126 Notification of Deleading Work 2006 �jmt/t6ioJ1-
.oide Job# 06522
Department of Public Health/Department of Labor&Workforce Development
NOTIFICATION OF DELEADING WORK
All sections of this form must be compkatsd in order to comply wi
the notification requirements of M.O.L.G111%197, OCT 454 CMIR 22.00 and 105 CM 460.000,as most recently amended OC — 6
Courtesy Notification '�------- --
ArriPTCV autitiD.
Contractor performing project Abide, Inc.(Frank Tilli) License#D0001619 Exp.Date 08/2802007 ` — - - '
ii
Lead Paint Inspector T.B.A.
DateofimpeWon T.B.A. theme#T.B.A.Diana, T.B.A.
ADDRESS OF PROJECT:
Street Address Smith College-Boiler Plant, 126 West Street Apt.Number N/A
city Northampton, MA
Property Owner Smith College
Telephone Number 413-5852458
Address
zip 01063
126 West Street, Northampton, MA 01063
Wending Method: Wet/Dry Scraping Heat em Lmdd Emapsulant
Demolition Canada)Opp( Replacement
Covering Other
[Miller"selected,please amble
Check one Dwelling is multi-family She-family Omer Boiler Plant
Start Date 10/2/2006 Completion Date' Dt lo-la -$004
When will work be dome: AM 7:00 PM5:00 (Syedp•times CD de) Wws:Pader
Project Supervisor Name Jerry Gray Limos.#0.4003770 Exp.Dam 81112006
Workers Compensation Policy Number WC7013278012006 carrier Aim Mutual Insurance
Ito sit of emergency contact Frank Tilli, Abide, Inc.
(Contractor's Representative)
DEILannar CONThA IDR
T4110( 5259644
The undersigned hereby states,under the pains and penalties of perjury,that beshe has read and understood theCommonwalth of
Mas,actusetb Ddading Rcguladons,454 CMR 2200,and the Lad Poisoning Prevention and Control Regulations,105 CMR 460.000,and
that the information contained In this notification is true and correct to ofbb/haknowled belief.
Date 9/29/2006 - Sham / -Z.i�iv
Frank Tilli, Abide, Inc.
Company Name Abide Inc.
Address P.O. Box 886, 483 Shaker Road, East Longmeadow, MA 01028
Telephone Number 413525-0644
1P-5-0 4 4/Asa l-t 4 8444'
OVER-t
U/Ua;ZUpn I➢t
p
Oas
Paget of 2
lu accordance with Massachusetts Central Laws C ill 8197,454 CMR77.00 and 105 CART 460.000,sodce of the date and method(s)of
removal or coverbsg of paint,plaster or other aeassibk materials centanbm dmgmau Dve&of lead Is to be provided and must be received
by the following agencies,at least/0(10)days prim to the beginning of dekading.
NOTIFICATIONS MAY BE FAXED.
Department of labor,Lead Program,Division of Occupational Safety
399 Washington Street,Sas Floor,Boston,MA 02108 FAX 617-727-7563
Director,Childhood lad Poisonbg Prevention Program
Department of PubBCHealth,Dmme=Health Building,5 Randolph Street,Canton,MA 02021 FAX 781-774-6700
Occupants of dwelling unit
All other occupants of the residential premises,if any
5. Local Board of Health/Cede EafmamentAgeoey Town of Northampton Fax#413-587-1221
Massachusetts Historical Commission
220 Morrissey Blvd.
Nosten,MAO2202
FAX(617)727-5128
(if premises are listed on the State Register of Historic
Places,this notification must be made upon receipt of an
Order to Correa Violaams or at leact 30 days prier to
initiating preventive deleading)
NOTIFICATIONS SHALL BE COMPLETED IN THEIR ENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT
BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORKFORCE DEVELOPMENT.
Not Applicable
PROPERTY OWNER(If inner or unlicensed owm's agent was be performing low-risk&leading work,complete the following):
Property owner Not Applicable
Address
Agoras)
Telephone Number_( J-
1 emit:that have complied with the training roryuemcata of the Commonwealth of Massachusetts Lad Poisoning Proven on and Control Regulations,105
CMR 460.175,for owner/agent low-risk abatement and ammimient 1 further certify dial]or my agog will be paforming the following low-tide activities
(I have circled all that apply):
applying liquid enapsulant
capping baseboards removing doors,cabinet doors,shutters
applying exterior vinyl siding covering surfaces
I certify that ail the information contained in this mafioetiou is true and cm um to the best of my'knowledge a d belief.
