15-17 Notification of Deleading Work 2006 Sma..___._e,,_... Health/D •►
:Y h
NOTIFICATION OF DELEADING WORK
All sections of this form must he Completed is order to comply with
the notification requirements of Ka C.III§197,
459 CP4R 22.00 and 105 CMR460.000,as most recently amended
REV!ScD* LEAD SAFE RENOVAfp(,f_CAUR.SY NonH(Art otJ
Contractor perkrminS pmiect Abide,Inc. (F p
C001619 g�Dat 8/30/06
Lead Paint Inspector A)%
-�r-�Dale of Impaction ����
ADDR O S E SOY-- ---EsR DatcTpj%�,.
Street Address i -!7 A/ORR MARIE STREET
_ApLNomber
City FORE CE
Zip 0!060
Property Oweer_SERUICENET fit
—^"`a``—AddeL9 K/NEJaAn
Telephone Number �413")ssG-1324 TOM
�-ROS.S�_
Deleading Method:
Demolition CC.mtk, LiquidEncapsulate
Covering Replaeemeat
Other
If"Otha^adected,please explain
Check one: Duelling is rasa-fen*
Start Date 4U&OsT 21,2008
Single-fomdy Other
Compkika Date '' ''•" _, SEPrPA1$ J28,2004
When will work be done: AM7 OO PM 5:0
QSpecify times usite) Weekends' n0
Project Supervisor Name Jerry Gray LicenseY-0300377(L
Wnrkrrscem �:sp.Dat 7�dt{ /0-7
pematkn Potty Number WC 7 0332 7 801 2 n n S
Cartier ATM
°remelt Reuyeuntset Frank Ti 11i, Abide,InC.iet 413 525-0644
(Contractor's Representative) %)
EELEADDNG CVNTRarrnn
TThemh Chet hereby
i[ stela under the goer Cr figW eLead cry,that be/she has read and andenthed the Commonwealth of
that the information contained in this notification is true Maud Poisoning Prevention and Control
correct to the best ofhWherknowledge and t lOSCTrIIid60.000,and
Eat *1/10DG
___--gie Frank Till!, Abide, Inc.
Company Name Abide, Inc.
Address Box 886 (483 Shaker Rd. ) , East Lon•meadow MA 01028
Telephone Nombcr )�qq_o
OVER-*
-:IAMPTON BOARD OP iiEA LTA 1
ew.
Page 2 of 2
In accordance with Massachusetts Central Laws C.111§197,454 CMR 22.00 and 105CMR666.000,notice of the date and method(s)of
removal or covering or mint,plaster or other accessible materials eontaiaiug_daggtins levels ofIced is lobe-prodded-aodmuatim received
by the followingagndes,at least-Ma(10)dayspnor to the beginning ofddeading.
NOTIFICATIONS MAY BE FAXED.
Department of Labor and Workfare.Development,Division of Occupational Safety
399 Washington Street,5u Floor,liosten,MA 02105
FAX(617)717-9565
Director,Childhood Lead Poisoning Prevention Program
Department of Public Health,56 Roland Street,Suite 100,
Boston,MA 02129
Occupsets of dwelling unit
FAX
it1--77Y-67oo
4. All other occupants of the residential premises,they LI/ 3 - 5`SS- r
3 / 7
S Local Dead ofB IA Enforcemat Ageacy ''rr jj rc,
lIJ�S D�_ IZn
Massachusetts Historical Ca nnibabu
220 Monivey Blvd, (HPremlsm arc listed on the State RKlda of Historic
Boston,MA02202
Places,Order °O�madOO mn.to<made honey,prior ern
FAX(61Y)727-5123 Oster to Comet Violation.or at kmt30 days prior to
initiating preventive deluding)
NOTIFICATIONS SHALL BE COMPLETED IN THEIR ENMITY,DATED AND SAVED-INCOMPLETE NOTIFICATIONS WILL NOT
BE ACCEPTED AND WI LBE RE111BNEp BY THEDFPAR1MENT OF LABOR&WORXFORCE DEVELO MENT.
PROPERTY OWNF4(Ifowom or milkmaid comer's aged will be
Fnfomilag kwtsk deleading wort,
Property Owner
ur)
Addrw P.O. Box 886
Mowing):
Telephone Number (413), 525
I notify that I have complied with the
CMR 460.175,for owweriaga4 law-risk
(I have circled all that apply)_
ne
and Control Regulatimu,105
owing low`dstactivities
applying liquid eacapsulant
applying exterior vinyl riding
I certify that all the udormation contained•
Date
02102
Aut 04488—AL
ide,. Inc.
a b i d e
Abide, Inc.. Environmental Contracting- -- -
LEAD NOTIFICATION FAX COVER SHEET
DATE: 0 0/Qtf
ATTENTION: - FAX#:
[ ✓j irector,CLPPP(Boston) 781-774-6700
[ -'al (rector,LEAD PROGRAM (Boston) 617-727-7568
[ Town/City of II✓oHhcroagiyn 103-try-422-1
(Local Board of Health)
[ ] Massachusetts Historical Commission 617-727-5128
FROM: FRANK TILLUABIDE,INC.
