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BLDGS 1-19 Notification of Deleading 1998 In accordance with Massach Tr's General Laws c. 111 S 191 CHR 22.0( 105 061 460.000 notice of the date and methods(s) removal or covering of paint, plaster o other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit 2. 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 6 Lead Program Department of Labor c Industries Room 110061100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor 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 b t of his/he rr'knowledge and belief. Date Adminis trativr Assistant company: AccuTeCh Insulation & Cnnrrarring Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. u' 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 capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters _ I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COrDNWEALTH OF MASSACHUSEPIS Department of Labor & Industries and Department of Public liealth NOTIFICATION OF DELEADING WORK ((�� ( s�11 0� All sections of this form must be completed in order to comply \VIAU\� O alk4 with the notification requirements of M.G.L. c.111 5 197, 454 (MR 22.00 and 105 CMR 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contmctor pedonning projectAccuTech Insulation & Contractinz License # DC1600 Exp.date 04/27/99 Lead Paint Inspector Behmad A Samimi License M M-1776 Date of Inspection O•71,1\_qS If low-risk deleading work is being performed, complete the following line: Property owner - Agent (s) Address of Project Building Name (if any) Hampshire Heights Apnrrmeorc Street Address Floor Apt. No. \-a City Northampton, MA yip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition CReplacement1 Other If "Other" selected, please explain Check One: Start date dwelling is multi-family X single family Completion date s— U 3-u.°s When will work be done: A.M. 8:00 P.M. 5:00 Weekends? Project Supervisor's name Property Owner Address City Telephone Northampton Housing Authority 49 Old South Street No License if -'1.1.1.§1ATd..:ri Nnrrhnmptnn (413) 584-4030 State MA Zip 01060 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach re3 General Laws c. 111 4 197 CMR 22.0( ^105 CMB 460.000 notice of the date and methods(s) -- removal or covering of paint, plaster a other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any Director, Childhood Leading Poisoning P[e4ention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006,'100 Cambridge Street ' Boston, MA 02202 ._._.. 5. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Fax 617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor 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 C4R 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 b t of his/her knowledge and belief. Date -y3 Signed: O- F q Tide: Admdi a trat 1ve Accicta nr Company: AccuTech Insulation & Cnntrarrine Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. c^ Mr.ssachusetts 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 doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COrDNWEALTH OF MASSACHUSEjS6 Department of Labor L Industries and Department of Public Health NOTIFICATION OF DELEADING WORE All sections of this form � O t be completed in order to comply -F1K��\\k% with the notification requirements of N.G.L. c.111 S 197, 454 CMG 22.00 and 105 04R 460.000 as most recently amended FILE HUMBER: (rGENCY USE) Contractor pedonning projedAccuTech Insulation & Contracting License # DC1600 Lead Paint Inspector Behead A Samimi Exp.date 04/27/99 License It M_17eA Date of Inspection If low-risk deleading work is being performed, complete the following line: Property owner - Agent(s) Address of Project Building Name (if any) Hampshire Heights Apartments Street Address - - -- City Northampton, MA Floor Apt. No. \-\-2-) Zip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition CHeplacemenC) Other If "Other" selected, please explain Check One: dwelling is mu: sillily X single family //7� Start date "-. C1c0 Completion date %4T+%4T+ "nn11 t"3"L% When will work be done: A.M. 8:00 P.M. 5.00 Weekends? No Project Supervisor's name Property Owner Address City Telephone Northampton Housing Authority 49 Old South Street License # Nnrthnmptnn (413) 584-4030 In case of emergency contact Phone: day (413) 592-5326 State MA Zip nlnfio Keith Jenkins evening (over) (413) 665-2372 In accordance with Massach ' S General Laws c. 111 5 197 04R 22.0( 444`105 om 460.000 notice of the date and methods(s) _ _emoval or covering of paint, plaster i -cher accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any Director, Childhood Leading Poisoning Prebention Program Fax (6 17) 753-641Q Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006, 100 Cambridge Street Boston, MA 02202 - - " Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 727-7568 • (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 b- t of his/her knowledge and belief. (- Date � �'1b Signed: Title: Administrative Avaiatanr company: AccuTech Insulation fi rnntrarring Property Owner (If owner or unlicensed owners agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealtl. r.` 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 doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. • Date: Signed: REV 10/12/95 CC , ONWEALTH OF blASSACEUE3FincS Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK � , A11 sections of this form t be completed in order to comply `,➢`' Iy� with the notification requirements of N.G.L. x.111 § 197, 454 am 22.00 and 105 CMG 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contractor pelfolming projectAccuTech Insulation & Contracting License # DC1600 Exp.date 04/27/99 Lead Paint inspector Behead A Samimi License # M-1796 Date of Inspection ct-\ArgS If low-risk deleading work is being performed, complete the following line: Property owner - Agent(s) Address of Project Building Name (if any) Hampshire Net hrc Apertmente Floor Street Address - . - Apt. No. \-C city Northampton, MA Zip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition (Replacement-) Other If "Other" selected, please explain Check One: dwelling is multi-family X single family Start date 71a5C4 Completion date a3-c When will work be done: A.M. 8:00 P.M. 5.00 Weekends? Nn Project Supervisor's name \\\16. ■i\C` ■(` License # %,�� Property Owner Address City Telephone N 49 Old South Street Nnrrha.eptsa (413) 584-4030 State MA In case of emergency contact Keith Jenkins Zip 01060 Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach ^a; General Laws c. 111 4 197 OM 22.0( ' 105 04R 460.000 notice of the date and methods(s) _ removal or covering of paint, plaster u. other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any Director, Childhood Leading Poisoning Piebention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Department of Labor r Industries Room 110061100 Cambridge Street Boston, MA 02202 - ' Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor - Fax (617) 753-9410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 iiss..true and correct to therb t of his/her knowledge e dgand belief. 3.x.0 signed:— Date ' Title: -' Adminivtra iivp A psi rant company: AccuTech Insulation & Contracting Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. 61" 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 ligdid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COt )NWEALTH OF MASSACHUSE B Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form QD must be completed in order to comply \ % Uk with the notification requirements of N.G.L. 0.111 5 197, 454 CUR 22.00 and 105 CS 460.000 as most recently amended FILE fig; (AGENCY USE) Contractor performing projectAccuTech Insulation & Contracting License A DC1600 Exp.date 04/27/99 License A 74_1726 Lead Paint Inspector Behzad A Aamimi Date of Inspection 9s15 If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Hampshire Reighta Apartments Floor Street Address _ . Apt. No. \-1 ) City Northampton, MA Zip 01060 Deleading Method: Heat Gun Caustics CReplacementl) Other (Wet/Dry Scraping) Liquid Encapsulant Covering Demolition If "Other" selected, please explain check One: dwelli ny is multi-family X single family Start date fir' 5 Completion date When will work be done: A.M. 8:00 P.M. 500 Project Supervisor's name Property Owner Address City Telephone elefiieiin 4' Nnrrhamnrnn Honsinc Authority 49 Old South Street Weekends? License No A Northampton (413) 584-4030 State MS Zip fllr6fl In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) notice In accordance with Massachus ^a General Laws C. 111 4 191 C[4t2 0�waa\�5 CIe accessible materials of the date and methodsls) o amoval or coveting of paint, plaster containing dangerous levels of4leeaad is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. , II Occupants of the dwelling unit All other occupants of the residential premises, if any Director, Childhood Leading P 5 gPre n[ on Program Fax !617) 753-8410 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos c Lead Program Department of 100 Cambridge Street Room 13006( .- Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) ]2]-5128 n.l adino Contractor The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts I]eleading 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 oflhis/her knowledge and belief. k Date 8/28/98 Signed: Administrative Assistant ' Company: AccuTech Insulation & Contracting, Inc. Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards siding covering surfaces applying exterior vinyl 9 removing doors, cabinet doors, shutters - I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: CON. elorREALTH OF MASSACHUSE7 A Department of Labor L Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 $ 19 7, 454 Q91 22.00 and 105 01R 460.000 as most recently amended F�@A 6 a22-G% FILE NUMBER: (AGENCY USE) Contractor performing project AccuTech Insulation & Contracting License # DC1600 Lead Paint Inspector Behzad A. Samimi Exp.date 4/27/99 License M M-1796 Date of Inspection If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Hampshire Heights Apartment Floor vv--11 Street Address Apt. No. `��'\C City Northampton, MA Zip 010F0 Deleading Method' Wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement Other If "Other" selected, please explain Check One: dwelling i mlti- X single family Start date 9/9/98 Completion date -$65±98- OVA?* When will work be done: A.M 8.00 P.M. 4.00 Weekends? No Project Supervisor's name Kirk Jasko License q DS3232 Property Owner Northampton Housing Authority 49 Old South Street Address City Telephone Northampton 413-584-4030 State MA yip 01060 In case of emergency contact Keith Jenkins Phone: day 413-592-5326 evening 413-665-2372 (over) In accordance with Massachus /e. General Laws c. 111 5 197 Ct4R 22.00 '1.05 chill 460.000 notice of the date and methods(s) o amoval or covering of paint, plaster o her accessible materials containing dangerous levels ut lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit _ All other occupants of the residential premises, if any Director, Childhood Leading Poisoning P[ebention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos c Lead Program Department of Labor c Industries Roam 110061100 Cambridge Street Boston, MA 02202 - ---- '" - '- Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Oeleading Contractor Fax (617) 757-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 o his/her knowledge and belief. Date 8/28/98 signed: ( �.�� "C: Title: Administrative Assistant- Company: AccuT2ch Insulation & Contracting, Inc. Property Owner If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COM e1WEALTH OF MASSACHUSE4 Ors Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELUDING WORK pp�� All sections of this form must be completed in order to comply(� ."; � 'd-C155 with the notification requirements of M.G.L. c.111 5 197, \1W) 454 a41 22.00 and 105 a4+ 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contractor perfonniog project AccuTech Insulation & Contracting License # DC1600 Exp.date 4/27/99 Lead Paint Inspector_ Behzad A. Samimi License # M-1706 Date of Inspection If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner_ Address of Project Building Name (if any) Apt. No. Street Address Zip 0060 City Dole ading Method: wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement If "Other" selected, please explain Floor Check One dwelling is multi-famil Start date 9/9/98 When will work be done: Project supervisor's name Other single family Completion date 9/25/98 Q•ai46- 8.On P.M. L.nn Weekends? License # DS3232 Kirk Jasko Property Owner Northam.ton Housinn •u h.ri Address 49 Old South Street Northampton City Telephone 413-584-4030 State In case of emergency contact Keith Jenkins 413-592-5326 evening 413-665-2372 (over) Phone: day No Zip 01060 In accordance with Massachus ^, General Laws C. 111 S 191 Q4( 22.00 r �105 am 460.000 notice of the date and methods(s) o emoval or covering of paint, plaster a .her accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit 2. All other occupants of.the residential premises, if any Childhood Leading Poisoning Prevention Program Fax (61] 3. Director, Department of Public Health, 4l0 Atlantic Avenue, Boston, MA 02110 Fax (617) 727-1560 4. Director, Asbestos a Lead Program Department of Labor fi Industries - - Room 11006,'100 Cambridge Street M Boston, MA 02202 lsa-8410 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) ) 727-5120 Deleading Contractor - - 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. Date 8/28/98 . Signed: / UA\i,„ o Y � � Title: ' Administrative Assistant" Company: AccuTech Insulation & Contracting, Inc. property owner If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters - I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: COM f 1WEALTH OF MASSACHUSE1 elk Department of Labor S Industries and Department of Public Health NOTIFICATION OF WELEADING NOES All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 O . 