Date
Abide Inc. Job# 06522
Notified on 9/29/2006 mat
06/04
Signed
'05/2006 Till 1$:11 Pu
a b i d e
Abide, Inc., Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: /D" S pG
ATTENTION:
FAX#:
[ ] Director,CLPPP(Boston) 781-774-6700
[4 Director,LEAD PROGRAM(Boston) 617-727-7568
14' Town/Cityof 61-l3 - 611-la
(Local Board of Health)
I ] Massachusetts Historical Commission 617-727-5128
FROM: FRANK TILLI/ABIDE,INC.
REGARDING:
[ ] PROJECT NOTIFICATION
14" REVISED NOTIFICATION Dana
[ ] OTHER:
NUMBER OF PAGES (including this one):
COMMENTS:
If you experience problems in receiving this transmission,please call 413-525-0644.
CONnDENnALrY NOTICE; The dolmans acc ompan ying this mlapy transmission may Cedilla ccafdeotialald P^vigeul -
information from Abide,Inc.Tins information is intendd for the use of the addressed individual� •
cattily. If you am not the intended recipient,be aware that any disclosure,copying,distribution,�m
use cite comma of this transmission is pmlibud. If you have received this transmission ia
phase notify us by telephone(413-5250644)immediately. 'thank yon
P.O. Box 886 East Longmeadow,MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • wnvw.abideinc.com
a FIINANCE standard AGE computed al aCmonthMNa rate f t1 require(2%payment NUALrPERCENTAGE RATE T presentation o thInvoices aximum percentage allowed by past
he law. Caere es to
a respansAle for local and collection costs it necessary to collect past due amounts.
'10/2006 TOE 10:25 FAA
Pa 4 1/1.610/1- oide Job# 06522
Department of Public Health/Department of Labor&WorlgorceDexclopment
NOTIFICATION OF DELRADNG WORK _!� (W�
All sections of this form must be completed in order to comply with Wt , 0 {JUG
the notification requirements ofM.CL C I11§197,
454 CMR 22.00 and 105 CM 1460.000,as most recently amended
Courtesy Notification
Contractor performing project Abide, Inc.(FrankTilll) uanse#DC001619 Rm.Date 08/28/2007
Lead Pailtlaspenor T.B.A. Date of inspection T.B.A. - theme T.B.A.Esp.Date T.B.A..
AMDRPCS OF PROS T'
Sweat Address Smith College-Boiler Plant, 126 West
city Northampton. MA
Property Owner Smith College
Telephone Number 413-585-2458
Street Apt Number N/A
Address
Zip 01063
126 West Street, Northampton, MA 01063
Deleading Method: Wettry Scraping Rea[ Liquid Encapsulant
Demolition Cau.tia7W0( Replacement
Covering Other
If"Other"selected.please explain
Check one: Dwelling is multi-family Singl>fis:My oom Boiler Plant
/0-A0-06
Start Date 10/2/2006 completion Date 40t61260t- ./.19m454
When will work be done: AM 7:00 pMS_OO (Specify times on site) Weekends?
Project Supervisor Name
Jerry Gray LiamegDSD03770 Exp.Dais 611f2008
Worker's Compensation Polley Number WC7013278012006 carder Aim Mutual Insurance
u Frank Tilli, Abide, Inc. Tt?( 525-9644
In se of emergency comber
(Contractor's Representative)
AOWG COa Bata R
The undersigned hereby states,under thepelm and penalties of pajury,that heishe has read and understood the Commonwealth of
Massarhuuets Deleadiug Reguatlon,4S4 CMR 21.00,and the Lead Poisoning YreVentln and Control Regulation,W05 CMR 440.00e,and
that the information contained En this notification is true and correct to t set of hhlher toweled belief, n '` //
Date 9/29/2006 - Signed mil/ //4�/�/" r"Y
Frank Tilli,Abide, Inc.
Company Name Abide, Inc.
AddrOS P.O. Box 886, 483 Shaker Road, East Longmeadow, MA 01028
Telephone Number 413-5255-0644
/0-51-e& 4. 1ea 2c cef f'd
5-0 -/0-06 e-e✓,s4 I rued M..f-t7.