REGARDING:
1 ] PROJECT NOTIFICATION
[7/f REVISED NOTIFICATION
[ ] OTHER:
NUMBER OF PAGES (including this one): 3
COMMENTS:
If you experience problems in receiving this transmission,please call 413-525-0644. -
CONF1DENITAInY NO a,t: The documents accompanying this tdcopy name ivm may contain cmfidmial and ponleged •
• information from Atvde,S. 'Iiis iofmmdon is intended for duelist of the Matsui individual or
entity If you are not the mleded recipient be awe that any dixbmq copying.disbibwim,or-
- .. use of the contents of this lnitsmisakm is pmhibiled. If you Moe rcdvedthis transmission in arm,
please notify us by telephone(411525-0644)immediately. Thank you. •
P.O. Box 886 East Longmeadow,MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • www.abideinccom
Abide, not standard TERMS AND CONDITIONS require payment for services upon presentation of invoice. Invoices unpaid alter SO DAYS are past due and subject to
a FINANCE CHARGE computed at a monthly rate of on 1/2%(ANNUAL PERCENTAGE RATE OF 18%)or the maximum percentage allowed by the law. Client is
responsible or legal and sanction cosh It necessary to collect past due mounts.
Utl/II/ZUUD UM 14.4e FAA
3 I '�.partment of Public Health/Department of_i r&Workforce Development
Gljl4, °3p NOTIFICATION OF DELEADING WORK
tr
,ill ,i� �� All sections of this form must he completed in order to comply with
the noti rceation requinmenb of M.G.L.C.HIM?,
IM?,
454 CMR 22-00 and 105 CMR 460.000,as most recently amended
LEAD .S#F6 RENovltl'tpy_CoURitsy NOTlH(ATI(NNI
Contractor performingpmjeat Abide,Inc.(F.Tilliikaee p DC001619-E,,p.1D/ye 8/30/06
Lead Paint lmpedor__J/4 Date of Inspection NfA License 0 ry`k
ADDRESS OF PROJECT:
Street Address 15-17 NORTH MARIE STREET Apt.Number
City -FLORENCE,M4 Zip 0/060
Property Owner SERvicENET,/N,-. Address 129 KINFr ST,NORTHAMPTRA6RM
Telephone Number (4f3)5g5-f324 TOM GROSS
Deieadiag Method: (met/Dry Snutmeg? Dmt Gan
L a mry.bve Demolition Caustic Replacement Other
If"Other selemed,please card ,
Check one: Dwelling is multi-family ✓ Singlnfemtly Other
Start Date AUGUST 21a 200G Compbtian Date AU&USf3/,2006
When will work be doom AM77 00!4 5:0 gSpedb time on site) Weekends? no
Project Supervisor Name Sorry. Gray Lie e0 .DS003.771 Date 7/a t♦ /07
Worker's Compeamties Policy Number AWC7013278012005--
Carrier AIM
In mar afemmgeocy contact Frank Tilli, Abide,Inc aN (413 ) 525-0644
(Coahactor's Representative)
Du F-ADING_CONIRACTOg
The undersigned hereby states,under the pals mid penalties of perjury,that he/she ha read and understood the Commuuweauh of
Marnchuamb Ddead'mgR ecnkno ns,454 CMR 2100,and the tad Poisoning Prevention and
nwkdge ad belie¢y 105(MIt 460.000,and
that the information eaatyced'u this notification b ins and correct W�Wr�best�ofhb/her knowledge and 6d'u[
Date gl(j02004 Si#1,#, � ` � Frank Tilli, Abide, Inc.
Company Name Abide, Inc. -
Address P.O. Box 886 (483 Shaker Ed. ) , East Longmeadow, MA 01028
Telephone Number (413) 525-0644 -.
OVER-*
AUG I l `GUUo
t LOW Cr HEALTH l
Pa Page t oft n
In accordance with Massachusetts General Lana C,111§197,454 CMR 22.00 and 105 CMR411000,amine of Om date and method(a)of
removal or covering of paint,palter or other acassible materials containing dangeroaa levels of lead is to be provided and mast be received
by the following agacia,at hat TFN(10)days prior to the beginning of deluding.
NOTIFICATIONS MAY BE FAXED.
