NIA Y Storm Door AIM L N/A Y B Cd Win Sash A/M L N/A Y Door AIM L NIA Y # Cel Win Frame AIM L N/A Y B Door Casing A/M L NIA Y Screen Frame A/M L N/A Y 1 2 Door Jamb AIM L NIA Y Cellar Win Sill AIM L NIA Y 3 4 Threshold. AIM L N/A Y B Cel Win Sash AIM L NIA Y Kickplate AIM L N/A Y # Cel Win FrameAIM L NIA Y Door AIM L NIA Y Screen Frame AIM L NIA Y B Door Casing AIM L NIA Y Foundation L NIA Y 1 2 Door Jamb AIM L NIA Y B Bulkhead A1119 L N/A Y 3 4 Threshold AIM L N/A Y Fences AIM L N/A Y Window Sill bb AIM L NIA Y Shutters AIM L WA Y B Win Casing �. AIM L N/A Y Newel post AIM L NIA Y # l Window Sash QV AIM L NIA Y Railing Cap A/M L N/A Y Window Sill 5N/A Y Handrail /U A/M L N/A Y B Win Casing /. A/M®NIA Y B Balusters ' AIM L N/A Y Window Sash AIM L N/A Y Lower Rail AIM L NIA Y Window Sill A/M L N/A Y Treads 44, AIM L N/A Y B Win Casing AIM L NIA Y Risers AIM L NIA Y # Window Sash AIM L NIA Y Stringer AIM L NIA Y Br.:: ;;y -�jp L N/A Y lattice A/M L NIA Y COMM N f STRUCTURAL DEFECTS��� 'f' j, �� �/ �c rtU r <dZ' j Dsia Pipes -�� L NIA Y 4 l�a1 B. Elec Conduit L N/A Y Oil Fill Pipe L NIA Y Overhang T• A/M L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC 'LOCATION AREA MEASUREMENT RESUL REMED REMED 8 (MORE THAN 1440 SQ.IN.) DATE' METH (Square Feet) (PPM) DATE METH B Play Area B Bare Soil' ~ B Comments: B LIRA RepExtB,6/15 John Maclsaac IIR-2378 10/27/15 '22 Page 'Of inspector(print) Lic# na r �i Date Johrr Madsaac IIR-2378 Risk Assessor (print 2 AVE Lrc# Signature OYANNIS Address of Property: Q Apt # City: EXTERIOR C Side — SIDE LOCATION/ LEA TYPE OF URG IC, IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD C SURFACE HAZARD HAZ? DATE METH .DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METH Siding t NIA Y Window Sill AIM L NIA Y Comer Boards /A Y C Win Casing AIM L NIA Y C Lower Trim L NIA Y Window Sash A/M L N/A Y Upper Trim N/A Y Cellar Win Sill AIM L NIA Y Win Above 5' L NIA Y C Cel Win Sash AIM L NIA Y Porch Above 5' L NIA Y # Cel Win FrameAIM L NIA Y Storm Door AIM L N/A Y Screen Frame AIMtNIAY Door AIM L N/A Y Cellar Win Sill AIM C Door Casing AIM L N/A Y C Gel Win Sash AIM 1 2 Door Jamb AIM L NIA Y . Cel Win FrameAIM 3 4 Threshold AIM L N/A Y Screen Frame AIM L NIA y Kickplate AIM L WA Y Cellar Win Sill AIM L NIA Y Storm Door AIM L N/A Y C Cel Win Sash AAA L NIA Y Door AIM L NIA Y # Cel Win Frame AIM 1 NIA Y C Door Casing AIM L NIA Y Screen Frame AIM L N/A Y 1 2 Door Jamb AIM L NIA Y Cellar Win Silo AIM L NIA Y 3 4 Threshold AIM L N/A Y C Cel Win Sash AIM L NIA Y Kickplate AIM L N/A Y # • Gel Wiry FrameAIM L N/A Y Door AIM L NIA Y Screen Frame AIM L N/A Y C Door Casing AIM L NIA Y FoundationA10, L NIA Y 1 2 Door Jamb AIM L N/A Y C Bulkhead AIM L NIA Y 3 4 Threshold AIM L NIA Y Fences AIM L N/A Y Window Sill AIM L NIA Y Shutters AIM L N/A Y C Win Casing AIM L NIA Y Newel post AMI L NIA Y # Window Sash AIM L NIA Y Railing Cap AIM L NIA Y Window Sill AIM L NIA Y Handrail AIM L NIA Y C Win Casing AIM L NIA Y C Balusters AIM L N/A Y # Window Sash AIM L NIA Y Lower Rail AIM L NIA Y Window Siff AIM L N/A Y Treads AIM L N/A Y C Win Casing AIM L NIA Y Risers AIM L NIA Y # Window Sash A/M L NIA Y Stringer AIM L NIA Y C Lamp Post L NIA Y Lattice AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS: Fr j /Iila�d l Drain Pipes L N/A Y C, Elec Conduit L NIA Y Oil Fill Pipe L NIA Y Overhang TrimAIM L N/A Y ` Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results - intact only by a licensed deleader (Must be less than 400 ppm for play area!1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED C (MORE THAN 1440 SQ.IN.) DATE METH ,C (Square Feet). (PPM) DATE METH Play Area C Bare Soil C Comments: C' , Lt/RA RepExtC,6/15 John Maclsaac IIR-2378 � 10/27/15 22 Page Of Inspector(print) Lic# : atu a Date JohnMaclsaac I/R-2378 Risk Assessor (priQ W". E AVE Uc# ,: 6ignature , D YANNIS Address of Property: ,Apt # ' City EXTERIOR D Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEAD DELEAD D SURFACE HAZARD HAZ? DATE METH DATE METH D SURFACE HAZARD HAZ? DATE METH DATE METH Siding N/A Y Window Siil AIM L NIA Y Comer Boards N/A Y D Win Casing AIM L NIA Y D LawerTrim L NIA Y # Window Sash A/M L N/A Y Upper Trim NIA Y ' Cellar Win Sill AIM L N/A Y Win Above 5' NIA Y D Cel Win Sash AIM L NIA Y Porch Above 5 L NIA Y # Cel Win Fram AIM L N/A Y Storm Door AIM L NIA Y Screen Frame A/M L NIA Y Door 4go NIA Y Cellar Win Sill A/M L N/A Y D Door Casing e &6)NIA Y / D Cel Win Sash.± A/M L NIA Y 2 Door Jamb NIA Y # Gel Win Fram AIM L N/A Y 3 4 Threshold AIM L N/A Y Screen Frame_ A/M L N/A Y Kickplate A. AIM L NIA Y Cellar Win Sill A/M L N/A Y Storm Door AIM L NIA Y D Cel Win Sash A/M L NIA Y Door ( AIM L N/A Y # Get Win Frame A/M L N/A Y D Door Casing A/ NIA Y c Screen Frame A/M L NIA Y 16 Door Jamb NIA Y Cellar Win Sill AIM L NIA Y 3 4 Threshold A/M L N/A Y D,•Cel Win Sash AIM L NIA Y Kickplate AIM L NIA Y # Get Win Frame / AIM L WA Y Door AIM L NIA Y - Saeen Frame AIM L N/A Y D Door Casing AIM L N/A Y Foundation L N/A Y 1 2 Door Jamb A1M L NIA Y ,.D Bulkhead AIM L N/A Y 3 4 Threshold AIM L N/A Y Fences AIM L NIA Y Window Sill NIA Y Shutters AIM L NIA Y D Win Casing AIM IA Y Newel post AIM L NIA Y # Window Sash A!M L NIA Y Railing Cap AIM L NIA Y Window Sill NIA Y Handrail, AIM L NIA Y D Win Casing A/lv)NIA Y ` D. Baiusters AIM L N/A Y i_ # Window Sash �� A!M L NIA Y Lower Rail A!M L tVlA Y • Window Sill 77 AIM L NIA Y Treads AIM L NIA Y ,DZ2 Win Casing AIM L N/A Y Risers AIM L N/A Y #v Window Sash AIM L NIA Y Stringer ;A�IML NIA YD Lamp Post L NIA Y Lattice L N!A Y COMMENTS/STRUCTURAL DEFECTS�J rs L/Cu PJ �� t2rR Pipes ".cl L NIA Y D Elec Conduit L NIA Y +, Oil Fill Pipe L N/A _Y Overhang Tri AIM L NIA Y `Excluded Surfaces: Surfaces listed in this box can be made .. ,•,` Soil Test Results intact only by a licensed deleader (Must he less than 400 ppm for play area/1200 ppm for bare soil) ID ' LOCATION MEASURE:LOOSE PAINT IC, IC LOCATION AREA MEASUREMENT RESUL REMED REMED (MORE THAN 1440 SO.IN.) DATE METH (Square Feet (PPM) DATE METH Play Area,- Bare Soil D. LjE ;, mments: D 'u LYRA RepExtD,6/15 John Maclsaac 23T8 10/27/15 22 Inspector(print) Lic# ign Page—Oi Date John Macisaac IIR-2378 Risk Assessor (print Lic# Signature Address of Pro ert ..2 PINE AVE. DgYANNIS A t.# City: ' EXTERIOR A Side SIDE LOCATION/ LEADI TYPE OF URG IC Ic DELEAD 'DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD A SURFACE HAZARD HAZ? DATE METH DATE METH A SURFACE HAZARD HAZ? DATE METH DATE METH Siding q _ !A Y Window Sill A/M L NIA Y" Comer Boards g 'NIA Y A Wm Casing A/M L NIA Y A Lower Trim t�N/A Y S # Window Sash A/M L NIA Y Upper Trim A Y Cellar Win Sill A/M L N/A Y Win Above 5' A/ NIA Y A Cel Win Sash A/M L N/A Y Porch Above 5 L N/A Y Cel Win FrameAIM L NIA Y Storm Door AIM L NIA Y Screen Frame AQA L NIA Y Door A/M L NIA Y Cellar Win Sill A/M L NIA Y A Door Casing AIM L NIA Y A Cel Win Sash A/M L NIA Y 1 2 Door Jamb AIM L N/A Y Get Win Frame A/M L NIA Y 3 4 Threshold (� ` AIM L N/A Y Screen Frame A/M L N/A Y Kk*ptate U AIM L N/AT Cellar Win Sill A/M L WA Y Storm Door AIM L NIA A Cel Win Sash A/M L NIA Y Door NIA - Cel Win Frame A/M L N/A Y A Door Casing NIA Saeen Frame A/M L NIA Y 1 Door Jamb NIA Y Cellar Win Sill A/M L N/A Y 3 4 Threshold A/M L NIA Y. A Cel Win Sash AIM L N/A Y Kickpiate AIM L N/A Y Cel Win Frame A/M L NIA Y Door AIM L N/A :Y ; 4--- Screen Frame A/M L N/A Y A Door Casing AIM L NIA Y Foundation L N/A Y 1 2 Door Jamb A/M L NIA Y A Bulkhead AIM L N/A Y 3 4 Threshold ,:A!M L NIA Y Fences A/M L N/A Y Window SlII L NIA Y Shutters AIM L N/A Y A Win Casing L NIA Y' <. A/M L NIA Y 4 # Window Sash AIM L NIA Y Railing Cap A/M L NIA Y Window Sill L NIA Y Handrail A/M L NIA Y A Win Casing L N/A Y A Baluster; AIM L N/A Y #Z-Window Sash V A/M L NIA Y Lower Rail AIM L NIA Y Window Sill A/M L N/A Y Treads A/M L N/A Y A Win Casing AIM L NIA Y r Risers A/M L NIA Y #,3 Window Sash G A/M L NIA Y Stringer A/M L N1A Y B Lamp Post L N/A Y Lattice AIM L NIA Y COIlMM TS ISTRUCTURAL DEFECTS: Drain Pipes L NIA Y J G 6 Af CO 4- v U,f1r rat 40 A. Elec Conduit L N/A 6itFitl Pipe �j l L NIA Y " ' d Overtiang Tri �' A/M L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE ;LOCATION MEASURE:LOOSE PAINT IC" IC LOCATION AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SO.IN.) DATE METH. (Square Feet) (PPM) DATE METH A ,, Play Area A Bare Soil A " Comments: A LURA Re ExtA 6/15 John Maclsaac IIR-237814.6 10/27/15 j 22 Page L Of_ Inspector(print) Lie# tur Date 46 John Maclsaac I/R-2378 Risk Assessor {pri12 PINE AVE'`� Signature DHYANNIS Address of Property: A t.# Ci EXTERIOR B Side e y� SIDE LOCATION/ LEAE TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD HAZ? DATE METH DATE METH B SURFACE HAZARD HAZ? DATE METH DATE METH Siding a(� (L /A Y Window Sill L NIA Y Comer Boards NIA Y B Win Gasirtg L NIA Y B Lower Trim L NIA Y Window Sash A/M L NIA Y Upper Trim Alfl ON/A Y Cellar Win&I Win Above 5' NIA Y 'B. Cel Win Sash NIA Y >✓ A/M L L NIA Y Porch Above 5' L NIA Y # Cel Win FrameL N/A Y Storm Door AIM L NIA Y Screen Frame A/M L N/A Y Door N/A Y Cellar Win Sill jl NIA Y B Door Casing NIA Y B Gel Win Sash A/MA NIA Y 1 2 Door Jamb NIA Y A Cel Win FramefAJ/M N/A Y 3 4 Threshold A- ` CWi ONIA Y Saeen Frame 2a /A Y Kickplate NIA Y Cellar Win Sill �/� /A YStorm Door A/M L N/A Y B Cel Wirt Sash GO IA Y Door A/M L N/A Y # Cel Win Frame 'Z� 1 N/A Y B Door Casing A/M L N/A Y s Screen Frame A/M L NIA Y 1 2 Door Jamb A/M L N/A Y Cellar Win Sill A/M L NIA Y 3 4 Threshold AIM L N/A Y B Cel Win Sash AN L NIA Y Kickplate AIM L N/A Y # Cel Win Frame A/M L NIA Y Door j A!M L N/A Y Screen Frame AIM L N/A Y B Door Casing A/M L N/A Y Foundation L NIA Y 1 2 Door Jamb AIM L N/A Y B Bulkhead 3 4 Threshold AIM L NIA Y, Z AIM L N/A Y Fences A/M L NIA Y Window Sill L N/A Y Shutters AIM L N/A Y B Win Casing NIA Y Newel post AIM L NIA Y # Window Sash AIM L NIA Y Railing Cap AIM L N/A Y Window Sill L N/A Y Handrail AIM L N/A Y B Win Casing L NIA Y B Balusters A/M L NIA Y # Window Sash . I I A/M L NIA Y Lower Rail AIM L NIA Y Windom,Sill L NIA Y Treads AIM L N/A Y B Win Casing L N/A Y Risers A/M L NIA Y #>� Window Sash V4, AIM L NIA Y Stringer A/M L N/A Y B Lamp Post L N/A Y Lattice AIM L N/A Y CO MENTS/STRUCTURAL DEFECTS:O1 a)0 /A Drain Pipes Le M4 L NIA Y O e r` ! B Elec Conduit L N/A Y Oil Fill Pipe L NIA Y Overhang Trim AIM L N/A Y Excluded Surfaces:Surfaces listed in this box can be made . Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED _REMED B (MORE THAN 1440 SQ.IN.) DATE METH (Square'Feet) (PPM) DATE METH B Play Area B Bare Soil B Comments: B LURA RepExtB,6/15 , U -John Maclsaac tIR-2378 eke, 10/27/15 J� 22 Page b Of Inspector(print) Lic# i a ai Date John Maclsaac lfl -2378 Risk Assessor (print)22 PINE AV�lq Signature Dat YANNIS Address of Property: A t.`# City: EXTERIOR Po Side SIDE LOCATION/ LE TYI3E OF URG IC !C DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ, DATE METH DATE METH Window Sill L WA Y Window Sill A/M L NIA Y Win Casing L N/A Y Win Casing A/M L NIA Y Window Sash V AIM L NIA Y Window Sash A/M L N/A Y n Window Sill t N/A Y Window Sill A/M L WA Y Win Casing 37 L N/A Y Win Casing A/M L NIA Y Window Sash �/ AIM L N/A Y Window Sash A/M L NIA Y Window Sill / NIA Y Window Sill A/M L NIA Y Win Casing AI NIA Y Win Casing A/M L NIA Y Window Sash C A/M L N/A Y Window Sash A/M L N/A Y Window Sill AIM L N/A Y Window Sill A/M L NIA Y Win Casing AIM L N/A Y Win Casing A/M L N/A Y Window Sash AIM L NIA Y Window Sash AIM L N/A y Window Sill AJM L NIA Y Window SM A!M L N/A Y Win Casing A/M L N/A Y Win Casing 7tAJM L N/A Y Window Sash AIM L NIA Y Window Sash A/M L N/A Y Window Sill AIM L N/A Y Window Sill A/M L N/A Y Win Casing AIM L N/A Y Win Casing A/M L N/A Y Window Sash A/Pd L NIA Y Window Sash AIM L NIA Y Window Sill A/M L N/A Y Window Sill A/M L NIA Y Win Casing A(M L NIA Y Win Casing AJM L NIA Y Window Sash A/M L N/A Y Window Sash A!M L NIA1 Y Window Sill AIM L N/A Y Window Sill A/M L NIA Y Win Casing AIM L N/A Y Win Casing A/M L NIA Y Window Sash A/M L N/A Y lWindow Sash AIM L NIA Y Window Sill A/M L NIA Y Window Sill A A/M L N/A Y Win Casing AIM L NIA Y Win Casing AIM L NIA Y Window Sash AIM L N/A Y Window Sash AIM L NIA Y Window Sill AJM L NIA Y Window Sill AIM L N/A Y Win Casing A/M L N/A Y Win Casing AJM L N/A Y Window Sash AIM L NIA Y Window Sash AIM L NIA Y AIM L NIA Y Window Sill A/M L N/A Y AIM L NIA Y Win Casing AIM L NIA Y COMMENTS I STRUCTURAL DEFECTS: Window Sash AIM L NIA Y • Window Sill A/M L NIA Y t Win Casing AIM L NIA Y Window Sash AIM L N/A Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results ` intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESULI REMED REMED A (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH A Play Area A Bare Soil A Comments: A LIRA RepExtA,6/15 , , John PNaclsaac IJR-2378 10/27/15 _ 22 Page�v Of Inspector(print) Lic# na ri Date John Maclsaac IIR-2378 Risk Assessor (prin122 PINE AVELiG# Signature D IYA Address of Property: Apt # City: EXTERIOR C Side — TT SIDE LOCATION! LEAJ TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD C SURFACE HAZARD HAZ? DATE METH DATE METH C • SURFACE HAZARD HAZI DATE METH DATE METH Siding LLL N/A Y Window Sill AIM L NIA Y Comer Boards SV L /A Y C Win Casing AIM L N/A Y C Lower Trim L NIA Y # Window Sash AIM L N/A Y Upper Trim A& 19 JL NIA Y Cellar Win Sill AIM L NIA Y Win Above 5' N/A Y C Cel Win Sash AIM L NIA Y Porch Above 5 AO L NIA Y # . Cel Win FrameAIM L NIA Y Storm Door AIM L N/A Y Screen Frame AIM L NIA Y Door AIM L N/A Y Cellar Win Sill AIM L N/A Y C Door Casing AIM L N/A Y C Cel Win Sash AIM L N/A Y 1 2 Door Jamb AIM L NIA Y # Cel Win Frame AIM L N/A Y 3 4 Threshold AIM L NIA Y Screen Frame AIM L NIA Y Kickplate AIM L N/A Y Cellar Wini Sill AIM L NIA Y Storm Door AIM L N/A Y C Cel Win Sash' A/M L NIA Y Door AIM L N/A Y # Cel Win Frame AIM L N/A Y C Door Casing AIM L NIA Y Screen Frame AIM L NIA Y 1 2 Door Jamb AIM L N/A Y ` Cellar Win Sill AIM L NIA Y 3 4 Threshold AIM L NIA Y C Cel Win Sash AIM L NIA Y Kickplate AIM L NIA Y # Cel Win Frame AIM L NIA Y Door AIM L N/A Y Screen Frame AIM L N/A Y C Door Casing AIM L NIA Y Foundation L NIA Y 1 2 Door Jamb AIM L NIA Y C Bulkhead �(J AIM L NIA Y 3 4 Threshold AIM L NIA Y Fences AIM L NIA Y Window Sill 1 L NIA Y Shutters AIM L NIA Y C Win Casing L N/A Y Newel post AIM L N/A Y #! Window Sash \jR AIM L NIA I Y Railing Cap AIM L NIA Y Window Sill 60 AIM L NIA Y Handrail AIM L N/A Y C Win Casing AIM L N/A Y C Balusters AIM L NIA Y #Z Window Sash V AIM L NIA Y Lower Rail AIM L N/A Y Window Sill v AIM L N/A Y Treads AIM L NIA Y C Win Casing Z AIM L NIA Y Risers AIM L NIA Y #3 Window Sash AIM NIA Y Stringer AIM L NIA Y C Lamp Post L N/A Y Lattice AIM L N/A Y COMMENTS 1 STRUCTURAL DEFECTS: Drain Pipes L NIA Y t C Elec Conduit pJj L NIA Y Oil Fill Pipe L N1A Y Overhan Trim 9 AIM L NIA) Y Excluded'Surfaces:Surfaces listed in this box can be made Soil.Test Results intact only by a licensed defender (Must be less than 400 ppm for play area/1200 ppm for bare soil) . SIDE LOCATION MEASURE:LOOSE PAINT lC IC LOCATION AREA MEASUREMENT RESULA REMED REMED C (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH C Play Area C Bare Soil C Comments:, C LIRA RepExtC,6/15 John Macisaac IIR-2378 10/27/15 22 Page Of____ Inspector(print) Lic# atu a Date John Maclsaac I/R-2378 it Risk Assessor (prin22 PINE AVEuc 41 Signature -DRY-AN NIS Address of Property: EXTERIOR D Side 0/- Z SIDE LOCATION/ LEAD TYP OF URG IC IC' DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ. DATE METH DATE METH D SURFACE HAZARD HAZ? DATE METH DATE METH Siding N/A Y Window Sill L N/A Y Comer Boards (I)N/A Y 7 D Win Casing N/A Y D Lower Trim NIA Y Window Sash A/M L WA Y Upper Trim AA a)N/A Y Cellar Win Sill A1# L N/A Y Win Above 5' 94 15 N/A Y D Cel Win Sash A/M L NIA Y Porch Above 5' L N/A Y Cel Win Fram 3 WA Y Storm Door AIM L N/A Y Screen Frame AIM L NIA Y Door Q N/A Y Cellar Win Sill AIM L WA Y D Door Casing WA Y D Gel Win Sash A/M L N/A Y 2 Door Jamb 7H L N/A Y # Cel Win Frame A/M L NIA Y 4 Threshold 03 A/M L NIA Y Screen Frame A/M L NIA Y �. Kickplate Q AIM L NIA Y Cellar Win Sill AIM L NIA Y Storm Door AIM L NIA Y T D Cel Win Sash A/M L NIA Y Door D A/M L N/A Y # - Cel Win Frame A/M L NIA Y D Door Casing AIM L NIA Y Screen Frame A/M L NIA Y 1 oor Jamb 6b A/M L N/A Y Cellar Win Sill A/M L NIA Y 3 4 Threshold A/M L N/A Y D Cel Win Sash A/M L N/A Y Kickplate 4 AIM L N/A Y Cel Win Frame: A/M L N/A Y Door AIM L N/A Y Screen Frame A/M L NIA Y D Door Casing• AIM L NIA Y Foundation A,(j L N/A Y 1 2 Door Jamb "A/M L NIA Y D Bulkhead AIM L N/A Y 3 4 Threshold AIM t N/A 'Y Fences AIM L N/A Y Window Sill AIM L N/A Y Shutters A/M L NA Y D Win Casing OD A/M L N/A Y A/M L NIA Y # t Window Sash 061J AIM L WA Y ailing CaP AIM L NIA Y Window Sill d,0 AIM L NIA Y Handrail A/M L N/A Y D Win Casing AIM L WA Y D Balusters AIM L N/A Y Window Sash Cps A/M L N/A Y Lower Rail AIM L NIA Y Window Sill AIM L N/A Y Treads AIM L NIA Y D Win Casing AIM L N/A Y Risers AIM L NIA Y #3 Window Sash AIM L NIA Y Stringer AIM L NIA Y D Lamp Post L N/A Y Lattice rN Y COMMENTS I STRUCTURAL DEFECTS(Z�fl.F A l—4 3 bul-td d� Drain Pipes Y 1,4&!UC' s C 0110 I'Pn.l -�- (j()rjlrAila2c D Eiec conduit Y G'�1� �k/'.G d� � Oil Fill Pipe Y Overhang Tri Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT *IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED D -(MORE THAN 1440 SO.IN.) DATE METH (Square Feet) (PPM) DATE METH D Play Area D Bare Soil , ` D Comments: :D LIRA RepExtD,6/15 • f •John Mactsaac UR-2378 a� 10/27/15 1y22 Page—Of_ inspector(print) Lic# a �i Date John Maclsaac I/R-2378 Risk Assessor (pdnt)22 PINE AVEtic# Signature Da YANNIS Address of Property: Apt.# City ' EXTERIOR-- Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH /� Window Sill .D AIM L NIA Y Window SRi A/M L N/A Y D Win Casing ( A/M L NIA Y Win Casing A/M I. N/A Y Window Sash 1W A/M L NIA Y lWindow Sash AN L N/A Y Window Sill A Y Window Sill A/M L WA Y !