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421 Notification of Deleading Work 2007 hJdr : Ot� .1�1 P+ ... Abide, Inc. Job#07257 Contractor performing project Lead Paint Mark Haynes. VyVVZ/VVd " %bide Job#07257 Department of Public Health/Department of Labor&Workforce Development NOTDICATION OF DELUDING WORK All aectbno of this form that be cemptelad a order to comply With the notification requirements of M.O.L.C 1111197, 454 CMR 27.00 and 105 CMR 46a00,as most recaty wended Courtesy Notification Abide, Revision #1 Dates Inc.(Frank Tilli) uosmedDC001619 sp.Dde08/28/2007 hntpatr ar avnes. EC.$awoftaprtiea T.B.A. lame*T.B.A.RCp.Dde T.B.A. ADDRESS OF PROM—P. Street Address VAMC-421 North Main Street Apt NWa Property owner Veteran Admin. Medical Building Admere 421 North Main Street Telephone Number 413-582-3014 city Leeds-Northamoton. MA pethidine Method: Wetmry atrepdng=a-Chemical Demoatiaa Coveting selected,phase explain HMG= Caustics Other Check one: . Dwelling k mold-?cords Si glo mdy Start Date 6/18/2007 omen Medical Center Compktla Dab 7/27/2007 When will work be dome AM7 PM (Specify dens a ate) Weekends? Project sysnknrliss Jerry Gray License#06003770 Rap, 7/24/2007 Wotker'r Compensation Policy Number WC7013278012006 am,:Aim Mutual Insurance g1431 525.9644. V case of emergency contact Frank Tii, Abide, Inc. (Contractor's Repraamtive) • DEIFADINC.CONIRACM➢ The omdenilgned hereby sate,mode the pato sod psalm of perjury,that hankie has read and node/Woad the Commonwealth of Maar&uette Ddrmanf Regulations,454 ChM 2100,and the Lead Poisoning Pteradeo sod Coati*RegaiWa..,105 CMR 460100,and that the iniormatia cemralned in this notation Is trite a .bat of bis__fhar and bdd mm 6/1/2007 Signed rank Tllll,Abide, Inc. Company Name Abide, Inc. Addre n P.O. Box 886, 483 Shaker Road, East Longmeadow, MA 01028 Telephone Number 413-525-0644 Abide, Inc. Job#07257 - - OVER-_ Notificed on: 6/1/07 Revised 7 17 07 Dates mat v. Page 2 of 2 In accordancemth Massachusetts General Laws C III 1197,456 CMRM AO ad 105 Crag KRONA notice of tato date and methods)of removal or covering of paint,plaster or other accessible materials containing degrees RMs of lead Is to be provided and menthe recefvs by the following agaeiea,at least ME(II)days prior le tits beginning of&Wei . NOTIFICATIONS MAY BE FAXED. 1. Department of Labor,Lead Prop am,Division OSO.t ,adoal Safety 399 Washington Street,5°Flom,Boston,MA 0210 FAX 617427-7560 2. Director,Childhood Lad Posing PrnaEe Program Deportment of Public Rua Donovan Health Building,5Ra d&pk Street,Cata.MA02P21 FAR 711-fl4$100 3. Occupants el threats urn 4. MI other ottapsots of the residential premises,If my 5. Load Board ofliedthfCodetnfureemntAgaey Town of Northampton 413-587-1221 6. Massachusetts BbtorieslCo®ladoo Cdpresloa are Bats on the State RcVt of RIMS 220 Monistcy Blvd. Plain,t W notification mast be made won receipt of an Boson,MA 02202 Order to Corset Violations rat lent 31 days Pilot to FAX(617)7274130 fnidating preventive Minding) NOTIFICATIONS SHALL.BE COMPLEtED IN THEM ENMITY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT EE ACCEPTED AND WILL BE RIIORNED BY TEE DEPARTMENT OF LABOR&W ORIXPDRCl DEVELOPMENT. Not Applicable P ,R1Y (Towne or wi mead owner's agent will be performing low-risk ddwditg week,complete de fallowing Property Owner Not Applicable Age O) Address Telephoto Number 1 )- I artily that have complied with the o®log requirements