22.00 and 105 04R 460.000 as most recently amended FILE NUMBER: ck,,■W Ck as ac6 (AGENCY USE) Contractor peffonning project AccuTech Insulation & Contracting, License # DC1600 Exp.date 4/27/99 Lead Paint Inspector Behzad A Samimi License Y M-1776 Date of Inspection If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Hampshire Heights Apartment Floor Apt. No. Street Address City Nnrthamptnn, MA Zip 010A0 Deleading Method: Wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement Other If "Other" selected, please explain Check One: dwelling mlti-family X single family Start date 9/9/98 When will work be done: Completion date s.nn P.M. A.nn a/2s/°a c -avetSr Weekends? No Project Supervisor's name Kirk Jasko License ij DS3232 property Owner Northampton Housing Authority Address 49 Old South Street Northampton 413-584-4030 City Telephone State Zip 01060 In case of emergency contact Keith Jenkins Phone: day 413-592-5326 evening 413-665-2372 (over) In accordance with Massachus^1 General Laws c. 111 5 197 OM 22.00 : 105 CMR 460.000 notice of the date and methods(s) o amoval or covering of paint, plaster o. .her accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least tan (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of.the residential premises, if any Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-0410 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos c Lead Program Fax (617) 727-7568 Department of Labor 4 Industries Room 110061100 Cambridge Street Boston, MA 02202 ' Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission (If premises is listed on the State Register 220 Morrissey Blvd. of Historic Places, this notification must be Boston, MA 02125 made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor 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 o his/her knowledge and belief. Date 8/28/98 signed: • � “ Title: Administrative Assistant- Company: AccuTech Insulation & Contracting, Inc. Property owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COb.nliWEALTH OF MASSACHUSE'_r""i Department of Labor L Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply �-�9�1 n ...\„, q a'a with the notification requirements of M.G.L. c.lii 5 197, 454 (]4a 22.00 and 105 CMF 460.000 as most recently amended FILE NUMBER. (AGENCY USE) Contractor peffoiining project AccuTech Insulation & Contracting License # DC1600 Exp.date 4/27/99 License g M-1776 Lead Paint Inspector Behz d S Date of Inspection 2 -(-k5 If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner_ Adds s of Project Floor Building Name (if any) Apt. No. '�,'� Street Address Zip 01060 City .. ..�� . .. - Deleading Method: Wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition If "Other” selected, please explain Check One: Replacement Other dwelling is multi-family X single family Completion date 9-45498 q- -'-q4 Start date 9/9/98 When will work be done: A.M. fl•nD P.M. 4•fln Kirk Jasko Project Supervisor's name Property Owner Northampton Housin_ Autho Address 49 Street City Northampton Telephone 41 In case of emergency contact Keith Jenkins 413-592-5326 evening 413-665-2372 (over) State Phone: day Weekends? No License g DS3232 Zip 01060 4% In accordance with Massachus^. General Laws c. 111 5 197 tam 22.00 :^105 CHB 460.000 notice of the date and methods(s) o amoval or covering of paint, plaster o. .her ccessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling 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 c Lead Program Department of Labor c Industries Room 110061100 Cambridge Street Boston, MA 02202 - " " ' Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (61]1 753-8410 Fax (617) 727-7560 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5126 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 1 his/her knowledge and belief. Date 8/28/98._ . . Signed: ' 7) \. J' A4 I itti r ( - Title: Administrative Assistant- Company: AccuTech Insulation & Contracting, Inc. Property owner If owner or unlicensed 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters - I certify that all the information contained in this notification is true and correct to the best of my,knowledge and belief. Date: REV 10/12/95 Signed: COMea*1WEALTH OF MASSACHUSE'.Psi Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK �. \ All sections of this form must be i order co ply hj3 ''& q n'T( with the notification requirements 454 a. 22.00 and 105 am 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contactor performing project AccuTech Insulation & Contracting License # DC1600 Exp.date 4/27/99 a e C i License M M-1776 Lead Paint Inspector Date of Inspection covelC, If low-risk deleading work is being performed, complete the following line: Property owner_ Address ss�� Floor Building Name (if any) •.n , • ' - • '' "-' t. Apt. No. a Street Address City .. 1-Hl ., .. Zip n1n411 Deleading Method: Wet/Dry Scraping Heat Gun Caustics Coverin Demolition Replacement Other Liquid Encapsulant 9 If "Other" selected, please explain Agent(s) Check One: Start date When will work be done: A.M dwelling is mulri-family X single family 9/9/98 project Supervisor's name property Owner Northampton Housin_ Author Address City Telephone 413-584-4030 In case of emergency contact Keith Jenkins phone: day 413-592-5326 evening 413-665-2372 (over) Completion date H4-54-4 02,.\-q% Weekends? No License if DS3232 8.00 P.M. 4.0n Kirk Jasko 49 Old South Street Northampton State MA Zip 01060 Ask In accordance with Massada s General LAMS C. 111 4 197 OM 22.0f t. other accessible materials of the date and dangerous levels-. removal or covering of paint, plaster dangerous levels ays prio r is to be provided and must be received by the following persons, at least ten (10) days or to beginning of deleading. Occupants of the dwelling unit All other occupants of the Director, Childhood Leading Department of Public Health • residential premises, if any Poisoning Prevention Program , 470 Atlantic Avenue, Boston Director, Asbestos 6 Lead Program Department of 100 Cambridge Street Boston,n,006,' Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 , MA 02110 Fax (51]) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) 727-5128 reloading Contractor 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`berst of his/her knowledge and belief. Date Signed: Title: - Adminigtrativm 4caictant Company: AccuTPfh Tnsnlntior F, Cnntrarting property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealti. c' 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) :. capping baseboards covering surfaces applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 CObetNWEAL TR OF MASSACHUSE9St Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORE All sections of this form must be completed in order to comply \b� 0-g`1A with the notification requirements of X.G.L. e.111 5 197, 454 C4E 22.00 and 105 CA 460.000 as most recently amended FILE NOEZR: (AGENCY USE) Contractor performing project AccuTech Insulation & Contracting license DCI600 Lead Paint Inspector Brian Williams Exp.date 04/27/99 License 0 M-7958 Date of Inspection "4-c:5-C15 If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Hamnchirn ucighrc nperrmonr Floor Street Address Apt. No. j;.;2:--Q l-Q City Northampton, ALA Zip 01060 Deleading Method: et/Dry Scrapi Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement/ Other If "Other" selected, please explain Check one dwe u is muitt-family X single family Start date C,=`-!� Completion date �� When will work be done: A.M. 8:00 P.M. 5:00 Weekends? No � Project Supervisor's name �r\��ti �.(;S�(1 License q \cS127 Property Owner Northampton Housing-Authority Address 49 Old South Street City Northampton State MA Zip 01060 Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach ^‘; General Laws c. 111 5 197 CMR 22.0( ^105 Clot 460.000 notice of the date and methods(s) -. removal or covering of paint, plaster L. artier accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 400 Atlantic Avenue, Boston, MA 02110 • Director, Asbestos 6 Lead Program Department of Labor a Industries Room 110061100 Cambridge Street Boston, MA 02202 - " Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 753-8410 Fax (610) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 027-5128 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,b- t of his/her knowledge and belief. Date J `'t3 Signed: \ C Title: Admjnj strativP Acci gran Company: AccuTech Insulation & Contracting Property Owner (If owner or unlicensed owners agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:, MF 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 duets, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. _ Date: Signed: REV 10/12/95 COrK)NWEALTH OF MASSACHUSEFS Department of Labor a Industries and Department of Public Health NOTIFICATION OF DELEADING WORK `_ All sections at this on S �1i17 t be completed in order to comply � o aWP6 with the notification requirements of M.G.L. c.111 § 190, 454 O . 22.00 and 105 Qet 460.000 as most recently amended FILE NQIDER: (AGENCY USE) Contractor performing project Ac cuTech Insulation & Contracting License # 001 600 Lead Paint Inspector Behzad A Sami Exp.date 04/27/99 License # w-i7fl Date of Inspection s-\\4C If low-risk deleading work is being performed, complete the following line: property owner Agent(s) Address of Project Building Name (if any) Hampshire Raisiitc Apartments Floor (� Street Address - - . Apt. No. City Northampton, NA yip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition CeolacemenC; Other If "Other" selected, please explain Check One Start date dwelling is nvlti-family X single family Completion date When will work be done: A.M. Project Supervisor's name Property Owner N Address City Nnrrhamproa Telephone (413) 584-4030 8:00 - t e ak-ak 5:00 Weekends? r.n. IS •• • e. 49 Old South Street Nn License # ,ZD?-d7) State Zip 01060 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach a^ of the date and s General Laws c. 111 5 197 CMR 22.0( 105 acR 460.0e0 notice mousole(el _o cleada i or covering of paint,, stn bear u. other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least t ten ( n 110) days prior to beginning of deleading. Occupants of the dwelling 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 s Lead Program Department of Labor 6 Industries Room 110061100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Oeleading Contractor Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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. Date Signed: V. Adminigtrnrivp Assivranr company: AccuTech Insulation & Cnnrrncring Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. bf 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 capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 CON `NWEALTH OF MASSACHUSE90f+ Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this farm must be completed in order to comply \mow\ 454 CPR 22.00 notification and 105 ce 460.000 as most recently amended 5 nded FILE NUMBER: (AGENCY USE) Contractor perfomnng projectA c T ch Insulation & Contractin e License # DC1600 Exp.date 04/27/99 License # M_1796 Lead Paint Inspector ^ /ry_/)� Date of Inspection �l'-1 '1 If low-risk deleading work is being perrormed, complete the following line: Agent(s) property owner Address of Pro ect Building Name (if any) Street Address City _�- Deleading Method: (Wet/Dry Scraping Liquid Encapsulant Covering Demolition If "Other" selected, please explain Northampton, MA Floor Apt. No. Zip 01060 Heat Gun Caustics Replacement) other Check one: dwelling is multi-t Start date When will work be done: A.M. 8.00 P.M. 5:00 single family Completion date Project Supervisor's name Property Owner • •-e. .• .. 47 1 S. Weekends? N License # r-^? � Address 49 Old South Street State My Zip _alga — Telephone Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 (over) .‘ ., In accordance with Massach s General Laws c. 111 5 197 CMR 22.01 105 OM 460.000 notice of the date and methods(s) -.. removal or Covering of paint, plaster b, other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling 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 6 Lead Program Department of Labor a Industries Room 11006,'100 Cambridge Street Boston, MA 02202 - ' Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617 • 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 b- t of his/her knowledge and belief. rv,� / I/'7 Date —44-�3-`'tb Signed: C(.i.�\.i,6 Title: Company: Admini9trativp Assi=tan AccuTeCh Insular-inn & fnnrrarrint Property Owner If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. c' 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 doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: - Signed: REV 10/12/95 COtaINWEALTH OF MASSACHUSESS Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this fog must be completed erl 5 191, te B n.od comply with the notification requirements 454 091 22.00 and 105 01R 460.000 as mat recently amended \S r6 'kiS3 FILE NOmER: (AGENCY USE) Contractor performing projectAccuTech Insulation & Contractin¢ license# DC1600 Exp.date 04/27/99 Lead Paint Inspector Beh,ad A Samimi License # M-1796 Date of Inspection C4 -rr'sQS If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) Hempen-ire Hniohrc 4parrmanrs Floor Street Address - - . Apt. No. 'S'A J City Northampton, MA Zip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition CReplacement`) Other If "Other" selected, please explain Check One: dwe11L iulei-famib, x single family Start date Completion date When will work be done: A 8:00 P.M. 5:00 Project Supervisor's name '.0 A �.I,ISYL` Property Owner Northampton Hnnaino Art-hi-of-fry Address 49 Old South Street City Northampton State Telephone (413) 584-4030 Weekends? No License # Zip Ot Obn In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach T`s General Laws c. 111 5 197 OMR 22.0( 105 04R 460.000 notice of the date and methods(s) -. removal or covering of paint, plaster u. other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 • 4. Director, Asbestos c Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street • Boston, MA 02202 - " Fax (617) 753-8410 Fax (617) 727-7568 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (If premises is listed on the State Register 220 Morrissey Blvd. of Historic Places, this notification must be Boston, MA 02125 made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor - 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,b t of his/her knowledge and belief. r. Date _\'�"`{O ` . Signed: �L\.li' I Title: 4dm inietratiVa Avvictanr Company: AccuTech Insulation & Contrarting Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealti, r.