� Win Casing Y L N/A Y Win Casing A/M L WA Y �o Window Sash 1rj AIM L WA Y Window Sash A/M L NIA Y Window Sill kQ NIA Y Window Sill §—AIIINN/A Y Win Casing Q ��WA Y Win CasingWA Y 7 Window Sash V A/M L WA Y' Window Sash- WA Y O Window Sill 7 N/A Y Window SRiN/A Y Win Casing N/A Y f Win CasingN/A Y Window Sash Y AIM L N/A Y Window SashN/A Y D Window Sill N/A Y Window SiltN/A Y Win casing 6M WA Y. A Y Window Sash �/ AIM L N/A Y r. Window Sash /A Y Window Sill L NIA Y Window Sill A/M L WA Y Win Casing /. L NIA Y Win Casing A/M L NIA Y lb Window Sash A/M L N/A Y Window Sash A/M L WA Y Window Sill A/M L NIA Y Window Sill A/M L WA Y Win Casing AIM L WA Y Win Casing A!M L N/A Y Window Sash AIM L NIA Y Window Sash AIM L N/A Y Window Sill AIM L WA Y' Window Sill A/M L WA Y Win Casing AIM L WA Y Win Casing NA/ML Y Window Sash `. AIM L WA Y Window Sash Y Window Sill A/M L NIA Y Window Sill Y Win Casing A/M L N/A Y Win Casing Y Window Sash AIM L WA Y' Window Sash A!M L WA Y Window Sill AIM L NlA Y Window SRI AIM L NIA Y Win Casing AIM L WA Y Win Casing AIM L NIA Y Window Sash AIM L WA Y Window Sash —AIM L N/A Y AIM L WA Y. Window Sill AIM L N/A Y AIM L N/A Y Win-Casing A/M L NIA Y COMMENTS/STRUCTURAL DEFECTS: Window Sash A/M L NIA Y Window Sill A/M L N/A Y ' Win Casing AIM L N/A Y ' Window Sash A/M L N/A Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC- a LOCATION:' AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH A Play Area A Bare Soil AComments: Ll/RA Rep&LA.6/15 E f Lead inspection 1 Risk Assessment Report Page 1 Of Main Office: 1 Arcadia Street Dorchester,MA 02122 Toll Free: 800-349-7779 ENVIRONMEw7AL,INC. Phone:617-288-8870 Fax 617-282-7783 www.asapenvironmental.com St.# Street Name Street Type Unit "m city . Zip Code v �~ ,y Number of Rooms in Unit Owners Name: ( —�J 'G l ,— Property Type: Owner Address: Single Family Contact Information: 11i/0 1; � G _ ? �J�J Multi Family #of Units fit`' Client Name(if different from owner): .3t� , J(�Y El Condominium #of Units Client Address: • •❑ Day Care ❑ Other Kev Lead Column Key Delead/IC Method Colutn i Key Delead/IC Method Column Laundry in Basement? ❑Yes U No COV Covered CAP Capped ' SCR Scraped Finished Space in Basement Q Yes No VB Vinyl Baseboard COV Covered DIP Dipped MET Metal ENC Encapsulated ' REM Removed VR Vinyl Rep.Window MI Made Intact REP Replaced MR Metal Rep.Window PRE Prepared for Enc. REV Reversed Testing Method Used NA Not Accessible VR/MR Vinyl/Metal Rep Window INT Intact - NC No Coating SFR Stone Frame Removed Tile Tile(testing suggested) Component Does Not Exist Na2S Expiration Date: DC Dropped Ceiling X-Ray Fluorescence Model: L PA —1 Serial# i-7 0 Comments/Notes: Submitted for Compliance Evaluation❑ nk T Floor# •� (level within building of unit being inspected) Floor# t Property Diagram/Unit Labels c J C r B B D D r Tc A 36 f � 1 Rv l A(Street Side) Start Here • A(Street Side) Start Here A(Street Side) Pb(lead)equal to or greater than 1.0 m/cm2 with x-ray fluorescence or positive with Na�S is Dangerous. XRF Calibration Recorded In Log Book �'" ✓-Checkoff when complete Address verified through LISPS ®' ✓—Check off when complete Research on Lead Related History for Address . www.statc.n)a.us/dp //clonn.or 800-532-9571 -Check off when complete John Maelsaac 2378 � `D /2? /..J' Inspector's Name License# ignature Date Ll/RA revised 09/14 ADDRESS' Page 2 o INSPECTION His 1 INTERIM CONTR® , _ L Dexermination Risk Assessment y Inspector Name: Lic# Y RA.Name: Lic# g N _ N Signature NSignature Lead Hazards. . urgent Pb.Hazards? Comprehensive Inspector Na If ,Lic*,_' Dust Taken for Risk Initial Inspection MF R.A.Name: Lic#_ FO Assessment U 2 1 Signature 71 N Signature Lead Hazards? Visual Portion of Comp Initial Inspector Name: Lic# Reinspection for P w/Partial PCAD y Interim Control R.A.Name: Lic# N Signature Lead Hazards? o Signature Addendum add-on Dust Taken for Risk P Inspector Name: ,Lic# Assessment Reins . to Initial Inspection) y F N Signature Signature Lead Hazards? a Visual Portion of R.A.Name: z Lic# Reinspection for Addendum as Full T1Interim Control P . . Inspection y Inspector Name: Lic# Signature N Signature , Lead Hazards? Dust Taken for Risk P R.A.Name: Lic# -Assessment Reinsp. Walk Through for F Signature Ed/Consultation Inspector Name: Lic# Signature Risk Assessment Recertification REINSPECTION HISTORY y R.A.Name: Lic# Visual Portion of N Reocc.Reins ection E Inspector Name: Lic# Urgent Pb.Hazards? Signature . . Signature Dust Taken£or RA P R.A.Name: Lic# Recertification Visual Portion of F Signature Reocc.Reins Lion P Inspector Name: Lic# F ` Signature POST COMPLIANCE ASSESSMENT(DETERMINATIONS PCAD Dust Taken for Inspector Name: Lic# P Reocc.Reinspection Inspector Name: Lic# Y F N Signature Signatufe Lead Hazards? Dust Taken for P Full Inspection Reocc.Reins ection Inspector Name: Lic# F Acting as PCAD Signature y Inspector Name: Lic# Visual Portion of Lead Hazards? N Signature Final Rein ection P ' Inspector Name:. Lic# F Visual Portion of P Inspector Name: Lic# Signature PCAD Reinspection fi " Signature Visual Portion of p Inspector Name: Lic# Final Re inspection Pe F , u*. Dust Taken for P Inspector Name: Lic# Signature PCAD Reins ection Dust Taken for Final P Inspector Name: Lic# Signature Rein .(No Reocc) Signature Dust Taken for PCAD Reins ection Inspector Name: Lic# Dust Taken for Final Rein .{No Reocc P inspector Name: Lic# Signature F Signature ' ADDRESS: Qicw WVAKIK Page 3 o� REOCCUPANCTUMMIAlrE HISTORY COMPLIANCE Certificate of Certificate of Reoccupancy Inspector Name: ,Lit# Maintained Inspector Name: ,Lic# Compliance Signature Only after Signature High/Mod Risk No Work=No Dust (#rooms rule) Work=7 Dust Certificate of Certificate of Reoceu ancy Inspector Name: Lic# Restored Compliance Inspector Name: Lic# Only after Signature Signature High/Mod Risk Dust wipes and auth. g (#rooms rule people Certificate of Inspector Name Lic# Reocc ancy p Certificate of Maintained Inspector Name: Lic# Signature Co m fiance Only after High/Mod Risk Signature (#rooms rule No Work=No Dust t Work=7 Dust COMPLIANCE HISTORY Letter of Full Initial Certificate of Restored Compliance Inspector Name: Lic# Cmn Hance Inspector Name: Lic# No prior history/ Signature Signature No signs of UD Dust wipes and auth. ' 'people Letter of Interim OTHER HISTORY: WAIVERS/UD' Control Inspector Name:. ,Lic# Approved CLPPP Waiver No prior Comp.- Signature Inspector Name: Lic# Expires in I yr. Attach to Comp Does Signature Recertification of Interim Control Approved Inspector Name: Lic# Approved Waiver Inspector Name: Lic# Expires 2 yrs from Signature ' Attach to Com Signature originate Interim, s � p Control Does Letter of Full , Deleading Inspector Name: ,Lic# '' UD/DES visual Corn lance' Reins ection Inspector Name: Lic# Signature Dust wipes if No Signature Reocc. No LOC Issued F FNo ertificate of UD/DES Dust Maintained Inspector Name: Lic# Taken Inspector Name: Lic# Com Rance Si nature P g 9 No LOC Issued Si nature Work=No Dust ork=7 Dust UD/DES Dust Taken "Certificate of Inspector Name: Lic# Restored F Compliance Inspector Name: . ,Lic# � . " kr No LOC issued Signature Signature - Dust wipes and auth. UD l;DES.Final le Rein ection Inspector Name: Lic# ` ' 'No toC Issued F Signature Page 4_ of EEXMa6AION_Of&LEAD INSPECTION/RISC{ASSESSMENT RE]pqja MgM COLUMNS 22 This page provides general information needed to understand the lead inspection/risk assessnaent report.However,you should speak with the inspector/risk assessor before you start to do any work on your home.: SIDE Refers to A,B,C,or D side of the building or room. See the diagram on the cover sheet. The"A"side of the building or room is the side facing the street that gives the property its address(usually,it is the front of the building).Keeping your back to this street,from the"A"side move clockwise to the"B"side on your left,the"C" side opposite you,and the"D side to the right. Numbering is from left to right. LOCATION/ Refers to the building component(s)being tested. Some surfaces may be made up of more than one part.For SURFACE example,"Baseboard"may refer to four separate pieces of wood(one on each wall),but is still considered one surface. LEAD The actual lead result.Each surface tested must have a result recorded in the "Lead"column. • 'A number shows that the surface was tested with an XRF analyzer.A number(or average number)equal to or greater than 1.0 mg/cm2 is a dangerous level of lead. • A"pos"or"neg"shows that the surface was tested with sodium sulfide,."Pos"means that there is a dangerous level of lead. • "N/A"means that the inspector was not able to test the surface.Unless the owner can get a sample to test,the inspector must assume the surface contains lead and require it to be deleaded,if necessary. • "MET"or"MR"means that a metal surface was not tested and only needs to be intact,even if it is a leaded. surface. However,metal handrails,metal window sills,and metal railing caps,need to be deleaded if they test equal to or greater than 1.0 mg/cm2,or is marked`N/A.'' " For key to abbreviations like`:COV , VB ,"VW'or MR",'WC", Tile","DC",see the cover page. • When a component box is slashed and there are test results above and below the diagonal line,the result on the "bottom"represents results below 5 ft.and the"top"result indicates the test result above 5 ft. TYPE OF Not all lead paint must be deleaded.This column tells you IF and WHY a surface needs deleading.The deleading HAZARD standards below may not apply for Interim Controls. Speak to your risk assessor for more information. • "M/1"circled means that the surface"is a moveable/impacted surface and must be deleaded in its entirety. • "SF"circled indicates that there is a storm frame present which requires the blind stop and exterior sill be deleaded as interior moveable/unpacted surfaces. • "A/M"circled means that the surface is"accessible mouthable"and must be deleaded to a minimum of five feet - high,.four inches in from the edge or comer. ® "L"circled means that the surface is loose and must,at minimum,be made intact. • If more than one choice is circled,the rules for deleading may change depending upon what method of deleading you choose. Speak to the inspector for more information. • "N/A"means the inspector was unable to determine if th.e surface was a lead hazard.The person doing the deleading must check this surface and follow all the rules'for deleading. Speak to the inspector for more information. • If nothing is circled in the column,then it is likely the surface does not need deleading.Speak to the inspector for more information. Remember,this does not mean the entire surface is lead free,it just does not require deleading in its current condition. f URG HAZ? This column is only completed'during a risk assessment,A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment,not all inspectors are risk assessors. If"Y"is circled,then this surface is considered an"Urgent Lead Hazard"and some type of deleading work is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim Control. IC METH The deleading method or structural repair done to qualify the surface for Interim Control.Refer to the deleading codes key on the cover page. DELEAD The date that the'lead inspector.reinspects the surface and finds that it has been successfully brought back into DATE - compliance. e DELEAD The method used to bring a surface into full compliance.Refer to codes in the Key on the cover page of the PCAD METH ' EXCLUDED The amount of loose paint on a surface as measured by the lead inspector."N/A"means that the inspector was not - SURFACES able to measure the loose paint,but has determined it is more than the cut-off for moderate risk making intact. LIRA Exp.8/08 John Maclsaac IIR-2378 Risk Assessor{prin� 69 SOUTH Signature D t 1 �TYANNIS Address of Pro rt : Apt.# city: ROOM# SIDE LOCATIONI LEAD TYPE OF URG IC IC JDELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE `METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A e Up Wafts �') ANON1A Y 4 A Window Sill MA A/M L N/A Y Low Walls I� L NIA Y CZ� B Win Apron � AIM L NIA Y Baseboards Z(�, /A Y t C Win Casing A/M L NIA Y ;Fbor air Rail Z! NIA Y �} Header Stop &D MA A/M L NIA Y N/A Y Int Stops tMll A/M L N/A Y ( A!M L N1A Y 1, Win IntSash Q Mll A/M L N1A Y iling A/M L N/A Y 2 Exterior Silt Q� M11 SF L N/A Y A Door AIM L N/A Y 3 Part Bead MA L NIA Y C D Door Casing &ON/A Y 4 Blind Stop { MA SF L N/A Y 12 Door Jamb &gINIA Y s Win Ext Sash .g Mll L NIA Y 34 Threshold 6-7 AIM L N/A Y A Window Sill MA A/M L N/A Y AB Door AIM L N/A 'Y B Win Apron A/M L NIA Y CD Door Casing AIM L N/A Y C Win Casing A/M L NIA Y 12 Door Jamb A/M L N/A Y Header Stop Mil A!M L N/A Y 34 Threshold AiN L NIA Y IM Stops M/I AIM L N/A Y A B Door A/M L N/A .Y 1 Win Int Sash MA A1M L N/A Y C D Door Casing AIM L N/A Y Exterior Sill Mil SF L N/A Y 12 Door Jamb AIM L N/A Y 3 Part Bead Mil L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop 0.1 MA SF L NIA Y A B Door AAw L NIA Y Win Ext Sash M/I L N/A Y C D Door Casing A/M L'NIA Y A Window Sill MA A/M L NIA Y 12 Door Jamb A/M L N/A Y B Win Apron U,•'' A/M L N/A Y 34 Threshold AIM L NIA Y C' Win Casing • W A/M L N/A Y Window Siff MA A/M L NIA Y 47� Header Stop I aSFL Y B Win Apron AIM L N/A Y CJ Int Stops r} Y C Win Casing A/M L NIA Y 1 Win Int Sash ( Mil Y D Header Stop MII A/M L WA Y 2 "Exterior Sill C? Y Int Stops ( M!I A/M L N!A Y 3 Part Bead coo Y 1 Win Int Sash MA AIM L NIA Y 4 Blind Stop o MA SF L N/A Y 2 Exterior Sill ef-jq MA SF. L NIA Y Win Ext Sash Mil L NIA Y 3 Part Bead Mil L NIA Y AB Fireplace A/M L NIA Y 4 Blind Stop ( M111-SF L NIA Y CD Mantle A/M L NIA 'Y 6 , Win Ext Sash �� M11 L-NIA Y A A p Win Above 5' AIM L NIA Y COMMENTS/STRUCTURAL DEFECTSf(l 1g L J`jIv jj Ceiling Mold' Z{ A/M-ON IA Y §Neez6 as9>a:S,1+ L NIA Y ` L N/A Y eO AIM L N/A Y 'EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION .. MEASURE:LOOSE PAINT IC IC Check the box if this ROOM is RULED OUT for {MORE THAN 288 SO.IN.) DATE METHOD encapsulation because there ere are 3 or more surfaces with adhesion problems and/or 3 or more loose AIM surfaces LYRA RepRoosn,6/15 " , I ? John Mactsaac IIR-2378 10/27/15 Pag D, Inspector(print) Lic# nat Date John Mactsaac I/R-2378 Risk Assessor(print) Lic# Signature Date Address of Pro ert :369 SOUTH ST. Apt.# 1 city: HYANNIS ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION! LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH DATE METH A B Up Walls L AIM L N!A Y Window Sill ? MA NIA Y gF ow Wags A/M L NIA Y B Win Apron q L N/A Y aW&rw s N/A Y C Win Casing L IA Y hair Rail AIM L NIA Y D Header Stop �` M/I AN L NIA Y i 11 q, adiator A/M L NIA YInt Stops MII (� NIA Y loor AIM L N/A Y Win Int Sash Vim MA AIM L N/A Y eiling AAN L NIA Y 2 Exterior Sill V/tr MII SF L NIA Y oar IA Y 3 Part Bead VA�-M/I L N/A Y C D Door Casing N/A Y 4 Bend Stop M/I SF L NIA Y 12 DoorJamb NIA Y Win Ext Sash V MA L NIA Y 34 Threshold A/M L N/A Y Window Sill f M/I ON/A Y A B Door AIM L NIA Y B Win Apron 101A Y ®D Door Casing N/A Y . C Win Casing NIA Y 02 Door Jamb J N/A Y D Header Stop M/I A/ N/A Y 3 4 Threshold A/M L N/A Y int Stops MI 1DN/A Y A B Door �, ,2� NIA Y 1 Win Int Sash (/ M11 A/M L NIA Y OD Door Casing ` NIA Y Exterior Sill t//L M I I SF L NIA Y 1 C Door Jamb Z N/A Y. 3 Part Bead VAL I M/I L NIA Y 3 4 Threshold 600NIA Y 4 Blind Stop MA SF L NIA Y A B Door AIM L N/A Y ` Win Ext Sash V,� WI-L NIA Y Door Casing L NIA Y - A Window Sill MA AIM L N/A Y. 1 Door Jamb OZ, A/M L NIA Y B Win Apron A/M L N/A Y 34 Threshold AIM L N/A Y C Win Casing AIM L N/A Y A Closet Door N/A Y D Header Stop M/l A/M L NIA Y B Cl Casing N/A Y Int Stops M/I A/M L N/A Y C Closet Jamb NIA Y 1 Win Int Sash M/I A/M L NIA Y D Closet Walls a O` AIM L N/A Y Ti 2 Exterior Sill M/I SF i NIA Y C 1 CI Baseboard A/M L N/A Y 3• Part Bead MI L NIA Y 1 Closet Pole AIM L N/A Y 4 Blind Stop MA SF L N/A Y 2 Closet Shelf elffN/A Y lWin Ext Sash M/I C NIA Y 3 Cl Supports AIM L NIA Y r A B Fireplace dV AIM L N/A Y 4 Closet Floor 4 0 rN/A Y Mantle /?? NIA Y Closet Ceiling AIM L NIA Y n B � �' Co Win AboveS' A, AIM L N/A Y COMMENTS/STRUCTURAL DEFECTS:( Ceiling Mold' AIM L NIA Y - AIM LNIA Y AJM L NIA Y AIM L N/Al Y Surfaces listed in these boxes can only be made intact by a Deleader SIDE • LOCATION ' MEASURE:LOOSE PAINT .. IC iC• (MORE THAN 288 SO.IN.) DATE METHOD Check the box if this ROOM IS RULED OUT for rY encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces L11RA RepRooni,6/15 a John Macisaac IlR-2378 far 10/27/15 22Page of Inspector(print) Lic# re Date John Maclsaac VR-2378 46 Risk Assessor(print)369 SOUTH W. i9nature 1 Da�YANNiS Address of Property: Aft# Cit HALLWAY: Interior # or ommon Haliwa • ro Rear Floor# &e,4 SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls AIM L NIA Y A Closet Door AIM L NIA Y A B Low Wails AIM L NIA Y B Cl Casing AIM L N/A Y A o Baseboards 00 AIM L NIA Y C Closet Jamb AIM L NIA Y A e Chair Rail AIM L NIA Y D Closet Walls AIM L NIA Y AB CD Radiator AIM L NIA Y Cl Baseboard AIM L NIA Y Floor Vor AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling AIM L'NIA Y 2 Closet Shelf AIM L N/A Y A Door NIA Y 3 ' Cl Supports AIM L NIA Y C D Door Casing AIM L NIA Y 4 Closet Floor AIM L NIA Y 12 Door Jamb NIA Y Closet Ceiling AIM L NIA Y 34 Threshold AIM L fdlA Y A Window Sill MA AIM L NIA Y B Poor AIM L NIA Y B Win Apron AIM L NIA Y C D Door Casing AIM L NIA Y kC Win Casing AIM L N/A Y 12 Door Jamb AIM L NIA Y D Header Stop MA AIM L NIA Y 34 Threshold AIM L NIA Y fnt Stops MA AIM L NIA Y A B Door NIA Y 1 Win int Sash MII AIM L NIA Y Door Casing (70 AIM L NIA Y 2 Exterior Sill MA SF L NIA Y 12 Door Jamb NIA Y 3. Part Bead. MII L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop MA SF L NIA Y A B Door AIM L'NIA Y Win Ext Sash I IM/I L NIA Y C D Door Casing AIM L NIA Y A window Sill Mll AIM L NIA Y 12 Door Jamb AIM L N/A Y B Win Apron AIM L NIA Y 34 Threshold AIM L NIA Y C Win Casing AIM L NIA Y A B Door AIM L NIA Y D Header Stop Mil AIM L NIA Y C D Door Casing AIM L NIA Y Int Stops. M/l AIM L NIA Y #, Door Jamb AIM L NIA Y 1 Win fnt Sash M/l AIM L NIA Y Threshold AIM L NIA Y 2 Exterior Sill MII SF L NIA Y A Closet Door AIM L NIA Y 3 Part Bead MA L NIA Y B CI Casing AIM L NIA Y 4 Blind Stop M/1 SF L NIA Y Win Ext Sash Mn Closet Jamb AIM L NIA Y L N/A Y D Closet Walls AB(,f7 AIM L WA Y c p Win Above 5' Mil AIM L NIA Y AB (1 Cl Baseboard AAaI L NIA Y C o Ceiling Mold 4, MA AIM L NIA Y 1 Closet Pole AIM L NIA Y MII A1M L NIA Y 2 Closet Shelf AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS: 3 Cl Supports 60 AIM L NIA Y (� 4 Closet Floor V.( AIM L NIA Y Closet Ceiling AIM L NIA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT IC IG (MORE THAN 288 SQ.IN.) DATE METHOD -- Check the box if this ROOM is RULED OUT for encapsulation'because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces John Macisaac I/R-2378 + 10/27/15 2 Page9Of 2 2 Inspector(print) tic# tur Date John Maclsaae IIR-2378 Risk Assessor{print) Signature p 19 Address of Property:369 SOUTHYANNIS Apt.