of the Commonwealth ofMmsarios lad FOboneg Privation and Como'Regulations,105 C 8460.115,for owner/agent bow-risk abatment and md*u nt I further certify that I army sac be paxmfl the following lovire*activities (I have dried all that apply). applying liquid aapadaot capping baseboards applying exterior vinyl riding covering surfaces . I certify that all&e in(eevaton contained in this potitteadon b trap d correct to the hat of my knowledge d belief. Date 51ped removing ton,cabinet doors,Auden b I de Abide, Inc., Environmental Contracting LEAD � NOTIFICATION FAX COVER SHEET r' DATE: / 7 a 7 ATTENTION: FAX#: [b,]/D rector,CLPPP(Boston) -781-7746700 I ector,LEAD (Boston) 6,17%727-7568 [,Toown/City of 'Ti3- n/d-eli (Local Board or Health) I I Massachusetts Historical Commission 617-727-5128. FROM: FRANK rn,LVABIDE,inc. REGARDING: [ ] PROJECT NOTIFICATION ] ]. REVISED NOTIFICATION I ] OTHER: NUMBER OF PAGES Cmcluding this one): COMMENTS: If you experience problems in receiving this transmission,please call 413-525.0644.. . CONFIDENTIALITY Nan Tbodomv®a acwmpoying this tdcortmtangedm, youuainmoM Ssm pdalleged • iommdm 9amANde.lea 1W bamYlmuh¢mdW 6lasowottbedd,anMidvidod« ally. Drumm( ieebrnampy*.Gibtalielloll useetthecooless otitis wonispSlbS .Nycohanirecdxd this mo®d—inaunty . tdesvd6w Msatom(413d734644)imed'etey. Trask you. P.O.Box 886 East Longmeadow.MA 01028 Phone 413-525-0644 • Fax 413-525-0678 • www.abiddnccom Wide.ins.'s aendard TERMS AND CONDITIONS remote pepwa kw SWAM a upon paennsuon al Invoice. brwlma weld otter ag DAYS us past we and warn ID FINANCE CHARGE compotid at a men1h pis all PEG(ANNUAL PERCENTAGE RATE OF 16%)at tlee wt,man psardapeatlw.wd by VIA law.Caert Is espmsible is legal and mlaelon met s nsWmy to weal peat we amou - ' • W 5 i • Abide, Inc. Job#07257 bide Job#07257 Department of Public Health/Department of Labor&Workforce Development NOTIFICATION OF D08ADA'G WORK MI sections of 0ls form twist be completed in order to amply with the nealt:L en requirements ofM.GJ.C 111¢197, 45401k 11.00 and 105 CMR 460.000,as ma ready amended Courtesy Notification Revision #1 Dates Contractor periermi.ggreat Abide, Inc.(Frank TYk) IJanesDC001619 bp,Dog 08/28/2007 Lemsrintbnpada Mark Haynes, EC&ietedlmpaaa. T.BA. IJa.a#T.BA.arp,DSe T.B.A. ADDRESS OF PROJECT: Surat AddressNAMC-421 North Main Street Apt Nabs. city I eeds-Norhamoton MA Zip 01053 Property owner Veteran Admin. Medical Building Admen 421 North Main Street, Leeds, MA 01053 tdepaae Number 413-582-3014 Deluding Method: WetDry Sera MOCCa-Chemical Heat Gm Demeadon Caustics Covering Other If-Other"selected,piasa mean af. ,N..17 LG Raplacisat JUL 2 7 2007 J ,NORTHA 41501 RGARn OF HEALTH Check one: . Dwelling ismoiti-hmly Shgle-family Other Medical Center &minis 6/18/2007 Completion Dam 7/27420117--- 2 ev7 8?-31-07 who ml work be den AM 7 PM 5 (Spad&tan a dm) Weeuads7 -Project Supervisor Mum Jerry Grdv License D6003770 hp Dam 7/24/2007 Worker's Compensation Paget'Number WC7013278012006 cute Aim Mutual Insurance xi,tug at"totem wain Frank TIM,Abide, Ina. Ten?( 525-9644 (Contractor's Repmumdve) The undersigned hereby amnia,order Na pains and penalties of aerial,that babe has and end ende food the Ca'...veaahet Massachusetts Weeding Rgataduy 454048 1100,and the lad Pabae(y Pinatas ad CumM iteration,105 CMR 440.0M,ad that the iofamadu containedle flm todRudu is net ands baba hWhr a.d beget. Dam 6/1/2007 /"�!///if,.6i.