Deparbwat of Labor and Workforce Drrrlopmest,Division of Occupational Safety
399 Washington Street,Sn Fleet,Boston,MA 02108 FAX(617)727-7568
Director,Childhood Lead Poisoning Prevention Program
Department of Public Health,56 Roland Street,Suite N0,Boston,MA 02129
Occupants ofdwelling unit
All other occupants of the residential pamisa,if any
Local Board of"- Enforcement Agency
Mmachudrs Historical Commission
220 Morrissey Blvd.
Boston,MA 02202
PAX(617)7275128
FAXy4l7JM
Tai-77Y-G7°°
(if premier are limed os the State Register of Historic
Pam,this nodf don mast be made upon receipt of a
Order to Correct Violations or at hart 30 days prior to
ianatiog preventive deleadag)
NOTIFICATIONS SHALL BE COMPLETED INTHEIR ESTI:MI P.DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WAIL NOT
BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORKFORCE DEVELOPMENT.
PROPFITIY OWNPR([fowm or unlicensed owner's gent wig be
performing low-risk deaeGmg the foRowaBk
Property Owner
Ks)
Telephone Number 1413). 525
I certify that I have complied with the
CMR460.175,for owner/agent low-risk
(I have circled all that apply):
applying liquid eaeapaulani
applying exterior vinyl siding
I certify that all the information contained this atificatia is true
Date Signed
ne.
Address
and Conodl Regvacom,105
Roving km-risk activities
02/02
Aut !e ization
ide,. Inc.
04488-AL
L1/2006 FRI 14:21 FAA
ii Iii iie .
Abide, Inc., Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: 44067
ATTENTION:
Director,CLPPP(Boston)
Director,LEAD PROGRAM(Boston)
Town/City of S..
(Local Board of Health)
Massachusetts Historical Commission
FROM: FRANK TILLI/ABIDE,INC.
REGARDING:
[ A/PROJECT NOTIFICATION
[ ] REVISED NOTIFICATION
[
I OTHER:
NUMBER OF PAGES (including this one): 3
FAX#:
781-774-6700
617-727-7568.
6113-687--727-1
617-727-5128
If you experience problems in receiving this transmission,please.ca11.413525-0644•
WNFIDEYnAIIRNOTICE The documents accomPamPngthis ttlempy transmission may contain ccdideutial and privileged
information from Abide,Mc.This infama5m is iNmded for the the ofthcaddleaatdd S .d,w1c
entity. If you am net Am-intended ncipieet•be swam that any di cbaaq copying,distribution,ar-
me of the cements ofdus[msmisdonn prohibited. If you have received this LSamlviad in error,
please notify m by telephone 013425,0644)immediately. thank yon.
P.O. Box 886 East Longmeadow, MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • www.abideinccom invoices
Abide. CHARGE coamplded at aOma/0G rate of 111 2%4ANNUAL PEERRCENTAGE RATE OF of 18%or Otte maximum percentage avowed by the law. Client is m pamnsmt for responsible for legal and telethon costs 6 necessary to°HMG past dm amounts.
5:2006 TIN 11:14 FAX
Department of Public Health/Department of Labor&
once Development
NOTIFICATION OF DELEADDVG WORK i"� °""----- -�. ;
qii
i i
All tenth of Ibis form must be completed in order m comply with'. ' AN 15 ./» ,l
ns
Na mti¢ratlm requirements of M.G.L.C.11l)♦197, LJ
454 CMS 22.00 and IOS OAR 460.0*m most recently amt
Lead Safe Renovation-Courtesy Notification
:ontraclorperrtmmlugprolert id Inc (F Tillll License#rlCnnIR19 Exp.Date B/30/I(1(IR
bead Paint Inspector N/A
Date of Inspection N/A License N/A _Exp.Date TBA
RDDRYSS OF PROJECT:
Stria Address_ 15-17 North Maple Street
city_ Florence, MA zip_ 01060
Yreperry
Owner__ Service Net Inc_ Address 129 King Street Northampton, MA
Apt.Number
Telephone Number- (413)585-1324,Torn Gross
Delcadiag Method: XWe jDry Scraping
Demolition
Covering
If"Oka"selected,please explain
Heat Goa Liquid Eneaptulant
Caustics Replacement
Other
Single-family �'tr
Check one: Dwdiiog is multi-family X -
Start Date__ June 26,2006
Completion Data_ July 8, 2006
When will work be done: AM 7-nn FM..Df) (Specify Poxes on site)
Project Supervisor Name Jerry Gray License#110003770-Eap.Date R11) 006
Worker's Compensation Polley Number AWC701 32 7 801 20 0 5 Carrier AIM
Weekends" T B A
In cam of emergency contact Frank Tiili Abide. Inc. nt41 l 525-0644
(Contractor's Representative)
OARD OF HEAL
TH
aN CWIERACTOR
The undersigned hereby states,ander the pins and penalties of penury,that Mlrhe her read and uaderatrood theCommonwealth of and
Massachusetts he information ationcogainedint
Regulations,454 MR 2L00,and the Lead Poisoalag P veatbd a d Control Regulations,
that iheinformatim coemlad in the noti¢eaden is true and correct to the hest of his/her Imowledge and belief.