# City: KITCHEN SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A B Up Walls ( AIM L NIA Y A Window Sill M11 AIM L NIA Y A B Low Walls A/M L N/A Y B Win Apron. AIM L NIA Y A B Baseboards AIM L NIA Y C Win Casing AIM L NIA Y A 8 Chair Rail AIM L NIA Y D Header Stop Mll A/M L N/A y N AB CD Radiator AIM L NIA Y Int Stops M/I A/M L NIA Y gFloor A/M L N/A Y 1. Win Int Sash M/I A/M L NIA Y Ceiling AIM L N/A Y p 2 Exterior Sill MA SF L NIA Y Door A/M L N/A Y 3 Part Bead M/1 L NIA Y Door Casing AIM L NIA Y 4 Blind Stop M11 SF L N/A Y 12 Door Jamb L AIM L N/A Y Win ExtSash M/I L N/A Y 34 Threshold "41 AIM L N/A Y A window Sill Mll AIM L N/A Y A B Door AIM L N/A Y B Win Apron A/M L N/A Y C D Door Casing A/M L N/A Y C Win Casing q L wq y 12 Door Jamb A/M L N/A Y D Header Stop M/I A/M L NIA Y 34 Threshold AIM L NIA Y Int Stops MA AIM L NIA Y A B Door A/M L N/A Y 1 Win Int Sash MA A/M L NIA Y C D Door Casing AIM L N/A Y 2 Exterior Sill MII SF L NIA Y 1 2 Door Jamb AIM L NIA Y 3 Part Bead. M11 L N/A Y 3 4 Threshold AIM L NIA Y 4 Blind Stop. M/I SF L NIA Y A B Door AIM L NIA Y - Win Ext Sash MA L NIA Y C D Door Casing AIM L N/A Y A B Up Gab Frame A/M L NIA Y 12 Door Jamb A/M L NIA Y C D Up Cab-Door A/M L NIA Y 34 Threshold A/M L NIA Y Up Cab Walls AIM L N/A Y A Closet Door AIM L NIA Y 12 Up Cab Shlvs AIM L NIA Y B Cl Casing A/M L N/A Y 3 4 Supports AIM L NIA Y C Closet Jamb AIM L NIA Y Low Cab Fram AIM L N/A Y D °Closet waits AIM L N/A Y A B Low Cab Door AIM L NIA Y Cl Baseboard A/M L N/A Y C D Low Cab WallsAIM L N/A Y 1 Closet Pole AIM L NIA Y Low Cab Shlv AIM L NIA Y 2 Closet Shelf AIM L NIA Y 12 Supports A/M L NIA Y 3 Cl Supports . AIM L NIA Y 34 Drawers AIM L NIA Y AB 4 Closet Floor AIM L NIA Y CD Win Above 5' MA AIM L NIA Y Closet Ceiling A1M L N/A Y _ MR AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS, MA AIM L NIA Y W 1 AIM L NIA Y =aensed Y Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by lic deleader. -SIDE LOCATION MEASURE:LOOSE PAINT IC IC r(MORE THAN 288 S0.IN.) DATE WETHOD ` Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more surfaces with adhesion , problems and/or 3 or more loose A/M surfaces >4 LIRA RenKitchen.6/15 John Maclsaac IIR-2378 04614 10/27/15 Padof 22 Inspector(print) Lic# a Date John Maclsaac 11R-2378 Risk Assessor(print) Lic#. Signature- Date Address of Pro e :369 SOUTH ST. Apt.# 1 C; : HYANNIS ROOM# SIDE LOCATION! LEAD TYPE OF URG IC IC= DELEAD DELEAD SIDE 'LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH A s Up Watts AIM L N/A Y A Window Sill M/I AIM L N/A Y A B low WallA/M L NIA Y ® Win Apron `� AN L NIA Y A D :b]jrj AIM L NIA Y C Win Casing AIM L N/A Y A B AIM L NIA Y D Header Stop 6D MA AN L N/A Y AS Radiator D b0 A/M L N/A Y Int Stops 3 MJl A/M L NIA Y Floor AIM L N/A Y Win Int Sash V M/I AN L NIA Y Ceiling A/M L N/A Y " 2 Exterior Sill J Mll SF L WA Y A B Door A/M L NIA Y 3 Part Bead U M!i L NIA Y Ufl Door Casing A/M L NIA Y 4 Blind Stop M/I SF L NIA Y 2 Door Jamb AIM L NIA Y Win Ext Sash (I M/I L N/A Y 3 4 Threshold A/M L NIA Y A Window Sill M/I A/M L NIA Y A B Door NIA Y Win Apron A/M L NIA Y CA Door Casing A/M L NIA Y C Win Casing .L A/M L N/A Y 1 2 Door Jamb AN L NIA Y D Header Stop Mil A/M-L N/A Y 34 Threshold A/M L NIA Y Int Stops Mil A/M L N/A Y AB Door A/M CNIA Y 11( Win Int Sash V M/I AJM L N/A Y C D Door Casing AIM L WA Y r Exterior Sill r/ M/I SF L N/A Y 12 Door JambT AIM L NIA Y 3 Part Bead fjfj Nifi L NIA Y 34 Threshold AIM L N/A Y 4 Blind Stop M/I SF L N/A Y A B Door AIM L N/A Y Win Ext Sash U�T M/l L N/A Y C D Door Casing A/M L N/A Y A Window Sit[ MA AIM L NIA Y 12 Door Jamb AIM L NIA Y B Win Apron AJM L TWAY 34 Threshold A/M L NIA Y ' C Win Casing" 0 A/M L A Closet Door A/M L N/A Y D Header Stop Mil AJM L B CI Casing t, A/M L NIA Y Int Stops ja M!! Aim L C Closet Jamb L A/M L NIA Y 1 Win Int Sash Mh AIM L N/A Y Closet Walls AIM L N/A Y 2 Exterior Sill D M/I SF L N/A Y Cl Baseboard AIM L N/A Y 3 Part Bead M/I L NIA Y 1 Closet Pole A!M i NIA Y 4 Blind Stop IDZ4 M/I SF L N/A Y 2 Closet Shelf A/(, A/M L NIA Y Win Ext Sash od MII L N/A Y 3 CI Supports A/M L NIA Y AB IFireplace AIM L NIA Y 4 Closet Floor ( AIM L NIA Y C D Mantle AIM L N/A Y Closet Ceilin G AIM L N/A Y A n g C D Win Above 5' A A1M L NIA Y COMMENTS J STRUCTURAL DEFECTS: Ceiling Moldinc AIM L WA Y 6 to AIM L N/A Y v usf• - A1M L N/A Y of AIM L NIA Y Surfaces listed in these boxes can only be made intact by a Delea er SIDE LOCATION MEASURE:LOOSE PAINT !C IC Check the box if this ROOM is RULED OUT for (MORE THAN 288 SQ.IN.) DATE METHOD encapsulation because there are 3 or more surfaces With adhesion - problems and/or 3 or more loose A/M surfaces . L.I/RA RepRoom,6/15 John Maclsaac uR-2378 It wtv".410/27/15 22 Inspector(print) Lic# n ture Date Page f John Maclsaac I/R-2378i Risk Assessor (print�369 SOUTH Signature Da YANNIS Address of Property: Apt # City: BATHROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC • DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URGI IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH 'SURFACE HAZARD HAZ?j DATE METH DATE METH A B Up Walls L AIM L NIA Y Low Cab Fram A/M L NIA Y A B Low Walls �AI"M L NIA Y A Low Cab Door A/M L NIA Y A B Baseboards (Z VM L N/A Y GO Law Cab Walls (T(� AN L WA Y A B Chair Rail AIM L NIA Y Low Cab Shly AIM L N/A Y AB c D Radiator j AIM L NIA Y 12 Supports AIM L NIA Y FCD or 3 AIM L N/A Y 3 4 Drawers A/M L N/A Y iling AIR/L NIA Y A Window Sill ( Mfl A/M L NIA Y or IA YB Win Apron AIM L NIA Y or Casing AIM L N/A Y win Casing tD AIM L NIA Y 12 Door Jamb AIM L NIA Y D Header Stop M11 AIM L N/A Y 34 Threshold UU AIM L N/A Y Int Stops MA A/M L NIA Y A B A/M L NIA Y 1 Win Int Sash Jf Mn AIM L WA Y C oor Casing AIM L NIA Y 2 Exterior Sill Mil SF L NIA Y 12 Door Jamb p1j •A/M L NIA Y 3 Part Bead M11 L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop M!f SF L NIA Y A Closet Door AIM L N/A Y Win Ext Sash MA L N/A Y B AB CI Casing AIM L NIA Y CD Win Above 5' MA A/M L NA Y C Closet Jamb IJ? AIM L N/A Y ABC D Ceiling Moldi Mil AIM L NA Y Closet Wails ./ 'A/M L NIA Y AB C D Medicine Cab MA A/M L NA Y CI Baseboard A/M L NIA Y A8 C 0 Wall O/C W A1M L NA Y 1 Closet Pole AIM L N/A Y M/1 AIM L NA Y 2 Closet Shelf AIM L NIA Y MA AIM L NA Y 3 Cl Supports A/M L NIA Y Mti AIM L NA Y 4 Closet Floor AN L NIA Y Mfl A/M L NA Y Closet Ceiling 3 A/M L N/A Y Mn AIM L NA Y Up Cab Frame A/M L NIA Y MII AIM L NA Y C D Up Cab Door AIM L NIA Y Mli NM L NA Y Up Cab Walls AIM L N/A Y Mll AIM L NA Y 1.2 Up Cab Shlvs AIM L NIA Y M/I A/M L NA Y 3 4 Supports AIM L NIA Y MD AIM L NA Y MI l NM L NIA Y MII AIM L NA Y MII AIM L N/A Y Mli AIM L NA Y MA 'AIM L NIA Y Mil AIM L NA Y COMMENTS/STRUCTURAL DEFECTS(()f�io eN �j l °(e COMMENTS!STRUCTURAL DEFECTS: EXCLUDED SURFACES:Surfaces listed in these boxes can be"made intact only by a licensed deleader. SIDE LOCATION iAEASURE:LOOSE PAINT IC IC - - (MORE THAN 288 SQ.IN.) DATE METHOD Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more surfaces with adhesion r problems andlor 3 or more loose A/M surfaces r; LVR A Rep$at}i,6/15 John Maclsaac IIR-2378 lb "4e, 10/27/15 Page !`of 22 Inspector(print) Lic# ae Date John Maclsaac UR-2378 Risk Assessor(printi kc# Signature Dade Address of Pro rt :309 SOUTH J City:T.' A t # 1 HYANNIS ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE 'LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ. DATE METH . DATE METH A B Up Walls d0 AIM L NIA Y A Closet Door, lit / NIA Y A e Low Walls AIM L NIA Y Cl Casing 6 AIM L NIA Y A p Baseboards AN L NIA Y C Closet Jamb i) A/M L NIA . Y A e Chair Rail AIM L NIA Y D. Closet Walls .1 61 AIM L NIA Y A o Radiator AIM L N/A Y Cl Baseboard Go A/M L NIA Y Floor AIM L NIA Y 1 Closet Pole AIM L N/A Y Ceiling �j17 AIM L NIA Y 2 Closet She A/f6 NIA Y Door AIM L N/A Y 3 C1 Supports ( NIA Y C D Door Casing A/M L NIA Y 4 Closet Floor j AIM L NIA Y 12 Doorjamb AIM L NIA Y Closet Ceiling AIM L N/A Y 3 4 Threshold AIM L NIA Y A Window Silt /1 AIM L N/A Y A Door AIM L WA Y B Win Apron &0 AIM L N/A Y C D Door Casing j AIM L NIA Y C Win Casing Q A/M L N/A Y (y2 Doorjamb (� AIM L NIA Y (�7 Header Stop Mll AIM L NIA Y 34 Threshold AIM L NIA *Y =R. Int Stops , &0 M11 AN L NIA Y A B Door 2, NIA Y Win Int Sash 6.1 M/1 AIM L NIA Y C D Door Casing AIM L NIA Y 2 Exterior Sill Z, M/I SF L NIA Y 12 Door Jamb AIM L NIA Y 3 Part Bead M/I L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop•. �jil Mil SF L NIA Y A B Door Z. N/A Y Win Ext Sash WI L N/A Y Door Casing Z ,'N/A Y A Window Sill M/I A;W L N/A Y 12 Door Jamb AIM L NIA Y B Win Apron AIM L NIA Y 3 4 Threshold AIM L NIA Y C Win Casing A/M L NIA Y A Closet Door AIM L NIA Y Header Stop MA A/M L NIA Y B Cl Casing AIM L NIA Y Int Stops M11 AIM L NIA Y C Closet Jamb OD AIM L N/A Y 1,• Win Int Sash Vk M!I AIM L NIA Y D Closet Walls AIM L NIA Y 4 xtedor Sill1A, M/I 5F L NIAI Y Cl Baseboard NIA Y Part Bead Vim- MA L NIAJ Y 1 Closet Pole AIM L NIA Y 4' Blind Stop M/I SF L NIA Y 2 Closet Shelf AIM L N/A Y Win Ext Sash MA L NIA Y 3 CI Supports AIM L NIA Y AB Fireplace Al AIM L NIA Y 4 1CIDset Floor 1 AIM L NIA Y C 0 Mantle A/M L NIA Y Closet Ceilin AIM L N/A Y A B. g c p Win Above 5' AIM L NIA Y COMMENTS//STRUCCT :URAL DEFECTSA '( Ceiling Moldi A/M L N/A Y n �dl'JC/ AIM L N/A Y AIM L NIA Y /// z AIM L NIA Y EXCLUDED SURFACE Surfaces listed In these boxes can be made intact only by a licensed deleader. SIDE LOCATION MEASURE:LOOSE PAINT Ic IC Check the box if this ROOM is RULED OUT for (MORE THAN 288 SQ.IN") DATE METHOD encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A/M surfaces l.URA RcnRoom.6/l5 s John Mactsaac IIR-2378 , 10/27/15 P �7 22 Inspector(print) Lic# Jignalure re Date John Maclsaic UR-2378 '� Risk Assessor(print) Da369 SOUTH1 NYANNlS Address of Pro rt : -Apt.# City: HALLWAY nter' #_ or Common Hallway: Front Rear Floor#_ SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH n B Up Walls AIM L NIA Y A Closet Door A/M L NIA Y A 11B Low Walls AIM L NIA Y B Cl Casing AIM L NIA Y A B Baseboards A Y C/ C Closet Jamb A/M L NIA Y A B Chair Rail AVM L N/A Y D Closet Walls AIM L NIA Y AB CD Radiator A/M L N/A Y Cl Baseboard A/M L NIA Y Floor AIM L N/A •Y 1 Closet Pole AIM L NIA Y Ceiling AIM L N/A Y 2 Closet Shelf A/M L N/A Y Door AIM L N/A Y 3 Cl Supports A/M L NIA Y D Door Casing N/A Y. 4 Closet Floor AIM L N/A Y 12 Dooi Jamb 1AN/A Y Closet Ceiling AIM L NIA Y 34 Threshold A/M L NIA Y A N ; Ml! A/M L N/A Y A&Door AIM L NIA Y B Win Apron A/M L NIA Y C D Door Casing AIM L NIA Y C Win Casing A/M L NIA Y 02 Door Jamb A/M L NIA Y D Header Stop M/I A/M L NIA Y 3 4 Threshold A/M L N/A Y Int Stops MA A/M L NIA Y Door /Z IA Y 1 Win Int Sash MA AIM L NIA Y C D Door Casing ( AIM L NIA Y, 2 Exterior Sill MA SF L N/A Y 1g Door Jamb 61 AIM L N/A _Y ,3 Part Bead MA L NIA Y 3 4 Threshold AIM L NIA Y 4 Blind Stop Mil SF L NIA Y A B Door z� CCW NIA Y Win Ext Sash MA L NIA Y 3 rev D Door Casing AIM L NIA Y A, Window Sill M/t A/M L N/A Y 2 Door Jamb AIM L NIA Y B` Win Apron A/M L N/A Y 4 Threshold A/M L NIA Y C Win Casing AIM L NIA Y A B Door N/A Y D Header Stop Mil AIM L NIA Y �D Door Casing -p AIM L NIA Y IntStops MA AIM L N/A Y #t Door Jamb AIM L N/A Y 1= Win Int Sash Mil AAUI L NIA Y Threshold AIM L NIA Y 2 Exterior Sill M/I SF L N/A Y A Closet Door j NIA Y 3 . Part Bead M/I L NIA Y B Cl Casing AIM L NIA Y 4 Blind Stop MA SF L NIA Y Closet Jamb AIM L NIA Y Win Ext Sash MA L N/A Y D Closet Walls A/M L N/A Y tq� MII AIM L NIA Y C!Baseboard A/M L NIA Y DWd ,j MA AIM L NIA Y 1 Closet Pole AIM L N/A Y , 17 Gb MA AAvI L NIA Y 2 Closet Shelf dia N/A Y COMMENTS/STRUCTURAL DEFECTY(jf 1 G� 3 Ctsupports 3 N/A Y f 4 Closet Floor (. A/M L NIA Y r Closet Ceiling 6)6 AIM L WA Y EXCLUDED SURFACES:Surfaces listed in these boxes can be made intact only by a licensed deleader. SIDE ,LOCATION MEASURE:LOOSE PAINT IC IC Check the box if this ROOM IS RULED OUT for (MORE en THAN 288 SQ.IN.) DATE METHOD ®' capsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose AIM surfaces r John Maclsaac "�- 11R-2378 Inspector(print) Lic# i 7I�5 Page_`�#� g Date John Maclsaac I!R-2378 Risk Assdssor (print) Lic# Signature Date Address of Pro e SOUTH ST Apt.# EXTERIOR A HYANNIS SIDE LOCATION/ LEAD TYPE OF URG IC 1C DELEAD DELEAD SIDE LOCATION/ LEAD TYpE OF URG IC IC DELEAD DELEf A SURFACE HAZARD HAZ? DATE METH DATE METH A SURFACE HAZARD HAZ DATE METH DATE METF Siding fj � IA Y Window Sifl ' AIM L N/A Y Comer Boards Q �N/A Y A Win Casing A Lower Trim adjL NIA Y AIM L N/A Y Window Sash A/M L N/A Y Upper Trim /A Y Cellar Win Sill Win Above 5' /t j N/A Y AIM L N!A Y A Cel Win Sash A/OA L N/A Y Porch Above 5' L N/A Y Cel Win Frame A/M L N/A Y Storm Door AIM L NIA Y Screen Frame A/M L NIA Y Door A/M L NIA Y Cellar Win Sill A Door Casing AIM L NIA Y AIM L NIA Y A Cel Win Sash A/M L N/A Y 1 2 Door Jamb AIM L N!A Y # Cel Win Frame 3 4 Threshold (� AIM L NIA Y A/M L tV/A Y Screen Frame A/M L N/A Y Kickplate AIM L N/A Y C ellar Win Sol A/M L NIA Y Storm Door A/M L N/A Y A Cel Win Sash A/M L N/A Y Door N/A Y # CeI Win Frame A/M L NIA Y A Door Casing t NIA Y I Screen Frame AIM L 1 Door Jamb N/A Y Cellar Win Sill A/M L N/A Y 3 4 Threshold AIM L N/A Y A Cel Win Sash A/M L N/A Y Kickplate AIM L NIA Y Cel Win FrameAIM L N/A Y Door A/M L NIA Y Screen Frame A/M L N/A Y A Door Casing AIM L NIA Y Foundation L NIA Y 1 2 Door Jamb AIM L N/A Y A Bulkhead AIM L NIA Y 3 4 Threshold A/M L WA Y Fences A/M L N/A Y Window Sill L NIA Y Shutters A/M L NIA Y A Win Casing L N/A Y � AIM L N/A Y # Window Sash A/M L N/A Y Railing Cap AIM L NIA Y Window Sill L NIA Y Handrail A/M L N/A Y ` A Win Casing L N/A Y A Balusters AIM L N/A Y #Z Window Sash (/ A/M L NIA Y Lower Rail A/M L N/A Y Window Sill VL A/M L NIA Y Treads A/M L N/A Y A Win Casing AIM L N/A Y ° Risers• A/M L N/A Y #3 Window Sash A/M L N/A Y Stringer A/M L WA Y 6 Lamp Post L N/A Y Lattice AIM L N!A Y CQIMM S//I STRUCTURAL /DEFECTS: Drain Pipes L N/A Y ! l(/C�J �dtu�slt/d 6uTf�G�clv�lf� A ElecConduit Al L WA Y 9it"FHI Pipe . l L NIA Y C� , d Overhang Tri AIM L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by.a licensed�deleadt:r (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION, MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED A ; (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet A ) (PPM) DATE METH Play Area A Bare Soil A Comments: A LIRA RepExtA,6/15 Of } John Maclsaac I/R-2378 10/27/15 Page � Inspector(print) Lic# g tur Date John Maclsaac UR-2378 Risk Assessor.(print) Lic# Signature Date Address of Pro Apt,# 1 city. HYANN IS EXTERIOR B Side e SIDE 1 LOCATION/ LEA TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION! LEAD TYPE OF URG IC IC IDELEAC DELE/ B SURFACE HAZARD HAV DATE METH DATE METH B SURFACE HAZARD HAZ. DATE METH DATE METE Siding NG L A Y Window Siff L NIA Y Comer Boards WA Y B Win Casing L WA Y B Lower Trim L NIA Y Window Sashi,- A/iV► L N/A Y Upper Trim /V NIA Y Celar Win Sill L NIA Y Win Above 5' N/A Y $ Cell Win Sash V.4 A/M L NIA Y Po Above 5' L NIA Y at Win Fro L NIA Y Storm Door A/M L WA Y Lax Screen Frame A/M L N/A Y Door WA Y Cellar Win Sill N/A Y B Door Casing WA Y B Cel Win Sash A/M WA Y 1 2 Door Jamb N/A Y Cel Win Frame N/A Y 3 4 Threshold a /;� t/A Y Screen Frame 2>t L N!A Y Kickplate N/A Y Cellar Win Sit{ A/M L N/A MY Storm Door AIM L NIA Y B Cel Wm Sash Cp A/M L WA Door A1!L N/A Y # Cel Win Fram z7N/A$ DoorCasing AIM L NIA YScreen Frame A/M L WA 1 2 Door Jamb A/M L N/A Y Cellar Win Sill A/M L NIA Y 3 4 Threshold A/M L WA Y B Cel Win Sash A/M L NIA Y Kickplate A/M L NIA Y Cel Win Fra A/M L N/A Y Door AIM L N/A Y Screen Frame AIM L NIA Y B Door Casing A/M L N/A Y Foundation L NIA Y 1 2 DoorJamb AIM L N/A Y B Bulkhead Z A/M L NIA Y 3 4 Threshold AIM L WA Y Fences AIM L NIA Y Window Sill L NIA Y Shutters AIM L NIA Y B Win Casing : NIA Y Newel post A/M L NA Y # Window Sash AIM L N/A Y Railing Cap AIM L N1A Y Window sill L N/A Y Handrail AIM L N/A Y B Win Casing L N!A Y - . B Balusters AIM L N/A Y # Window Sash A/M L N/A Y Lower Rail A/M L N/A Y Window Sig L NIA Y Treads AIM L N/A Y $ Win Casing L WA Y Risers AIM L WA Y Window Sash Uk AIM L NIA Y Stringer; AIM L N!A Y B Lamp Post L NIA Y LatSce AIM L N/A Y C MENTS/STRUCTURAL DEFECTS:,I W 017C,4111t e Drain Pipes 6z, L WA Y B Elec Conduit L N/A Y Oil Fill Pipe L N/A Y Overhang Trim I I I Z.J:�AAMA L NIA Y Excluded Surfaces: Surfaces listed in this box can be made Soli Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) [SIDE MEASURE:LOOSE PAINT IC IC LO CATION AREA MEASUREMENT RESUL REMED REMED (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH' Pixy Area Bare Soil Comments:_ t LT/RA RepEztB,6/15 John Maclsaac IIR-2378 10/27/15 Page-Eu Inspector(print) LIC#. i a �t Date John Macisaac I/R-2378 , Risk Assessor (print) Lic# Signature Da e Address of Pro a SOUTH ST. A t.