270 Notification of Deleading Work 2012 12/2012 MON 9:34 FAX Northampton Board Beaitn
Abide Job#12499e..
Not On:9/27/1 Sao
Rev#111/1�/ & 11,,
"4Pn
Department of Public Health&Department of Labor
NOTIFICATION OF DELEADMG WORK
All sections of this form most be completed in order to comply with
the notification requirements of M.G.L.C.111§197,
454 CMR 22.00 and 105 CMR 460.000,as most recently amended
Contractor performing project Abide Inc. Lic #DC001619 pip.pap 8/2013
Lead Paint Inspector Eileen Manley
ADDRESS OF PROJECT:
Catherine Cocco
street Address 270 South Street
City Northampton, MA
Date of Inspection 8/23/2012 "Arnie p M3305 E,p Dad TBA
Apt Numha Units 1 &2
zip 01060
Property rTener Katherine Cocco Address
89 Hanson Drive, Vernon, CT 06066
Telephone Number 660-202-1808
Deleading Method:®Wet/Dry Scraping ❑Real Gun ['Liquid Encopsutont
0Remolidon ❑Caustics 3 Replacement
®Covering 0 Other
If"Other"selected,please explain
Check one: Dwelling is multi-fmnilyj XX
Sioglc4amityJ I Other 1
Start Dam 12/3/2012 Completion Date 12/7/2012
When will work be done: AM 7 PM 5 (Specify limes oa site)
wetkait? TBA
Project Supervisor Name Jerry Gray up.,,,.p DS003770 Exp.Date 8/6/2013
worker',Cbmpevatiw Polley Number AWC7013278012012 came, A.I.M.Mutual Insurance
In ease of emergency contact Tilli,V.P.Abide, Inc. Tel.0I 413 ) 525-0644
(Contractor's Representative)
PELEADING CONTRACTOR
,main Vac
The undersigned hereby states,under the pains and penalties of perjury,that he/she Si read and understood the Commonwealth of
Massachusetts Ddnding Regulations,454 COOL 22.00,and the Led Pakoahg Prevention and Control Regdatione,105 Ch4R 460.000,and
that the information contained In this notification h tree and correct to the bat of his/her howled and bdicf.
Date //- /Z 10 /2_
Signed
F_ 111, V.
Company Name Abide Inc.
Address P.O. Box 886,483 Shaker Road, East Longmeadow,MA 01028
Telephone Number 413-525-0644
Notified On: 9/27/2012
Abide Job#12499
Rev#1 11/12/12
OVER-a
r20L2 MON 9134 FAX --- Northampton Board Health
Page 2 of 2
accordance with Massacbmom General Laws C.1111197,454 CMR 22.00 and 105 CMR 460.000,notice of the date and method(s)of
mount or covering of pint,plaster or otter accessible materials arontahutg daagerom levels of lead is to be provided and mast be received
the following agencies,at least I {(11)days prior to the beginning efdNeadieg.
OTIFICATIONS MAY BE FAXED.
Department of Labor,Lead Program,Division of Occupational Safety
19 Stamford Street,In Flour,Boston,MA 02114 FAX:611-6264965
Director,Childhood Lead Poisoning Prevention Program
Department of Public Raldh Donovan Restih Building,5 Randolph Street,Canton,MA 02021 FAX 711-T746700
Occupants of dwelling unit
All ether occupants of the residential premises,if any
Local Board of Healer/Cade Enforceneat Agency City of Northampton, MA 413-587-1221
Massachuset6 Historical Commission
--220 Morrissey Blvd.
Boston,MA 02202
FAX(617)7275128
(if premises are Rated on the State Register of Historic
Places,this notification omit be made upon receipt of an
Order to Correct Violadoas or at least 30 days prior to
Initiating preventive deleadlag)
IOTHM1CATIONS SHALL BE COMPLETED IN THEIR ENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT
E ACCEFFED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORLO'ORCE DEVELOPMENT.
ARTY OWNER(Downer or Wio:neeL motes agent will be performing low-risk deleadm8 work,complete the Mowing):
'roperty Owner Agent(s)
darn, NOT APPLICABLE
telephone Number ( )-
certify that 1 have complied with the hinting requirements of the Commonwealth of Massachusetts Lead Poisoning Prevention and Control Regulations,105
7MR 460.175,forowner/agent low-dais abatement and containment. I further artily that/or my agentwill be perform:og the following taw-risk activities
1 have circled alt that apply):
applying liquid encspsulant
tapping baseboards removing doors,cabinet doors,abutters
applying exterior vinyl siding coverhsg surfaces
I certify that all the in/emotion coMaimed in this notification is true and cont to the bast of my knowledge and bell
Date Signed
Revised 12/2007
Notified On: 9272012
Abide Job#12499
Rev#1 11/12/12
2012 THU 15:36 FAX ■,4. Northampton Board neaitn
dt Job#12498r-
On1/27/1 �1�
*fAh.