^ 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 doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COrwONWEALTH OF MASSACHUSE740 Department of Labor 6 Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All section, of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 OM 22.00 and 105 OM 460.000 as most recently amended yILE um ER: than= USE) Sku.:kcp.A `sauq`a Contractor performing projectAccuTech Insulation & Contractinz License # DC1600 Exp.date 04/27/99 Lead Paint Inspector Behzad A Samimi License I M_1726 Date of Inspection R 'AS If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address Building Name (if any) Hamp sAirc Hei•htc Apartments Floor Street Address city ➢eleadirg Method: Heat Gun Caustics Northampton, NA Apt. No. L1-� Zip 01060 (Wet/Dry Scraping) Liquid Encapsulant If "Other" selected, please explain Covering Demolition CReplacement) Other � Check One: dwelling is multi-family X single family 43-4=14,15 Start date p�� Completion date �- When will work be done: A.M. 8:00 p.M. 5.00 Weekends? No Project Supervisor's name 4. N i.-J- License 14 'J`.'�ic property Owner Northampton Honaini Authority Address 49 Old South Street City Nrrthamrrnn State MA Zip _Almon__ Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach 0(se.,s General Laws c. 111 4 197 04i 22.0[ ^105 CMR 460.000 notice of the date and methods(s) _ removal or covering of paint, plaster t_ other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit All other occupants of.the residential premises, if any • Director, Childhood Leading Poisoning Prebention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos c Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-512B 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,b t of his/her knowledge and belief. Date n' 'KA Signed: ,S L,_cf Title: - Adminisrrativp 4s sieranr Company: AccuTech Insulation & fnnrrarring Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:, cF 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 doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 Mellr7NWEALTH OF MASSACHUSE';aS Department of Labor 6 industries and Department of Public Health NOTIFICATION OF DELEADING WORK r�C All with them of this form quit be tsmpofcM. in L order c.11 to comply \°)f)IJ 454 the notification CMG 460.000 of M.G.L. ntly 5 197, 454 C4i 22.00 and 105 CMG E60.000 as most scantly amended FILE HUMES: (AGENCY USE) Contractor performing projectAccuTech Insulation & Contracting License p DC1600 Exp.date 04/27/99 Lead Paint Inspector Beb7ad A Samimi Date of Inspection License I If low-risk deleading work is being performed, complete the following line: property owner Agent(s) Address of Pro ect Building Name (if any) Street Address City Dele ailing Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant If "Other" selected, please explain Hampshire Heiohrs Aperrmenrs Northampton, MA Floor n Apt. No. 1\5 yip 01060 Covering Check One: Demolition Ceplacement) dwelling is multi-tamily X single family Start date Completion date When will work be done: A.M. 8:00 Project Supervisor's name Property Owner Address 49 Old South Street State M5 Zip City Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (overt P.M. 5:00 Other Weekends? N License n1nbn In accordance with Massach ' s General Laws C. 111 4 197 CMR 22.0( a^105 Q41 460.000 notice of the date and methods(s) - val or covering of paint, plaster -,her accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling 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 Fax (617) 753-8410 Director, Asbestos 6 Lead Program Fax (617) 727-7568 Department of Labor i Industries Room 11006,'100 Cambridge Street Boston, MA 02202 - - Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5129 Deleading Contractor 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 b- t of his/her knowledge and belief. Date -1'q-`'`‘ Signed: ; lk' Title: :ell II Company: AccuTeoh Insulation & Contracting Property owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. r 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 capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this not best of my knowledge and belief. cation is true and correct to the Date: Signed: REV 10/12/95 C040WONWEALTH OF MASSACHUSE S Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. e.111 5 197, 454 04R 22.00 and 105 CMR 460.000 as most recently amended Qul9N\Cs4\46 FILE NUMBER: (AGENCY USE) Contractor performing projectAccuTech Insulation & Contracting License # DC1600 Lead Paint Inspector Behzad A Samimi Exp.date 04/27/99 License 4 M-1796 Date of Inspection 4 yc If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) HampahirP HPightq Aparrmonka Floor Street Address - - Apt. No. 14-C City Northampton, MA Zip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition CReplacementj other If "Other" selected, please explain Check One Start date dwelling is multi-family X single family .�,,�� u�I, 15 \�.`i Completion date -'::?-77; -"�.J 'Sift%4d When will work be done: A.M. 8:00 P.M. 5:00 Project Supervisor's name Property Owner Address City Telephone N 49 Old South Street Northampton (413) 584-4030 Weekends? Nn License q '?+`c" State In case of emergency contact Keith Jenkins Zip 0106( Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massach s General Laws c. 111 5 197 CMR 22.0( ismN of the data and methods(s) removal or covering her G. 460.000 notice containing dangerous levels of lead is to be g de paint, plaster c, other accessible materials persons, at least ten (10) days provided and din be received by the following Y prior to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 4 Lead Program Department of Labor a Industries Room 11006, '100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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)b t of his/her knowledge and belief. Date 13 Signed: A 1 Tide: ' - Administrative Ap i= qt lot - Company: AccuTech Insulation & Contracting Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt;, c+ 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 capping baseboards • applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 (Wet/Dry Scraping) car)NWEALTH OF MASSACHUSErcS Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK ;;�� ,,,,`` All sections of this form must be completed in order to comply ck0,0411C'6 45 vith the notification requirements of M.G.L. c.111 4 197, 454 Cak 22.00 and 105 CHa 460.000 as mat recently amended TILE NUllEP: (AGENCY 05E1 Contractor performing projectAC uTech Insulation & Contract in License # DC1600 Exp.date 04/27/99 License I M-1196 Lead Paint Inspector -^ " y ry� c( Date of Inspection ^'l`1 If low-risk deleading work is being performed, complete the following line: Agent(s) property owner Address of Building Name (if any) Street Address city Deleading Method: Northampton, MA Liquid Encapsulant If "Other" selected, please explain Covering Heat Gun Demolition Check One: Start date Completion date When will work be done: A.M. 8:00 F.M. 5:00 project Supervisor's name `mA\ Property Owner Apt. _ Zip 01060 Caustics ReplacemenE) Other dwelling is multi-family X single family Address - Zip 01060 State My City Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 (over) Weekends? N 49 Old South Street In accordance with Massach s General Laws C. 111 5 197 am 22.04 105 GMR 460.000 notice of the date and methods(s) _ removal moval or covering of paint, plaster o. other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling 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 4. Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006,"100 Cambridge Street Boston, MA 02202 '--- ---- 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 b t of his/her knowledge and belief. Date - �"Clb Signed: '��.�Llb' ttA Title: Administrative Ascisranr Company: AccuTech Insulation & fonrrsrrirg Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. cT 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 capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COIF► NWEALTH OF MASSACHUSE70+ Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this for must by completed H.G.L.order erl 5 cccaply with the notification requirements ` 454 COi 22.00 and 105 04K 460.000 as most recently amended FILE NUMBER: {)nlj`tp 34,4% DIGENCt USE) ContactotpedomningprojectAccuTe h Insulation & Contractive License# DC1600 Exp.date 04/27/99 License R M_1776 Lead Paint Inspector 5--1,b-C15 Date of Inspection If low-risk deleadina work is being performed, complete the following line: property owner Address of Pro ect Floor Building Name (if any) _ _ •' - Apt. No. Street Address Zip 01060 Northampton, MA city Heat Gun Caustics Deleading Method: CWet/Dry Scraping) Liquid Encapsulant Covering Demolition Replacements Other If "Other" selected, please explain Agent(s) Check One: dwelling is nm l c.-bmi P! X single family Start date �^-C<NKc C cmpletion date ""' n-7C__ When will work be done: A.M. 8:00 P.M. 500 weekends? M project Supervisor's name property Owner Address City Telephone (413) 584-4030 In case of emergency contact Keith Jenkins phone: day (413) 592-5326 evening (413) 665-2372 (over) N 49 Old South Street State MA License Zip 0106❑ In accordance with Massach s General Laws c. 111 5 197 CMR 22.0( 105 ate 460.000 notice of the date and s(s) -- removal or covering of paint, plaster c- other accessible materials containing dangerous rous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any Director, Childhood Leading Poisoning Prebention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,-100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Manacling Contractor Fax (611) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 b- \t of his/her knowledge and belief. Date Signed: Title: Company: \ 1u' Administrative Axxi¢ran AccuTech Insulation & Cnntrarring Property Amer (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commenwealt:. c' 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 doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COrONWEALTH OF MASSACHUSE,0 Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 C4i 22.00 and 105 C41 460.000 as most recently amended FILE NUMBER: (AGENCY USE) R.3■Lea %x34455 Contractor performing projectAccuTech Insulation & Contracting License # DC1600 Exp.date 04/27/99 Behead A Samimi License # m-179(. Lead Paint Inspector ` Date of Inspection `",1I('4-0. If low-risk deleading work is being performed, complete the folio Agent(s) Property owner Address Building Name (if any) Ramp ahire Heic3r4 Aparrmanrc Floor Street Address City Northampton, MA Deleading Method: (Wet/Dry Scraping) Liquid Encapsulant If "Other" selected, please explain Covering RTHAMPION HOARD OF HEALTH Apt. No. Zip 01060 Heat Gun Caustics Demolition CReplacement-) Other Check One: dwelling is multi-family .Y single family Start date pt Completion date �5�.._ni Weekends? When will work be done: 8:00 P.M. 5_00 Project Supervisor's name Property Owner Address Northampton Horsing Authority 49 Old South Street State City Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) License k `� Zip n1061) In accordance with Massachusa General Laws c. 111 5 197 CMR 22.00 a ^ g am) 460.000 notice of the data and methods(s) of removal or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit 2. All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-8410 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006,'100 Cambridge Street Boston,- MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deluding Contractor Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 ilsl true and correct to the bbesl-of his/her knowledge and belief. Date -1—�>)",iC& -- Signed: ..Liti .1.� wi. ` Adminigtrariva Agq+craflr Company: AccuTech Insulation & rnnrrartinv Property Owner (If owner or unlicensed owner s 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my.knowledge and belief. Date: Signed: REV 10/12/95 COITINWEALTH OF MASSACHUSEP,fi Department of Labor L Industries and Department of Public Health (� NOTIFICATION OF DELEADING WORK NIA All sections of this form must be completed in order to comply puUl with the notification requirements of M.G.L. c.111 5 197, 454 (2411 22.00 and 105 C741 460.000 as most recently amended FILE NuBER: (AGENCY USE) Contractor pedolm4(9 projectAccuTech Insulation & Contractins License # DC1600 Exp.date 04/27/99 License # M_177(. Lead Paint Inspector hh Date of Inspection �AV,`q 17 If low-risk deleading work is being performed, complete the following line: Agent(s) property owner Address Iect Building Name (if any) Street Address City Dole ading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition Replme acent) Other If "Other" selected, please explain Northampton, Floor Apt. No. 5'\ Zip 01060 check One: dwelling is multi-family X single family ThA Completion date Start date When will work be done: A.M. 8:00 P.M. 5'00 Project Supervisor's name property Owner Address 49 Old South Street State NA Zip 0106n City Telephone (413) 554-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 — (over) C Weekends? No License # D '" a 1 If accordance d0me methods(s) of oval ror Laws c. III 5 197 Cpl 22.00 r CN ssible notice of the date and rousolele) oo removal or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of She residential premises, if any er, Childhood Leading Poisoning Pie,ention Program Fax (617) 753-8410 Department ent of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos f Lead Program Department of Labor & Industries Room 11006,'100 Cambridge Street Boston, MA 02202 ' - Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor -- Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 bes; f his/her knowledge and belief. Date i—Q-A6 Signed: r��. .av �I Title: Administrative Qc ad Gtarr Company: AccuTech Insulation & Cnrtrarritlg Property owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: - Signed: REV 10/12/95 COhNWEALTH OF MASSACHUSE'r# Department of Labor 6 Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 4 197, 454 CHIT 22.00 and 105 mdi 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contractor peroDDm9 projectAC uTech Insulation & Contractin e License # DC1600 Exp.date 04/27/99 License # M_1776 Lead Paint Inspector Date of Inspection CS-1YACT If low-risk deleading work is being performed, complete the following line: Agent(s) property owner Address Building Name (if any) Street Address City Deleadinq Method: Liquid Encapsulant Covering If "Other" selected, please explain Northampton, MA (Wet/Dry Scraping) Floor Apt. No. S-� yip 01060 Heat Gun Caustics (Replacement Other Demolition Check One: dwelling is multi-tam:'/ Y single family �MA,Ci� Completion date �3 Start date When will work be done: A.M. 8:00 P.M. 5_00 V1 OR( �L License N �� ' project Supervisor's name �"l property Owner N Address 49 0ld South Street State MJ_ Zip 0106/1 City Telephone (4131 584-4030 In case of emergency contact Keith Jenkins Phone: day 413 592-5326 evening (413) 665-2372 — (aver) Weekends? N .. In accordance with Massachust toners' Laws c. 111 S 197 C 22.00 a 4111\5 460.000 notice of the date and methods(s) of removal or covering of paint, plaster or er accessible materials containing dangerous ous le levels of lead is to be provided and must be received by the following persons, at least tan (101 days prior to beginning of deleading. + I - Occupants of the dwelling unit All other occupants of.the residential premises, if any Director, [, LHealth Poisoning Prevention Program Fax (6 17) 753-$¢10 Department of Public Health, 170 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006,'100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor --. The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 954 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 bestt',��of his/her knowledge and belief. Date 1.