# 1 ; YANNIS EXTERIOR.Po Side SIDE LOCATION/ LEAE TY0 OF URG IC IC DELEAD DELEAD SIDE LOCATIONI LEAD TYPE OF URG IC IC DELEAD DELEA SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH Window Sill .24 L NIA Y Window Sill AIM L N/A Y e�Win Casing L N/A Y Win Casing A/M L NIA Y Window Sash �/ A/M L NIA Y Window Sash A/M L WA Y 3 Window Sill b L NIA Y Window SRI A/M L N/A Y 16 Win Casing L NIA Y Win Casing A/M L N/A Y Window Sash �/ A/M L NIA Y Window Sash A/M L N/A Y Window Sol A/ N/A Y Window SRI A/M L N/A Y Win Casing NIA Y Win Casing A/M L NIA Y / Window Sash C A/M L N/A Y ftdow Sesh1. . :;:,: A/M L N/A Y Window SRI A/M L N/A Y Window Sill A/M L N/A Y Win Casing AIM L N/A Y Win Casing A/M L NIA Y Window Sash A/M L WA Y Window Sash A!M L NIA Y Window Sill A/M L WA Y Window SRl AIM L NIA . Y Win Casing AN L NIA Y Win Casing A/M L NIA Y Window Sash A!M L N/A Y Window Sash AIM L NIA Y Window Sill AIM L NIA Y ° Window Sill AIM L NIA Y Win Casing A/M L NIA Y Win Casing A!M L NIA Y Window Sash A/M L NIA Y Window Sash AIWA L N/A Y Window Sill A/M L NIA Y Window Sill AIM L NIA Y Win Casing A/M L WA Y Win Casing AIM L NIA Y Window Sash AIM L NIA Y Window Sash AIM L N/A Y Window Sill A/M L N/A Y Window SRI AIM L NIA Y Win Casing AIM L N/A Y Win Casing AIM L NIA Y Window Sash AIM L N/A Y Window Sash AIM L NIA Y Window Sill AIM L NIA Y Window SRI AMI L N/A Y Win Casing AIM L NIA Y `" Win Casing AtM L NIA Y Window Sash AIM L N/A Y. Window Sash AIM L NIA Y Window Sill AIM L N/A Y ` Window Sill A/M L N/A Y Win Casing AIM L NIA Y Win Casing AIM L N/A Y Window Sash AIM L N/A Y Window Sash AIM L N/A Y AIM L N/A Y Window Sill AIM L N/A Y A/M L NIA Y Win Casing AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS: Window Sash A/M L N/A Y Window Sul A/M L WA Y Win Casing AIM L NIA Y Window Sash AIM L N/Al Y Excluded Surfaces:Surfaces listed in this box can be made -. Soil Test Results intact only by a licensed deleader », (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC . IC LOCATION AREA MEAg�ENT RESUL REMED REMED A (MORE THAN 1440 SQ.IN.) DATE METH A {Square Feet) (PPM) DATE METH Play Ara A Bare Soil LAj comments: LIRA RepExtA,6115 ' f Jphn Maclsaac I/R-2378 10/27/15 22 Inspector(print) Lic# n r �i Date Page ILI Of John Maclsaac I/R-2378 , Risk Assessor (pri169 SOUTH Signature 1 �'ANNIS Address of Propegy: Apt # Cihr EXTERIOR C Side SIDE LOCATION/ LEA1 TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEA C SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD HAZ? DATE METH DATE METE Siding L N/A Y Window sill AIM L N/A Y Comer Boards L !A Y C• Win Casing A/M L N/A Y C Lower Trim L NIA Y # Window Sash AIM L NIA Y Upper Trim L NIA Y Cellar Win Sig A/M L N/A Y Win Above 5' NIA Y C Gel Win Sash A/M L N/A Y Rorch Above 5 L N/A Y Gel Win FrameAIM L N/A Y Storm Door AIM L NIA Y Screen Frame ATM L WA Y Door A/M L NIA Y Cellar Win Sill A/M L NIA Y C Door Casing AIM L WA Y C Gel Win Sash A/M*N/Ay 1 2 Door Jamb A/M L NIA Y- Cel Win FrameA/M 3 4 Threshold AIM L N/A Y Screen Frame AIM Kfdcplate A/M L NIA Y Cellar Win Sill A/M L Nir Y Storm Door A/M L N/A Y C Cel Win Sash AIM L N/A Y Door A/M L WA Y Cel Win FrameA/M L N/A Y C Door Casing AIM L WA Y Screen Frame AIM L WA Y 1 2 Door Jamb A/M L NIA Y Cellar Win Sol A/M L NIA Y 3 4 Threshold AIM L NIA Y C Cel Win Sash A/M L WA Y Kickplate AIM L N/A Y Cel Win FrameAIM L N/A Y t Door ARvI L N/A Y Screen Frame A/M L WA Y C Door Casing AIM L N/A Y Foundation L N/A Y 1 2 Doar Jamb A/M L N/A Y C Bulkhead A/M L NIA Fences Y 3 4 Threshold AIM L N/A Y A/M L NIA Y Window Sill L NIA Y Shutters A/M L NIA Y C Win Casing L WA Y Newel post A/M L N/A Y #! Window Sash, V4 A/M L'WA Y Railing Cap AIM L NIA Y Window Sill AIM L N/A Y Handrail A/M L N/AT Y C Win Casing AIM L WA Y C Balusteis A/M L N/A I Y # Window Sash WE A/M L N/A Y '` Lower Rail A/M L NIA Y Window Sill O A/M L.NIA Y Treads A/M L N/A Y C Win Casing L AIM L N/A Y Risers AIM L WA Y #3 Window Sash AIM L'NIA Y Stringer A/M L NIA Y C Lamp Post L WA Y Lattice A/M L WA Y COMMENTS/STRUCTURAL DEFECTS: Drain Pipes L WA Y C Elec Conduit L N/A Y Oil fill Pipe L WA Y Overhang Trim AIM L NIA Y Excluded Surfaces Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC. •IC LOCATION: AREA MEASUREMENT RESUL REMED REMED C (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH C Play Area G Bare Soil C Comments: LIRA RepExtC,6/1 5 , John Maclsaac IIR-2378 10/27/15 i122 Inspector(print) Lic# it atu e - page`Of, Rai Date Af John Maclsaac UR-2378 Risk Assessor (0169 SOUTH ,.• "' Signature 1 ANNIS Address of Pro e : Apt.# Cit EXTERIOR D Side n G Z SIDE LOCATION/ LEAE TYPtOF URG IC IC DELEAD DELEAD ID IDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEA D SURFACE HAZARD HAV DATE- METH DATE METH D SURFACE HAZARD HAV DATE METH DATE METH Siding NIA Y Window Sill L NIA Y Comer Boards (� /A Y Win Casing N!A Y D Lower Trim R e4 N/A Y # Y, Window Sash A1M L NIA Y Upper Trim 204 la)NIA Y Cellar Win Sill tQ—L N/A Y Win Ave 5' 04 1 NIA Y D Cel Win Sash VAt AIM—L NIA Y Porch Above 5'qq I L N/A Y # Cel Win Frame NIA Y Storm Door AIM L NIA Y Screen Frame A/M L N/A Y Door 0 N/A Y Cellar Win Sill A/M L N/A 1 Y D Door Casing NIA Y D Cel Win Sash A/M L NIA Y 2 Door Jamb N/A Y Cel Win FrameA/M L N1A Y 4 Threshold 0, AIM L N/A Y Screen Frame A/M L NIA .Y Ilickplate A!M L NIA Y Cellar Win Sill AIM L N/A Y Storm Door A/M L N/A Y D Cel Win Sash AIM L N/A Y Door D AIM L WA Y # Gel Win Fra AIM L NIA Y D Door Casing A/M L NIA Y Screen Frame AIM L N/A Y 1Poor iamb A/M 6• L N/A Y . Cellar UVin Sill A/M L NIA Y 3 Threshold AIM L N/A Y D- Cell Win Sash A/M L N/A Y Kickplate .) AIM L NIA Y Cel Win FrameAlA9 L N!A Y Door A/M L N/A Y `. Screen Frame A/M L NIA Y D Door Casing j A/M L NIA Y Foundation AjU L N/A Y _................ __ _ 1 2 Door Jamb AIM L NIA Y D Bulkhead AIM L WA Y 3 4 Threshold A/M L N/A Y Fences A/M L N/A Y Window Sill A/M L NIA Y Shutters A/M L NIA Y D Win Casing ob A/M L N/A Y AIM L N/A Y # Window Sash edt, AIM L NIA Y + +ailmg Cap AIM L N/A Y Window SM 6© A/M L N/A Y Handrail AIM L NIA Y D Win Casing AIM L NIA Y D Balusters . A/M L N/A Y #2-Window Sash 4A) , AIM L N/A Y Lower Rail AIM L N/A Y Window Sill AIM L N/A Y ` , a fi Treads A/M L N/A Y D Win Casing AIM L NIA Y Risers AIM L NIA Y Ga Shtnger A/M L NIA Y # Window Sash AIM L WA . Y D Lamp Post L NIA Y Lattice AIM L NIA Y COMMENTS 1 STRUCTURAL DEFECTS(j�At 4(.-4 3 L j-ald a W Drain Pipes L NIA Y yur �U C+ S C f3 lv 4-P A,( 4- (f U t-J��e � !K D Elec Conduit `/ L NIA Y ct�f ��kr CACti 00 Fill Pipe L N/A Y Ovediang Trim AIM L N/A Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results 'intact only by a licensed deleader (Must be less'than 400 ppm for play area/1200 ppm for bare sail) SIDE LOCATION MEASURE:LOOSE PAINT IC' ICELOC-AION AREA MEASUREMENT RESUL REMED REMED D (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH D reaoil D nts: D LYRA RepExtD,6/15 John Maclsaac IIR-2378 19/27/15 11 2 Inspector(print) Lic# i a Date Page Of____ John Maolsaac 11R-2378 Risk Assessor (print c# Signature D,a� Address of Pro 69 SOUTH �T. 9 A t.# t'i�S'ANNIS _ _.. City: EXTERIOR,— Side SIDE 11 LOCATIONI LEAD TYPE OF URG IC `IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEA SURFACE HAZARD HAZ. DATE METH DATE METH SURFACE HAZARD HAZ? DATE METH DATE METH �//�� Window Sig D A/M L WA Y Windowsill A/M L N/A Y D Win Casing ( AIM L NIA Y Win Casing A/M L N/A Y Jr- Window Sash AIM L WA Y Window Sash A/M L N/A Y Window Sill /A Y Window Sill A/M L N/A Y Win Casing L N/A Y Wm Casing A/M L NIA Y . �o Window Sash V( A/M L N/A Y Window Sash A/M L NIA Y Window SM r(Ir Q5 N/A Y Window Sill AIM L NIA1 Y o Win Casing Q N6 WA Y Win Casing A/M L N/A I Y 7 Window Sash V A/M L NA Y Window Sash A/M L N/A Y OWindow Sill 7 Q7 WA Y Window Sig Win Casing �(a f t WA Y A/M L NIA Y f ° +. Win Casing AN L NIA Y Window Sash V AIM L N/A Y Window Sash A/M L NIA Y D Window Sig NIA Y Window Sill A/M L NIA Y Win Casing &ft N/A Y - Win Casing A/M L NIA Y Window Sash A/M L NIA Y x. Window Sash A/M L N/A Y Window Sig XL NIA Y Window Sill AA/NI L WA Y Win Casing �� L WA Y Win Casing A/M L NIA Y lb Window Sash AIM L N/A Y Window Sash A/M L N/A Y Window Sig A/M L N/A Y Window Sill XLNA IA Y Win Casing A/M L NIA Y Win Casing IA YWindow Sash A/M L N/A YWindow Sash A YWindow Sill A/M L N/A YWindow Sill A YWin Casing A/M L NIA Y Win Casing A YWindow Sash l. A/M L WA Y Window SashA YWindow Sill A/M L NIA Y Window Sill YWin Casing A/M L N/A -YWin Casing Y Window Sash AIM L N/A Y Window Sash A/M L NIA Y Window Sill 'AIM L NIA Y Window Sill AIM L NIA Y Win CasingAIM L N/A Y Win Casing AIM L N/A Y Window Sash, A/M L N/A. Y Window Sash AIM L WA Y AIM L NIA Y Window Siff A/M L N/A Y AIM L NIA Y Win Casing AIM I, NIA Y COMMENTS/STRUCTURAL DEFECTS:, ; Window Sash AIM L NIA Y + . Window Sill A/NI L N/A Y Win Casing AIM L N/A Y Window sash A/M L NIA Y Excluded Surfaces:Surfaces listed in this box can be made r. - Soil Test Results intact only by a licensed deleader {Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) (1'FM) DATE METH A Play Area A Bare Soil A Comments:- a" LIRA.RepExtA,6/I S r John Maclsaac UR-237s 10/27/15 Page J2t2 Inspector(print) Lic# ig QG Date John Maclsaac I/R-2378 Risk Assessor (print) Lic# Signature Date Address of Pro ert Apt# City HYANNIS EXTERIOR A Side — SIDE LOCATION/ LEAD TYPE OF URG IC IC. DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC iC DELEAD DELEAI A SURFACE HAZARD HAZ. DATE METH DATE METH A SURFACE HAZARD HAZ? DATE METH DATE METH Siding L NIA Y Window Sill A/M L N/A Y Comer Boards N/A Y A Win ding A/M L N/A Y A Lower Trim L N/A Y Window Sash A/M L N/A Y Upper Trim (§N/A Y Cellar Win Sill AN L WA Y Win Above 5'• WA Y A Cell Win Sash AIM L N/A Y Porch Above 5 L NIA Y # Cel Win fra A/M L NIA Y Storm Door A AIM L NIA Y Screen Frame A/M L NIA Y Door A/M L WA Y Cellar Win Sill AIM L N/A Y A Door Casing AIM L N/A Y A,Cei Win Sash A/M L WA Y 1 2 Door Jamb A/M L NIA Y CeI Win Frame AIM L N/A Y 3 4 Threshold A/M L N/A Y y Screen Frame A/M L NIA Y foD )r kplate AIM L NIA Y Cellar Win Sill AIM L N/A Y rm Door AIM L N/A Y A Cel Win Sash A/M L N/A Y A/M L NIA Y # Cell Win Fra A/M L NIA Y A oor Casing AIM L N/A Y Screen Frame A/M L NIA Y 1 2 Door Jamb A/M LN/A Y Cellar Win Sill AIM L N/A Y 3 4 Threshold AIM L WA Y A Cel Win Sash AIM L N/A Y Kickplate AIM L N/A Y # Cel Win Fra A/M L NIA Y Door AIM L N/A Y Screen Frame A/M L NIA Y A Door Casing A/M L NIA Y Foundation L N/A Y 1 2 Door Jamb A/M L NIA Y A Bulkhead A/M L NIA Y 3 4 Threshold A/M L NIA Y Fences A/M L N/A, Y Window Sill L N/A Y Shutters A/M L WA Y A Win Casing AIM,§N/A Y Newel post A/M L NIA Y # Window Sash �/ I L WA Y Railing Cap A/M L N/A Y Window Sill N/A Y Handrail AIM L NIA Y A Win Casing ? A/ NIA Y A" Balusters A/M L NIA Y #Z Window Sash aU 3 M L WA Y Lower A/M L N/A Y Window Sill AIM L N/A Y Treads A/M L N/A Y A Win Casing A/M L NIA Y Risers AIM L NIA Y # Window Sash .AIM L N/A Y Slinger A/M L WA Y 6 Lamp Post L NIA Y Lattice AIM L WA Y COMMENTS/STRUCTURAL DEFECTS: Drain Pipes L NIA Y A Elec Conduit L NIA Y Oil Fill Pipe L NIA Y Overhang TrimA/M L N/A Y Excluded Surfaces:Surfaces listed in this box can be made I Soli Test Results intact only by a licensed defeader (Must be less than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT INP10oar ION AItEAMEASUREMENT RESUL REMED REMED 'A (MORE THAN 1440 SQ.IN.) DAA (Square Feet) (PPM) DATE METH reaAoilnts; A LYRA RepF-xtA,6/15 John Maclsaac i/R-2378 10/2 7/15 Page Z& Inspector(print) :11R-2378 g tur Dade 4GG John Maclsaac Risk Assessor (print) Lic# Signature Date Address of Pronerm—@W—NTH ST Apt # City HYANNIS EXTERIOR B Side SIDE LOCATION/ LEA[ TYPE OF URG IC iC DELEA[-DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELFJ B SURFACE HAZARD HAZ?' DATE METH DATE METH B SURFACE HAZARD HAZ? DATE METH DATE METI Siding L N/A Y j Window Sill AIM L N/A Y Comer Boards �llJ m N/A Y B Win Casing A/M L N/A Y B Lower Trim L N/A Y Window Sash A/M L NIA Y Upper Trim L A Y Ce((ar Win Sill AMl L NIA Y Win Above 5' L' A Y B. Cel Win Sash AIM L N/A Y Porch Above 5 L NIA Y # + Cel Win Fram A/M L NIA Y Storm Door AIM L NIA Y Screen Frame A/M L NIA Y Door AIM L N/A Y Cellar Win Sill AIM L N/A Y B Door Casing AM L NIA Y B Cel Win Sash AIM L NIA Y 1 2 Door Jamb• A1M L NIA Y Cel Win FrameA/M L N/A Y 3 4 Threshold AIM L NIA Y Screen Frame A/M L N/A Y < Kickplate AIM L NIA Y Cedar Win Sal A/M L N/A Y Storm Door AIM L NIA Y B Eel Win Sash A/M L N/A Y Door A/M L N/A Y Cel Win Frame AIM L N/A Y B Door Casing A/M L N/A Y Screen Frame AIM L N/A Y Cellar Win Sill 1 2 boor Jamb AIM L NIA Y AIM L N/A Y 3 4 Threshold A/M L NIA Y B Cell Win Sash A/M L N/A Y D okplate A/M L N/A Y # Cel Win Fram A/M L NIA Y Door A/M L NIA Y Screen Frame A/M L WA Y I —B Door Casing AIM L WA Y Foundation L NIA Y 1 2 Door Jamb AIM L NIA Y B Bulkhead AIM L NIA Y 3 4 Threshold A/M L NIA Y Fences A/M L NIA Y Window Sill bb A/M L N/A Y - Shutters A/M L NIA Y B Win Casing J, AIM L NIA Y Newel post AIM L NIA Y # l Window Sash ('QV L WA Y Railing Cap AIM L NIA Y Window Sill ,b NIA Y Handrail AIM t N/A Y B Win Casing / A/Mjq N/A Y B Balusters AIM L NIA Y Window Sash A/M L NIA Y Lower Rail AIM L NIA Y Window Sill AIM L NIA Y Treads AIM L WA Y sers B Win Casing AIM L N/A Y Ri AIM L NIA Y # Window Sash AIM L NIA I Y Stringer AIM L NIA Y B _ .:r. "�! L NIA Y Lattice AIM L N/A Y COMM STRUCTURAL DEFECTSeld -. b j i��� j Pipes L NIA Y Elec Conduit L NIA Y �3 ) ON Fill Pipe L NIA Y Overhang Tri AIM L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREAMEASUREMENT RESUL REMEQ REMED B (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet B, A ) (PPM) DATE METH Play Area B Bare Soil B Comments: LURA Rcp&tB,6/15 , ` i John Maetsaac UR-2378 k 10/27/15 Page Inspector(print) Lic# na r �i Date John Marlsaac UR-2378 Risk Assessor (print) Lic# Signature to Address of Pro e 6 TH ST. Apt.# 1 t�YANNIS p � City. EXTERIOR C Side SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG iC iC DELEAD DELEI C SURFACE HAZARD HAZ. DATE METH DATE METH C SURFACE HAZARD HAZ DATE METH. DATE METE Siding L N/A Y Window Sill A/M L NIA Y —7 Comer Boards /A Y C Win Casing AIM L N/A Y C Lower Trim L NIA Y Window Sash AM_L NIA Y - Upper Trim. N/A Y Cellar Win Silt AIM L NIA Y Win Above 5' L NIA Y C Cell Win Sash AN L N/A Y Porch Above 5' L N!A Y # Cel Win Frame AIM L NIA Y Storm Door AIM L NIA Y Screen Frame AIM L N/A Y Door A/M L NIA Y Cellar Win Siii AIM L WA Y C Door Casing AIM L NIA Y C Cal Win Sash A/M L NIA Y 1 2 Door jamb AIM L N/A Y - # Cel Win FrameAIM L N/A Y 3 4 Threshold AIM L NIA Y Sam Frame AIM L N/A Y Kickplate AIM L NIA Y Cellar Win Sill A!M L NIA Y Storm Door AIM L NIA •Y C Cel Win Sash AIM L N/A Y Door AIM L NIA .Y Gel Win Fra A/M L N/A Y C Door Casing AIM L N/A Y Screen Frame AIM L NIA Y 1 2 Door Jamb A/M L NIA Y Cellar Win Sill A/M L N/A Y 3 4 Threshold AIM L N/A Y C Cal Win Sash A/M L NIA Y Kickplate AIM L N/A Y # Cel Win Frame A/M L NIA Y Door A/M L NIA Y Screen Frame A!M L NIA Y C Door Casing A/M L NIA Y Foundation (� L NIA Y 1 2 Door Jamb AIM L N/A Y C Bulkhead AIM L N/A Y 3 4 Threshold A/M L NIA Y Fences A/M L NIA Y Window Sill AIM L NIA Y Shutters A/M L N/A Y Eyn C asing A/M L NIA Y Newelp� AtM L N/A Y # w Sash AIM L NIA Y Rairing Cap AIM L NIA Y Window Sill A/M L N/A Y Handral• A/M L NIA Y C Win Casing A/M L NIA Y C Balusters A/M L N/A Y # Window Sash A/M 1 NIA Y Lower Rail AIM L N/A Y Window Sill AIM"L N/A Y Treads A/M L N/A Y C Win Casing AIM L N/A Y Risers AIM L NIA Y Window Sash AIM L N/A Y Stringer A/M L N/A Y C Lamp Post L N/A Y. Lattice AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS�1 e FTC G�GJ` Drain Pipes L NIA Y j C Elec Conduit L N/A Y Oil Fig Pipe L WA Y Overhang Trim A/M L N/A Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader {Must be less than 400 Ppin for pla y area/1200 ppm for bare soil} SIDE LOCATION MEASURE:LOOSE PAINT IC tC LOCATION AREA MgAgLIRFMEW RESUL REMED REMED C (MORE THAN 1440 SQ.IN.) DATE MECN (Square Feet) {PPM) DATE METH. "C Play Area . L , Bari Soil C Comments: C LURA RepExtC,6/I5 John Madsaac IIR-2378 10/27/15 PageZ—n� Itlspector.(print) Lic# tu ireDate . Q& John Madsaac UR 2378 Risk Assessor (print) Lic# Signature Address of Pro�er0 0UTH ST. Ant# 1 City, f i1fANNIS EXTERIOR D Side -- SIDE LOCATION/ LEAPZA!ZjARD URG IC IC_.. DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC IDELEAC DELE/+ D SURFACE HAZ DATE METH . DATE METH D SURFACE HAZARD HAZ? DATE METH DATE METE Siding Y WindowS� A/M L WA Y Comei Boards Y D Win Casing AIM L WA Y D Lower Trim L WA Y Window Sash A/M L WA Y Upper Trim N/A Y Cellar Win Sill- AN L NIA Y Win Above 5' N/A Y D Cel Win Sash A/M L N/A Y Porch Above L WA Y Cel Win Frame AIM L N/A Y Storm Door A/M L NIA Y Screen Frame AIM L N/A Y Door WA Y Cellar Win SM A/M L NIA Y D Door Casing q01 !I 1�WA Y / D Cet Win Sash A/M L N/A Y 2 Door Jamb OjITNIA Y # CeFrA/M L WA Y 4 Threshold AIM L N/A Y Frame A/M L WA Y Kdcplate AIM L WA Y Cellar Wm Sill A/M L WA Y Storm Door A/M L N/A Y D Cel Win Sash A/M L N/A Y Door ( AIM L WA Y # Ce!Win Fram A/M L N/A Y D Door Casing N/A Y Screen Frame AIM L N/A Y 16 Door Jamb WA Y Cellar Win Sill A/M L WA Y 3 4 Threshold A/M L NIA Y D Cel Win Sash AIM L WA Y Icdtptate A/M L wA Y Cel Win Fram A/M L NIA Y Door A/M L NIA Y Screen Frame AIM L WA Y D Door Casing AIM L NIA Y Foundation ALL NIA Y 1 2 Door Jamb A/M L WA Y D Bulkhead A/M L N/A Y 3 4 Threshold AIM L N/A Y Fences AIM L N/A Y Window S�11 WA Y Shutters AIM L WA Y D Win Casing AIM !A Y Newel post AIM.L N/A Y Window Sash AIM L N/A Y. Railing Cap AIM L NIA Y Window Sill LZN/A Y Handrail AIM L N/A Y D 1win Casing 1.71 A4V WA .Y D Balusters A/M L N/A Y #ZrWindow Sash AIM L WA Y Lower Rail AJM L NIA Y Window Sill AIM L WA. Y Treads AIM L WA Y D Wm Casing AIM L N/A Y _ Risers AIM L NIA Y #3 Window Sash A/M L N/A Y Stringer AIM L NIA Y D Lamp Post L N/A Y / Lattice AIM L WA Y COMMENTS/STRUCTURAL DEFECTS Gl(J DMik Pipe -•6! j L N/A Y D Elec Conduit L WA Y s Oil Fill Pipe L WA Y Overhang Trim AIM L N/Al Y Excluded Surfaces:Surfaces fisted in this box can be made Soil Test Results intact onlyb a licensed deleader Y (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED D (MORE THAN 1440 SO.IN.) DATE METH D (Square Feet) (PPM) DATE METH Play Area ' D .Bare Sop D t Comments:. Id/RA RepExtD,5/15 PROPOSAL CLEAN SURFACE DELEADING, INC. 203 Essex St. r Ph (781)340-0816 Weymouth,.NIA 02188 Fax: (781)337-5346 PROPOSAL SUBMITTED TO PHONE DATE Gary Maradian (508)362-2508 Oct'31 2015 STREET JOB NAME 25 Greenteal Wav Lead Abatement CITY,STATE,ZIP JOB LOCATION Yarmouthnort,MA 02675 22.Pine Ave. & 369 South St: Un #1 Hyannis MA We hereby submit specifications and estimates for , Clean Surface Deleading, Inc. to provide labor, material, equipment, permits and insurances For the deleading of the following: - To scrape doors 4" back from edges; - To scrape- doors to nearest header - To scrape door and window casing to, 7' level; ` - To replace intricate casing with lx6 #2 pine flat stock; ` - To scrape window sills to bare wood; - To scrape window aprons 4" back from edges; - To scrape baseboards 4" back from outside edges; - To apply 1-4 luan plywood to baseboards if necessary and to scrape or replace molding on - top of baseboards 'if necessary;' - To apply sheetrock to walls in front entryway; - To scrape shelf supports and replace shelving; " - To scrape small mantel and to demo full-size mantel and patch walls with sheetrock; - To apply 14 luan plywood to •outside corners' on leaded walls; - To clean interior. of property using T.S.P. and to •HEPA vac floors and walls in „order to pass reinspection and receive Letter.-of-Abatement Compliance.' Exterior:' To scrape woodwork (casings, jambs, sills, ^'etc. ) to .bare wood (all scraping on exterior side of property to. go ,to 5' level- except entryways to go to 7' level) ; To flake loose peeling paint on -exterior trim-in order to make intact; - To, replace one (1) rake. board'on "C" side of, 'property.• Total cost for 22 Pine Ave. & Exterior.:.......°............:....:.:'.:...::.:.........,..........:................:..:.......................`...::............$16,875:00 Total cost ,for 369 South, St.. Interior......................:::..:............... :...................................................................................