Date 6/13/2006 Signed ZD4Vkj i rank Tilli. Abide. Inc.
s _ a
Company Name
Admas P.O. Box 886(483 Shaker Road), East Longmeadow, MA 01028
Telephone Number (413)525-0644
OVER-)
15 2006 TM- 11:14 FAX
fia
a
Page 2of 2
In accordance with Massachusetts General Laws C.111§197,454 CMR 22.00 and 105 CMR460.000,nodce of the date and methods)of
removal or covering of paint,plaster or other accessible materials containing dangerous levels of lead Is to be provided and must be received
by the following agencies,at least]$q(10)days prior to the beginning of deleadlag.
NOTIFICATIONS MAY BE FAXED.
I.
2.
3.
4.
S.
6.
Department of labor,Lead Program,Division of Occupational Safely
399 Washington Steed,r Flom,Boston,MA 02108 FAX:611-727-7568
Director,CLDdhood Lead Poisoning Prevention Program
Department ofPub&e finish,Donovan Health BuildtL 5 Randolph Street,Cordon,MA 02021 FAX:7E4744700
Occupants efdwelog unit
All other weapons of the residential premises,if any
Northampton Board of Health FAX: (413)587-1221
Local Board of Health/Code Enforcement Agency
Massarhustb Historical Commission
220 Morrissey Blvd.
Boston,MA 02202
FAX(617)727.5128
(H premises are listed on the State Register of Historic
Plan,this notification muttbe made upon receipt of an
Order to Correct Violations or aeieast 30 days prior to
Initialing preventive dekading)
NOTIFICATIONS SHALL BE COMPIETED IN THEIR ENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT
BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORKFORCE BEVELOPMFArT-
PROPESRN OWNER(Downer or whIcer S owner's agent will be performing low-risk deleadnsg work complete the following):
Property Owner N/A ASent(s) N/A
N/A
Address
Telephone Number - N/A
I certify that I have complied with the training requirements of the Commonwealth ofMasechuset s Lead Poisoning Prevention and Conn!Regulations.105
Waster will bepmfonning the following low-risk activities
CMR 460.175,for owssclagem tow-riakabalamdand containment 7Lnshc certify mYagmt
(I have circled all at apply):
applying liquid encapsulant tapping baseboards removing doors,cabinet doors,shutters
applying exterior vinyl siding covering surfaces
I cat*that all the information contained hi this notincadon is tore and correct to the best of my knowledge and belief.
Date
08/04
N/A
signed N/A
/15/2006 TH1: 11: 14 FAA
abide
Abide, Inc., Environmental Contracting
LEAD NOTIFICATION FAX COVER SHEET
DATE: JUN,t T 15,2W6Wo
ATTENTION:
r./1
[ 1
FAX#:
Director,CLPPP(Boston) 781-774.6700
Director,LEAD PROGRAM(Boston) 617-727-7568.
Town/City of NOtitit0'il n 1413-50-l2al
(Local Hoard of Health)
Massachusetts Historical Commission 617-727-5128
FROM: FRANK TWLVABIDE,INC.
REGARDING:
PROJECT NOTIFICATION
REVISED NOTIFICATION
OTHER:
NUMBER OF PAGES (including this one): .3
COMMENTS:
If you experience problems in receiving this transmission,please cait413-525-0644.
CONFIDENnAIfYNOTI E The dnnats accompanying this telecopy tonmiss'mn may contain confidential and OARS'ed
.
information information lonfromAbide,Nc. lit infoation is Uncalled felhe Sc of the a.. .individuals
entity. Ifraate not lhdbitmded acipiad,be aware that any dierbmre.copying,dbmbuno0.on
use dale conteobofH>a bmrmesw upmh1Mtd.If yea have waivedthis mod in err,
pleaenoti fy us byadNhoo (4l3-525-0644)i mdisd4:Thank you.
P.O. Box 886 East Longmeadow,MA 01028
Phone 413-525-0644 • Fax 413-525-0678 • wawA.abideinc.com
Abide,lne's standard TERMS AND CONDITIONS require payment fee services upon presentation of Mew. Invoices unpaid attar 33 DAYS am past doe and subject to
a FINANCE CHARGE computed at a mom*rate oft 1/2%(ANNUAL PERCENTAGE RATE OF 18%)or the maximum percentage allowed by the law. Client Is
responsible for kpal and cdleellan costs if necessary to coped Wet due amounts. -