63 DeLead 2019 12/05'2018 WED 1 3:27 FAX +-- Northampton Board Health 14)COr/003
12/5/2018 Notification of Deleachea Won
Department
ofP
oHealth
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NOTIFICATION OF DELEADING WORK
All sections of this form must be compietad in order to comply with the notification requirements of
.M.G.L. C. iii s 197, 454 CMR 22.00 and 105 CMR 460.000, as most recently amended.
This Routine Notification • submitted at least 10 days
State UA
Notification Is prior to project start date -- -
NOTIFICATIONS MUST BE SIGNED,DATED AND COMPLETED IN THEIR ENTIRETY.INCOMPLETE NOTIFICATIONS WILL NOT BE
ACCEPTED.
Project Information : A proper address is critical.All addresses must be verified through the USPS
database Address Verification
Nouse Erg�, 1 Street Name: Bradford
Number
Street Type 1St '_'.. Unit/Apt
Num
City; Northampton Zip Code: 1060 —1
Property :Ralph Litwin Phone:
073-538-2432
Owner/Agent:
Owner Address: Ralph Litwin, Email: rhlitwin�gmall.
.._. . .. ..
TYPE OF SinNle leF,a •_I
DWELLING:
Second Property Phone 2:
Owner/Agent:
Owner Address 2 72 Dean Roa Email
address 2:
TYPE OF _. ............
T
DWELLING 2: �-SaleclJi
Inspection Information: Before starting any work, contractors should check a property s previous lead
inspection history at CLPPP Lead inspected Homes Database
Name of Licensed Lead Tim Foley
Inspector/Risk:
Inspector/Risk Assessor License 1208
Number:
PBp',/Bwr.delme.agljX;116(y3p04saeommgkr45rkabgCZz)udeleadingworkno'ifcation.aeax?AspxANODetectecovieSuppod=l 1,2
12/05/2010 WED 13: 20 PAX Northampton Boar° Health 00022/OC 3
12:512018 DELEADING CONTRACTOR
DELEADING NOTIFICATION FORM
DELEADING CONTRACTOR
as-MODERATE RISK SUTERVISOR/LEAC-SAFE RENOVATION CONTRACTOR
•THIS SECTION MUSTBE COMPLETED BY THE DELEADING CONTRACTOR OR THE MODERATE RISK
SUPERVISOR/LEAD-SAFE RENOVATION CONTRACTOR WHO WILL BE PERFORMING THE DELEADING WORK.
CONTRACTOR INFORMATION
Contractor Name: Abide Inc
Contractor 00
Box 886,483 Shaker Road,
Address:
City. East Longmeadow State: MA Zip Coae: 01028
Contractor Contact Maria Tilli
Person: -
Of ce Phone: 4135250644 Cell Phone: Email:
maria(Rabideinc com
Contractor License Number: 'DC_ • 'i 01619 _ Expiration Date: 118/25(2019 IN
TYPE OF DELEADING WORK TO BE PERFORMED
Class l Molding Methods(check all that apply)
Malang Intact
_I Replacement
1'Wevnry scraping or wire brushing
�.:Other-Enter other celeadlrg moods
Moderate Risk Deluding Melhods(chak all that apply(
Covering
CJ LIqud Enapwlaton
Making Irtact(Exterior-up to 10 square feet total a(exterior surface)
Li Making Intact(Interior-up to 2 square feet per room)
.l Replacement
Lon Risk Deleading Methods(check aft[kat applyl
1 NIA
V Capping Baseboards
Cpering
Ix Liquid Encapsulation
Repiaamert iOf/LY doors,cab net doors,shutters,sielves not affixed drawers,windows on hinges)
WORK SCHEDULE
Project Start Date: 01/04/2019 IN Project Completion Date: 01/09)2019
List the hours the work will be conducted: Start time: 7.00 AM a I End Time: 5.00 PM •
In accordance with Massachusetts General Laws C. 111, sec. 197,454 CMR 22.00 and 105 CMR 460.000, notice
of the date and methad(s)
of removal or covering of paint, plaster or other accesslbie materials contain ng dangerous levels of lead is to be
provided and must be
received by the following agencies, at least 10 days prior to the beginning of the deleading work. By submitting
this form electronically,
hitp:Mawr doboe,pry(X(1)9(y3p045aeommgkr45rkabg02p)Ne:eadngConlrantor asps 112
12/05/2018 WED i31 29 FAX -+-• NortlanptCn Board Health 114003/et3.
12i512018 ewr.detna.orgr(X(1)S(y3p045aaommgb45rkabg02M/CorHvmaton_mmracmraspx
4,� ii THE COMMONWEALTH OF MASSACHUSETTS
llepanenl of Labor Standards
1 1 1. mHomepage_wow mass.gge/dols
Thank you fer your:ubm_sion.Your confirmation number is.242020.
A confirmation email has been sent to.maria!tabideinc.com
Continua Finian
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