$ 6, 650.00 Owner to purchase and.install doors in' both .units. This Proposal includes 369 South St. "A" Building exterior. . This proposal does not include painting: Owner to pay for first reinspection fee. All work conforms to State and Federal Regulations regarding Lead Removal Procedures. Owner to provide water and electrical connections and.to move all items out of the work area prior to any abatement. Arrangements can be made with Clean Surface Deleading, Inc. to move objects if owner cannot accommodate this request. NOTE: This proposal maybe withdrawn if not accepted within 20 days.' We Propose hereby to furnish material and labor =,complete in accordance with above specifications for the sum of: SEE ABOVE Dollars with.payment to be made as.follows: `1/3-; - 1/3; 1/3. 'All material is guaranteed to be,as specified. All work to be completed in a workmanlike manner according to standard practices. Any alteration or deviation.,from the above specifications involving extra costs will be executed only upon written orders and will become an extra charge over and above the estimate. All agreements contingent'upon strikes, accidents or delays beyond our control., owner to carry fire and other necessary insurance- Our workers are fully covered by Workman's Compensation insurance." Authorized Si9 nature . k F. ACCEPTANCE The above prices, specification and conditions are satisfactory and are hereby accepted. You are authorized to do the work _ c specified. - Payment will be made as outlined above. ACCEPTED: Date: 4 1u Signature: I November 12, 2015 Mr.Timothy O'Connell ' Town of Barnstable-Board of health 200 Main Street Hyannis, MA 02601 Re:369 South Street/22 Pine Ave , Dear Mr.O'Connell, This is a follow up to the lead paint inspection report provided to your office regarding the above . p captioned property. Enclosed is a copy of the contract for de-leading of the property. Most of the work has been done and the contractor is preparing to call in the inspector. I expect this to happen in the next week or so.When the certificate is received l will get you a copy.forthwith. Sincerely, Gary Maradian - 4 r r ASAP Main Office: 1 Arcadia Street 3' Dorchester, MA 02122 Toil Free: 800-349-7779 ENVIRONMENTAL, INC. Phone:617-288-8870 Fax 617-282-7783 www.asapenvironmental.com - LETTER OF FULL DELEADING COMPLIANCE 369 South St Trust k` c/o Gary Maradian . 25 Greenteal Way Yarmouthport,MA 02675 Dear 369 South St Trust. ' This letter is to certify that on 1111 /13/ 15 1 re-inspected your property located at 22 Pine Ave.,Unit none,and relevant interior and exterior common areas,in the City/Town of A annis. On that date,those surfaces cited in the initial inspection report by John r Macdsaac,License#2378 conducted on 10 /27/15.as being in violation of Massachusetts General Laws,Chapter 111,Section 197, and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control,were determined to be in current compliance with those same laws. Dust samples were taken and found to be'within acceptable limits. �. Massachusetts law does not require the abatement or containment of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance with the requirements of the Lead Laws referenced above only as long as there continues to be no peeling chipping or,flaking lead paint or other accessible leaded materials as lone as coverings and/or eneapsulants forming an effective barrier over such paint or other leaded materials remain in place and as long as surfaces reversed to correct lead hazards remain reversed and securely in place. The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint,and to clean up,during which time this Letter remains valid. The second page-or reverse side of this letter indentifies the authorized person(s)who performed deleading on the property and a general' summary of the methods used to achieve compliance with the Lead Laws. A complete Reinspection Report is attached to this letter,which specifies how and on what date each surface was brought into compliance. To the best ofany knowledge,the cost of the legally required deleading is$11,800.. The CLPPP authorized serial number for this Letter of Full Deleading Compliance is 83872378111715-22. This number is tracked and unique to this address and unit. DO NOT LOSE THESE DOCUMENTS. If the documents are lost,you will be required to have additional private inspector services that may cost you significant amounts of money.This Letter of Full Deleading Compliance is only for the address and unit noted above. If you change the street address,'unit number or any other identifying information pertaining to the residential premises referred to in this Letter of Full Deleading Compliance,this Compliance Letter may be considered null and void by the Department of Public Health and/or a municipal health office. Do not alter this document in any way.Altering this document is fraudulent and may endanger the health and safety of a child which may result in significant legal consequences. In addition,to any potential civil,liability which may arise as the result of the alteration of this Letter of Compliance,the Massachusetts Department of Public Health's'Childhood Lead Poisoning Prevention program may seek criminal prosecution of any person who filters this document after it is originally issued. . , Sincerely Jo aclsaac- . f 2378 11/ 17/-15 In Vector License# Date Questions?Call the Department of Public Health at 1400-532-9571. DO NOT LOSE THESE DOCUMENTS LOFDC—rev 01.15 Page 1 of 2 f ADDRESS: 22 Pine Ave.,Hyannis Serial Number: 83872378111715-22 Deleading History Deleading Contractor Mark Bianco License#: ®DC 001055 Exp.Date 02/09/16 ❑DS Deleading Methods: ® Scraping ® Making Intact(Exterior) ❑ Power Sanding ❑ Caustics ❑ Heat Gun ® Making Intact(interior) ® Removal ❑ Liquid Encapsulation ❑ Demolition. ® Replacement ® Covering ❑ Other t " ,[].Other Work was done in the following rooms: Room# 1,2,3,Hallways,Bathroom,Kitchen,and Exteriors. Work was done on the following types of components: Refer to Report.' Start Date: 11105115 Finish Date: 11 / 18/15 Cost: $ 11800 Authorization# MR- RRP wladditional Moderate Risk Training Issuance Date: /_ /- :p• 'Authorization# -❑OM[:]AM Moderate Risk Deleader(owner/agent) , Issuance Date: / I Deleading Methods: ❑ Replacement ❑ Making Intact(interior) ❑ Capping Baseboards Covering _ ❑ N aking Intact(exterior) ❑ Liquid Encapsulation ❑ Removal n'y ❑ Other t Work was done in the following rooms: Work was done on the following types of components, • r Start Date: J ! Finish Dater / / ti Cost:$ - m Low Risk Deleader(owner/agent) q. Authorization# - ❑OL❑AL ' Issuance Date: / / ❑OE❑AE w ' ❑OB❑AB Deleading Methods: ❑ Covering- ❑`Liquid Encapsulation ❑ Capping Baseboards ❑ Replacement (ONLY doors,cabinet doors,shutters,shelves not affixed,drawers,windows on hinges) `'Work was done in the following rooms: Work was done on the following types of components: Start Date: / / Finish Date: / / ' Cost$ ' t.oFDc-rev osns Page 2 of 2 SAP Main Office: 1 Arcadia Street Dorchester, MA 02122 Toll Free: 800-349-7779 ENVIRONMENTAL, INC. Phone:617-288-8870 Fax 617-282-7783 www.asapenvironmental.com LETTER OF FULL DELEADING COMPLIANCE 369 South St Trust .c/o Gary Maradian 25 Greenteal Way Yarmouthport,MA 02675 Dear 369 South St Trust This fetter is to certify that on 11 /13/ 15 I re-inspected your property located at 22 Pine Ave..Unit none,and relevant interior and exterior common areas,in the City/Town of Hyannis.On that date,those surfaces cited in the initial inspection report by John MacIsaac,License#2378 conducted on 10 /27/ 15 as being in violation of'Massachusetts General Laws,Chapter 111,Section 197, and 105 CMR 460.000: Regulations for Lead Poisoning Prevention and Control,were determined to be in current compliance with those same laws. Dust samples were taken and found to be within acceptable limits. i Massachusetts law does not require the abatement or containment of all residential lead paint. The residential premises or dwelling unit and relevant common areas shall remain in compliance with the requirements of the Lead Laws referenced above only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials, as long as coverings and/or encapsulants forming an effective barrier over such paint or other leaded materials remain in place, and as long as surfaces reversed to correct lead hazards remain reversed-and securely in place. The law grants you a 30-day maintenance period to repair deteriorated lead paint or detached coverings over such paint,and to clean up,during which time this Letter remains valid. The second page or reverse side of this letter indentifies the authorized person(s)who performed deleading on the property and a general summary of the methods used to achieve compliance with the Lead Laws. A complete Reinspection Report is attached to this letter,which specifies how and on what date each surface was brought into compliance. To the best of my knowledge,the cost of the legally required deleading is$11,800., The CLPPP authorized serial number for this Letter of Full Deleading Compliance is 83872378111715-22. This number is tracked and unique to this address and unit. DO NOT LOSE THESE DOCUMENTS. If the documents are lost,you will be required to have additional private inspector services that may cost you significant amounts of money. This Letter of Full Deleading Compliance is only for the address and unit noted above, If you change the street address, unit number or any other identifying information pertaining to the residential premises referred to in this Letter of Full Deleading Compliance,this Compliance Letter may be considered null and void by the Department of Public Health and/or a municipal health office.- Do not alter this document in any way:Altering this document is fraudulent and may endanger the health and safety of a child which may result in significant legal consequences. In addition to any potential civil liability which may arise as the result of the alteration of this Letter of Compliance, the Massachusetts Department of Public Health's Childhood Lead Poisoning Prevention program may seek criminal prosecution of any person who alters this document after it is originally issued. Sincerely Jo acIsaac 2378 11/ 17/15 In Vector License# Date Questions?Call the Department of Public Health at 1-800-532-9571, DO NOT LOSE THESE DOCUMENTS LOFDC—rev03ils Page 1 of ADDRESS: 22 Pine Ave.,Hyannis Serial Number: 83 8723 7 8 1 1 1 7 1 5-22 Deleading History Deleading Contractor Mark Bianco License#: ®DC 001055 Exp.Date 02/09/16 ❑DS Deleading Methods: ❑ Scraping ®Making Intact(Exterior) ❑ Power Sanding ❑ Caustics ❑ Heat Gun ® Making Intact(interior) ® Removal ❑ Liquid Encapsulation ❑ Demolition ® Replacement ® Covering ❑ Other ❑ Other Work was done in the following rooms: Room# 1,2,3 Hallways,Bathroom,Kitchen,and Exteriors. Work was done on the following types of components: Refer to Report. Start Date: 11 /05/ 15 Finish Date: 11 / 18/ 15 Cost: $ 11800 Authorization# MR- RRP w/additional Moderate Risk Training Issuance Date: Authorization# -[]OM❑AM Moderate Risk Deleader(owner/agent) Issuance Date: Deleading Methods: ❑ Replacement ❑ Making Intact(interior) ❑ Capping Baseboards ❑ Covering ❑ Making Intact(exterior) ❑ Liquid Encapsulation ❑ Removal ❑ Other Work was done in the following rooms: Work was done on the following types of components: Start Date: / / Finish Date: / / Cost:$ Low Risk Deleader(owner/agent) Authorization# - ❑OL❑AL Issuance Date; / / ❑OE❑AE ❑OB❑AB Deleading Methods: ❑ Covering ❑ Liquid Encapsulation ❑ Capping Baseboards ❑ Replacement (ONLY doors,cabinet doors,shutters,shelves not affixed,drawers,windows on hinges) Work was done in the following rooms: Work was done on the following types of components: Start Date: l 1 Finish Date: l I Cost:$ t.oFvc=rev 0315 Page 2 of 2 . :ENVIRONMENTAL HAZARDSSERV 10ES, INC.7469 WHITE PINE ROAD RICHMOND;.VA 33237 Phone: 804-275.4789 Fax: 804-27S_4907 ASAP Environmental; Inc IJate:. 1' Arcadia Street Agency: Dorchester, MA 02122 Owner: � Phone: 800-349-7779 Fax: 617-282-7783 Address: Inspections @asapenvironmental.com John MacIsaac License # 1/13-2378 °� 1 LEAD IN,DUST cHA N OF cuST-013Y FORM G .Sample# Sample Type Room Location Surface Samphd Dlmenslons Len th / Width Dust wipe } Floor 12. 12 . l 2 Dust Wlpe f Interior Window Sill Dust Wipe 2 3 p Exterior Window Trough 2 3 4 Dust Wipe � Floor 12 12 ' 5 Dust.WiPe aZ, Interior Window Sill g Dust wiped Exterior Window Trough 7 Blank Cw 8 9 . 10 11 1.2 13 . 14. 15 16 15-11-01764 17 1NNNNlNNll4lllNlIIIIIINIIINIINIININIIIIININIINIIN j 1$ Due Date: 19 11716/2015 (Monday) 20 AE v , CHAIN OF CUSTODY at /Ti a Aftleased B ; Date/Tlme Released B l JdLih Cz qr1A I IV. 1 Gabortvrres' Lead Dust Wipe Environmental Hazards Services, L.L.C. Analysis Report 7469 Whitepine Rd Richmond,VA 23237 Report Number: 15-11-01764 Telephone:800.347.4010 Client: ASAP Lead Paint Inspections Received Date: 11/16/2015 1 Arcadia Street Analyzed Date: 11/16/201.5 Suite 14 Reported Date: 11/16/2015 Dorchester, MA 02122 Project/Test Address: 22 Pine Ave, Hyannis Collection Date: 11/13/2015 Client Number: { (� } Fax Number: 22-1252 L a b o ra Lo ry I oes U l lS 617-282-7783 Lab Sample Client Sample ` Collection Location Surface Total Pb Wipe Area Concentration Narrative Number Number (ug) (ft2) (ug/ft') ID 15-11-01764- 1 RM 1 HALL#2 FL <10.0 1.00 <10 001 15-11-01764- 2 RM 1 Al SL <10.0 0.750 <14 002 15-11-01764- 3 RM l Al WW <10.0 0.562 <18 003 15-11-01764- 4 RM'2 A2 FL <10.0 1.00 <10 004 15-11-01764- 5 RM 2 A2 5L <10.0 0.598 <17 005 15-11-01764- 6 RM 2 A2 WW <10.0 0.500 <20 006 15-1.1-01764- 7 BLANK --- 007 Page l of 2 Environmental: Hazards Services, L.L.0 Client Number: 22-1252 Report Number: 15-11-01764 Project/Test Address: 22 Pine Ave, Hyannis Lab Sample Client Sample Collection Location Surface Total Pb Wipe Area Concentration Narrative Number Number (ug) (ft2) (ug/ft2) ID Method: ASTM E-1979-12/EPA SW846 7000B Accreditation#: Reviewed By Authorized Signatory: Deborah Britt QA/QC Clerk The Federal lead guidelines for dust clearance levels by wipe sampling: Floors(FL)-40 ug/ft2, Interior Window Sills(SL)-250 ug/ft2, Window Wells(WW)-400 ug/ft2. The Reporting Limit(RL) is 10.0 ug Total Pb. Reported results are not corrected for field blanks. Dust wipe area and results are calculated based on area measurements determined by the client. All internal quality control requirements associated with this batch were met, unless otherwise noted. The condition of the samples analyzed was acceptable upon receipt per laboratory protocol unless otherwise noted on this report.Results represent the analysis of samples submitted by the client.Sample location,description,area,etc.,was provided by the client. Results reported above in uglft2 are calculated based on area supplied by the client. If the report does not contain the result for a field blank,It Is due to the fact that the client did not include a field blank with their samples. EHS sample results do not reflect blank correction. This report shall not be reproduced except in full,without the written consent of the Environmental Hazards Service,L.L.C.California Certification#2319 NY ELAP#11714. Legend ug=microgram uglft2=micrograms per square foot Pb=lead mL=milliliter ft2=square foot e T Page 2 of 2 p,�n�nvG x�aAcE ' (Fult Compganoe) Plea,"camActoliy aid t laxrty fill 0%dApproviab idormsdon: Norm-(print) coi�y: Add= : zip Coda nsldz�b�l�stoadlag wvrlt � ' ,v .� .o Z.ist offtln �a /�� � '1 hereby ettmt ovd,all dolmatliag sedvhw md,rim ttp vmt dons m �aox with rho Dept of T,abat'ead.Q nesdo m Qevtiopaaottt'e Ilegulatic�m8,454 CTtitA 32.il0 and t1x Cttiklbaod I.aed Poii►wisg E`na+�oudo�Pmgam's.Reglitatiba�x;103 CIi�4b0.004. Dada: Only complete section regectfng your outbarizodapAbeme otatns Del`si�ng �'• Delading'M8606.1 Power Seeding 13 Contra �] Heat c ( -doplao�rnotit �}' .v S [ 'l�akang ItKact ❑ T ►id1Oa d Chi Work was dooe In&C 'a/aT1t W9y�4 C7i t11tt S01i0't9'TA O.YCAt' Otteab' .�,� /t j�1�r-�P 1:./ - . Cost !