108 APT#D1 Deleading Notification 2003 » 11111 le-ve59 tiOtt f t C/1/4.11Ce Nt
ABIDE, INC. PROJECT # O3t12'
COMMONWEALTH OF MASSACHUSETTS
Department of Labor s Industries and Department of Public Health
NOTIFICATION OF DELEADING WORN
All section. of thin for ®.t be ccoplotod in order to comply
with the notification req,dteents of M.G.L. c.lil S 191,
454 at 22.00 and 103 OCR 460.000 as mast recently annmdna
FILE Mtalfn: (AGENCY USE)
ContractorperfonNng project ABIDE, INC. (Frank Tilli) License (' DC001619
L Exp.date '
Lead Paint Inspector /t1G SnC<iG"y L License 0 3i-70
Date of Inspection GM') G/2S/91
If low-risk deleading work is being performed, complete the following line:
Property owner Agent(s)
Address of Project
Building Name (if any Floor
Street Address IOG C] S0.1n-t ST Apt. No.1.)-1 4a,1 coma ,arcs
City /UoRTHAM PTO A1 Zip Oi%n
Deleading Method: Curet/Dry Scraping Heat Gun Caustics
Liquid Encapsulant (`CorleriniN Demolition Replacement Other
If "Other" selected, please explain
enact One
Start date
dwelling i5 multi-fa
siagle family
Completion date
8-1 )s)03
When will work be done: A.M. -7 .00- P.M. %.(p Weekends? yC s
Project Supervisor's name Robert P. Lallountain License q D53605
Property Owner
1n;Th Ca1Lt39
Address 1 Uo W e Si*- Stet4+-
City
Nor'fl„ F+o_ �2 State__;
Telephone f�f - s -Zt&9
In case of emergency contact Frank Tilti ,
Phone: day
413-525-0644
President
Zip o)O& 3 -
-'.GMPTON BOARD OF HEALIP
y
In accordance wltn haanhusetts General Laws c. Ill Si 197 CMP 2at� and 105 CAR 460.o00 notice
of the dare and net ;Is) of removal n covering of paint. pla other accessible materials
containing dsngerous levels or load is t cobee n provfdei and rest be .ecelved by the following
persons. at least tan fled days prior to beginning of deleading. t
1. Occupants of the dwelling unit
2. All other Occupants or the residential promises. if any
Director, Childhood Leading Poisoning Prevention Program
Department of Public Health, 470 Atlantic Avenue, Boston. MA 02110
Fax (611) 284-8410
Director, Asbestos r Lead Program — Fax (6271 727-7569
Department of Labor k Industries
Room 11006, 100 Cambridge Street
Boston. MA 02202 //
Local Board of Health/Cede Enforcement agency` C3.1 4-Ah:"ri'lpei con Fitt 613)5g'7-1 221
Massachusetts Historical Commission
220 Morrissey Died.
Boston; MA 02125
Deleading Contractor
III premises is listed on the State Register
of Historic Places, this roelficatlon must be
made upon receipt of an Order to Correct
violations or at Least 30 days prior to
initiating preventive deleadino)
Fax 1617) 127-5IIa
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 CMR 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.
eV /
Date 25 b Signed: f A11.4.71 I. Frank Ti lli
Title: President `S
company; ABIDE., INC.
Property lNnm (If Owner Of unlicenso owners agent will be performing low-risk deleading 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-tisk activities II have circled all that apply) :
applying liquid a capsulant
applying exterior vinyl siding
removing doors, cabinet doors. shutters
capping baseboards
Covering surfaces
I certify that all the Information contained in this 0nt siltation is true and correct to the
best of my knowledge and belief.
Date: signed:
REV 10/iz/95
ABIDE, INC. PROJECT # 0342_1
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