—l.: Signed: A ∎ 'ft 1 ■::�lL l _ �t. - title: Admin istra t;vs 4ss1 clam Company: AccuTech Insulation & Cnntr.vrtine Property owner (If owner or unlicensed owner's agent will be performing law-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-risk activities (I have circled all that apply) :. applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters . I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 COEnNWEALTH OF MASSACHUSE" Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK all sections of this form most be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 Q91 22.00 and 105 02t 460.000 as most recently amended FILE NUMBER: (AGENCY USE1 Contractor performing projectAccuTech Insulation & Contractinz License # DC1600 Lead Paint Inspector Bebzad A Samimi Exp.date 04/27/99 License # M_1 ]96 Date of Inspection Cm—Th-3E If low-risk deleading work is being performed, complete the following Line: Property owner - Agent(s) Address of Project Building Name (if any) bampchira Hezlitc Apartment4 Floor Street Address - . Apt. No. \o-4 City Northampton, MA Zip 01060 Deleading Method: (Wet/Dry Scraping) Heat Gun Caustics Liquid Encapsulant Covering Demolition Ceplacement) Other If "Other" selected, please explain check One: Start date dwelling is multi-family X single family Completion date When will work be done: A.M. 8:00 P.M. 5:00 Project Supervisor's name C- ■D Weekends? License # Nn Property Owner Northampton Houcing Anthnr+ty Address 49 Old South Street City Northamptnr State MA Zip oin60 Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day • (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massachusa ;eneral Laws C. 111 s 191 (74R 22.00 a w15 OIR 460.000 notice of the date and methods(s) of r<eoval or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. I Occupants of the dwelling unit All other occupants of•the residential premises, if any Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-84l0 Department of Public Health, 170 Atlantic Avenue, Boston, MA 02110 Director, Asbestos a Lead Program Department of Labor a Industries Room 11006,-`100 Cambridge Street Boston. MA 02202 - - - 5. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (6171 727-7568 [If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax 1617) 727-5128 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 hespof his/her knowledge and belief. Date Signed: Title: AdmintgtrativP A=sisran company: AccuTech Irsulation & Conrrirting Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) :. applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters _ I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 (Wet/Dry Scraping) COTr;NWEALTH OF MASSACHUSE:A" Department of Labor s Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 CAW 22.00 and 105 Q9l 460.000 as most recently amended FILE NUMBER: (AGENCY USE) Contractor performing projedAccuTech Insulation & Contracting License # DC1600 Lead Paint Inspector Behzad A S;ii Exp.date 04/27/99 License 8 Date of Inspection M-1726 VA0-GS If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address Building Name (if any) Hampshire HP7,;b0-5 Apartments Street Address city Deleading Method: Northampton, Liquid Encapsulant If "ether" selected, please explain Covering Floor Apt. No. Zip 01060 Heat Gun Caustics (Replacement) Other Demolition g Check One: dwelling is multi-family X single family Start date *.j—)[k% Completion date When will work be done: A.M. 8:00 P.M. 5:00 Weekends? No Project Supervisor's name Property Owner Address City Telephone N \c\`‘, C b 49 Old South Street North i ptcn (413) 584-4030 State License # - A- mil Zip 0) 06n In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massachust ^Seneral Laws C. 111 5 197 aItt 22.00 a }5 CFR 460.000 of the date and methods(s) of rtmoval or covering of paint, plaster or notice containing dangerous levels of lead is to be p s er accessible materials 9 provided and be received by the following must persons, atl least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of.the residential premises, if any Director, Childhood Leading Poisoning Pte,ention Program Fax (617) 753-$410 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos r Lead Program Fax (617) 727-7568 Department of Labor 6 Industries Room 11006,°100 Cambridge Street Boston, MA 02202 .. " -'- Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor _- • (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleadinq) Fax (617) 727-5128 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. n3 Date —� cc Signed: Title: Administrative AsNcranr Company: AccuTech Tnsulation & Contrarring Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: signed: REV 10/12/95 CONre!NWEALTB OF MASSACIHUSE"N Department of Labor s Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must�beencomplet M.G.L.i order to comply with the notification requirements Od. 22.00 and 105 Cmi 460.000 as most recently amended FILE NUMBEAI (AGENCY UE£) ContimdtorpedonnMgpnijedAccuTech Insulation & Contracting License # DC1600 Exp.date 04/27/99 License # M-1795 Lead Paint Inspector Date of Inspection � "l If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Address Building Name (if any) Street Address City Deleading Method: (Wet/Dry Scrapin) Liquid Encapsulant Covering Demolition If "Other" selected, please explain Northampton, MA Floor Apt. No. Zip 01060 Heat Gun Caustics Replacement) Other Check One: dwelling is multi-family X Completion date single family Start date When will work be done: A.M. 8:00 P.M. 5_00 project Supervisor's name Q S� property Owner Address 49 Old South Street State Mme",_- nl Zip nfn City Telephone (413) 584-4030 case of emergency contact Keith Jenkins evening 413 665-2372 Weekends? License # In Phone: day (413) 592-5326 (over) In accordance with Massachusk ^;eneral Laws c. 111 5 197 CMft 22.00 a 444\5 CITRR 460.000 notice of the date and methods(s) of c'.,noval or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of.the residential premises, if any Director, Childhood Leading Poisoning Prevention Program Fax (617) 153-$410 Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 4 Lead Program Department of Labor 6 Industries Room 11006,"100 Cambridge Street • Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadinq Contractor Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order To Correct Violations or Cr at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 bes of his/her knowledge and belief. Date T.—K3746 Signed: (&, 11 'e. W r. Title: kdministrative 4scintent Company: AccuTech Insulatinn & Cnntraoting Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all .that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: COIP9NWEALTH OF MASSACHUSEr6 Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK �� All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 19'1, 454 ant 22.00 and 105 UOi 450.000 as most recently amended FILE NUNBEn: IAGENCE USE) Contractor perfotm(ng projectAccuTech Insulation & Contracting License # DC1600 Exp.date 04/27/99 License # M-1776 Lead Paint inspe<toc C-01-1-1 Date of Inspection If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner • Address of Project Floor Building Name (if any) _ . . - Apt. No. \n-t) Street Address 01060 Northampton, MA Zip City Dele ailing Method: (uret/Dry Scraping) Heat Gun Caustics Covering Demolition (Replacement) Other If "Other" selected, please explain Liquid Encapsulant Check One: dwelling is multi-family X single family �-j Completion date Start date �w�— When will work be done: A.M. 8:00 P.M. 5.00 Weekends? *� Project Supervisor's name Property Owner N Address State MS Zip 01060 City Telephone (413) 584-4030 License 49 Old South Street In case of emergency contact Keith Senlcins Phone: day (413) 592-5326 evening (413) 665-237 (over) In accordance with Massaehvse ^ of the date and ethods(s) of :eneral Laws c. 111 4 197 CMR 22.00 a er CMR accessible notice removal or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of.the residential premises, if any Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-8410 Department ent of Public Health, 170 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 4 Lead Program Fax (617) 727-7566 Department of Labor 6 Industries Room 11006,7100 Cambridge Street - - - Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 hes -of his/her knowledge and belief. Date Z—K3-gc6 Signed: ' � � 9 A ) •1�LAA.0 �U Titre: Adm{Riot rat ivp Assicrant company: AccuTeCh Insulation & Cnnrrarrinv Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters capping baseboards covering surfaces 1 certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: Department CObrNWEALTH OF MASSACHUSE'P" c of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of M.C.L. c.111 5 197, 454 CHIP 22.00 and 105 CIO. 460.000 as most recently amended TILE NUMBER. (AGENCY USE) c'a3 SS cs�\1-C-1c6 Contractor perommthy projectACCUTech Insulation & Contracting License # 0C1600 Exp.date 04/27/99 ,1 License # M-195+8 Lead Paint Inspector N Date of Inspection -`-F) If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Address of PEO'ECt Building Name (if any) Street Address City Deleading Method: Wet/Dry crapin� Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement Other If "Other" selected, please explain Northampton, MA Floor No. I-9 Apt. Zip 01060 Check One: dwelling is multi-Family_ Start date a When will work be done: A.M. 5:00 P.M. 5:00 single fa Completion date Project Supervisor's name property Owner N.rth Address City _ Telephone (413) 584-4030 y • m Weekends? No License # �` _ 49 Old South Street Northampton State In case of emergency contact Keith Jenkins evening (413) 665-2372 Phone: day (413) 592-5326 Zip 01060 (over) In accordance with Massachusa '^;eneral Laws c. 111 g 197 CMR 22.00 a 15 OCR 460.000 notice of the data and methods(s) of t=moval or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ton (10) days prior to beginning of deleading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street Boston, MA 02202 - - - 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor ■ Fax 617) 753-8410 Fax (617) 727-7568 at premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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. .- Date —.—Q-A Signed: .eA.`.:1iL - �C -.12, -- Title: Admintstrat ivn Acci stanr company: AccuTech Tnsulatinn & Cnnrrarrine Property owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) :. applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet ducts, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. ,. Date: Signed: REV 10/12/95 (Wet/Dry Scraping) COIea`JNWEALTH OF MASSACHUSE/S Department of Labor 6 Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply with the notification requirements of H.G.L. c.111 5 197, 454 424R 22.00 and 105 CAI 460.000 as most recently amended FILE NUMBER: c' y% s fx (AGENCY USE) Contractor performing projectAccuTech Insulation & Contracting License # DC1600 Lead Paint Inspector Behead A Samimi Exp.date 04/27/99 License I Date of Inspection M-177(. VThC If low-risk deleading work is being performed, complete the following line: property owner Agent(s) Address of Project Building Name (if any) Hampshire Heights Apartments Floor Street Address _.. . Apt. No. City Deleading Method: Northampton, NA Liquid Encapsulant Covering yip 01060 Heat Gun Caustics Demolition CReplacementj Other If "Other" selected, please explain Clerk One: dwelling is multi-family X Start date a414‹ single fa Completion date When will work be done: A.M. 8:00 P.M. 5;00 Project Supervisor's name Property Owner Address City Telephone y Northampton Houging Authoriry 49 Old South Street Nnrrh"mpron (413) 584-4030 Weekends? License No State MA yip 01060 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 (over) In accordance with Massachusr ^ k3 neral Laws c. 111 5 197 CMR 22.00 /� of the date and methods(s) of aamoval or covering a er acc 460.000 notice containing dangerous levels of lead is to be provided pandtmustabee received by the followmaterials persons, ati least ten (10) days prior to beginning of deleading. occupants of the dwelling unit All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Pre'ention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 4 Lead Program Department of Labor 4 Industries Room 11006,"100 Cambridge Street Boston, MA 02202 - , ..__. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 753-$410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive tleleading) Fax (617) 727-5128 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. Date I Signed: i ,r��` �� ,,_ ^iVU Title: ' Administrative 4ssisranr company: AccuTeCh Tnsularinn & Cnnrr=rtind Property owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: COIfNWEALTH OF MASSACHUSE e'S Department of Labor L Industries and Department of Public Health NOTIFICATION OF DELEADING WORK _ , �� rlc� All sections of this farm must be completed in order to comply c46.VA with the notification requirements of M.G.L. c.111 4 197, 454 Q11 22.00 and 105 OP 460.000 as most recently amended FILE ma mER: (AGENCY USE) Contracdor pedonning proledA c Te h Insulation & Contractia _License # DC1600 Exp.date 04/27/99 License # _�179A Lead Paint inspector Q � CC\S Date of Inspection If low-risk deleading work is being performed, complete the following line.: Agent(s) Property owner Address Building Name (if any) Street Address City Heat Gun Method: CWet/Dry Scraping Deleading me./ )arement ) other Liquid Encapsulant Covering Demolition If "Other" selected, please explain Northampton, MA Floor Apt. No. yip 01060 Caustics Check One: dwelling is multifamily X Completion date Start date When will work be done: A.M. 8:00 project Supervisor's name Ll Property Owner • .