� 'a,:;, OrtW&r&Exbmiw'coost),. Amibmizodob# 'EtbtP a titer �*~ MR- bmw=Dc, ! / ntffhbri�g -❑�M� bAQda:ato. De.4dsder tW rs ice: Deleadb�Mcti:oda rq ❑ Walc.g'bvm x(tiwrier.) ❑ Capping sas' ❑. Coves* ❑ Makin WMI;t(atmi.or) ❑ d.iVid Work wtis boat in the Wowing menu: work was dod$ttm the follming two of com poom a: Carr S uk-m-t WAN&gs!ma fi LAM_ Law Risk Dekadcr(~-Aww) A iaiQna - dl- Iasuaneo Dowi ! OE IIAL ❑:aBUAB Delesdiffg Math:ada. ❑ covering Q Liquid bttcalDsUtseMott ❑ Capping Bascb.amds beeplxzuu ac'(ONLY do=,cabiaerdoom a mntera,:sheWu trot AX4 drawem win&w as hfpges) Wait Was done in'&C-following rvatw- s Workk wss:done an the tollawittg b+pes.of cvm�orttmts sty : i Fig DSW -- C«r s ova, osw's L40n Qn.ru.sa?CPU dw DeparEaeaf otPo6itc Rufth-st I-W4 U-Ml. DD NOT LOSE'1'>FIux.v L0/ZO 39Vd 30Vjdns Nd3-10 94ESLEET6L 9b:6T STOZ/6T/TT 0 Lead inspection / Risk Assessment Report Main Office: -Lap 1 Of L� 1 Arcadia Street Toll Free: 806-349.7778 ` ENVIRONMENTAL,INC. Dorchester,MA 02122 Www,aeapenvtro800.34 -can Phone:617-288-8870 Fax 617-282.7783 St0 Street Name greet Type Unit cityA v� zl Code -n Number of Rooms in Unit tlwners Name: ( it J r y D i4 ,P�'fi jib t4� Property Type: Owner Address: OZG,� Contact Information: o Single Family ® Multi Family #of[Jnits Client Name(f dff.treat€ro owner): 0 -A e,� - L� Client Address: ��s"��• ,. Condominium #of Units r — Gb Q Day Care [j Other I,gad Column Ka P-dmd/1E Method Column Key DOesd11C Method Column Laundry in Basement? COV covered CAP Capped SCR Scraped Q yes No VB Vinyl Baseboard Ct3V Covered DT Dipped Finished Space in Basement ❑yes MNo MET Metal ENC Encapsulated REM Removed VR Vinyl Rep.Window MI Made Intact REP Replaced MR Metal Rep,Window PRE Prepared for Fmc, REV Reversed Testing Method Used NA Not Accessible VR/MR Vinyl/Metal Rep Window . lNT intact - NC: No Coating SFR Storm Frame Removed - Tile Tile(testing suggested) C71 Component Does Not Exist Na2S Expiration Date: DC Dropped Ceiling X-Ray Fluorescence Model:_LPA -I Serial# 1"7 bcl Comme;is/Notes: Submitted for Compliance Evaluation Floor# t (Iavel within building of unit being inspected) Floor#>r Property Diagram/unit Labels C C p 4 A- , A ` ram B B D D Q r Z. :,,2ZJ ---L- A(Street Side) : Start Isere - A(Street Side) Start Here A(Street Side) Pb(lead)equal to or greater than 1.0 rn/tan2 with x-ray fluorescence or positive with NaA is Dangerous. XRF Calibration Recorded In Log Book ✓_Check off when complete Address verified through USPS P Check off when complete Research on Lead Related History for Address - www_ statatf ma us/drat L0pD.n or 800-532-9521 `�-Check off when complete John MacIsaac _2378 Inspector's Name License# Ignature Date LIRA rev4ed a9Cf a f / ADDRESS: IKIC Page 2 of2 INSPECTION HISTORY TxtiTERZM CONTROL Determination R;sk Assessraerrt Inspector Name: Uctt Y R.A.Name- Lac# Signature x7� Sig�re Lead hazards? U entPb_Hazards? F J Comprehensive Inspector N i Liege-�5 SI Dart Taken for Risk Initial m7tion p R.A.Name: Lick— Assessment C? N Signattt e F Signature Lead Hazards? Visual Portion of P Compa Inspector Name Lie# ction for PCAD Y ta m ControlF R.A.Name: .Lie; • M Signature Lead Hazards,' Signakure Addendum(add-on Dust Taken for Risk P MM.Maim. rirN to Initial inspection), Inspector Name: Uc# Assessment R 8 _ F signature 9lgnature • Lead Hazards? Visual Portion of R.A,Name,, Uc# - Roim peotion for Addendum as Full . Interim Control P !,a ecdoa y Inspector Name: Lic# Signature F N Signature Lead Hazards? DuTa Assessmentken or Risk P R.A.Name: Uc# Walk Through for Signature Ed/Consultation inspector Name: Lie# Signature Risk Assessment Recertification REINSPECTIOIV HISTORY y RA Name Lid visa]eow, on non PP Inspector Name Lic# u eat Pb.Hazards? IV Signature l__:_1 Signature Dust Taken for RA P R.A.Name: .Uc# Recertification Visual Ponion of F Reocc.Rein bon �j Inspector Name: Uc# $ignature— _ F Signature POST COMPLIANCE ASSESSMENT DETER'1MATIONS PCAD Dust Taken for P . Inspector Name:. Uc# _ Reoce.Roan lion Inspector Name: Lic#._ y F i �r 1 Signature ... Signature I"d Ha�atds? �-N Dust Taken for P Dull Inspection Reocc.Reins on 8 inspector Name: Lic# F '-Acting as PCAD Signature Inspector Name: Lid — visual Portion of l � * Lmd hazards? N Signature Pinar ection P Inspector Na /ut . UcXLL Visual Portion of 1 i 1 3 t F inspector Name: .Lic# Signature PCAD Rein ran F Visual Portion of ; Signature Final Rein Lion P Ins or Name: UC# F fbr Signature PCAD Re;t,Dust �ection P Inspector Name: .Ue# Dust Taken for Final 14 �,= � , 3 r Signature Rein No Reoce P InspectorG Cam- � ' i F Signatu Dust Taken for AD ection Inspector Name:- Lic# Dust Taken for Final C R ' o Reocc �' Ins r Name: Lied Signature F Signature z I - ADDRESS: _ MUM_ Page 3 of�� R E 0 C C U P A N ATE HISTORY COMPLIANCE W450'(CONT.) Cenificate of Ccrtificato of Reoccu c Inspector Name: L1C# Maintained inspector Name,-_ Uc# liaacc. Only after Signature HigWod Risk No Work=No Dust Signature #rooms rule Work—i Dust Certificate of Certificate of Reo� sn inspector Name: Lie# Restored C tisnce Inspector Name: Lii On after xigtt/MoaRiek Signature Signature Dust wipes and auth. peop#rooms rult le Certificate of Inspector Name: Lic# Certificate of R Maintained Enspector Name Lic# Signature Compliance Only after Si nature High/Mod Risk No Worst=No Dust g p rooms rule Work='/Dust COMPLIANCE HISTORY Letter of Full Initial Certificate of Restored Coax fiance Inspector Name: Ltc#, Compliance Inspector Name: Lk# No prior history/ Signature Dust wipes and auth. Signature No si •of UD 25ale Utter of Interim OTHER HISTORY.WAIVERS/UD Control Inspector Name: Uc# Approved—I CL.PPP Waiver No prior Comp, Signature inspector Name:_ Lict Ex lies in 1 Attach to Comp Does Signature Rectification of _ Interim Control Inspector Name, ,Lie# CL PP Approv Waver inspector Name: Uc# Expires 2 yes tkom Signature I I I I = . 1 original Interim Attach to Comp Signature i Control is Letter of Fun Deleading Inspecto r u�+,/J 2 UD/DES Visual fiance ''_=— Reins ecdon inspector Name: Ue# Sign ure P Signature Dust wipes if No No IOC issued g Reo= FWo�rk— e of UD/DES Dust Maintained Inspector Name:. UC# Takes inspector Name; Lich ce Signature LA Signature o Dust No 1.00 issued I F iDust �—J UD/DES Dust Takea Certificate of �p Inspector Names_ _. - - Licl Restored Compliance inspector Name: Lic# ' No IOC Issued Signature Signature Dust wipes and auaL UD/DES Final People Reins ection Inspector Name: __ LIc# P No LOCI Issued Signature Page 4 of EXP T O OF LEAD INSPECTION/RISK ASSESSMENT RE LUMNS 22 This page provides general information needed to understand the lead inspectionhisk assessment report However,you should speak with the inspector/risk assessor before you start to do any work on your home. SIDE Refers to A,B,C,or D side of the building or room. See the diagram on the cover sheet,The"A"side of the building or room is the side facing the street that gives the property its address(usually,it is the front of the building),Keeping your back to this street,from the"A'side move clockwise to the'B"side on your left,the"C" side opposite you,and the"D"side to the right. Numbering is from left to right, LOCATION/ Refers to the building component(s)being tested.Some surfaces may be made up of more than one part.For SURFACE example,'Baseboard"may refer to four separate pieces of wood(one on each wall),but is still considered one surface. LEAD The actual lead result.Each surface tested must have a result recorded in the"Lead"column, 9 A number shows that the surface was tested with an XRF analyzer.A number(or average number)equal to or greater than 1.0 mg/emZ.is a dangerous level of lead, i A`pos"or"neg"shows that the surface was tested with sodium sulfide. "pos"means that there is a dangerous level of lead: • "N/A"means that the inspector was not able to test the surface.Unless the owner can get a sample to test,the inspector must assume the surface contains lead and require it to be deleaded,ifnecessary, • "MET"or"MR"means that a metal surface was not tested and only needs to be intact,even if it is a leaded surface. However,metal handrails metal window sills,and metal railing caps,need to be deleaded if they test equal to or greater than 1.0 mg/cmy,or is marked"N/A," Y For key to abbreviations like"COV","VB","VR"or"MR","NC","Tile","DC",see the cover page. • When a component box is slashed and there are test results above and below the diagonal line,the result on the "bottom".represents results below S ft.and the"top"result indicates the test result above 5 8, TYPE OF Not all lead paint must be deleaded.This column tells you IF and WHY a surface needs deleading.The deleading HAZARD standards below may not apply for Interim Controls.Speak to your risk assessor for more information. ® "M/I"circled means that the,surface is a moveable/impacted surface and must be deleaded in its entirety. • "SF"circled indicates that there is a storm frame present which requires the blind stop and exterior sill be deleaded as interior moveable/impacted surfaces, • . "AM'circled means that the surface is"accessible mouthabie"and must be deleaded to a minimum of five feet high,four inches in from the edge or corner. e "L"circled means that the surface is loose and must,at minimum,be made intact, • If more than one choice is circled,the rules for deleading may change depending upon what method of deleading you choose.Speak to the inspector for more information. O "N/A"means the inspector was unable to determine if the surface was a lead hazard.The person doing the deleading must check this surface and follow all the rules for deleading.Speak to the inspector for more information. • If nothing is circled in the column,then it is likely the surface does not need deleading,Speak to the inspector for more information. Remember,this does not mean the entire surface is lead free,it just does not require deleading in its current condition. URG IIAZ't This column is only completed during a risk assessment.A risk assessment is an evaluation of a home's suitability for Interim Control. Only a licensed risk assessor can do a risk assessment,not all inspectors are risk assessors. If"Y"is circled,then this surface is considered an"Urgent Lead Hazard"and some type of deleading work is required to qualify for Interim Control. IC DATE The date the licensed risk assessor determines the surface meets the standards for Interim Control. IC METH The deleading method or structural repair done to qualify the surface for Interim Control,Refer to the delea&,g, _ codes key on the cover page. DELEAD The date that the lead inspector reinspects the surface and finds that it has been successfully brought back into DATE compliance. DELEAD The method used to bring a surface into full compliance.Refer to codes in the Key on the cover page of the PCAD METE EXCLUDED The amount of loose paint on a surface as measured by the lead inspector,"N/A"means that the inspector was not SURFACES able to measure the loose paint,but has determined it is more than the cut-off for moderate risk making intact. LIRA Exp.8/08 John Maclsasc IIR•2378 10/27/15 �22 Page o Inspector(print) LIC# *inaturv DateJohn Madsaac UR2378Risk Assessor(print)22 PINE AVLt!o# vat YAN IS Amdr of Pro e A HALLWAY; i or Common Hallway: Front.,Rear Floor# SIDE LOCATION/ LEAD TYPE OF URG IC lC DELEAp DtELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAZ DATE METH DATE METH sla A e Up Wells 01 AIM L N/A Y A Closet Door AIM L NIA Y A 8 Low Watts AIM L NIA Y XB Cl Casing AIM.L NIA Y a 8 awboards (Z AIM L N/A Y C Closet Jamb AIM L NIA Y A s Chat Ran NM L NIA Y D Cioset Wails AN L N/A Y A8 co Radiates AlML NIA Y 01Baseboard AN L NIA Y Floor �,/ AIM L NIA Y 1 Closet Pohl A/M L NIA Y Calling o A/M L NIA Y 2 Closet Shelf AN L NIA Y B Door AIM L VA. Y 3 Ct Supports AIM L NIA Y C D Door Casing m XW L WA Y 4 Closet Floor A/M L NIA Y 12 DoorJamb A/M L NIA Y Closet Calling A/M L NIA Y 3 4 Threshold � A/M L NIA Y A window Slii Mn AIM L NIA Y A6 Door AIM L NIA Y B Win Apron A/M L NIA Y C D DoorGasing v3 AIM L NIA Y C Win Casing A/M L NIA Y 12 DoorJamb AIM L NIA Y D Header Stop A/M L NIA Y 3 4 Threshold A/M L NIA Y Int Stops Mtn A/M L NIA Y A B Door D AIM L WA Y 1 Win Int Sash W AIM L NIA Y Door Casing A/M L N/A: Y 2 Exterior siii Md SF L N/A Y 12 Door Jamb (}$ A/M LN/A Y 3 Part Bead M/I L WA Y 3$ Threshold AIM L N/A Y 4 etind Stop MA SF L NIA Y 713 Door A✓twl L NIA Y Win Ext Sash MA L NIA Y C D DwCasing AN L NIA Y A Window Sill MA A/M L N/A Y 12 DoorJamb AIM L NIA Y B Win Apron AJM L WA Y 3 4 Threshold AIM L WA Y C wm Casing AIM L N!A Y A B A/M L MIA Y D Header Stop MA A/M L NIA Y C J A/M L NIA Y ini Stops M/I A1M L WA I_ # Door Jamb AIM L N/A Y 1 Win Int Sash M/I AIM L+NWIAy Threshold AIM L N/A Y 2 Exterior sili MA 16— SF L A Closet Door AN L NIA Y 3 Part Bead Mn L � Cl Casing AIM L N/A Y 4 Band Stop MA SF L C ClosetJamb A/M L N!A Y Win Ext Sash MA L D Ckoset Walls AIM L N/A Y Aie. R A!!4f L NIA Y CI Baseboard 02, AIM L N/A Y � ..�l�' �j MA A/M I& Y �� 3 1 CtosetPole A/M L NIA Y ;_gr M(i AW L NIA Y /) 2 we shelf a} N/A Y Wmes COMMEN IS UGTtJRALDEFECTS�1),/f,� CjZw� $ CiSupports L NIA YLld 0irl v"v SaC ,lrL 4 Closet Floor AIML N/A Yf Closet Ceiliruj AIM L N/A Y EXCLUDED SU FACE in these boxes can be made intact My by a iZ`� 1e SIDE LOCATION MEASURE;LOOSE PAINT iC IC (MORE THAN 288 SQ.IN.) DATE METHob Check the box it this ROOM is RULED OUT for M encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose A1M surfaces t.VRA Rmffall 6111 John Macisaac ItR•237s 9. 10/27/15 .� 22 ' Inspector(faint) Lz# to 4 Pag of— JohnMadsaac I!R 2378 Risk Assessor(pdnQ22 PINE AVe Signature A�ress of ProortY; Apt # �aYANNI$ KITCHEN SIDE LOCATION( LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE j 4 IC iC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARDDATE METH DATE METH A e Up Walls AIM L WA Y Window Sill MR AN A a Low Wags AIM L NIA Y Win Apron AAN c 8 Baseboards AIM L WA Y C Win Casing pa AN L N/A Y A e Chair Rail AN L WA Y I D Header Stop 1 MA ARM L WA Y AB CD Radiator A/M L NIA Y IntStops MA ARM L WA Y Floor pc/ AIM L WA Y 1 Win IMh USas MA AAM L WA Y CeNing A/M L WA Y 2 Exterior N W SF L WA Y oor AIM! WA Y y 3 Part Bead MA L WA Y C D Door Casing Qa ARM L WA. Y 4 etind stop M$ SF L WA Y 12 Door Jamb ARNL WA Y WinExtSash A L WA y 3 4 Threshold (w A/M L WA Y A Window sm MA A/M L NIA Y A B Door AIM L WA Y B Win Apron A/M ! NIA Y D�rCasing 7, L WA Y ?� C WIn Casing A/M L NIA Y 2 DoorJamb AIM L WA Y D Header Stop Mff AIM L WA Y 3 4 hmshold AIM L WA Y Int Stops W AN L WA Y AS Door AN L WA Y 1 Win Int Sash W A/M L NIA Y Co DM CasirxJ AIM L WA Y 2 Exterior Sig M 1 SF L WA Y 1 Door Jamb A/M L WA Y 3 Part Bead WI L WA Y 3Y Threshold AIM L WA, Y 4 Blind Stop Mn SF L NIAI Y AS Door AIM L WA Y Win Ext Sash mn L WA Y C D Door Casing ARM L N/A Y B Up Cab Frame ( A/M L WA Y 12 DoorJarnb AIM L NIA Y C D Up Cab Door 8t, AIM L WA I Y 3 4 Threshold AIM L N/A Y UP Cab Wal AIM L WAI Y A Closet Daor AIM L N/A Y 12 Up Cab Shins .p AIM L N/Al Y 6 Cc casing Zt'p NIA Y J l l. 3 L 3 4 Supports 4 ARM L WA Y C Closet Jamb AIM L WA Y Law Cab Fram &b AIM L WA Y Closet Wags 2 !A Y j �T &B Low Cab Door ARM L WA Y Cl Baseboard AN L WA Y C D Low Cab Wai ARM L WA Y 1 Closet Pale, AIM L NIA Y Low Cab Shi AIM L NIA Y 2 Ciosst Shelf ARM L N/A Y 12 Supports AIM L WA Y 3 c1 supports AIM L WA Y 3 4 Drawers Z. A/M L NIA y 4 Closet Floor N/A Y °�} c p Win Above 5' M/I AIM L WA Y Closet ceiling 2- AIM L N[A Y ( .l'!j MIl AIM L NIA Y COMMENTS/STRUCTURAL DEFECTS:0 A Mtl AAA L WA Y MNI AIM L NIA Y MR AIM L NIA Y MII AIRf L WA Y EXCLUDED SURFACES.Surfaces listed in these boxes can be made"intact only by a 11660-1 3d deteader. SIDE LOCATION MEASURE:LOOSE PAINT IC IC (MDRE THAN 288 SO,IN.) DATE METHOD Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose AIM surfaces LYRA RepKitchen,6115 John Macisaac LIR-2378 1 Q127/15 Pis of 22 Inspector(print) Lic# at Date John Macfsaac I/R078 �9 Risk Assessor(print) Llc# Signature Date Address ofPr :22 PINE AvE, t. HYANNIS Room# 81DE LOCATION/ LEAT TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZ DATE METH DATE METH SURFACE HAZARD HAT DATE METH DATE METH A B Up Wails2 AIM L WA Y Window Sill �f MA A/M L NIA Y A s tow Wags AA1R L NIA Y B Win Apron NM L NIA Y A a Baseboards AIM L WA Y C Win Casing A/M L N/A Y A s Chair Rail AAut L NIA Y �? Header Stop .. MH A/M L NIA Y AB Radlator AN L WA Y Intstops Gd WI A/M L WA Y Floor AN L NIA Y E Win Int Sash tvUl AIM L NIA Y Ceiling AIM L NIA Y 2 Extsdorsw MI SF L WA Y A B Door AIM L NIA Y 3 Part Bead I/ L WA Y C Door Casing A/M L N1A. Y 4 Blind Stop tdA SF L NIA Y f Doorjamb A/M L NIA Y Wfi Ext Sash MA L NIA Y 3 4 Threshold AIM L MA Y Window Sill MA AIM L N/A Y A B Door AIM L NA Y Win Apron AIM L NIA Y D Door Casing AIM L NIA Y C Win Casing7 AAbt L WA Y I Doorjamb Zr.y AIM L N/A Y D Header Stop !)-S MA A/M L NIA Y 34 Threshold AN WA Y IntStops a51 AA4t L NIA Y A B Door LAg2N Y � i3 �G/1 11 Win NKSash MA AMI L N/A Y C 6 DoarCasirg 01A!M L NIA Y F.xtedorSig V MA SF L N/A Y Doorjamb AIM L NIA Y Part Bead V A L N/A Y 34 Threshold AAvt L N/A Y 4 Blind Stop MA SF L WA Y A B Door AN L tJ/A Y Win Ext Sash MA L WAI Y DaolCaSing 0 AIM L NIA Y A window Sol M/I AIM L WA Y 1 Door Aft Uf) A/M L N/A Y B Win Apron AIM L N/A Y 34 Threshold AIM I.N/A Y C Win Casing AIM L NIA Y A Closet Door Of AIM L W/A Y D Header Slop MA AN L N/A Y B C(Casing AIM L N/A Y Intstops WI AIM L N/A Y Closet Jamb Ak, AIM L N/A Y 1 Win Int Sash MA A/M L WA Y D Closet Wags Ltd/ AIM L NIA Y 2 Exterior SBI WI SF L WA Y j Cl Baseboard AIM L NIA Y 3 Part Bead NJl L NIA Y 1 Closet Pole A/M L N/A Y 4 Bind Slop 7SF—L WA Y 2 Closet Shelf AIM L N/A Y Win Ext Sash MA L NIA Y 3 CI Supports AIM L N/A Y 1AB Fireplace AIM L NIA Y 4 Coset Floor A,41 AIM L NIA I Y IC D Mantle AAA L N/A Y Closet Ceiling AJ,,1 AIM L N/A Y as 8 c p Win Above 5' AIM L WA Y COMMENTS/STRUCTURAL DEFECTStl) ip e*�� r Ceiling MWI AIM L N/A Y Y AM L NIA Y AIM L NIA Y /v'M—L N/A Y Surfaces listed in these boxes can only made intact by a VeleaOer ' SIDE LOCATION MEASURE:LOOSE PAINT IC, IC(MORE THAN 288 SO,K) DATE ME'n 0D Check the bOX If this ROAM is RULED OUT for encapsulation because there are 3 or more surfaces with adhesion problems and/or 3 or more loose AIM surfaces L VPA RepRoom,6/15 John Macisaac UR•2378 1 Q/27/15 Pagekoi,22 Inspector(print) Lie gnat Date John Maclsaac VR4378 Risk Assessor(print) Lio# Signature Date Address ofProoeyy:22 PINE AWE. Aot # Cltw HYANNIS ROOM# SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATIoNt LEAD TYpEOF URG IC IC DELEAD DELEAD SURFACE HAZARD DATE METH DATE METH SURFACE HAZARD NA29 DA METH DATE METH A B UDWatts A/ML NIA Y A Window Sol 7-1 Wl NIA Y (t•i G.t� A s Low Weds A/M L NIA Y 13 Win Apron L WA Y t A e Base�ards �iF ID NIA Y 3 C win Casing A Y IL13 r . A B Chair Rail AIM L NIA Y D Header Stop WI AIM L NIA Y A Radiator 40 AIM L NIA Y Int Stays W AN L NIA Y E AIM L NIA Y Win int Sash tiJ W, AIML WA Y AIM L WA Y Exterior Sdf 0t,Mtt SF L WA Y 'AS Door AIM L NIA Y 3 Part Bead (/ L WA Y OD Door Casing WA Y �.t $'L,L 4 Blind stop wl s� L WA Y 12 Doorjamb A Y I ( cSC,�. Win ExtSesh L N/A Y 3 4 Threshold Z, L WA Y ,l G wmdowSN MII AS Door AN NIA Y L N1A Y Wm L NIA Y 11 F Door Casing AL WA Y i., C Win casing L WA Y tr 12 Door Jamb A Y I 11,t 1 D HeaderStop Mn A/M L WA Y 3 4 Threshold A/M L WA Y I lilt Stops MII AIM L N/A Y A B Door AIM L NIA Y 1 Win Int Sash J W AIM L NIA Y C D r Casing AIM L WA ,Y Exiedor Si& Atli SF_L WA Y 12 Door Jamb AIM L NIA Y 3 Part Bead d L NIA Y 34 Threshold AIM L NIA Y 4 Blind stop MA SF L WA Y AS Door AIM L NIA Y Win.Ext Sash L WA Y C D Door Casing AIM L N/A Y A Window SM. MA L NIA Y 12 Doorjamb AN L N/A Y B Win Apron L NIA Y 34 Threshold AN L NIA Y Win Casing L WA Y I , A Closet Door AIM L N/A Y D Header Stop WI AN L NIA Y I 11 P7-L a Ci Casing A/M L NIA Y Int Stops M/I I_L WA Y Il t S Closet Jamb l NIA Y 17.13 s 6ie 1 win tot Sash M/1 AIM L WA Y D Closet Wags -0 A/M L NIA Y 2 Exmrror Sill M/1 SF L NIA Y CtBaseboard A* AN L Y ' t(= 3 Part Bead I MA L WA Y 1 Closet Pole AN L N/A Y JFh nd Stop MA SF L N/A Y 2 Closet Streit. AIM L WA Y 1l n Ext Sash i L WA Y 3 Cl Supports AIM L NIA Y i place / NM L NIA Y 4 Closet Floor AIM L Y nna �, : L WA YCloset Cemng AIM L WA Y :j'.t 3 '� Above 5` AIM L WA Y COMMEMS!STRUCTURAL D!FECTS{I) t / ling Moldi 4�, L NIA Y O AIM L N/A Y Q AIM L WA Y AfM L NIA Y Surfacesin ese Foxes can only Be-made tp Ma by a Deleader SIDE LOCATION MEASURE LOOSE PAINT IC IC Check the box if this ROOM Is RULED OUT for (MORE THAN 288 SO.IN.) DATE METHOD encapsulation because there are 3 or more surfaces with adhesion problems and/or3 or more loose AIM surfaces f , L'/RA RapRoorn 6/I 5 John Mactsaac UR-23n 10/27/15 22 Inspedor(print) UC# re Peg —Of— John _ John Meciseao UR-2378 Risk Assessor(pr1nt)22 PINE AVC# jire OD aklYANNlS ddress o Pro A f.