36 APT#19 Deleading Notification 2002 ABIDE, INC. PROJECT #
0z 321`
COMMONWEALTH OF MASSACHUSETTS
Department of Labor G Industries and Department of Pub
NOTIFICATION OF bELEADING WORK
All section of We toto sat be completed is order to
with the wetifieatla reinissota of M.G.L. *All 5 197
454 MR 12.00 sd 101 pK 110.000 as west stoutly
rill M24i1•
fgVVO!VV
l5 t7 l5 l'1 ty
earth
. 141 22002
ly
NORTHAMPTON BOARD OF HEALTH
(AGENCY ME)
Contractorperfonnig project ABIDE, INC. (Frank Tilli) Ucenseitg DC ept 0e 1619
Exp.date tmber 10, 20(Z
Lead Paint Inspector - STEVE Doti NSKI License 1 S-317f
Date of Inspection 42.4107_
It low-risk deleadtnq work is being performed, complete the following line:
Property owner Agent(s)
Address of Project
Building Name (if any) p w'c Floor Q
Street Address 3b €r.DC'oR0 'C E&RA� Apt. No. ' 1
City /l�9R HAMPTON zip Olp400
Defending +tethnd: etyDry Scrapin Heat Gun Caustics
Liquid Encapsulant a Demolition Replacement
kevwvAt
If "Other" selected, please explain
Llwct 0116: dulling is edits-family
Start date
GI Z41bz_
e(aq\t
Completion date 7/f 102..
When will work be done: A.N. 7 :(0- P.M. $ [OO Weekends? NO
Project supervisor's name Robert P. LaMotntain License R DS3605
Property owner SMIn. \9[.L_GE
Address (2f 1/J ESl" .
City No ThAM PIO n% State
Telephone Ric HA RD Ko(CtCA1 tow$1C.l
413-s8S-24S8-
In case of emergency contact Frank Tilli, President
MA- zip OIOG3
Phone: day 413-525-0644
evening 413-525-0644 _
(over)
UUI4414VV4 'MU 10.04 !AA %au 444 UVIO (WIVE 1.1l.
IgJVVI!VUI
In accordance with Ma.huactta Central Lava c. 111 5 177 CDR 22.1' id 105 OW 460.000 notice
of the dace and methods is of removal or covering of Paint, plaster other accessible materials
containing dangerous levels of lead is to be provided end oust be reeelved by the following
persons, at least ten (10) days prior to beginning of deleading. t
1. occupants of the dwelling unit
2. All other occupants of the residential premises, if any
Director, Childhood Leading Poisoning prevention Program
Department of Public Health, 470 Atlantic Avenue, Boston, M 02110
Director, Asbestos 4 Lead Pcagram
Department of Labor a Industries
Room 11006, 100 Cambridge Street
Boston, MA 02202
local Doard of Meal rh/Cede Enforcement Agency tea&mAMVWtt)
6. Massachusetts Historical Commission
220 Morrissey Blvd.
Boston, M 02125
Unloading Ceetractor
•
•
rax (6n) 784-8410
Fab (617) 721-7566
O4131j sal- 1221
I1f premises is listed an the State Register
of Historic Places, this notification must be
wade upon receipt of an order to Correct
Violations or at Dust 30 days prior to
initiating preventive dalaadang)
Pax 1611) 727-5128
The undersigned hereby states, under the pains and penalties of perjury, that
he/she has read and understood the Commonwealth of Massachusetts Deleading --
Regulations, 454 04R 22.00 and Leading Poisoning Prevention and Control
Regulations, 105 CDR 460.000, and that the information contained in this
notification i�ss true and correct to the bet of his/her knowledge and belief.
Date (/11 l Lela e_ signed: PM/CA
r
Title: President
Frank Tilli
Cowpony: ABIDE, INC.
Property amen (If owner of unlicensed owner's agent will be performing low-rise deleading wort)
I certify that I have complied with the training requirements of the
Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations,
105 CDR 460.175, for owner/agent low-risk abatement and containment. I
further certify that I or my agent will be performing
the following low-risk activities (I have circled all that apply):
applying liquid encapsulant
applying exterior vinyl siding
removing doors, cabinet tigers, shutters
capping baseboards
covering surfaces
1 certify that all the information contained in this ratification Is true and correct to thn
best of my readiege a,M Iw11•[.
Date: Signed:
REV 10/12/95
ABIDE, INC. PROJECT 6 023.21
(VNtT 1 \)