-,, • •• •• so Address Zip 0)06 State M4y city Telephone 413 584-4030 In case of emergency contact Keith Jenkins (413) 592-5326 evening 413 665-2372 Phone: day (over) single fa P.M. 5.00 y Weekends? License # = 49 Old South Street In accordance with Massachust �-General Laws C. 111 5 197 O R 22.00 ^ of the date and methods(s) of atmoval or covering of paint, plaster or er OM 460.000 notice containing dangerous levels of lead is to be provided and must be received byathesfollowi�ng trials persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit A11 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 6 Lead Program Department of Labor c Industries Fax (617) 727-7568 Room 11006,7100 Cambridge Street - Boston, MA 02202 Fax (617) 753-8410 Local Board df Health/code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 De1eading Contractor If premises is listed on the State Register of Historic Places,, this notification must be made upon receipt an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727_5128 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. Date -1-C3-49SC6 `.IK\\ 11 Signed: : \G.CW ^l, Title: - - Adminintra HVe Assistant Company: AccuTech Insulation & fnnrrartinn_ Property owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet ducts, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. capping baseboards covering surfaces Date: REV 10/12/95 Signed: Department CO rel.NTr7EALTH OF MASSACHUSE' elk of Labor 6 Industries and Department of Public Health NOTIFICATION OF DELEADING WORK Q-1.02\� All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 a6 197 454 O . 22.00 and 105 O . 450.000 as most recently FILE NUMBER: Contractor performing projedAccuTech Insulation 6 Contractin ((AGENCY USE) License # DC1600 Exp.date 04/27/99 License # M 1796 Lead Paint Inspector Date of Inspection 6:-1 t If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Adct Floor ---- Building Name (if any) Apt, No. 1"� Street Address Northampton, MA gip 01060 City g Heat Gun Caustics Deleading Method: Wet/Dry scrapin Liquid Encapsulant Covering Demolition Replacement) Other If "Other" selected, please explain dwelling is multi-family X single family Check One: � ^r � .��f�� l 3 Completion date Start date 5 5( Weekends? >t When will work be done: A.M. 5:00 P.M. 00 License if n project Supervisor's name Property Owner 49 Old South Street 0)06 Address State My Zip City Telephone 413 584-4030 case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 over) • 4-11. .$ •• In In accordance with Massachust '^1%eneral Laws c. 111 5 197 OCR 22.00 a 4114S5 CIR 460.000 notice of the data and methods(s) of r_movel or covering of paint, plaster or er accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. ' 1. Occupants of the dwelling unit All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Fax (617) Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Fax (617) 727-7568 Department of Labor 4 Industries Room 11006,0220 Cambridge Street - - Boston, MA 02202 53-8410 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 bes Hof his/her knowledge and belief. Date i.—��"Y . . Signed: �� V Title: ` - Administrative aavi=tan Company: AccuTech Insulation & Cnnrrarring Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid a capsulant applying exterior vinyl siding removing doors, cabinet ducts, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: Signed: REV 10/12/95 C00.4INWEALTH OF MASSACHUSE ric Department of Labor S Industries and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to comply eith the notification requirements of H.G.L. c.111 S 197, 454 C941 22.00 and 105 OR 460.000 as most recently amended FILE sUMRFR: (AGENCY USE) 0ontractor performing projectA c Te h Insulation & Contractin License # DC1600 Exp.date 04/27/99 License # H_1776, Lead Paint Inspector ,C Date of Inspection � T `r>.� If low-risk deleading work is being performed, complete the following line: Agent(s) property owner Address Building Name (if any) Street Address City Deleading Method: Liquid Encapsulant If "Other" selected, please explain Northampton, MA Covering Floor Apt. No. D=` Zip 01060 Heat Gun Caustics Demolition dwelling is multi-f ami Check One: a Completion date ��4.% �-3\ Start date When will work be done: A.M. 8:00 P.M. 5.00 single family Other project Supervisor's name Property Owner Address 49 Old South Street State My Zip m men City Telephone (413) 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 (over) Weekends" License # �. In accordance with Massachusa ^General Laws c. 11 CM 1 5 197 R 22.0o a 15 Cm 460.000 notice of the date and methods(s) of ...,noval or covering of paint, plaster or r accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. Occupants of the dwelling unit All other occupants of_the residential premises, if any Director, Childhood Leading Pcisoninq.Pie4ention Program Fax (617) Department 753-8411) p ecto ent of Public Health, 470 Atlantic Avenue, Boston, MA 02110 - Director, Asbestos c Lead Program Department of Labor c Industries Room 110061100 Cambridge Street - Boston, MA 02202 - . " - "- Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor Fax (617) 727-7569 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5129 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 bes �of his/her knowledge and belief. Date • Signed: Title: Pdtinistrar-ve Acgietnnt company: AccuTeCh Insulation & Cnnrrarring Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters capping baseboards covering surfaces I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: COE'NWEALTH OF MASSACHUS. Department of Labor & Industries ,and Department of Public Health NOTIFICATION OF DELEADING WORK All sections of this for must trnbeencomplete Gin oa er1 to c�ly with the notification requi 454 0M1 22.00 and 105 Gli 460.000 as most recently amended FILE mamEl: (AGENCY USE) Contractor performing projectAccuTech Insulation & Contracting License # DCI600 Exp.date . 04/27/99 License # M-177A A Samimi Lead Paint Inspector Hehoad If low-risk deleading property owner Address of Project Date of Inspection t r\'FCe ork is being performed, complete the following line: Agent(s) Building Name (if any) }lamps/Aire Heights Apartments Street Address City Deleading Method: (Wet/Dry Scraping, Heat Gun Northampton, MA Liquid Encapsulant If "Other" selected, please explain Covering Demolition Check One: dwelling is multi-family X Start date When will work be done: A.M. project Supervisor's name 8:00 Floor Apt. No. -2• Zip 01060 Caustics Replacement Other single family Completion date P.M. 5'00 property Owner Address 49 Old South Street State City Telephone (413) 584-4030 In case of emergency contact Keith Jenkins evening (413) 665-2372 Phone: day (413) 592-5326 Weekends? N License # Zip Ot fbft (over) In accordance with Massachust general Laws C. 111 S 197 CMR 22.00 .a� of the date and methods(s) of ..,oval or covering of paint, plaster or er Cot 460.000 notice containing dangerous levels of lead is to be provided and must be received by n the followmaterials persons, at. least tan (10) days prior to beginning of deleading. 1ng 1. Occupants of the dwelling unit 2. All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoning Piebention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006,"100 Cambridge Street Boston, MA 02202 - - 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Manacling Contractor Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 is true and correct to the rhis/he contained in this her of his/her knowledge and belief. Y\„1,1 L (. �l Date Z— B Signed: sue: Company: A cuT ch Incu l e ' d r ereperty Owns (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: emgNWEALTH OF MASSACHUS Department of Labor b Industries and Department of Public Health NOTIFICATION OF DELEADING MAX �':Q-�` All sections of this form mus he completed with the notification requirements e.Gn e11 o c97,of sit C 2 .00 and 105 Cl?. 460.000 as most .ennui amended TILE NUMBER: (AGENCY USE) Contractor performing ProledAcc Tech Insulation 6 Contractive License #3C1600 Exp.date 04/27/99 License R _1796 teed Paint inspector Date of Inspection �171 If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Address of Pro tt Floor Building Name (if any) . - Fit_ No. �— Street Address Zip 010fi0 Northampton, MA City Heat Gun Caustics Deleading Method: Wei/DrY Scraping Ae la cement Other Liquid EDCap5Ulant Covering Demolition P If "Other" selected, please explain duelling is multi-fa mily R single family Check One: g �34s Start date P.M. 5:00 Weekends? '�N When will work be done: A.M. _00 License R ��'.�� . �g� project Supervisor's name _. Completion date Property Owner 49 Old South Street zip �0106� Address State My City Telephone 413 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 (over) Anon In accordance with Massachus s General Laws C. 111 4 197 OMR 22.00 Ian of the date and methods(s) of removal or covering 105 acR 460.000 notice containing dangerous levels of lead is to be g e paint, stabeer or other accessible materials persons, at least ten (10) days provided and must be received by the following Ya prior to beginning of deleading. Occupants of the dwelling 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 Fax (fi P) Director, Asbestos 6 Lead Program Department of Labor c Industries Room 11006,"100 Cambridge Street Boston, MA 02202 - ' -- Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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\\b \\\!!!t of his/her knowledge and belief. /y(� Signed: � v 1 n i ^ 4,2045s 10 Date hole: Adm�n�srrarive Assi srarer Company: AccuTech Tnsu7atinn & Cnnrrerring Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying ligdid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters best of my knowledge and belief. I certify that all the information contained in this notification is true and correct to the Date: REV 10/12/95 Signed: CG �ONWEALTE OF MASSACHUS, TM 7 Department of Leuor & Industries and Department o- PubliC M faft- NOTIFICATION OF DELEADING WOEX All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 CMG 22,00 and 105 act 460.000 as most recently amended FILE NUMBER: (,AGENCY USE) JUL 15 1998 HAMPTON BOARD OF HEALTH I orDactor performing projectACCUTech Insulation & Contractin ,ead Paint Inspector Date of Inspection License # DC1600 Exp.date 04/27/99 License # 1_1796 EC low-risk deleading work is being performed, complete the following line: Agent (s) Property owners address of Pro eet Floor Building Name (if any) _I -•- ,� \ _ _ Apt. No. 1 Street Address - - - 01060 Northampton, MA yip City Deleading Method: (Wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition CReplacement) Other Liq If "Other" selected, please explain Check One: Start date dwelling is multi-family R single family When will work be done: A.M• 8_00 project Supervisor's name Property Owner Address State Mme- Zip curia_ City Telephone (4131 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening (413) 665-2372 — (over) Completion date 5:00 Weekends? License # 49 Old South Street In accordance with MassachusP,' of the date and methods(s) of oval or Laws c. 111 g int OM pl st r ,. containing dangerous levels of Beada i or covering of paint, 10 b Ct•IR 460.000 Provided and must other accessible material"once i. ricer beginning be received by the g of deleadi ng, following 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning. Preae tion Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 8410 Fax (61] 4. Director, Asbestos 4 Lead Program f Room 11006,'100 Cambridge uStreet Boston, MA 02202 - Fax (617) 727-7568 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor (of premises istoric Places Ceth on the State s notificationgmustr made upon receipt of an Order to Correct be Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 The hesundersigebydstates e t ns and penalties of perjury,r the Commonwealth of Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control that Regulations, 105 CMR 460.000, and that the information contained in t this notification is true and correct to the)b- t of his/her knowledge and belief. in s Date —c3-4C5 � d � � Signed: UsU-CC C Company: ACC Piopett Owner (If owner or unlicensed owner's agent will be performing low-risk deleadi I certify that I have complied with the training "g work) Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations, 105 CMR 460.175, for owner/agent low-risk abatement Band econtainment. I further certify that I or my agent will be performin the following:low-risk activities (I have circled all that apply) : applying ligdid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters best of my I certify that all the dnfbel n iefon contained in this notification is true knowledge and orati. ' - and correct to the capping baseboards covering surfaces Date: Signed: REV 10/12/95 CalociNWEALTE OF MASSACHUSE Department of Labor industries and Department of Puh lla gealth INC WORK JUL 15 1998 NOTIFICATION OF DE7,EAD 4 I All form must be completed in order to comply --"—° requirements (;'rhpIA PTONpTON E 454 CM 22.00Ei this Q 60.000 as most recently ame° 65< Q� 22.00 and 105 Q� {AGENCY USE) FILE 1024021e License# nr16�00 tractor i>eeomnn9 PfoieCt SSMTech Insulation & Contractin £xp date 04/27/99 ad paint Inspector License $ 1 9F Date of Inspection the following line: low-risk deleading work is being performed, complete Agent(s)� coperty owner�- ddress of Pro'ect Wilding Name (if any) street Address _ City — Deleading Method: Liquid £ncapsulant If "Other" selected, Northampton, NA Check One: Start date done: A.M. 8.00 When will work be Ns Heat Gun Covering Demolition please explain dwelling is multi-family X Completion date Weekends? _ Project Supervisor' s name Property owner 49 Old South Street Zip Address State yl Floor Apt. No. Q Zip 01060 Caustics single family Other P.M. 5'00 License k city Telephone 413 584-4030 In case of emergency contact _ (413) 59 phone: day Keith evening (over) 413 665-2372 In accordance With Massachus a` of the date and methods(s) or ' General Laws C. 105 C71R 460.000 notic containing dangerous levels •leads or covering de § 197 CMR be re -^ persons, at least ten methods(s) daf lead paint, ys n is to beginning and mustabeare, rioter to be 1. Occupants 9 of tlel eading, pants of the tlwell ing unit 2. 