108 APT#D2 Deleading Notification 2003 1/2003 THE 16:55 FAX 413 525 0575 ABIDE 1Nt
CciESI /Jan Fl:c .'O1V .
ABIDE, INC. PROJECT # 03'i air
3�
COMMONWEALTH OF MASSACHUSETTS
Department of Labor G Industries and Department of Public Health
NOTIFICATION OF DELEADING WORK
All nations of this foss suit be oemoletwd Se order to comply
with the notification requirements of M.e.L. c.111 5 197,
451 CHR 22.00 and 105 DR •60.000 as most :scantly aleodsd
Contractor performing project
rIrl IUMBER;
(AGENCY USE)
ABIDE, INC. (Frank Tilli) License # DCOOI&L9
Exp.date ' 1 1103
Lead Paint inspector Ann
CaUms Cecc ece_
License
#1725'
Date of Inspection BiiCiit111I3c)q
If low-risk deleading work is being performed, complete the following line:
Property owner Agents)
Address of Project
Building Name (if any) Floor
Street Address I Ufi Sown 4 ST Ape_ No. 0 2-
City &Ic .TMAMPiOtAL Zip Ot%cm
Deleading method: ry Scrap Heat Gun
Liquid Encapsulant Covering Demolition Replacement
If "Other" selected, please explain
Caustics
Other
Check Ono: Melling is multi-family 1/
Start date
$I M1o3
single family
Completion date
When will work be done: A.N. 7 .(j0 - P.m. 7:00
Project Supervisor's name
Property Owner _: i y
Address
City
$1 ,510..3
Weekends? yCs
Robert P. LaMountain License # DS3605
Co11eJe
12(o wr i-
Ale r-tai mptof-.
e State_ _
Telephone 413- S$s. -USSR
in case of emergency contact Frank
Phone: day 413-525-0644
Ti lli , President
zip GIOG ?
evening 413-525.044 ( 4-
M% - 1 2003
(over)
F.;r:Rf)3- HEAL .
1/2003 THE 18:58 FAX 413 525 0878 ABIDE 15C
In accordance with iaehmet a Cenera) Laws ill 5 297 alb 2a and Ids Wt .60.000 notice
of the date and met s(s) of removal Cr veering of paint, Alas other i CC9iible materials
Containing dangerous levels of lead is to be provided and must no received by the following \
persons, at leans tee (101 days prior be beginning of delrading.
1. Occupant, of the welling unit
All other occupants of the residential premises, if any
Director, childhood Leading Poisoning Prevention Program
Department of Public Health, 470 Atlantic Avenue. Boston. MA 02110
Director, Asbestos a Lead Program
Department of Labor a Industries
Room 13006, 100 Cambridge Street
Boston, MA 02202
Far 1617) 284-8410
Fax (617) 727-7568
CC .4 of Alrianr.m,firo) L4t1Y13)58Z 1 22,1
Local Board of Health/Code Enforcement Agency ' I
Massachusetts Historical Commission
220 Morrissey Blvd.
Boston, MA 02125
(II premises Is 05, this notification r
must he
of Historic dep0
made upon receipt of an Order Co Correct
Violations at l 30 dayS prior to or
initiating preventive lve dFaxa(617) 727-5136
Reloading 2etcaotor
The undersigned hereby states, under the pains and penalties of perjury, that
he/she has read and understood the Commonwealth of Massachusetts Deleading
Regulations, 454 [MR 22.00 and Leading Poisoning Prevention and Control
Regulations, 105 CMR 460.000, and that the information contained in this
notification is true and correct to the best of his/her knowledge and belief.
Date
-1/261d2.›
Signed: 1 404pA t.A
Title: President
Frank Tilli
1
Company: ABIDE, INC.
Property Owner (If owner or unlicensed owner's agent will be performing low-risk aeleadIng work)
I certify that I have complied with the training requirements of the
Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations,
105 CMR 460.175, for owner/agent low-risk abatement and containment. I
further certify that I or my agent will be performing
the following low-risk activities (I have circled all that apply) :
applying liquid encapsulant
applying exterior vinyl siding
removing doors, cabinet dcurs, shutter's
capping baseboards
Covering surfaces
I certify that all the Information contained in this notification Is true and correct tb the
best of my knowledge and belief-
Date: Sigaw;
RSV 10/12/95
ABIDE, INC. PROJECT #
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