274 Notification of Deleading Work 2008 ?-1 r
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441 4!
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1017/2008 MON 13:15 FAX
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Northampton Hoard Health 002/003
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Department of Public Health&Department of Labor
NOTIFICATION OF DELUDING WORK
MI sections of ibis form mast be completed korder to comply with
the notification reqtdrements of M.G.L.C.11M§I51,
454 CMR.22.00 sad HIS CMR401.010,as mod remedy amended
Abide Inc. Job# 085y9
Notified On:10-27-2008
Contractor Performing project Abide Inc. LicnseO DC001619 � 8/25/2009
Lead Paint Inspector J&M Inspections Date ofimpediom 7/16/2008 License F TBA Epp Date TBA
ADDRESS OF PR(LJR.CT:
Street Address 274 Crescent Street Apt Number
out Northampton,MA Zip 01060
Property Owner Chantaohet Clark and Mamaret Lamb Address 274 Crescent St Northampton MA 01060
Tdetioa Number
Deleding Mdbnd:F3 Weatey Serapiag C Heat Ga
Opelau lion C Gustier
Derwin 0 Other
If"Other selected,pose captain
DLigddEneapsYant
t3 Replacement
Check one: Dwelling is malli-tamily j I SingbfamiyF o J /gym
Start Date 11/312008 CmpkdonDate 12/1/2008
When will work he tat AM7 Pm5 (spedfy does ea ate) Weekends? TEA
Project Supervisor Name Jerry Gray lkeam# D&3770 Exp.Date 8/09
Worker's Commenaaa Porto,Number AWC7013278012008 curie AIM Mutual Insurance
In ease emergency contact Frank Tilh,V.P. Tgy(413 ) 525 0644
(Contractor's Represeandve)
LLADE DING OWIRACIDR
The nndecalgod hereby states,Oder the Iwo end penalties efperjrey,that hehhe has read and eadeslaod the Cmnawata of
Massachu,etb Ddodlag Repdaday 454 CMR flu ,ad the Lead Pasoan recreation and Coact(RegWabons,105 CMR a AMM and
that the hdormda eaained in this notification Is and and correct to�t bee W d hidber knewkdge a better.
Dam October 27,2008 std ` *
Frank Tihi,V.P.
Company Name Abide Inc
Address P.O. Box 886,East Longmeadow, MA 01028
Tdephane Mamba' 413-525-0644
Abide Job# 146-59 OVER-P
Notified On:10/27/08
E C E Q l7 CE
1 OCT 0� 2
NORTHAMPTON BOARD OF HEALTH
10/4/2006 MON 13:16 PAX Northampton Board Bealtn
a
Page 2 of 2
In acmrdnce Ida Massachusetts carrel Laws C.III¢197,45408R 2100 ad 10501R 40.000,OOtiCC of lb.date sad metbed(.)ef
removal or covering ofpato;plaster or other seeable materials a talabg dangerous levels of had L to be provided and must be received
by the following,Beatles,at lam (t0)days prier to the beginning of defending.
NOTIFICATIONS MAY BE FAXED.
L Department of Labor,Lead Pr or an,Divhkn of Oa:asthma Safely
19 Stamford Street,Y'Floor,Dort,,MA 02114 FAX:6176266965
2. Director,Childhood Lead Poisoning Prevention Program
Department ofRb&Health,Donovan Health Betiding.5 Randolph Stack Canton,MA 02021 FAX:761-7746700
Ocrnpaob of dwelling unit
4. Au ether ec apaa Mae residential plebes,if any
5. Leal Bow of Health/Cat YWramatMacy City of Northampton 413-587-1221
• Massachusetts Historical Commission (I premises are Vamd a the State Fleabite of lister&
220 Morrissey Blvd. Places,this aetliea mart be made spa receipt of en
Boston,MA 02282 Order to Correct Violations or Mast 30 days prior to
FAX(617)727-5128 initiating preventive desnding)
NOTIFICATIONS SHALL It COMPLETED IN THEIR ENITItBf Y,DATED AND SIGNED-INCOMPLETE NOIUFICAIIONS WILL NOT
SE ACCEPTED AND WILL BE RRNRNED BY'THE DEPARTMESS OF LABOR&WURKFORCE DEVELOPMENT.
pR(pFV OW? (if own or unlicensed maces agent will he prtmmmg low-risk dobdug wank,complete the following):
Property Owner Arica°
NOT APPLICABLE
Address
Telephone Number ( J-
I certify IS I have complied with the traiabg reaiwla s of the Comraweshb ofMassachmals Lead Poisoning Prevention and Control Regalatka,105
CMR 460.175,for owner/agent low-risk abstmm and cona®uent l farther certify tat l or my agent will be perbonieg the following kw-risk activities
(I have circled all than apply)
aPPIYMS Xald
capping baseboards na.vi g dew;cabinet doors,ebmbts
easier vinyl si eovmbg sadism
I certify that all the incantation comnmd to Drs notification is true and coifed to en beet of my WwMye and bd4e
Date Opted
Revised 122007
•
10/7/2008 NON 13:15 FAX Northampton Boar° Hearn]
is �►
h�� abide
Rl }(� environmental contracting a coatings a restoration
it LEAD NOTIFICATION FAX COVER SHEET
DATE: /o - 77-0V
ATTENTION: FAX#:
[ 4' Director,CLPPP(Boston)
[ ' Director,LEAD PROGRAM(Boston)
[ ] Town/City of_
(Local Board of health)
[ ] Massachusetts Historical Commission
FROM: FRANK TILLI/ABH)E, INC.
REGARDING:
781-774-6700
617-626-6965
5(7-4/-3f
617-727-5128
[ AVPROJECT NOTIFICATION
[ ] REVISED NOTIFICATION
[ ] OTHER: `` aa
NUMBER OF PAGES (including this one): V
COMMENTS:
If you experience problems in receiving this transmission,please call 413-525-0644.
CONFIDENT1AL[IY NOTICE: Thc doamma accompanying this td¢vpy fonsmmim may contain confidential and privileged
information fmm Abide,Jae TBis ut'pnatiw it lntmdel for d»usa of the addressed i ividualor
entity if am non ht intended reclaim&be aware that any disclosure,copying,distribution,or
use of We contents of this t amminim is prohibited. If ycu have received this transmission m army
please notify us by telephone(413.525-0644)inoncdimdy Thank you.
p.o. box 886 I east tongfneadow,ma 01028 I phone 413.525.0644 I tax 413.525.0678 1 www.abideinC.cnm
Abide,Inc.is SOMWBA certified by the Commonwealth of Massachusetts,Department of Business and Tech ology.
AbIde,Inc.'s standard TERMS AND CONDITIONS regmre payment for servkes 1pun peemttation of invoice.Invoices unpaid after 30 DAYS
are past due nod subject to a FINANCE CHARGE computed at a monthly rate of 11/2%(ANNUAL PERCENTAGE RATE OF 1B%I or the maxi
mum et-montage allowed by the taw Client is rewmmbte fw legal and collection casts if necessary to cd!ect put the amounts.