111 other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning ?retention Program of Public Health, 470 Atlantic Avenue, gram Director, _ Boston, MA 02110 4. Asbestos -- Department of Labor a6 Lead - Room 11006,'100 Cambridge Street Boston, MA 02202 .. (617)Fax 020_ _-, 727-7568 Fax (617 753-8410 5. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission g e ncy 220 Morrissey Blvd. Boston, MA 02125 Deleadina Contractor etpr (If premises is listed on the State Register of Historic Places, this notification made upon receipt of Violations or an Order to must be initiating ° v[ least ei ad n Correct 30 9 preventive deleading) poor to Fax )619) 727-5128 The he/she udersigned hereby states, under the Regulations,read and understood the Commonwealth pains and Regulations, 95q CMR 22.00 and Leading of penalties of perjury, that 105 CMR 460.000,1d Leading Poison Massachusetts notification is true and and that the prevention a Del eading nd correct to be he nd Control the b- � contained in this Date �_IT --(t - .1t of his/her knowledge and belief.�` lief. Title: Company: A Proper`- (If owner or unlicensed - e• • •• •• owner's agent will be performing low-risk deleading work) I certify that 2 have complied with the training re Commonwealth of Massachusetts Lead Poising Prevention and Control 105 CMR 460.175, requirements o further certify owner/agent low-risk w-risn of the the her ceitg y that I or my agent will beaperformi and containment.Re9ul Regulations, low-risk activities ircfedmall y) I r (Z have circled all .that apply applying liquid encapsulant applying exterior vinyl siding capping baseboards covering surfaces removing doors, cabinet doors, shutters best o fm hao waed ge and bl f.s ° ft knt all the information cone ned i n this notification is true and correct to the Date: Signed: REV 10/12/95 pLTH OF MASSACHUS� COIIfQ� artment of Public Department of Labor & Industries and Dep NOTIFICATION OF DELEADING WORE must be completed in order to comply is of M.G.L. .111 4 191H of this form dad All sections and Oe4"ir0.00 recently amen with the notification 105 � 060.000 as 656 Q� 22'00 (SSENCY USE) FILE NUMBER: actor pe rojectAccuTech Insulation & Contractin License# DC16 0 do�(ngp Exp.date 04/ t paint Inspector : '.• -• Date of Inspection —License N i]2.5-- line: being performed, complete the following Agent(s) al�' hrfL S �� J pH JUL 15 1998 iU '..�.",1PTON EOAFD OF ALTH low-risk deleading work is ,petty owner- dress of Ero'eet , - - o. •.. ^- Floor aiding Name (if anY) .• � _ . - Apt. No � Zip 1d 0_� tt y Address ton, MA Notthamp Caustics it Sotaping Heat Gun Other Method: Wet/DEY Replacement ) )eyeadin4 Demolition Liquid Encapsulant If "Other" selected, please dwelling is multi-family X Comp letion date Weekends? Y.M. 5.00 �s:92 License k Coveting explain Check One: Start date A.M. �;pp When will work be done: single family Project Supervisor's name property Owner 49 Old South Street Zip Address State----m-� City 584-4 Telephone Jenkins In case of emergency contact Keith evening 413 665-2372 (413) 592-5326 phone: day (over) In accordance With Massa thus^ oak of the data and methods(s) of . General Laws c. 111 5 197 CMR containing dangerous levels Of•leadais t be provided plaster . 105 Cth 460.000 noel persons, at least dangerous f10) dava covering of paint, plaster o =�`tp beginn��ided and must be ° other accessible 9 of deleading. received by the following et � owing 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Pre- ntion Program Department Of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Fax (617) 753-8410 4. Director, Asbestos Department of Labora Lead Program Room 11006,- 100 Cambridge Street • Fax (617) ]2]- Boston, HA 02202 7568 a 5. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 DeleadinQ Contractor (If premises is listed on the State Register made of Historic Places, this notification must Viola bons receipt of an Order to Correct Violation at least 30 days prior to 9 preventive deleading) Fax (617) 727_5128 The he/shedhasaread hereby states, the under the pains Massachusetts Deleading Regulations, Penalties of perjury, that Regulations, 105 CMR 22.00 and Leading Poisoning Prevention and Control CMR 460.000, and that the information contained in notification is true and correct to the,b t of his/her (r, /her knowledge and belief. Date ?—`�_ab /. Signed: �� p Company: ,a UT Propert Own (lf owner or unlicensed owner's agent will be performing low-risk deleadin I certify that I have complied with the training g work) Commonwealth of Massachusetts Lead Poising Prevention and Control Re 105 CMR 460.175, for owner/agent low-risk abatement Band scents of the further certify that I or my agent will be e containment,gulations, the following low-risk activities (I have ?ve clrcled cled all I all that apply) : applying liquid encapsulant applying exterior siding vinyl capping baseboards covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this best of my knowledge and belief. notification is true and correct to the Date: Signed: REV 10/12/95 COo NWEALTH OF MASSACHUSE D Labor 5 J Department of Lobos b industries and Dep artment o£ pnbli.c)H$a1 ING WORK I NOTIFICATION OF DELEAD � 5JI sections of this form must be completed in order to pO6PlY All requirements of M.G.L. c.1119191, THAM PION BOARD OF HEALTH! Cfia.0 G0 as most recently amen 454 00122.00 notification d05 and (AGENCY USE) FILE NUMMI: ectAccuTech Insulation & Contractin License % Tr 6- — ctorPerfonnin9P ro 1 Exp.date 04/_ 27 paint Inspector ow-risk deleadin9 work is being erty owners ress of t .lding Name of any) Beet Address ty �- :leading Method: Jquid Encapsulant f "Other" selected, please License Date of Inspection W performed, complete the following line: Agent(s) Not Floor Apt. NO.___ Zip 0160 ampton,� Heat Gun Caustics Demolition Replacement Covering explain dwelling is multi-fa ;Weer One; Start date Completion date P.M. 5.0� Weekends? . -- �^`,----- When will work be done: A.M. 8'00 ga , � License % X single family Other Project Supervisor's name Property Owner 49 Old South Street Zip Address State y�,.. M City Telephone 413 584-4030 In case of emergency contact Keith Jenkins (413) 592-5326 evening 413 665-2372 Phone: day (over) In a with Massa ch usa of the accordance date and methods(s) s removal Laws c. I11 5 197 '� of the at dangerous levels lead o paint, plaster st r 105 contain, of t covering of QW 460.000 ld at least ten (30) da is to be provided Plaster or other accessible nail ' e rior to beginning and must be received by the follow' g of del end' Maier 1. Occupants of the dwelling unit following 2. All other occupants of.the residential p emises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department f Public Health, 470 Atlantic Avenue, Boston, MA 02110 ._ Fax (617) 753-0411) 4. r, Asbestos - . Director, Department of Labor 6 Lead Program Roam 11006,•100 Cambridge Boston, MA 02202 9e Street - 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadi Contractor Fax (617) 727_7568 (If Premises is listed on the State Register made uon of Historic Places, this notification mu Violations receipt of an Order day to Correct st t vt least days prior to initiating pr preventive deleading) eading) Fax (617) 727-5128 The undersigned hereby eby states, under the henpainsh penalties of perjury, he/she has read and Regulations, pains and Regulations, 105 CMR 22000 O ands Leading o Prevention and that and that information Massachusetts in this the ed Control the b contained in this notification is true and correct to Date t of his/her knowledge and belief. �—G-4x6 � Signed: t1-13kkA Title: Company: Proper. Owner f - - e• 4. I terry` (If 1 owner haver unlicensed owner's agent will be performing low-risk deleading work b I certify complied with the ) 105 Commonwealth Massachusetts Lead Poising requirements a nd Contrf the further 460.i75, for owner/agent low-risk gabatementon and Control the r rt certify that k I or activities will be performing ent and containment. following:low- ities ll ny) . I -,. (I have circled all ,that apply) : applying liquid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces best certify that ledgeehaandinformation contained in this notific i on is true my knowledge i _ .. belief. j --. and correct to the Date: Signed: REV 10/12/95 �ALTH OF MASSACHUSr;i C0I�'�1Q �da16h Department of Labor & Industries and Department of publi'Qi NOTIFICATION OF DELEADING BORE 15 1998 _� of this form must completed in order to comply requirements a1 M.G.L. c.111 S Ml sections oti£icatian requirements most recently. c.1.1 1 -;,,'.;gip.^,�,pTpN BOARD OF REALTY, amended rift th ...�nCY t931?T-.—.—.• 454 OS 22.00 and S05 � PILE wJsB - cuTech Insulation & Contractin License # Dc16� 0�- tGlpertatmingp Fo 1 ectAc Exp.date 04/ License Rye Inspector Date of Inspection A� Paint Insp line.: deleading work is being performed, complete the following Agent ls) ,ertY owner teas of Pro'act . Floor - .lding Name (if any MA Apt. No.�� Zip 01060 Beet Address Northampton, A Heat ty Wet/Dry Scraping Other Method: t Gun Caustics la cement) "leading Demolition sulant Covering Rep iquid Encap lain f "Other" selected, please exp dwelling is multi-fandls X Check One: Completion date Weekends? Start date :00 P-M. 51- be done: A.M. 8_ ___ Pj`(�.3`a, When will work License k single family Project supervisor' s name • 4.u. .. Property Owner 49 Old South Street Z Address State�M nttl.amPt-nn_� City Sl 584-4030 Telephone 413 In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 lover) P X6� In accordance with Massachus i General caws c, of the date and met hods(s) o removal or Laws c. 111 f containing dangerous levels F lead lof § 197 persons, at least ten is to be paint, plaster a toy act 460.000 a(10) da s rior to beginning and l aster gi^ning of delead' received other accessible mate must be i. Occupants lno. by the 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading poisoning Prayention Department of Public Health, 470 Atlantic Avenue /n. of the dwelling unit 4. Director, Asbestos s Lead Program Department of Labor < Industries Room 11006 ,"100 Cambridge Street MA 02202 5. Local Board of Health/Code Enforcement AQency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadino Contractor _tor Program Boton, . MA 02110 ax (617) 751-841( Fax (617) 727_7560 (If premises is listed on the State Re a Historic Places, this notification Violations receipt Sister of an 0 Order to Correct must 1 initiating preventivet 30 deleadin days g) di ngj prior to The Fax (617) 727-5128 he/she undersigned i ens read and hereby states, the and penalties of of Massachusett perjury, adi that under the Regulations, understood une pins CMR 22. 00 a Regulations, 105 CMR 460.000, and Leading Poisoning information contained ands in this Deleading ion is true and correct to ththe the information Prevention Control Date _`�_1'�_gfd- b of his/her ledge iandhbelief. Signed: { , Title: Company: PrhpetN a, ` (If owner or unlicensed owner's age,, I certify that I have complied with the t Commonwealth of Massachusetts Lead 105.CMR 460.175, for owner/agent Poising the her err certify that 1 agent willsk my g low-risk activities /will be (I have applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters I cerotify that best f my knowledge handnfbelief�n contained in this no t will be performing low-risk deleading work) raiYin4 requirements of the abatement and Control Regulations, ment and containment. I ns, performing circled all that apply) : capping baseboards covering surfaces Date: Signed: REV 10/12/95 cation is true and correct to the TH OF TgpgSACAUSE'�iY;e COT�Q nt of Pub2>ir � )epartment of Labor & industries and Department ➢£LEADING WOAK I5 nrcfi NOTIFICATION OF y red in order to co . ,, at be completed M.G.L. r d r o co ) rementa 5 All sections o£ this form ma ntyy anon HAMPTON BOARD OF HEALTH 454�Q41 22.00 notification d 105 60.000 afloat rece (pnENC1 USE)the FILE NUMBER: ro)ectAccuTech Insulation 5 Contractin Licensed nCl - dor Pe Aonnin9P ExP.date 04/2�� License M_y??6- -" Ci5� 1. Paint Inspector :-.ip -' - Date of Inspection s being performed, complete the following line: Agent(s) Low-risk deleading wor petty owners tress of Proect ilding Name (if any) .xeet Address Heat Gun e1 Wet/DtY Scraping Method: Demolition eleading Demob sulant Covering tfilo Encap please explain Lf "Other" selected, P Single family dwelling is multi-family� speck over Completion date a1 � Weekends? „lip,date `• P.M. When will work be done: A.M. Slat_ �' Project Supervisor' s uPe rviso is name License k.