(' Company Name Abide, Inc. Addrae P.O. Box 886, 483 Shaker Road, East Longmeadow, MA 01028 rank Tilli,Abide, Inc. Telephone Number 413-525-0644 Abide, Inc. Job#o72b7 Notiliced on: 6/1/07 Revised 7-17-07 Dates mat OVER-P- - RLf/iSeA-1�a9�o7 t keze m.y /I/CI Gaul Paget of 2 In accordance with Maaathuaa Cement laws 0.1114197,454 ChM 23.00 and 105 MIR abet wthe at doe dam and metod(r)of remoral or cevalag of paint,plaster or other smemmie materials eontokmg dawn=MW of lead ken be provided and meat be received by the meowing agenda;at least3 (10)den prior to the bedewing otddn NOTIFICATIONS MAY BE FAXED. Dependent oflahopLndProgram.Divides dOceandinnl Safe 399 Washington Street,5aFloor,Bestow MA 02118 PAX:617-727.7568 2. Director,Childhood lad Poisoning Prevendon Program Departmat of Palk Health,Donovan B 2t Building,5 Randolph Strut,C a MA01nL FAX:711-7748700 3. Occupants of dwelling nut 4. All other occupants of the residadd premises,B any 5. Led Bard oflkaetICodeWamraaatANEW Town of Northampton 413587-1721 6. Massachusetts Hkmriml Cmmimmn (Newman are Wad on the Stem Register of Historic 220 Mertlnry Blvd. Pinny this aodfleatin miM be made gran attspt of an Rata,MA 62202 Order to Cornet VkNadws or at least 30 days prior to FAX( I1)7!7.121 faldadag preventive detached) NOTIFICATIONS SHALL.BE COMPWFED IN mnREMIREIY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS POLL NOT BE ACCENTED AND WU.BE RETURNED BY THE DIMANIMENf OF LABOR&WOBIffdmZ DEVELOPMENT. Not Applicable (if aria or atamtd owner's;gem w11 be perfuming Ioweiek&lading amt,coory4M ilea following): Properly Owe Not Applicable Arnie) Address Telephone Number ( )- I curdy that I have complied with the n®big regobmrm of the Commonwuhh ofMbchmdk Load Poisoning Pmya6a and(bmol kt uMtws,LDS CMR460.175,for owner/agent kw-risk abatement admamoowt IfurdmroadtyfdtI craw erne veal bepetfmmkg die following lowish dicta (I have circled all that appiyk apppind WNW acapsdant capping baseboards applying exterior vinyl&ding covering snrkem 1 amity that ail rho inOmmtion contained in this noti8atb.is true ad cornet bthe best ofmy knowledge Nbdrd Daft Slgnd ranovkg bon,cabinet door;Ashen 00/04 a b i d e Abide, Inc., Environmental Contracting LEAD NO'1'1F'ICATION FAX COVER SREET DATE: 727-07 ATTENTION�� FAX#: [bk Director,CLPPP(Boston) 78I-774-6700 [- DD r,LEAD (Boston) 617 727-7568- - [flown/City of !1 /04-07/ (toed Board e[Besnb) I I Massachusetts Historical Commission 617-727-5128. FROM: FRANK TILLIIABIDE,INC. REGARDING: [ ] ,PROJECT NOTIFICATION [(.3. REVISED NOTIFICATION [ I OTHER: NUMBER OF PAGES (including this one): COMMENTS: If you experience problems in receiving this transmission,phase call 413.525-0644.. .... wNFIDFNIIA YNRTt 7Ydowarae wootzgawber this tekowytaastaksbr Gay ompmmafdmaaan'Ddelkgd • loamafiwa mAbid,hd.'Ri hetartmttwybnsMdkr gunge otatsadMrs.di aidualm saab. Cydaae aortae Wendtdrecipient,be aware HiWdieebmR SOyWs,d lrarea ,OF meoftbewobarofadwnamidm rpm.ihiad.n.eehneimdwdB;mm_obfiaaee plesenodlf'mbyrdathme(4U42so6q)lame&M re. Thmkyoa P.O.Bar 886 East Longmeadow,MA 01028 Phone 413-525-0644 • Fax 413-525-0678 • wwwabideinccom 14 Nose NandaN TERMS AND COMMONS require payment for wakes won p eareaaon of Mob. Wakes u Sd NW 30 DAYS an peat due and adeed b NANCE CHARGE oompamd ate moon rate al T/2%(ANNUAL PERCENTAGE RATE OF 1e%)or the nSnwu,Waage Glad by dm ter.Call W ,ondbe for legal and mMOtion wok E nmamuyto weft past*.arm..