OVER-*
10/2006 TUE ]0:[b rn.a
don
a
Page 2 of 2
In accordance with Massachusetts General Laws C.111§197,454 CMR22A0 and 105 Chill 461000,notice of the daft sad method(a)of
removal or covering or paint,plaster or other accessible materials containing dangerous leach of lead is to be provided and mast be received
by the following agencies,at least TEA(10)days prior to the beginning ofdeleading
NOTIFICATIONS MAY BE FAXED.
S.
Department of Labor,Lead rrogram,Division of Occupational Safety
399 Washington Street 5^Floor,Batton,MA 02108 FAX:617-727-7568
Director,Childhood Lead Poisoning Prevention Program
Department of Public Health,Donovan Health Banding,S Randolph Street,Cantor',MA02021 PAX:781-774-6700
Occupants of dwelling unit
AU other occupants of the residential premises,If any
Local Board of Health/Cade Enforcement Agency Town of Northampton Fax#413-587-1221.
Massachusetts IHsmrical Commission
220 Morrissey Blvd.
Boston,MA 02202
FAX(617)7274128
(if premises are listed on the State Register of Rhtoric
Places,this notification must be made upon receipt of an
Order to Correct Violation,or at least 30 days prior to
laidatiag preventive dreading)
NOTIFICATIONS SHALL BE WMPLETEDIN THEIR ENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT
RE ACCEPTED AND WILL BE RBLURNED BY THE DEPARTMENT OF LABOR&WORKFORCEDEVELOPMENT.
Not Applicable
PROPERTY OWNER(If owner or unlicensed owner's agent will be performing Sus'-risk del°&ng work,complete die fotbwbg):
Property Owner Not Applicable Agent(s)
Address
Telephone Number_(_, )-
I certify gull have complied with the training requirements of the Commonwealth of Massachusetts Led Poisoning Prevention end Control Regulates',105
CMR 460.175,for muss/agog low-risk ebatemau and merinmenc I further certify that I army agent will be performing the following low-tick activities
(I have circled all that apply):
applying Squid eacapsulant capping baseboards removtg doors,cabinet doors,shutters
applying exterior viral siding covering surfaces
I certify that all the information contained inthis notification is out and oarrmtto the best of my knowledge and belief
Data Signed
Abide Inc. Job# 06522
Notified on 9/29/2006 mat
08/04
r0/2006 TUE. 10:2d FAX
As
saa
b i d e
Abide. Inc.. Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
,-/d -OG
DATE:
ATTENTION: FAX#:
[ I Director,CLPPP(Boston)
[4 Director,LEAD PROGRAM(Boston)
[r Town/Cityof 6113,-,6Y7-12'4
(Local Board of Health) (v%ka.,ffa y 4`
[ I Massachusetts Historical Commission
FROM: FRANKTI.LI/ABIDE,INC.
REGARDING:
[ I PROJECT NOTIFICATION
( ,X REVISED NOTIFICATION bait.,
[ I OTHER:
NUMBER OF PAGES (including this one):
COMMENTS:
781-774-6700
617 427-7568
617-727-5128
If you experience problems in receiving this transmission,please call 413-525-0644.. . _-
CONFIDENTIALITY NOTICE The documents accompanying this tdecopy transmission may mutate confideatialaod privileged
infmmtion team Abide,lnc.T is iofomotion is wtmdo for the use of the addressed individual or
°airy. If you are not the handed,°rp w.be aware that at dlaclmme,copying.dtadbnmon,or
use of the contents ofthis transmission is prohibited If you have received this is transmission factor,
please notify us by telephone(413-525-0644)immediately. Thank you
P.O. Box 886 East Longmeadow,MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • www.abideinc.com
a
Abide,NANCE CHARGE TERMS AND computed atammonthly rate of 11/2�%ANN AL PERCENTAGE aRATE OF i18%or me maximum percenlape Mowed by the law. Client nKs to past due and
responsible for legal and coaedian costs if necessary to collect past due amounts.
10/2008 FRI 13:39 FAX
,►. KC V1.6 1.0 PLIA '�ids Job# 06522
Department of Public Health/DeparDneat of Labor&Workforce Development
NOTIFICATION OFDELEADING WORK
AD sections dthis form must be completed in order to comply with
the notification requirements of Mgt C.111519I,
454 CMR 22.00 aad 105 Chin 460.050,as most recently amended
Courtesy Notification
alieatmrperfmuulngprojeet Abide, Ino.(Frank Tilli) Wass gD0001fi19 pep.Dug x/28/2007
;nd P,mtRupocwr T.B.A. Data el Inspection T.B.A. Licensed T.B.A.&paw. T_B A.