• Property Owner 49 Old South Street Address State Northampton Floor — Apt. Zip 01060 Caustics Replacement) Other City 413 584-4030 Telephone contact Keith Jenkins In case of emergency 413 665-2372 evening Phone: day (413) 592-5326 lover) MA Zip ^ In accordance with Massa ch us a General Laws c. not of the date and methods(s) of removal or covering containing dangerous n 111 g paint,Cpl 22 00 persons, at least ten levels of lead is to be g of paint, stabee r 105 OM 4fo.0o0 (10) da riot to beginning of and adin be or other accessible mat must 9rnning of deleading. received by the following 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading PoisoningPrnemntion Program '- Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 .._ ._.. , - _ Fax (61] 4. Director, - - - ) ]53-841 Asbestos c ' -Department of Labor &LIndustriesm Boston10MA 02202 Cambridge Street - Fax f6ll1 727-7568 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadin Co tr ctor (If HistorIf Places,ted on the State Registe. this notification must made upon receipt of Violations or at least 30 Order to Correct initiating preventive deleading) or to days pri Fax (617) ]2]_5128 The undersigned hereby states, under the pains and he/she has read and understood the Commonwealth of Regulations, 454 CMR 22.00 and Leading penalties of perjury,no Regulations, 105 CMR Massachusetts in this ingha' notification is true 460.000, and that the information Prevention and Control and correct to the tnofrhis/he contained in he b- t of his/her knowledge e thi Date %-13_4 „ 4 and beli er Signed: Title: Company: ACC - Pro per� Owner (If owner or •• unlicensed Owner's agent will be performing low-risk deleading work) I certify that I have complied with the training of Massachusetts Lead Poising 105 CMR 960.175, 9 requirements of the further CMR 460.17 for owner/agent g Prevention did Control the certify that I or q low-risk abatement and containment. following low-risk activities /will be ircled all lly) : I (I have circled all that apply) :liquid encapsulant - capping baseboards applying exterior vinyl siding removing doors, cabinet dooms, shutters I certify that all the information contained best ° my knowledge and belief, in th Date: Signed: REV 10/12/95 covering surfaces iea[ion is true and correct to the COI °WEALTH OF MASSACFivaa and Department of Publrg Ilaalih{ it iq )epartment of Lesbos 6 Industries an TION OF DELEADING ROAR 15 Paint Inspector NOTIFICATION ! to of r.er1 o comp _ I 1 x60.ent as most M.G.L..L. c.li amended All with thannotiEic>tion=caQnis>meno�latad in order to comply 4 TO\EOAnD OF HEALTH must be 454 CMG 22.00 and 105 IAGFH� FILE NUMBER' roeCtAccuTech Insulation & Coutractin LiceflSe# DC16 0 1ol pefform)n9P 1 Exp.date 04/ License 11 t��F Date of Inspection work is being performed, complete the following line: Agent(s) )w-risk deleading erty owner :ess of Pro act Lding Name (if any) eet Address .y �- Scraping Heat Gun Leading Method: Wet/Dry sulant Covering Demolition quid Encap explain selected please peck One duelling is multi-family X Northampton, MA Comp Start date D.M. 5:00 When will work be done: A.M. Floor Apt. No. it?) Zip 01060 Caustics single family ion date Project Supervisor's name Property Owner 49 Old South Street Zip 06D� Address State City _ �1 Telephone 413 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 (over) Other Weekends? License 4 In accordance with Massa Gnus oalk In the date and methods(s)ss s. . General Laws c. 111 5 197 i1 containing dangerous removal or CMR 22.00 a gerous levels of leads is tocbee nog of paint, plaster or other adhesf ill not persons, at least ten (10) days provided and must be `beginning of del ea tling, received by the following e I. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director., Childhood Lead Department of Public Health,Poisoning Atlantic Program Department s_ 470 Atlantic Avenue, Boston, MA 02 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street Boston, MA 02202 - ..._. 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deluding Contractor 10 Fax (617) 753-8414 • Fax (617) 727-7568 (If premises is listed on the State Registe of Historic Places, this notification must made Violations receipt of an Order to Correct initiating at least 30 days prior to preventive deleading) Fax (617) 727_5128 The undersigned hereby states, under the pains and penalties of perjury, tha has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading Poisoning f l ha Regulations, 105 CMR 460.000, notification is true and correct to the b- . g Prevention and Control and that the information contained in this t of his/her knowledge and bel ;va Date Signed: e: Company: {jfi Inc- 1 Prooerty Ow t � (If owner or unlicensed owner's agent will be performing I certify that I have complied with the training requirements of th easing worm Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations, 105 CMR 460.175, for owner/agent low-risk abatement and econtainmente I further certify that I or my agent will be ming the following low-risk activities L ( have circled all that apply) : applying liquid encapsulant rds applying exterior vinyl siding capping baseboa daces removing doors, cabinet doors, covering surfaces ors I st roffm that all the dnfbelief. contained in this best ce ti my knowledge and belief. not ca ciao is true and correct to the Date: Signed: REV 10/12/95 CO EALTE OF MASSACAUSET N�IQ lepartment of Labor L Industries and Department of Pub1yc Pealtb NOTIFICATION OF DELEADINO WORK 15 LJ leted in order to 19�1t C be camp of M.G.L.order 4 ;ill sections 22.00 this farm requirements amended 4 101.of 45th the 2�o00 and 105 Cm 4460.000 as most recently yOFiHAMPTON EOARD OF HEALTH 454 aal a - tsin.,.cr Irv% FILE nGMEEA: roectAccuTech Insulation & Contractin license # DC1600 tot performing t Exp.date 04/27/99 License ' 1770. ?aint Inspector • '.. ' Date of Inspection �5y ? -- w-risk deleading work is being performed, complete the following line: Agent(s) ,rty owner ess of Pioecr ding Name (if any) et Address y �- eading Method: ;uid Encapsulant Covering Demolition "Other" selected, please explain Northampton, MA Heat Gun eck One: tart date then will work be done: Project Supervisor's name dwelling is multi-family X Floor — Apt. Zip 010_ 60 Caustics Aep3acement2 Other single family Completion date 2-14. 5:00 Weekends? N A.M. 5:00 Property Owner 49 Old South Street Zip Ol n6n� Address State N�— City Telephone 413 584-4030 In case of emergency contact Keith Jenkins Phone: day (413) 592-5326 evening 413 665-2372 (aver) License • 4.,•. .. •• In accordance with Massacnus� In the r date and with of ' General Laws c containing dangerous levels removal or covering of § 197 /1 dil CMR 2e.00 persons, at least tan (10) daf is to be provided Pain[, plaster or other 105 GMR 460.000 a rlor co beginnin of deleading.be received by the ^off 1. Occupants following E of the dwelling unit 2. All other occupants Of.the residential premises, if any 3. Director, Childhood Leading Poisoning pre Prevention pro Department of Public Health, 470 —._-. .. Program ._Public_ - . Avenue, • Atlantic 4. Director, Boston, MA 02110 Fax (61]) ]53- D Department of Labor 6 Lead Program - - -- 8411 Room 110061'100 Labor r Industries Boston, MA 02Oambri Cambridge Street Fax - . - . (61]) ]2]- .___ ]566 5. Local Board of Health/Code Enforcement Agency • 6• Massachusetts Historical 220 Morrissey Blvd. Commission Boston, MA 02125 (If premises of Historic receipt on the State Register Violations oceipt of an Order must initiating o or at least Correct i [i ng Pre ven[i ve deleading)prior to Fax (617) ]2]_5128 The undersigned hereby states, under the pains of penalties of pet he/she has read and understood Regulations,ass, Commonwealth and Regulations, 95g CMR 22.00 and Leading Mventconsetts notification 105 CMR 460. 000, that the Deleadl'nghat is true and co and thtt the inff 4 D /h kn a correct to ti on co and Control Date the best of his/her knowledd in this Daleadino Contractor tos Signed: belief. e: n " Pioperc Company: CET a ` (If owner or unlicensed owner's agent will be performing aloe-risk deleading w / certify Commonwealth atfl have complied with the training orkl 105 CMR 460.175, Lead raining tion and Cos further 0CMR 4 certify.17 for owner/agent low-risk abatement of that will ape Control the or low- and Co the following low-risk activities[ will be circled and containment.nR?gulati Regulations, (I have circled n I appl rn all that apply y g liquid encapsulant applying exterior Vinyl siding capping baseboards covering surfaces removing doors, cabinet doors, shutters best cart of fy that all the information contained my knowledge antl belief, in this not is true and correct to the Date: Signed: REV 10/12/95 pI,TH OF 14ASSACHubms CO nt of ¢Oblic vestment of Labor & Industries and DePartma NOTIFICATION OF DELEADING WORK °m must be complete Oin order erl o comply 191, of this form .Leach amended S t97 All sections with the 22.00 notification and 195 � y6�00 as most 454 FILE NUMBER: or peffO1 "9 ptOject AccuTech Insulation 6 Contractin saint Inspector w_risk deleading wor arty owner 'ass of Pro•act Lding Name (if any) eet Address :y leading Method: sulant Covering .quid Encap lease explain E "other" selected, P Date s being performed, complete Agent(s)�- i hl9 CIS r 1!j r JUL 19 199a o- eOAKO OF HEAc��. NO^E USE) License # Df 1_60 Exp.date 0404/ License M_r?2.6 of Inspection the following line: Northampton Heat Gun Demolition :heck One: Start date A.M. When will work be done: project Supervisor's name . Property owner t.4. Street Address 49 Old South Floor - Apt. No. 1ri-\ Zip 01060 Caustics Other Replacement / single family dwelling is multi-family Comp letion date _ L gyp Weekends? 5:0� P.M. Y License it City 13 584-4030 Telephone In case of emergency contact _ (413) 592-5326 Phone: day State Keith evening (over) 4133 66 tip �1.05i1� In accordance with Massachus^ containing the date and methods(s) oat General Laws c dangerous levels -emoval or covering Ill 4 int Cpl 22.00 ;^ of contain, at least ten eve) daf lead is to be plaster or 105 Cth 460.000 olloW nog Pningofpdete rioz Co be must be received other accessible mate �beginning of deleading, by the follow' b 1. Occupants of the rag dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning-preention Program of Public Health, 470 Atlantic Avenue, gram Fax (61>) ]53- Batcon, MA 02110 841 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street Boston, MA 02202 Fax (fil]) 727-7568 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Delaadin Contractor Llf ses Places,ed on the State Registe made upon Historic receipt this notification must Violations or of an Order to Correct ttion r at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 The undersigned hereby states, under the pains and penalties he/she has read and understood the Commonwealth of f Ptelea Regulations, 459 CMR 22.00 and entin o Regulations, Leading Poisoning Massachusetts Control ingha Regulations, is true 460 aoo, andtthat the or information and in ofrhis/he cknowledgControl the b- \t of his/her knowledge randhbelief. Date Signed: Company: Acc Pr art - - e - •, , -�� (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training of Massachusetts Lead 105 CMR 960.175, raining requirements of the further certify for owner/agent low-risk Control nme t. the r nt to what I or my agent will be performing and containment.Regulations, following low-risk activities (I have ircledmall I - - _ circled all that apply) : applying liquid encapsulant applying exterior Vinyl siding capping baseboards removing doors, cabinet doors, snuctecs covering surfaces I best roffmytknowledge the and belief. contained in this notification is true and correct to the Date: Signed: REV 10/12/95 ALTH OF MASSACHUSE n } COI•�IQ iic � � � 'i� • � �I & Industries and Department of Pub 9 Ill''( apartment of Labor ING WORE .AA. � 5 i�/ NOTIFICATION OF DELEAD order to coca _ - �-„� Kl sections of this form aeatnC9"PoL M.G1L c 111 5 19'I amended "I'TO@ EJA FO OE HEAITkI notification 105 Gm 460.000 as most recently with tt`°T2.00 and 454 aeL (AGENCY USE) FILE NUM®EN' ectAccuTech Insulation & Contractin License #.17/c1_640-- or peAofmin9P ro 1 ExP.date 04/ License M • t12F ector . - . -. -�� Inspection - �� ,aiut Insp Date of lnsp w_risk deleading work is being performed, complete the following line: Agent(s) ;rty owner ess of Proect ding Name (if any) :et Address Heat Gun Caustics Wet/Dry Scraping Other psid E Me 1ed Replacement laid ncap sulant Covering Demolition "Other” selected, please explain Northampton, NA Floor — Apt. Zip 01060 single family eck One: dwelling is multi-famiLY n � Completion date date eekends? �— tart 5:00 P.M.M• 5.00 Then will work be done: A.M. P� `�`�3 -.'� V License # �� project Supervisor' s name ��. ,. Property Owner N 49 Old South Street Zip __03_069--_Address State 1 _ __03_069--_City 4030 Telephone 413 584- In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) In accordance with Masao char", General Laws C. of the date and methods(s) of removal or covering of of the containing dangerous levels of lead lof pand must st er `^105 at least dangerous (10) da lead is bee provided and plaster ce other accessible no or�� ginnin must received by the follovibn g of deleading. 1. Occupants of the g unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Pcisoning'p1-.ention Program Department of Public Health, 410 Atlantic Avenue 4. Director, Asbestos c Lead Program Department of Labor a Industries Room 11006, '100 Cambridge Street Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadin Contractor Boston, MA 02110 Fax (617 753-841 Fax (617) 727-7568 (If premises is listed o of Historic Places, s the State Registe made upon r this notification must Violations or c at of an order to Correct t tivet days prior to initiating preventive deleading) eading) Fax (617) 727-5128 The undersigned hereby states, under Commonwealth Perjury, tha he/she has read and understood the Co Regulations, pains and penalties of Regulations, 454 CMR 22.00 and Leading of Massachusetts De leading 1s5t CMR 460.000, and that thesinfor Prevention and leading rue and correct tohth the information contained the b- t of his/her rued in this Date 7_S_a� /her knowledge and belief. signed, Company: Pro aa ty pwn (If -der owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training of Massachusetts Lead Poising 105 CMR 460.175, g requirements Cos of the 105t CMR certify for owner/agent low-risk abatement Prevention and Control the following y that I or my agent will be aperfornt and containment.Regulations, g:low-risk activities performing y) I {- - (I have circled all that apply applying liquid encapsulant applying exterior Vinyl siding removing doors, cabinet doors, shutters t str of fm that all the info lief. contained in best of y knowledge t and belief. m this notification is true and correct to the capping baseboards covering surfaces Date: Signed: REV 10/12/95 SSACHUSEG a COQ TH OF MA F Department 'Public Heaiti nt of Labor & Industries and D P -,. 5_� epartme ING WORK NOTIFICATION OF DELEAD � 15 � ' must be completed in order to cOORIY sections of this On r mnr £ M.G.L. .111 amended ice— -�" All 454 460.000 as most recently nc7rF."APTON 80APD OP HEP with the notification requirements 454 aal 22.00 and 105 OS _ FILL 10n'mYn: AccuTech Insulation & Contractin License# 6�0� :or peAortnin9 PpGjec[ ExP.date 04/27/99 License A x lvva ?aint Inspector . -' � Date of Inspection ' 1� ,w-risk deleading work is being performed, complete the following line: Agent(s) .rty owner ess of Project ding Name (if any) =_et Address Y .eading Method fluid Encapsulant "Other" selected, please Northampton, MA Heat Gun Covering Demolition explain leek one: ;tart date dhen will work be done: A.M. 8_ 00 L dwelling is multi-family X Floor Apt. No. Zip 01060 Caustics single family Other Completion date %-\L/(AY Weekends? License N Project Supervisor's name Property Owner 49 Old South Street Zip _010.60--__Address State______* ----- City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) P.M. 5_500 In accordance with Massa chusAm\ of the date and methods(s) of ' oval or Laws in 111 containing dangerous levels ofGleada i or covering of persons, at least ten (Sol daysl lead is to be provided �`ta beginning of 1. Occupants of the dwellip unit paint, 22.00 ^105 ChM 460.000 no and mu plaster or other accessible mat deleading be received by the following 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,9100 Cambridge Str . 