#. i HALLWAY: #2Lor Common Halfway; Front Rear Floor#._.,_ SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF Ty IC fC IDELE11DELEAD SURFACE HAZARD HAZ DATE METH .DATE METH SURFACE HAZARD ATE METH DATE METH A a Up Walls (j AIM L NIA Y A Closet Door AIM L NIAA B Low Walls A/M L NIA Y B Cl Casing AIM L NIA A a Baseboards NIA Y C Closet Jamb AN L NIA Y A n ChairRaii AIM L NIA Y D Closet Walls AIM L NIA Y AS C D Radiator AIM L NIA Y of Baseboard AIM L NIA Y Floor AIM L NIA Y 1 Closet Pole AIM L NIA Y Ceiling (,� AN L WA Y 2 Closet Shell AIM L NIA Y A Door WA Y t 3 Ci support A/M L WA Y D Door Casing AIM L WA Y 4 Closet Floor A/M L NIA Y 12 Door Jamb. A/M L NIA Y t ClosetCel AIM L NIA Y 3 4 Thfesfrold AIM L NIA Y A Window SIfI MR A/M L NIA Y Door lJ AIM L_NIA Y 8 Win Apron AIM L WA Y C f? Door Casing WA Y ;�` C Wm Casing AIM L NIA Y 12 DoorJamb N/A Y D Header Stop Mil AIM L NIA Y 34 Threshold AIM L NIA Y IntStops Mil AIM L wA Y 713 Door NJA Y Aq 1 Win Int Sash M/i AIM L NIA Y DoorCasing NIA Y i;f 2 Exterior Sol MR SF L NIA Y t 2 [;;Jamb NIA Y w 3 Pad Bead MR L NIA Y 34 Threshold AIM L NO Y 4 Blind Stop MR SF L NIA Y A B Door AIM L NIA Y Win Et Sash j MR L NIA Y at DoorCaslr>g /A Y J/, A window Slli MR AIM L NIA Y Door Jamb N/A Y « / B Win Apron AIM L N/A Y 34 Threshold AIM L NIA Y C Win Casing A/M L WA Y A 8 Door AN L WA Y D Header stop MR AN L NIA Y C D Door Casing MAML—WA Y fnt stops MA AIM L NIA Y DoorJamb Y 1Win Int Sash MR AIM L WA Y hreshold Y 2 Exterior Sill Mil SF L WA Y Closet Door Y 3 Parl Bead MR L NIA Y Cl Casing A/M L WA Y f 4 Blind Stop W1 SF L WA Y C Closet Jamb OIL WA Y �' =0 Win Ext Sash MR 1 WA Y D Closet Waft AIM L N/A Y A a CID Will Above 5 Wl AN L NIA Y AG CI Baseboard Al 6Y6 NZA Y `' I?!3 S C o Gelling MOWIN MR AIM L NIA Y 1 Closet Pole AW L NIA Y MR AIM L NJA Y 2 Closet Shelf 07, A/M E NIA Y• ( Mthese COMMENTS I STRUCTURAL DEFECTse3 cl supports .� t33AR+t NIAY4 Closet Floor b AIM L NIA Y CimetCeiling A/M L N/A Y L ED RFACES:Surfaces listscan be made Intact an y y a ilcensed a seder. SIDE LOCATION MEASURE:LOOSE PAINT IC to (MORE THAN 2W SO.IN,) DATE METHolo Check the box if this ROOM is RULED OUT for encapsulation because there are 3 or more surfaces Wfth adhesion problems and/or 3 or more loose A/M surfaces IINRA RnnHail IJ15 I John Mactsaac uR-2378 10/27/15 ,y_, 22 Inspector(print) Lic# rn@ John Madsaac UR 2378 tm 4 Risk Assessor(print)22 PINEAULtc# i nature Da YANNtS AMdd r Pro .# i HAU WAY: me' #, : or Common Hakay: Front Rear Floor;Y_ SIDE LOCATI I LEAD TYPE OF URG le IC DELEAD DELEAD SIDE LOCATION1 LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAZI DATE METH DATE METH SURFACE HAZARD KAZI, DATE METH DATE METH A s Up Walls AIM L WA Y A Closet Door AIM L NIA Y A B Low Walls AIM L NIA Y B Cl Casing A/M L NIA Y A B Baseboards Q AIM L NIA Y C Closet Jamb A/M L N/A Y A B Chair Rail AIM L WA Y D Closet Wells An L N/A Y AB c D Radiator AIM L NIA Y Of Baseboard AIM L N/A Y Fklor AIM L NIA Y 1 Close#pole AN L N!A Y Ceiling p AIM L NIA Y 2 Closet Shetr AN L NIA Y A Door AIM L NIA Y 3 Ci Suppor s A/M L WA Y C D Door Casing Allot L NIA Y 4 Closet Floor A!M L N/A Y 1 2 Door Jamb AIM L N/A Y CiasoCeiling AiM L NA Y 34 Threshold AIM NIA Y A Windowsill Mil A/M L NIA Y A oor A/M L NIA Y B Win Apron AIM L NIA Y C D.�oorCasing VENIA Y C Wm Casing AIM L NIA Y 1 2 OoorJamb N/A. Y !'( dLti D Header Stop MA AIM L NIA Y 34 Threshold A/M L N/A Y I Int stops MA AIM L NIA Y AS Door A Y 1 Win Int sash Mil AIM L NIA Y Poor Casing AIM L NIA Y 2 Exterior Sill M/l SF L NIA Y 1 Door Jamb A/M L NIA Y 3 Part Bead MII L NIA Y 34 Threshold AIM L NIA Y 4 Blind Stop Mil SF L NIA Y A B Door AIM L NIA Y Win Ext Sash MIl L NIA Y CO Door Casing AIM L NIA Y A Window Sill MII AIM L NIA Y 12 Door Jamb AIM L NIA Y B Win Apron AIM L NIA Y 34 Threshold AIM L NIA Y C Win Casing A/M L NIA Y AS Door AN L N/A Y D Header Stop W AIM L N1A Y C D Door Cashlg AIM L NA Y Int Stops "I AIM L N/A Y Door Jamb AIM L WA Y 1 Win Int Sash MR AIM L NIA Y Threshold AN L N/A Y 2 Exteriorso MA SF L N/A Y A Closet Door A/M L NIA Y 3 part Bead Mil L NIA Y B Cl Casing AIM L N/A Y 4 eilnd Stop MA SF L NIA Y C Closet Jamb AN L N/A Y Win Ext Sash Me !N(A Y + D Closet Wads AIM L NIA Y A B p Win Above 5' tdn AIM L N/A Y AB CI Baseboard AIM L N/A. Y CD Cetfing Moldin MCI AN L NIA Y 1 Closet Pole AIM L NIA Y Mfl AJAt L N/A Y 2 ClasetSheif AIM L NIA Y COMMENTSIMUCTURALDEFECTS: 3 CISupports AN L NIA Y 4 Closet Floor And L N/A Y ClosetCuing AIM L N/A Y FJ(C UDEDSURFACES:Surfaces listed ifltheseboxes an be made intact on y by a licensed Bader, SIDE LOCATION MEASURE:LOOSE PAINT IC IC Check the box if this ROOM is RULED OUT for {MORE THAN 288 SQ.IN.) DATE METHOD encapsulation because there are 3 or more Surfaces With adhesion problems and/or 3 or more loose A/M surfaces T YR A R mRall 611 rs • i John Macisaac UR•2378 10/27/15 Pa��Dt 22 Inspector(print) LAC# ure Date John Macisaac UR-2376 Risk Assessor (p6nt)22 PINE AVEQi Signature D Address of Property: Ant # City BATHROOM# SIDE LOCATION/ LEAD TYPE.OF URC IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SURFACE HAZARD HAV DATE METH DATE METH SURFACE HAZARD HAZI DATE METH DATE METH A s Up Walls AIM L NIA Y Low Cab From A/ML N/A Y A e LOW Waits U f 1 AIM L WA Y A Low Cab Door A/M L NIA Y A e Baseboards A/M L WA Y C D Low Cab W A e AIM NAY AMLN Y Chair Rail Low Cab AIM L WA Y . All Co Radiator AIM L WA Y 12 Supports AlM L NIA Y Floor 3 ( AIM L WA Y 34 Drawers AIM L WA Y Ceiling AIM L WA Y / A Window slit MII AIM L WA Y oot L N/A Y It,i3 B Win Apron AIM L NIA Y C D Door Casing AIM L WA Y Win Casing AIM L WA Y 12 Door Jamb A/M L WA Y D Header Stop MA AIM L WA Y 3 4 Threshold A/L, AIM L WA Y Int Stops MA AN L WA i Y A B Door A/M L WA Y 1 Win Ind Sash MII AIM L NIA Y C D Door Casing AIM L NIA Y 2 ExteriorSgl A SF L NIA Y 12 DoorJamb AIM L WA Y 3 Part Bead Mn L NIA Y 34 Threshold A/M L NIA Y 4 Blind Stop MA SF L NIA Y A Coset Door AIM L NIA Y Win Ext Sash ii . L N/A Y T ,13 Cl Casing AIM L NIA Y -co Win Above 5' MA AIM L NA Y C Closet iamb AIM L N/A Y n il C p Cog moldkx MA AIM L NA Y D Closet Walls AN L W ABA Y Ce Medicine Cab MA AIM L NA Y Ci Baseboard AIM L N/A Y B Wall O!C M/I A/M L NA Y 1 Closet Pole AIM L NIA Y MA AIM L NA Y 2 Clout'Shelf AIM L NIA Y MA AIM L NA Y 3 CI Supports AIM L NIA Y W AIM L NA Y 4 Closet Floor A/M L WA Y MA A/M L NA . Y Closet Ceiling A/M L WA Y MA A/M L NA Y A UP Cab Frame AtM L NIA Y Mil A/M L NA Y C D Up Cab Door D AIM L NIA Y A4lI A/M L NA Y Up Cab Walls AIM L WA Y MA AIM L NA Y 12 Up Cab Shiva AIM L NIA Y MA AlM L NA Y 34 Support AIM L WA I Y MA AIM L NA Y MA A/M L WA Y ► MR AIM L NA Y IM A/M L WA Y Mtl AIM L NA Y MA AIM L NIA Y MA AIM L NA Y COMMENTS/STRUCTURAL DEFECTS,/V 7—1/G COMMENTS I STRUCTURAL DEFECTS: EXCLUDED SURFACES;Surfaces listed in these boxes can be made intact only b 8 licinsed deleader. SIDE LOCATION MEASURE;LOOSE PAINT (C IC (MORE THAN 288 SQ.K) DATE METHOD Check the bDX if this ROOM is RULED OUT for encapsulation because there are 3 or more Surfaces with adhesion problems and/or 3 or more loose A/M surfaces LYRA RepBath,46/15 John Macfsaac UR•2378 10/27/15 Page4& 2 Inspector(print) tic# Aatt�i Date John Macfsaac UR-2378 Risk Assessor(print). Lic# Signature pate Address of Pro :22PINEAVE. Apt,# o; ; ,YANNIS ROOM# SIDE LOCATION 'LEAD TYPE OF URG IC IC DELI=AD DELEAD SIDE LOCATION) LEAD TWE OF URG IC IC bam DELEAD SURFACE HAZARD HAZE DATE METH DATE METH SURFACE HAZARD HAZ7 DATE METH DATE METH A B Up Welts AIM L NIA Y A Window Sol MA AIM L N/A Y a s Low Wags A/M L WA Y B Win Apron D AIM L NIA Y A e Baseboards AIM L NIA Y Win Casing AN L NIA Y A e Chair Rail AN L NIA Y D HeaderStap MA AIM L N/A Y Aa Radrator AIM L NIA Y IntStops &-V Mil AN L WA Y Floor AN L N/A Y 1 Win Int Sash VV Wl A/M L NIA Y Ceiling AIM L WA Y 2 Exterior Sig t/ W SF L WA Y Door 61 AIM L NIA Y 3 Part Bead t1W W L NIA Y C D Door Casing AIM 1 NIA Y 4 t3lind Stop W SF L WA Y 1 2 Doorjamb AN L NIA Y Win Ext Sash MA L N/A Y 34 Threshold AIM L NIA Y A windowsill (-1 MA AIM L WA Y Door WA Y � B Win Apron AIM L WA Y D Door Casing AIM 1 WA Y C Win Casing A/M L NIA Y 12 Doorjamb AN L WA Y Header Stag W AIM L NIA Y 34 Threshold AN L WA Y Int stop$ W A/M L NIA Y A B Door A/M L NIA Y 1 Win Int SashTvk MA A/M L NIA Y C D Door Casing A/M L NIA Y 2 ExterfarSia (X MB SF L NIA Y 12 Doorjamb AIM L N/Al Y 3 Part Bead �A( MA L N/A Y 34 Threshold A/M L WA I Y 4 Blind Stop MA SF L WA y A B Door ABvt L N/A Y Win Ext Sash ti/ Mn L NIA y C D Door Casing AIM L NIA Y A Window S(N MY A/M L WA Y 12 Door,farnb AIM L N/A Y B Win Apron AIM L N/A Y 34 Threshold AAU L WA Y C win Casing AIM L N/A Y Closet Door A/M L NIA Y D HetaderStop M/I AIM L NIA Y CI Casing AIM L N/A Y IMStops W AIM L NIA Y C Closet Jamb 66rAIM L WAI Y 1 :Win Int Sash Mn AIM L NIA Y D Closet Walls L WA Y R-stop Mn SF L WA Y Cl Baseboard /lt A/M L Y 11.15 A 7 Mil L N/A Y 1 Closet Pole A/M L N/A Y BlindW 8F L WA Y 2 Closet Shelf r(j AIM L NIA Y t t '0d W L WA Y 3 Cl Supports A/M L WA Y Li. P A S Fireplace NM L WA Y 4 Closet Floor ±J A/M L& Y 1I ( CD Mang AN L WA Y Closet Ceiling I dui AIM L WA Y CD Win Above 5' AN L NIA Y COMMENTS]STRUCTURAL DEFECTS: Ceiling MoldIN AAA L N/A Y AIM L WA Y 0 t N/A Y A/M L NIA Y U aces fisted in Mese boxes can only m e intact by a e ea er SIDE LOCATION MEASURE;LOOSE PAINT IC IC (MORE THAN 288 SO,IN.) DATE METHOD ED Check the box if this ROOM Is RULED OUT for encapsulation because there are 3 or more surfaces with adhesion problems andlor 3 or more loose A/M surfaces Ll/RA RepRoom,6/15 John MacWaac UR•2378 E, 10/27/15 Inspector(print) Lic# ig Page Date John Madsaan IIR-2378 . Risk Assessor (print Lic# Signature Addressol'Prooert . 2 PINE AVE. D0YANNIS EXTERIOR A Side Aot # City SIDE LOCATION/ L TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF I RtG IC IC DE EA DELEAD A SURFACE HAZARD HAZ, DATE METH DATE METH A SURFACE HAZARD HAZ? DATE METH DATE METH Siding �j — /A Y Window S�f A/M L NIA Y Comer Boards NIA Y t A in Casing A/M L N/A Y A Lower Trim t 1A Y l 3 5 U'Z # Window Sash AIM L NIA Y Upper Trim /A Y CallarWarSRi AIM L N/A Y Win Above 5' li/ N/A Y (, A eel Win Sash AIM L N/A Y Porch Above 6 L NIA Y —I Win Fra AIM L N/A Y Storm Door AIM L WA Y Screen Frame A/M L NIA Y Door AIM L NIA Y Celli Win SW A/M L N/A Y A DoorCasirp AIM L NlA Y A Cal win Sash A/M L NIA Y 1 2 Door Jamb AM L N/A Y Cal Win F A/M L IV/A Y 3 4 Threshold �, AIM L.N/A Y Screen Frame A/M L N/A Y Kb#ate () AIM L N/A Y Celar in Sig AIM L WA Y Storm Door AIM[ NIA Y A Cei t�Sash AIM L WA Y Door NIA Y Cel win Fram A/M L N)A Y A Door Casing t WA Y t ILA L4 Scram frame A/M L N/A Y 1 Door Jamb N/A Y mti Cellar On Sill A/M L NIA Y 3 4 Threshold AIM L NIA Y A Cal win Sash A/M L NIA Y fttckplate AIM L NIA Y Cel On Fram AIM L Door AIM L NIA Y Screen Frame A/M L NIA Y A DoorCasing AIM L N/A Y FoundaWn L NIA Y 1 2 DoorJamb AIM L N/A Y A Bulkhead AIM L NIA Y 3 4 rnreshold AIM L NA Y Fences AN L WlndowSiu L NIA Y ,1 �!� Shutters AiM L NIA Y A Wtn Casing L NlA Y !�) A!M L N/A Y Window Sash AIM L N/A Y Railing Cap A/M L N/A Y Window sif L N/A Y HandraN A/M L NIA Y A Win Casity L NIA Y 9'y A Balusters AIM L N/A Y Z Wdrtdow Sash iC AIM L NIA. Y Lower Raii A!M L NIA Y Window Slfl AIM L NIA Y Treads AIM C WA Y A win Casing A/M L NIA Y Risers A/M L NIA Y #S Wirxtow Sash ( AIM L NIA Y Stringer A/M L NJAJ Y B Lamp Post L NIA Y Lattice- �� A/M L'A Y COMM/E'�TS i STRUCTURAL DEFECTS: Dray Pipes L N/A - 1 Y L✓t c k ja j 604mwd > A Elec Conduit L NIA Y �/(? 7 a"Pipe CY1 r� L N/A Y Overhang T4 AAr A, /M L N/A Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED A (MORE THAN 1440 SQ.IN.) DATE METH A (Square Feet) {PPM} DATE METH Play Area A Bare Soil A Comments: A t:3/RA Rep&tA,6115 John Macisaac UR•2378 10/27/15 �22 Inspector(print) Uc# tut Da te Page Of�_• John Mactsaac UR-2318 Risk Assessor (pri12 PINE AVE�r� Signature DRYANNIS Address of Pro .# Cit EXTERIOR 8 Side a `Z- SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC IC DELEAD DELEAD B SURFACE HAZARD KAZ DATE METH DATE METH B SURFACE I HAZARD tiA29 DATE METH OATS METH Siding L A Y ( Window Sill L N/A Y Comer Boards ANIA Y t 1` B Win Casing L N/A Y yj B lower Trim L N/A Y # Window Sash AN L NA Y Upper Trim A Y l� t CetiarWin Si<I L NIA Y �j Win Above 5' N/A Y !i' 1 B Cat Win Sash AIM L WA Y Porch Above 5' L N/A Y Cel Win Fra. L WA Y Storm Door AIM L NIA Y Screen Frame A/M L NIA Y Door q f OUNIA Y ( Cslarft SM NIA Y t B Door Casing NIA Y t ' B Cal Win Sash A/M N/A Y 1 2 Doorjamb NJA Y I. Cel Wln F 4 Threshold a A Y �l WA Y t ( l j Screen Frame 2 L N/A Y t Kmcwata N/A Y N),3 Ceilarftslll �{/ A/M L WA Y Storm Door A/M L WA Y B Cal Win Sash a A/M L NIAWY Door A/M L N/A Y 3 Cal Win Fra S WA1, B Door Casing A+M L WA Y Screen Frame AIM L WA f Z Doorjamb AJM L NA Y Cellar Win Sill AIM L NIA3 4 rnreshotd AIM L N/A Y $ Cal Win Sash AIM L WA itlCkplate A/M L WA Y N CetWinFrarm, AIM L WA Y Door AIM L NIA Y Screen Frame A/M L NIA Y B Door Casing AJM L NIA Y Foundation L WA Y 1 2 Doorjamb A/M L NA Y B Bulkhead A4vl L WA Y 3 4 Threshold AIM L WA Y fences AIM L WA Y Window SM L N/A Y [( Shutters A/M L WA Y 8 Win Casing N!A Y f t, Newel post A/M L WA Y # Window Sash AIM L NA Y Railtng Cap AIM L N/A Y Window Siff L WA Y Handrail A/M L NIAI Y B Win Casing L WA Y t ^ B Balusters AIM L WAJ Y All Window Sash AIM L WA Y Lower Rail AIM L N/A Y Window SM L WA Y ( Treads AIM L N/A Y B Win Casing L WA Y 11 . ' Risers AIM L WA Y 3 Window Sash {/ AIM L NIA Y Stringer AIM L N/A Y B Lamp Post L NIA Y Lattice Arid L NIA Y COMENTS/STRUCTURAL DEFECTS:`/J 4()p 14 d Drafn Pipes L L WA Y ofne rt• B Elec Conduit ' L WA Y Oil Fill Pipe L WA Y Overhang T AIM L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area 11200 ppm for bars soil) SIDE LOCATION MEASURE:LOOSE PAINT iC {C LOCATION AREA MEASUREMENT RESULT REM REMED B (MORE THAN 1440 SQ.IN.) DATE METH (Square Feet) ) (PPM) DATE METH Play Area B Bare Sod B Comments: - B I A _ LYRA RepExtB,6/15 John Maclsaac I/R.2378 10/27/15 22 Page Of_,__ Inspector(print) Lic# at � Date � John Maclsaac I/R-2378 RskAssessor (pdnt)22 PINE AVLtiq# Signature Dot YAN q IS Address f Pr e : EXTERIOR Q Side SIDE LOCATION! L TY OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD: TYPE OF URG !C IC DE DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD 1HAr, DATE METH DATE METH 8 Window Sill Y i i'•i jam, Window Sill A/M L N/A Y 1_Win Casing XL.WA Y i i Win Casing E jAJMM�L WA YL Window Sash V AIM L WA Y Window Sash WA Y n Window SNi gj L N/A Y (•l (� Wow Sill A/M 1 N/A Y `/3 Wrtr Casing L WA Y t(� t 3 rJL/L Win Casing AIM L WA Y to Window Sash V, AIM L NIA Y Window Sash A/M L N!A Y Window Sig WA Y t 1'{ Window Sgt Win Casing N/A Y i t A!M L N/A Y M Wan Casing. AIM L NIA Y Window Sash C AIM L NIA Y Window Sash AIM L WA Y Window Sit AIM L WA Y Window Sig AAA L WA Y Mn Casing AIM L WA .Y Win Casing A/M L NIA Y Window Sash AIM L WA Y Window Sash AIM l WA Y Window Sig AIM L WA Y Window Sig AIM L NIA Y Win Casing A1M L WA Y Win Casing MI L NIA Y Window Sash AIM L WA Y ftdow Sash A/M L WA Y Window Sig AIM L NIA Y W Indow Sig ATM L N/A Y Win Casing AIM L N/A Y Win Casing AIM L NIA Y Window Sash AIM L NIA Y Window Sash A/M L WA Y Window SM AlM L N/A Y Window Sill A/M L WA Y WlnCasing A/M L NIA Y Win Casing AIM L WA Y Window Sash AIM L WA Y Window Sash AIM L NIA Y VkidowSii AIM L WA Y Window Sig A/M L N/A Y Win Casing AIM L WA Y Win Casing A/M L N/A Y Window Sash AIM L NIA Y Window Sash AIM L WA Y Window Silt A/M L NIA Y Window Sig AJM L WA Y Win Casing AIM L N/A Y Win Casing A1M L WA Y Window Sash AIM L NIA Y Window Sash A/M L WA Y Window Sig AIM L NIA Y Window SIg A/M L WA Y Win Casirg A/M L WA Y Win Casing A/M L NIA Y Window Sash AIM L WA Y Window Sash AIM L WA Y AIM L NIA Y Window Sill AIM L WA Y A/M L WA Y Win CasingI tji -----AIM L WA Y COMMENTS I STRUCTURAL DEFECTS: Wlhdow Sash AIM I.N/A Y Window Sig AIM L NIA Y Win Casing AIM l NIA Y Wtndov Sash AIM L NIAI Y Exduded Surfaces:Surfaces fisted in this box can be made Soil Test Results intact only by a Licensed deleader (Must be less than 400 ppm for play area!1200 pprn for bare snit} SIDE LOCATION MEASURE;LOOSE PAINT IC IC LOCATION AREA MBASC7REM1IHNT RESUL REA4ED REMED A (MORE THAN 1440 SQ.lN.) DATE METH (Square Feet) (PPM) DATE METH A Play A;aa A Baca Solt A Comments: A LJ/RA RepExtA,6/15 John Mactsaac u�.237s 10/27/15 22 Page Or Impactor(print) Lic# i Date f John Macdsaac - UR-237B Risk Assessor(prin22 PINE AVE00# Signature D Address of Prooerty: ADt# City EXTERIOR C We ."�"~------ SIDE LOCATION/ TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD 'I-YPE OF URG IC IC DEL DiLEAD 11 C SURFACE HAZARD HAZ? DATE METH DATE METH C SURFACE HAZARD H DATE METH DATE METH Siding L NIA Y Window SUI AIM L N/A. Y Comer Boards IA Y C Win Casing . L N/A Y C Lower Trim L N/A Y Window Sash A/M L N1A Y Upper L NIA Y �f ?> / Cellarft Sol AIM L N/A Y Wirt Above 5' N1A Y f C Call Win Sash AIM L N/A Y Porch Above 5' L N/A Y # Cal Win FrameA/M L N/A Y Sim Door A/M L NIA Y Screen Frame AIM L N/A Y Door AIM L N/A Y Cellar Win SIR AIM L WA Y C Door Casing A/M L N/A Y C Cal Win Sash A1M L WA Y 1 2 Door Jamb AIM L N/A Y Cal Wm FrameA/M L N/A Y 3 4 Threshold AIM L WA Y Screen Frame AIM L N/A Y fGct 1w AIM L N/A Y Cellar Win SIN AIM L N!A Y Storm Door AIM L NIA Y C Cal Win Sash AIM L NIA Y Door A/M L NIA Y Cal Win Frame AIM L N/A Y C Door Casing A/ML N/A Y Screen Frame AIM L N/A Y 1 2 Door Jamb AIM L NIA Y Cellar On Sol : A/M L NIA Y 3 4 Threshold AIM L NIA Y C Cal Win Sash A/M L N/A Y Kickplats AIM NIA Y #, Cat Win Frame AIM L N/A Y Door AA 4 L N/A Y Screen Frame A/M L N/A Y C Door Casing AIM L NIA Y Foundation L WA Y 1 2 Door Jamb AIM L NIA Y C Bulkhead A 4 L N/A Y 3 4 Threshold A/M L N/A Y Fences A/M L NIA Y Window Sill t NIA Y L4 ShuBers AIM L NIA Y C/ Win Casing _jja &L NIA Y ,) Newel post AIM L N/A Y #1 Window Sash A/M L NIA Y Ralkrrg Cap AIM L NIA Y WMesh RI A/M L N/A Y Handrail AIM t NIA Y C Wg AIM L NIA Y C. Balusters AIM L N/A Y # V AIM L NIA Y Lower Rall A/M L N/A Y Window SRI o A/M L NIA Y Treads A!M L N1A Y C Win Casing iZ AIM L NIA Y Risers A/M L NIA Y #3 Window sash A/M L NIA Y Stringer AIM L NIA Y C Lamp Post L NIA Y Lattice AIM L NIA Y COMMENTS i STRUCTURAL DEFECTS: Drain Pipes L NIA Y C Eleo Conduit L WA Y Oil Fill Pipe L NIA Y ®fian9 T A/M L NIA Y Excluded Surfaces:Surfaces fisted in this box cats be made Soil Test Results intact only by a licensed deleacr (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAW IC IC LOCATION AREA I PASURINF.NT RESUL REMEO REMED C (MORE THAN1440SQ.IN.) DATE METH (Square Feet) (PPM) DATE METH C Play Area C Bare Sall C Comments: C LVRA RepPxtC,6115 John Macisaac UR-237a 4 10/27/15 22 Pa * Of_Inspector Inspector(print) Uc# i e Qate �� 4r John Maclsaac VR-2378 Risk Assessor (prinT2 PINE AV;IY# Signature YANNIS Addrey of t.#1 Cit : EXTERIOR D Side G L SIDE LOCATION! LEA TYP OF URG IC IC DELEAD DELEAD SIDE LOCATtOW LEAD TYPE OF URG IC IC DELEAD DELEAD D SURFACE HAZARD HAZ DATE' METH DATE METH D SURFACE HAZARD HAZ? DATE METH DATE METH Siding NIA Y Window Sig l NIA Y •I Corner Boards fj IA Y a /(-t 3 D Win Casing M { wA Y D Lower Trim A I0 NIA Y t( I f� Window sash V AAd L NA Y UPper Trim AA a)WA Y 1 .