ADDRESS OF PROJECT:
Street Address Smith College-Boiler Plant, 126 West Street Apr.Number N/A
city Northampton, MA zip 01063
properly owner Smith College Address 126 West Street, Northampton,MA 01063
Telephone Number 413-585-2458
Deleading Method: Wet/Dry Scraping Real Liquid Ennpsniant
Dementia* Cansdcf)COOL Replacement
Covering
Treiber'selected,please explain
Check one: Dwelling is multi-family.
Start Date 10/2/2006
Single-family
omen Boiler Plant / no
campueo.note 004
When will wont be done: AM 7:00 PM5_00 (Specify than on site) Week®det
Project Supervisor Name Jeny'Glay unae#DS003770 Lip.Date 811/2006
Worker's Compensation Policy Naas*WC7013278012006 CanI&Aim Mutual Insurance
lant ofnnmgeoey e.t.a Frank TO, Abide, Inc. T€y1g3f 525-9644,
(Contractor's Represant*dve)
DRlEAfING CONTRACTOR
Thetadeealgaed hereby states.under the pains stud paaldes of perjury,that he/she has rad ad nadea:tad the Comm ,end
Mauubmens Ddading Regulations.454 CMR 22.04 and the taad Paleaing Prevention aad Central Regasadon'
Date 9/29/2006 9/29/ 00pntalned in this aotifieatlom4 true and co �°*lad�%
Date 9/29/200fi - Slgnd �/
Frank Tilli,Abide, Inc.
Company None Abide, Inc.
Address P.O. Box 886.483 Shaker Road, East Longmeadow, MA 01028
Telephone Number 413-525-0644
/0-5-e b 'La 4..ace 104A
/D -10-ere 1 ta/o IAAt (
1 p-3-0.0 6 .94//5-41 A the AM i 44i
OVER-5
OCT 20606 � .
..�;a?•TpN
E0AiiD Or HEALTH
/20/2006 FRT 13:4u
II oh
Page 2 of 2
In accordanmwlth Massachusetts General Lawn C.Ili 1197,454 CMR 22.00 and ICS CMR460.400,notice of the date and method(n)of
removal or covering of paint,plaster or other accessible materials cantainbut dangaron levels of lead is robe provided end must be received
by the following meatiest at least 3ra(ID)days prior to the beginningofdeleadlag.
NOTIFICATIONS MAY BE FAXED.
Department of Labor,Lead Program,Division ofOccupatfonal Safety
399 Washington Street,Sts Deer,Busooe,MA 02108 FAX:611-727-7568
2. Director,Childhood iced Pointing Prevendm Program
Department of Public Health,Donovan Heath Btildiop,5 Randolph Street,Canton,MA 02021 FAX:711-7746700
3. Occupants of dwelling unit
4. AB other e.opna of the residential prunten,if any
5. Local Board orUealwcodaEnforeaaStAFRO Town of Northampton Fax#413-587-1221.
Maesathneena HistoricalComsWin (if premises are listed on the State Register of Historic
220 Monism End. Plata,this nodflealioa must be made tepee receipt of an
Boston,MA 02202 Order to Correct Violations or at least 30 thin prtar to
FAX(611)727-5128 Initiating prevawdve deleading)
NOTXFICATIONS SHALL BE COMPLETED IN TE M]BENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT
BE ACCEPTED AND WILL BE RETURNED BY THE DEPARIMENE OF LABOR&WORIO+ORCE DEVELOPMENT.
Not Applicable
PROPERTY O W NRR(If owner or miirmed tremor's agent will be performing tow-risk dclrading work,tmmpee the following):
Property Owner Not Applicable
Agent(*)
Address
Telephone Number (_ )-
I certify that I have complied with the training requirements of the Commonwealth ofMaccachuants Lead Poisoning Prevention and Control Regulations,105
CMR 460.175,Sin owner/agent tow-risk abatement and containment I fuller catity that)or my agent will be performing Sc following low-tink active*.
(I have ended all that apply):
•
applying liquid eempeulamt
capping baseboards removing doors,cabinet dons,shard.*
applying exterior vinyl aiding awning surfacer
I calif),that all the information contained in this notification is Mee and corm b the bet of my knowledge and belief
Date Signed
Abide Inc. Job# 06522
Notified on 9/29/2006 mat
08/04