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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 LpaHucentoflabor Slandares Ch/hn/ oodL1cd 'aisoniv Prevention Prop me • la Stanifbrd Sr e 2nd Flop; 1111101011 N /tl Bdll 4 vnn 1462/14 Randolph: r t • cCanton. trllZf y.. +t:. e tiv'w m0rge4r/dP�dIRRR 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 F op l/evs dolma.rxgllX(1)$(y1p045aeomlgkr46ikabg02<)YCor temabammntractor assx