( Cegar WIn Sill Win Above 5' � NIA Y L NIA Y I( t 1 /Li>' D Cel Win Sash AN L NIA Y Porch Above 5' L NIA Y 1 # Gel Win Frame Storm Door AIM L NIA Y t NIA Y t("J. �U✓ Screen Frame AIM L NIA Y Door Q NIA Y Cellar Win Sm AIM L NIA Y D Door Casio WA Y 11•1 S[di D Cal Win Sash A)M L N/A Y 2 Dow Jamb NIA Y { Cal Win Frame AIM L N1A Y 4 Threshold p.3 A/M L N/A Y Screen Frame AIM L NIA Y KKptats p AIM L N/A Y Celtar Win Sig fflN��I.AStomr Door A!M L NIA Y D Cal Win Sam Door AIM L N!A Y Cel Win Fra D Door Casing A!M L NIA Y Scmn Frame owjemb tj. AIM L N!A YCelgar WIn Sib !M L NIA Y 3 4 Threshold I MA AIM L WA Y D CBI Win Sash A!M L WA Y lUckpiat$ d AIM L NIA Y ft Cot Win Frame AIM L N1A Y Door AIM L NIA Y Screen Frame AIM L WA Y D Door Casing j A/M L WA Y Foundation ✓ L N/A Y 1 2 Doorjamb. AREA L NIA Y D 8ugchcad AIM L NIA Y 3 4 Threshold A!M L WA Y Fences AIM L WA Y Window Sill AIM L N/A Y Shutters AIM L NIA Y D Win Caaarg ob AIM L NIA Y # t f Window Sash eif AIM L wA Y. AfM L NIA Y f;ng CaP AIM L NIA Y Window Sill 40 AIM l NIA Y Handrail AIM C NIA Y D Win Casing AIM L WA Y D Balusters AIM L NIA Y #L Window Sash �� AIM L NIA Y lower Rail AIM L N!A Y Window Sill AIM L NIA Y Treads AIM L WA Y D Win Casing AIM L WA Y Risers A/M L WA Y Window Sash CB✓ A/M L NIA Y 5trger AIM L NIA Y D Lamp Post L NIA Y Lattice AN L NIA Y COMMENTS I STRUCTURAL DEFECTS& AT .4(_-/4 3{ A-Ld d W Drain Pipes L WA Y .L/rcr, Lr S/j�d 10 44- V + G(1 r'J 1 r(C I;Cejl t� D Elec Condult 1 WA Y 0(I Fill Pie L WA Y OvefiangT'. AfM L WA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results Intact only by a licensed del8ader (Must be Iess than 400 ppm for play area 11200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT EC IG LOCATION ARFA MEASUREMENT RESUL REMED REMED D (MORE THAN 1440 SQ,IN.) DATE METH (square Feet) (PPM) DATE MM D Play Area D Bare soli D Comments: D 1.&RA RepExtn,rant 5 Jahn tl9actsaac I111-2378 1 a12711 5 22 i Inspector{print} Lic# Dale Page _Of of44 �p John Maelsaac I/R-2378 00 Risk Assessor (pdnt22 PINE AvL'ic# Signature WYANIS TIS d P A # is EXTERIOR- Side SIDE LOCATION/ LEAC TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG lC IC DELEAO DELEAD SURFACE HAZARD HAZ? DATE METH DATE METH SURFACE HAZARD W1 DATE METH DATE METH Window Sill AIM L NIA Y Window Sill A/M L NIA Y LJ Win Cash+g AN L NIA Y Win Casing AIM L N/A Y Window Sash t AIM L N/A Y Window Sash A/M L N/A Y Window Sill A Y L Window Sill ;g:L y ;! Win Casing L NIA Y �lR. Win Casing WA Y Window Sash Vt AIM L NA Y Window Sash A/M L WA Y D FSash Sig �jQ NIA Y Window Sill AIM L WA Y Qdj WA Y Win Casing A/M L WA Y 7 h y A/M L WA Y Window Sash A/M L WA Y 0 WA Y Window Sill A/M L N/A Y d ae- NIA Y •f Win Casing AIM L N/A Y V A/M L NA Y Window Sash A/M L WAI Y Window Sill NIA Y j Widow Silt AIM_L N/A! Y Whi Casing 4M NA Y (,1 Win Casing A/M L WA Y Window Sash A/M L WA Y window Sash AN L NIA Y Window SW 1 1.7 t WA Y Window Sill A/M L WA Y Win Casing /. L NIA Y win Casing A/ML WA Y lb Window Sash AIM L WA Y Window Sash AIM L WA Y Window SIN AIM L N/A Y Window SIN AIM L WA Y Win Casing AIM L WA Y Win Casing AIM L N/A Y Window Sash AIM L WA Y Window Sash A/M L N/A Y Windowsill AIM L NIA Y Window Sill A/M L NA Y Win Casing AIM L NA Y Win Casing AIM L W.A Y Whdow Sash A/M L N/A Y Window Sash AIM L NIA Y Window SN AIM L NIA Y Windowsill AIM L NA Y Wan Casing AIM L NIA Y Win Casing A/M L WA Y Window Sash AIM l NIA Y Window Sash AIM L WA Y Window Sill A/M L N/A' Y Window Sm A/M L WA Y Win Casing AIM L N/A Y Win Casing A/M L WA Y Window Sash A1M L WA Y Window Sash AIM L NA Y A/M L WA Y Window SIR AIM L WA Y AM L NA Y Win Casing AIM L NA Y COMMENTS/STRUCTURAL DEFECTS: Window Sash AIM L NA Y Window Sill AIM L WA Y Win Casing AIM L NIA Y Window Sash AN L NA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleader (Must be less than 400 ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE:LOOSE PAINT 1C IC LOCATION AREA MEASURBiENT RESUL REMED REMED A (MORE THAN 1440 Sa IN.) DATE METH (Square Feet) (PPM) DATE METH A Play Area A Bare Soil A Comments: A I.1/RA RepectA.,6/15 Joan NlaclsMac IIR•2378 ��`�" 10/27/15 22 Inspector(print) W # ig A6t?ata PagalkOf---- jam Madsaac UR-2378 t RiskAssassor (prinl)j Ic# Signature roa Address of Perty;"� PjYJE tL QlYANNIS EXTERIOR A Side SIDE LOCATION/ TYPE OF URCs IC IC DELEAD DREAD SIDE LOCATION/ LEAD jP1 F URG IC IC DELEAD bELFAD A SURFACE HAZARD HAZ7 DATE METH DATE METH, A SURFACED IfAZ? DATE METH DATE METH Skiing L N!A Y Window StU NIA YComer Boards WA Y A WM Casing N/A Y A LowerTrim L NIA Y # Wlndowsash N/A Y Upper Trim (§`N/A Y i ( Cellar Win Sill AN L NIA Y Win Above 5' 0 NIA Y A Cei Win Sash A/M L NIA Y Porch Above 5 L NIA Y Gel Win F A/M L N/A Y Storm Door AIM L NIA Y Screen Frame A/M L N/A Y Door AlM L N1A Y Cellar Win Sill A/M L NIA Y A Door Casing AIM L NIA Y A Cel Win Sash AN L NIA Y 1 2 Door Jamb AIM L NIA Y Cel Win Fra A/M L NIA Y 3 Threshold AIM 11 L NIA Y Screen Frame WN Y iOckpiate AIM L NIA Y Ceftarwin Sill Storm Door AIM L NIA Y A Cal Win Sash Door AIM L NIA YCel Win Fra A Door Casing. AIM L NIA Y Sewn Frame 1 2 DoorJamb AIM t N!A Y Cellar Win Sill 3 4 Threshold AIM L NIA Y A Cel Win Sash AIM L NIA Y fCickptalg AIM L NIA Y # Cal Win Fmnw AIM L NIADoo Y * AIM L NV1A Y Screen Frame AIM L NIA Y A Doo[Casing AIM L NfA Yz --- ---- Foundation L N/A Y 1 2 Door Jamb AIM L NIA Y A Sulkheed A/M L NIA Y L34 Threshold A/M L NIA Y Fences AIM L WA Y IhindavSm l N/A Y Shutters AIM L N/A Y Win Casing AIM N/A Y /yy!' !Newel post A!M L WA Y Window Sash L N/A Y Barring Cap A/M L NIA Y Window Sil! NIA Y i t`y Harniraif AIM L WA Y A Win Casing 1 N/A Y t'I A Balusters AIM L NIA Y #Z Window Sash pU L WA Y Lower Rai A/M L NIA Y Window Sill AIM L NIA Y Treads AIM L NIA Y A Win Casing A/M L NIA Y Risers AIM L NIA Y Window Sash A/M L NIA Y Stdr>ger AIM L NIA Y l3 Lamp Post 71L NIAI Y Letace AN L N/A Y COMMENTS 1 STRUCTURAL DEFECTS: t-w—Drain Pipes L NIA Y A ElecConduH 1 L WA Y 011 Fill Pipe L WA Y Overhang T' AIM L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Sail Test Results intact only by a Licensed deleader (Must be less than 400 ppm far play area 11200 ppm for bare soil) SI]I- LOCATION MEASURE:LOOS£PAINT IC IC LOCATION AREA MFASUREMEIVT RESUL REMED REMED {MORE THAN f440 SQ tN.) DATE METH (Square Feet) (PPM) DATE METHPlay Area Bare Soil A Commerfs A LIVRA RepExtA,6/15 • 1 t John Macrsaac UR•2378 10/27/15 22 Inspector(print) :VR-2378 # tur Pageo—Of---� 46 Date John.Maclsaac c7v Risk Assessor (print E AVELI`' Signature DQ ANNIS Address of Property: A CI EXTERIOR B Side SIDE LOCATION/ TYPE OF URG IC IC DELEAD DELEAD SiDE LOCATION! LEAD T 1'F'E OF URG IC fC DElbAD DELEAD B SURFACE HAZARD DATE METH DATE METH B SURFACE HAZARD HAZ. DATE METH DATE METH Siding L WA Y ) I `I Window Sig AIM t N/A Y Comer Boards -WA Y )1•t 44 B Win Casing . AIM L N/A Y B Lawer7rim L WA Y Window Sash AIM L NIA Y Upper Trim All (L)WA Y f-1 Cellar Win all AIM L N!A Y Win Abode 5 t A Y t•t B Cei Win Sash A/M L N/A Y [Door orrdt Above 5 L NIA Y Cei Win Fre A/M L NIA Y torm Door AIM L N/A Y Screen Frame A/M L NIA Y A(M L WA Y Celar Win Sill AIM L NIA Y B oor Casing A/M L NIA Y B Cal Win Sash A/M L NIA Y 1 2 Door Jamb AIM L N/A Y Cal Win Fro AIM L NIA Y 3 4 Thmshoid A/M L NIA Y Screen Frees A/M L N/A Y Kickpiate AIM L NIA Y Cellar Win SM A/M t N/A Y Storm Door AIM L N1A Y $ Cal Win Sash A/M L NIA Y Doti AIM L N1A Y Cal Win Frame AIM L NIA Y B Door Casing AN L NIA Y Screen Frame A/M L NIA Y 1 2 Door Jamb A!M L NIA Y Cellar Win Sill A/M L NIA Y 3 4 reowd A/M L N/A Y $ Cet Win Sash "late AIM L N/A Y A/M L N/A Y CelWin Frame AMA L NIA Y Door AN L NIA Y Screen Frame A/M L Na Y B Door Casing AN L WA Y Foundatiaon Y 1 2 Door Jamb A/M L NIA Y $ Bulkhead A/M l NIA Y 3 4 Threshold AIM L N/A Y Fencer AIM L N/A Y Window Sit) (�6 AIM L WA Y Shutters A/M L NIA Y B Win Casing A/M L N/A Y Newel post AIM L N/A Y # Window Sash ot1 AIM L N/A Y Railing Cap. AIM L NIA Y Window Sill NIA Y �'G Handrail /1J AIM t NIA Y B Wm Casing J AIMO N/A Y (3 B Balusters AIM L NIA Y Window Sash ABM L N/A Y Lower Rail .AIM`L N!R Y Window Sill AIM L NIA Y Treads AIM L NIA Y B Win Casing AIM L NIA Y Risers A/M L N/A Y # Window Sash AIM L NIA Y Stringer AJM L N/A Y B ..::.i.. • LN)Aj Y La f AIM L N/A Y COMM lSTRUC7URAL DEFECT56j1 Cop. r _ �� 3 L NIA Y( Rraia P;pas ! G1 f/ B Eloc Conduit t NIA Y C?j U r 1 La Oil Fit Pipe L N/A Y t� ► 9 Trim NM L N/A Y Excluded Surfaces:Surfaces fisted in this box can be made Soil Test Results Ove intact only by a licensed deleader (Must be less than 40D ppm for play area/1200 ppm for bare soil) SIDE LOCATION MEASURE.LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REM REMED 8 (MORE THAN 1440 SQ.IN.) DATE METH {Square Feet) (PPM) DATE METH B Play Area B Bare$od a Canmenl�: a I.1/RA RepExtD,6/15 Jahn Macisaac UR•2376 ' ' 10/27/15 r 0f ""22 _._ inspector(print) L!c# n r �G Date Pore R-OilJohn Maotsaac VR-2378 Risk Assessor Ipdr+t 2 AVE.'e Signature ANNIS Pd4s_Q_f Property: n AN.# EXTERIOR C Side SIDE LOCATION/ L TYPE OF URG IC IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC 1C DELEAD DELEAD C SURFACE HAZARD HAZ DATE METH DATE METH C SURFACE I-lAZARD HAZ4 DATE METH DATE METH Sides L WA Y Whxlow SRI AIM L WA Y Comer Boards y f A Y ( C Win Casing AIM L WA Y C LowerTrim L tJJA Y W6idowsash NM L NIA Y UpperTrtm NIA Y CallarWin AIM L NIA Y Wtn Above S L NSA Y C Cei Win Sash AIM L NIA Y Pordt Above 5' L NIA Y # Cal On FrameAIM L NIA Y Storm Door A/M L NIA Y Sawn Frame AIM L NIA Y Door A/M L NIA Y Caltar Win$01 AIM L NIA Y C Door Casing A/M L N1A Y C Cel Win Sash A1M L NIA Y 1 2 Doorjamb AIM L N/A Y Cat Win Frame AIM L N/A Y 34 Threshold A!M L WA Y Saw Frame AIM L NIA Y Ki0plate AIM L NIA Y Cellar Win Slii AIM L WA Y Storm Door AIM L WA Y C Cat Win Sash AIM L WA Y Door A/PA L NIA Y Cal Win F AIM L NIA Y C Door Casing A/M L NIA Y Screen Frame AIM L NIA Y 1 2 Door Jamb AIM L NIA Y Cellar Win Sill : AIM L NIA Y 3 4 Threshold AIM L NIA Y C Cet Win Sash A!M L WA Y lGokplate AIM L NIA Y # Cal Win Frame AIM L NIA Y Door AIM L N/A Y Screen Frame AIM L NIA Y C DoorCasUg AIM L WA Y Foundation (� AO L NIA Y ! 1 2 Door Jamb A/M L WA Y C bulkhead AIM L NIA I Y 3 4 Threshold AIM L NIA Y Fences AIM L NIA Y Wurdow Sly 4AA Shutters AIM L N/A Y C Win Casing Newel post AIM L NIA Y # Window Sash Baiting Cap AIM L NIA Y Window Sgl Handrail AIM L NIA Y C Win Casiro A/M L WA Y C Balusters AIM L WAI Y # Window Sash AIM L WA Y Lower Raft AIM L WA Y window Sgi Abut L WA Y Treads AIM L NIA Y C WACaSIN AIM L WA Y Risers AIM L NIA Y # Window Sash A!M L WA Y Stringer AIM L NIA Y C Lamp Post L N/A Y Laft A/M L NIA Y COMMENTS I STRUCTURAL DEFECTS ) c Dram Pipes L NIA Y C Elec Conduit L N/A Y 011 FW Pipe L WA Y L—loverhang Tft AIM L NIA Y Excluded Surfaces:Surfaces listed in this box can be made Soil Test Results intact only by a licensed deleador (Must be to than 400 ppm for play area/1200 ppm for bars soil) SIDE LOCATION MEASURE:LOOSE PAWT IC IC LOCATION AREA ME.ASUREMM( rI RESUL RE—ME D REMED C (MORE THAN 1440 SQ.INJ BATE METH (Square Feet) (PPM) DATE METH C Play Area C bare Satl C Comments: . C L1/RA ItepRitC,6/15 John Maclsaac UR-2378 10/27/15 22 inspector(print) Lie# i ate Page I Of Date odd John Maoisaac VR-2378 Risk Assessor (pbr2 P-114 E AVE Lid# Signature p Address of Property: Apt. EXTERIOR D Side SIDE LOCATION/ LEAD TYPE OF URG fC —IC DELEAD DELEAD SIDE LOCATION/ LEAD TYPE OF URG IC (C DELEAD DELEAD D SURFACE HAZARD H . DATE METH DATE: METH D SURFACE HAZARD DATE MEIN DATE METH Siding —�u NIA Y !-( yY AFlN L WA Y Comer Boards N/A Y 11,13 D Win Casing AIM L NIA Y D LawerTrim L NIA Y WInISash AIM L WA Y Upper Trimz — NIA Y I Cellar WinSw AIM L WA Y Win Above S NIA Y l•13 D Cel Win Sash AIM L NIA Y Porch Above 5' L N/A Y Cal Win F A/M L WA Y Storm Door A/M L WA Y Screen Frame AIM L WA Y Door WA Y I Cellar Win Sill A/M L NIA Y [34 DoorCasir� �t t{,�WA Y / i I D Cef W!n Sesh AIM L NIA Y Door Jamb N!A Y 1 • �6ij Cell W»Frame' A/M L WA Y Threshold M6 AIM L NIA Y Screen Frame A/M L WA Y KkocpfeM AIM L NIAJ Y Cellar Win Sig ARM L NIA Y Storm Door A/M L NIA Y D Cel Win Sash AIM L WA Y Door ( AIM L NIA Y # Cal Win Fra A/M L WA Y D Door Casing N/A Y Saner Frame A/M L WA Y 1L§Door Jamb NIA Y S CdarWin Sill ARM L N/A Y 3 4 Threshold AW L WA Y D Cei Win Saah AIM L NIA Y Kid�ta9e AIM L NIA Y # Cal Win Frame A/M L WA Y Door AIM L WA Y Screen Frame A/M L NIA Y D Door Casing AIM L WA Y 4Fences L NIA Y 1 2 Door JambA AIM L WA Y D A/M L WA Y 3 4 Threshold AIM L N/A Y A/M L WA Y Window Sill NIA Y d (� AIM L WA YD Win Casi ng A/M /A YI /tif'L� eweps If AIM L WA Y # .Window Sash A/M L WA Y RarTmg Cap AIM L WA Y Window Sill N/A Y .l Handrail AIM L N/A Y D nCasing AIMS WA Y •j !) Balusters ARM L N/A Y #Ti Window Sash AIM L WA Y Lower Ralf AIM L WA Y Window Sill A/M L WA Y Treads Aavt L NIA Y D Win Casing f AIM L WA Y Risers AIM L NIA Y #�Window Sash AIM L NIA Y Stringer A/M L NIA Y D Lamp Post L WA Y Lattice A/M L NIA Y OMMENTS I STRUCTURAL DF_FECTS:� GfU 4,W e Drala Pipes dl L NIA Y (f"J C9 D EIec-Condult L WA Y Oil FH(Pipe L N/A Y Overhang T AN L WA Y Excluded Surfaces;Mces listed in this box Can be made Sod Test Results intact only by a licensed deleader (Must be less than 400 Ppm for play area 11200 ppm for Mare soil) SIDE LOCATION MEASURE:LOOSE PAINT IC IC LOCATION AREA MEASUREMENT RESUL REMED REMED D (MORE THAN 1440 SO.IN.) DATE METH (Square Feet) (PPM) DATE METH D Play Area D Bare Soil D Comments: D LnA RepExtb,b/f 5 ' •� a TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date/® J S to Time: In Out Owner 40 %sa T ��s� Tenant CAROL- Address ,361Address ? D OX Compliance Remarks or Regulation# Yes . NO Recommendations 2. Kitchen Facilities N17,410 3. Bathroom Facilities ���w,~• 4. Water Supply 5. Hot Water Facilities / of -� 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal- 3dq 17. Temporary Housing kelv G �"'► 18. Driveway Width � C 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles w ax) Number of Persons Allowed (max) Person(s) Interviewed Inspect i If Public Building such as Store or Hotel/Motel specify here BOOKA24 P:GE MASSACHUGETM aurrcu:w oeen INDIVIDUAL"' e I, EDWARD A. CARACOSTAS, Trustee of CARR REALTY TRUST, under a written Declaration of Trust dated December 1, 1966 and recorded in Barnstable County Registry of Deeds in Book 1357, Page 214, of Barnstable (Hyannis), Barnstable County,Massachusetts (mailing address: P. 0. Box 537, Hyannis, MA 02601), for consideration paid,and in full consideration of 4/OToAO.oO grantito MICHAEL PACY, Trustee of THREE-SIXTY-NINE SOUTH STREET TRUST u/w/d/t dated January 18, 1982, recorded with Barnstable County Registry of Deeds herewith. M it address: 104 Charles Street, #166, Boston, MA 02114, with *dttlubn towan to thelan&& together with the buildings thereon situate in Barnstable (Hyannis), Barnstable County, Massachusetts, bounded and described as follows: Beginning at the Northeast corner of the premises herein conveyed: thence running in a Westerly direction along the south side of so-called South Street, a distance of one hundred eighteen (118) feet, more or less, to so-called Pine Street; i f thence in a Southerly direction along the East side of so-called Pine Street, a distance of one hundred fifty-three (153) feet to a stake at land now or formerly of Walter H. Sherman et ali; thence running in an Easterly direction along said land now or formerly of Walter H. Sherman et ali in a line parallel to South Street, a distance of one hundred ". eighteen (118) feet, more or less, to land formerly of Jacob H. Bassett and now or �. formerly of N. Alphonso Bradford et al; thence in a Northerly direction along the land formerly of Jacob H. Bassett and now or formerly of N. Alphonso Bradford et al, a distance of one hundred fifty-three (153) feet to the point of beginning. The above-described premises are conveyed subject to a first mortgage to Ann C. Morrison dated October 1, 1970, in the original principal sum of $40,000.00, duly recorded in Barnstable County Registry of Deeds in Book 1486, Page 123, which said mortgage the Grantee by the acceptance of this deed assumes and agrees to pay. For Grantor's title, see deed of Ann C. Morrison dated September 30, 1970 duly recorded ` in Barnstable County Registry of Deeds in Book 1486, Page 122. t The Grantor by execution of this deed certifies that Carr Realty Trust is validly in existence and in current full force and effectgUp5 ([t4LM l�Cc ay/�tTfO t PROPERTY ADDRESS: 0369 South Street, Hyannis, MA 02601 Q f 6 ('Individual—Joint Tenants—Tenants in Common—Tenants by the Entirety.) f BOOK3424 ptu V9 hsa9l;w+a1 ���� xl�RN7ocltaMaidc>�atsaex >mig�Ce6C idelvsaia�dc� se6ca�hsex>mfeaxa�a�areiroc Nauss......TY..........hand and seal this........7Y. C........................day off.!.v!'....... .........M.N.. ..................................................................................... .ff.............�l..... ....:'.e-L. ;�!—¢�st..... ....... ............ Edward A. Caracostas, Trustee o Carr Realty Trust .......................................................................:........... ...................................................................................... 0 he (Sammanwrulth vt Massurhuliette 198z � Barnstable, �• / /� Then personally appeared the above named EDWARD A. CARACOSTAS, Trustee of CARR REALTY TRUST, and acknowledged the foregoing instrument to be his �ee, d de ore me l ........ ......................................................... Frank E. Green otaty Public ntorlFlpctc i My Commission Expires.:......A. ..1=IPll?2F..........19................ 1986 r CHAPM 183 SEC 6 AS ANEMDED BY CHAFM 497 OF 1969 i Every deed presented for record shall contain or have endorsed upon it the full name,residence and pat officr address of the grantee and a recital of the amount of the full consideration thereof in dollars or the nature of the other consideration therefor,if not delivered for a specific monetary sum.The full consideration shall mean the total price for the conveyance without deduction for any liens or encumbrances assumed by the grsntce or rems ring thereon.All such endorsements and recitals sheen be recorded as pan of the deal.Failure to comply with this section shall not affect the validity of my dad.No register of deeds shall accept a deed for recording unless it is in cdmpliance with the requirements of this seaitw. liti, �:�► JAN 18 82