Department of Public Health&Department of Tabor
NOTIFICATION OF DELEADING WORK
All actions of this form matt be completed in order to comply with
the notification regovements of M.G.L C.1110197,
454 CMR 2200 and 105 CMR 440.010,as most recently amended
ntracter performing project
Abide Inc. IJceoeeg DC001619 &p.Dane 8/2013
Id palmlarptetar Eileen Manley
Oscine
Adrq 270 South Street
ty Northampton,MA
Date orl.patm 8/23/2012 IMaa,d M3305 Exp.Data TBA
Apt.Number Units 1 &2
lap 01060
opMy
Owner Katherine Cocco Adarw 89 Hanson Drive,Vernon,CT 06066
tepnone Number 860-202-1808
deeding Method:®Wet/Dry Scraping []Beat Gans Q Ut4uId Eecapalaat
Q jDmcUrioa 0 Caustics 29 Replacement
'BCovrring ❑Other
"Ogee selected,ukase explain
halt one Dwelling is muki-fanily�XX Single-temily1 1 Oder
nnnate
11/12/2012 Coepktk Date 11/16/2012
/ken wgl work be dove. AM7 PM5 (Spedrr limes a site) Wedmodz TBA
rofeet3opmbor Name
Jerry Gray IJce.n# DS003770 Exp.Date 8/6/2013
yorkera commando,Pdey Number AWC7013278012012
Frank Tilli,V.P.Abide, Inc. T�g_t 13 525-0644
El lase of emergency natant
Contractor's Representative)
carder A.I.M.Mutual Insurance
Ile aadetYg1nd hereby Wens,order the palm and penalties of paltry,that ba4ie has read and aaderatnod the Commonwealth
b of mad
dasmdr.tW 2Meading RegolaIam,454 C 482101,ad dm Lead Pa soain PM/Min ad Canbti Regulations,105(MR
hat as iafaemathn contained Is this notification is tree and cornet to the bat of 110ter, wledge and belief.
fete 9-27-12 5gI,5
:omgnay Name Abide inc.
P.O.Box 886,483 Shaker Road, East Longmeadow,MA 01028
lddress
rehphme Nampa 413-525-0644
Notified On:9/27/2012
Abide Job#12499
OVER-F
2012 THU 15:37 PAX '-- Northampton Board Rearm
Page S of 2
accordance with Massachusetts Genera Lawn C.1115197,454 CMR 22.00 amt 105 CMR 460A00,notice of the date sod methinks)of
nova or covering of paint,plaster or otter accessible material containing daageroas levels of lead is m be provided and mint be received
the flowing agencies,at least 7'H'1(1F)days poor to the begbomg of deleadbg.
y27FICATIONS MAY EE FAXED.
Department a Labor,Lord Program,Divbioe of Occapatbeal Safety
19 Sbalord Street,I°Floor,Burton,MA 02114 FAX:6176266%5
Director,Childhood Lad Poisoning Prevadea Program
Department of Public Health,Donovan Haab Bedding,5 Randolph Street Cation,MA 02021
Occupants of dwelling unit
All other oaepanb of the readada promise;If any
IoW BardaseallMCaae fsdoremm<Agar
City of Northampton. MA 413-587-1221
Massachusetts Histmfal Comminioe
220 Morrissey Hlyd.
Berme,MA 02202
FAX(617)727-5128
FAX:761-7744700
Of premises aro listed on the State Register of Historic
Pleas,this ne00ntla mast be made'pow retain of an
Order to Correct Vidadas or at lent 311 days prior to
W tbdog prevanve deleading)
O'MICAT1ONS SHALL BE COMPLETED IN THOR MUMMY,DATED AND SII;NED-INCOMPLETE NOTIFICATIONS WILL NOT
E Aar7FD AND WILL BE REIIMMED BYTE DEPARTMENT OF LABOR&WORIO*ORCE DEVE OPMIT T.
ROMMILIWUR(If owner or unheated oawer's meet will be performing bw4isk dehadalg work,complete the fa9owbg):
ropetty Owner AMKe1
,gimps NOT APPLICABLE
'depose Number( )-
testify that I have complied with the training rayirataaa of the C®omwakh of Mmmrtlstls Led Poisoning Prevention and Control Regulations,105
MR460.175,fm oaw/agud low-risk abatement and amaomat I farther ratify the l or my aged sal be perform ing the following bwaidc activities
1 have circled all that apply):
applyNg BgtM acwsWat capping baseboards ramming ing doors,cabinet doors,shutters
applying exterior vinyl*Rag covering surbas
mdfy that a1 the bbrmedon am®d in this eulil aim is true cord comet to the bat ofmy knowledge and belief.
Date Sind
Revised 122007
Notified On:9/27/2012
Abide JOb#12499