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadin Contra tor Fax (617) 753-54] Fax (617) 727-756f (If HIf Places, ses is listed on the State Registe receipt of tansOrderftoa Corn must Violations or at least 30 days Correct 9 preventive deleading) to Fax (617) 727_5126 The undersigned hereby states, under the pains and he/she has read and understood the Commonwealth of Regulations, 454 CMR 22. 00 and Leading Prevention and perjury,n Regulations, 105 that the Massachusetts Delthis ha notification CMR 460.000, and that information ation Con is true and correct to thethe tnofrhis/he cknowled Control .b"t of his/her knowledge this Date /, 9 and belief Signed: �,� ride: a Company: A Prooeziy Owner (If —�` owner or unlicensed owner's ageni will be performing low-risk deleading work) I certify that I have complied with the training of Massachusetts Lead 105 Commonwealth 460,1 o5, gaPrevg requirements of the further certify for owner/agent w-riskgabatement Prevention and Control t.Regulations, y that I or 4agt tow- the following•low-risk activities (//will be ircled all containment. I (I have circled all ,that a applying liquid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, covering surfaces shutters I that all the information contained of my knowledge t and brief. certify ontained in this i notification is true - -_ and correct to the Date: Signed: REV 10/12/95 COtillQWEALTH OF MASSACHUSE epartment of Labor s Industries and Department of Public pea NOTIFICATION OF DELEADING WORE 15 C be completed in order to comply All sections of notification tote must ,mended (;PSNAMPTON 80ARD OF HEALTH 45th the 22.00 and 105 MR 4600000 as most roc new § .. 454 OMi UENCY USE-v- -� FILE NU!.EE: w er{AccuTech Insulation & Contract in License ti DC1 60 LOT perfomlin9P ro 1 Exp.date 04/27 License 4 • t22A Date of Inspection Q"-\ m-risk deleading work is being performed, complete the following Line: Agent(s) erty owner ess of Proect _, • Floor ding Name (if any) _ Apt. No. � � net Address Zip 010 Northampton, M/'_reading Caustics Y avid Encapsulant Neat Gun Method: Wet/Dry Scrap Ln9 Other Replacement / Covering Demolition "Other" selected, please explain Paint Inspector leek One Completion date date �� Weekends? ' ;tart P.M. Sy be done: A.M. Then will work \l..�� ak License 4 Project Supervisor's name , Property Owner N. a-"' 04 •• .. 49 Old South Street zip Address State�M —� City 4030 Telephone 413 584- Keith Jenkins In case of emergency contact evening 413 665-2372 (413) 592-5326 phone: day (over) dwelling is mule milt' single family j of accordance with Massachus,^ f the accordance and methods(s) of General Laws date containing dangerous d Meth removal c glof paint, a^105 persons, at least levels of is to must Len (SO) da provided and ce other CMR 4 olloo no' a rior to beginning of del ea di ng be received by the sfollowm�c' 1. Occupants of the i 9 dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Pievention Program Department par m nt Public.__ . Health, 470 Atlantic Avenue, top 4. Director, Boston, MA 02130 Asbestos & Lead Program - Department of Labor c industries Boston10MA'022000 Cambridge Street FaX X61] - . . ) 727-7568 ax 617) 753-841 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deieadino Contractor (If premises is listed on the State Register of Historic Places, this notification made receipt of an Order to Violations or must initiating ` v[ least el days Correct 9 Preventive deleading) to Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Commonwealth of Regulations, 454 CMR pains and penalties of Regulations, 22.00 and Leading eventionsa and perjury,of that notification 105 CMR 460.000, and that toesinfor Prevention cont Del this true and correct to the information and Control the,b- -t of his/her contained in this 3a to �7—\- knowledge and belief. Signed: Title: Company: A _ PrpperL Owner (If owner or unli<ensetl at �' •° owner's agent will be performing low-risk deleading certify that I have complied with the training g work) of Massachusetts Lead PoisingaPren 105 CMR 460.175, g re4ui rements further 0CMR for owner/agent low-risk Prevention of the the certify that risb abate g and Control following low-risk actilvitiest /will be ircled all containment.ppy)and applying liquid e (1 have circled all that apply) : ncapsulanc applying exterior vinyl siding capping baseboards covering surfaces removing doors, cabinet doors, shutters I certify that all best of m knowledge a information contained e ena or ati. in this notification is true and correct to the Date: Signed: REV 10/12/95 TH OF MASSACHUSE ie C0L9C0NA� artment ox Puby�a >sb f l ` Industries and Dep partment of Labor ING WORE � c loop NOTIFICATION OF DELEAD5a order to comply - of this farm worst be co ple M.G.L. r 1r1 o 197,m of All sections notification t recently c 11 amended 5 nAyS PT EJA� D Oi� AO' with the 2 105 60.000 as mss 454 and (AGENCY usr) FILE NCMBFA' AccuTech Insulation & Contractin License # DC1600 for PeAo�min9 Project Exp.date 04/ License 5 ____x_)��6` \� 0 Inspector Date of Inspection paint line: being performed, complete the following Agent(s) ow-risk deleading work is erty owner :ess of Pro act ldin9 Name (if any Floor . . _ Apt. No. \� � Zip 01060 Beet Address Northampton, MA Caustics =Y Scraping Heat Gun Other Method: Wet/Dry Caustic qu ding f'� Demolition Rep sulant Covering .quid"Other" please explain E "Other" selectedr P dwelling is multi-family Iheck one: letion date Comp Start date p.M. 550 be done: A.M. When will work s name Project Supervisor . . single family Property Owner 49 Old South Street Zip X1960-� T Address State ` City l ephone 413 584-4030 Telephone In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) Weekends? License 5 unit In accordance with Massachus, .s General Laws c. of the date and methods(s) of removal or covering containing dangerous levelsdofa leadoisto beginning pided pang emust beareceiother ved eb Cthe160, ing persons, at least or rng. by 1. Occupants of the dwelling 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading poisoning P'rayention Pro gram Department of Public Health, 170 Atlantic Avenue, Director, MA 02110 Dire 4. , Asbestos G Department of Labor a Lead es re Room 11006, '100 dgeuStes Camb Boston, MA 02202 r dge Street - 5. Local Board of Health/code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadinn Contractor Fax (617) 753-841 Fax (617) 7-7568 (/f of premises is listed on the State Re Historic Places, this notification made upon receipt piste Violations at of an Order ti must initiating pr vt tevst 30 days ng) Correct 9 preventive delead prior to Fax (617) 727-5128 The hereby states, the the henpainsh of penalties of perjury, Regulations,read understood pains and Regulations, CMR 22.00 and Leading Massachusetts Regulations, 105 CMR 460.000, that thesinfo Delead nghai is true a and that the information Prevention and Control and correct to the ffrmit/on �> 5- contained in this Date —��_n 6 - t of his/her knowledge and belief. Signed: v Company: A Property owner (If owner or unlicensed owner's agent will ae at I certify that be performing low-risk deleadin Commonwealth of Massachusetts have complied with the 9 work) 105 CMR filth or Massachusetts training further certify for owner/agent ent Lead Poising Prevention abatement nd condom of the the her era y that I or my agent low-risk performing rco Control Regulations, g.low-risk activities (I have ecircl dull that apply) : I apP/Vino liquid a capsulant . y� ' applying exterior nvinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces I best rtify tthat all the information contained in this Y knowledge and belief. soli Ci ati on Dare: Signed: REV 10/12/95 rue and correct to the ALTH OF MASSACHUSE —f� s COQ nt of PGb11deln r Department apartment of Labor 4 Industries and Dep rtm WORE � NOTIFICATION OF DELEAD sections of this form must be complete Ginn order 1to co LY ,J All xith the notification. requirements<6°�50' most recently amended\OMTHAMPTONEOAFOOFHEALTH 454 22.00 and Vas= USE) FILE NUMBER: Insulation 6 Contra tin Ucen5e# DC16 � taf Pe dDmlN9 pmjectAccuT ech Exp.date 04/2 License Paint inspector Inspector . •' Date of Inspection work is being performed, complete the following line: )w-risk deleadin9 Agent(s) ertY owner :ess of Project )ding Name (if any) eet Address -yam leading Method: ,quid Encapsulant Covering Demolition E "Other" selected, please explain North pton, MA Einar Apt. No. Zip 0160 Caustics single family other dwelling is multi-family X ;hark One: �� Completion date Weekends? �D� date P.M. _5_j)(2____ Start A.M. � �o When will work be done: License N Supervisor's name \\� Project Super -. .. . _ .. Property Owner 49 Old South Street Zip �10hD-� Address State - city - 413 584 Telephone Jenkins In case of emergency contact Keith evening 413 665-2372 (413) 592-5326 Phone: day (over) In accordance with Massa ch o!^ General Laws c of the date and methods(s) of re �a containing dangerous removal or covering 5 197 Cpl 22.00 a persons, at angerous levels of lead is to be g of paint, plaster or other CMR accessible no least Len (10) days 1 be lnrovidof and must be received b accessible mat 9 ning of deleading, by the following g Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, Atlantic Avenue, 470 Atlan . . _.. Boston, MA 02110 Pax (617) ]s3-84: 4. Director, Asbestos 6 Lead Program ] _ Department of Labor 6 Industries Room 110061'100 Cambridge Street Fax (617)MA 02202 - J 727-7561 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Beleadin Contractor If remises is(If premises Places,ed on the State Registi made upon receipt oftans notification must Violations or at least 30[days to prior Correct initiating preventive deleading) to Fax (617) 727-5128 The hereby under Omhenpains and nf Regulations, a59 penalties of perjury, g tin Regulations, 105 CMR 22.00 and Leading Poisoning Massachusetts Deleading Regulations, is true and correct 00, dtthat the r ationn cons and Control information contained in this t of his/her knowledge and belief Date c3_aCS Signed: �_A, T Company: D.1. (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training [ Commonwealth of Massachusetts Lead Poising Prevention 105 CMR 460.175, g requirements of the further for owner/agent low-risk gabatement a and Control the r ify that I or my agent will be e and containmenRegui otiose following low-risk activities I performing all .that apply) : applying liquid encapsulant applying exterior siding vinyl capping baseboards covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this best of my knowledge and orati. notification is true and correct to the Date: Signed: REV 10/12/95 CO110QNWEALTli OF MASSACHUSET Department of Public $eir1th .partment of Labor 6 Industries and Dep ...__ _ NOTIFICATION OF DELEADING WORK All sections of this form must be completed in order to tt:77-1:78 ri[h the notification ce4u�rnt as most sac 0111 ameF HEgLTH 454 a� 22.00 and 105 G�i (Abnaua ve^` FILE wmams:�� ectAccuTech Insulation & Contractin Licenseb DC 600 >r perfonnin9P ro 1 Exp.date 04/27/99 License li t»F eotor ection ( -t .7 aint Insp Date of lnsp „_risk deleading work is being performed, complete the following line: Agent(sl rty owner :ss of Pro act Floor Sing Name (if any) . Apt. No. �� _- - ZiP 01060 et Address Northampton, NA lading Method: Wet/DIY Scraping Heat Gun Caustics Demolition Replacement uid Encap sulant Covering "Other" selected, please explain .ck One: � Completion date :art date �—•�" M. 5:00 Weekends? N - yen will work be done: A.M. 8:00 p, c -a% License l dwelling is multi-family single family Other reject Supervisor' s name ?rcperty Owner 49 Old South Street zip _01.0.6.0--_Address Sta te_ � City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 (over) 592-5326 (413) phone: day - In accordance with Massach o^ of the date and methods(s) of s General Laws c of the niat dangerous ds(S) of lead oak persons, removal or covering of § 399 22.00 a[ least tam is to be proidedp paint, plaster or other Cfi0.low nt 1. Occupants s rani to beginning of deleadypg be received by accessible llovy racy of the dwelling unit 2. All other occupants of the d ncial premises, if any Director, Childhood Leading poisoning PF... io- Program of Public Health, 470 Atlantic Avenue, gram Director, Boston, MA 02110 Department of Asbestos 6 Lead Program - Room 11006,'100a Car 6 dgeuStreet Boston, MA 02202 Cambridge Street - 5. Local Board of Health/Code Enforcement Agency - .. - 6. Massachusetts Historical 220 Morrissey Blvd. Commission Boston, MA 02125 Deleadin C =-S�etor Fax (617) 753-84] Fax (617) 727-756E (If Premises is Listed on F Historic Places, this notification upon receipt gists must Violations or at tt of an Order 1r o initiating least t) Correct 9 pre ven[ive del ea dingj[ior to Fax (617) 727_5129 The undersigned hereby states, under the penalties of he/she has read and understood Regulations,read C pains and Regulations, MR 22.00 and Leading Commonwealth of Massachusetts Control notification 105 CMR 460.000, Poisoning Prevention Del eadio the' is true and correct that thet information hr contained in b g treat t Date _ _ - his/her n this ,� Signed: knowledge and belief. gned: Li.LA_Ad, Title: Company: Ac n Propert , i C-` (If owner or unlicensed owner's agent will be performing low-risk deleading work)of rtify that L have complied with the Commonwealth of Massachusetts 105 Commonwealth 460.1 o5, Lead Poising Lion and Cos further for owner/agent riskg a Prevention of the do r certify the the followinglow- t I or my gagent low-risk sk abatement handrehnta trot Regulations, risk activities (I have performing all .that I circled all apPl yi n9 liquid encapsulant ' - .that apply) : applying exterior vinyl siding removing doors, Cabinet doors, shutters I ce best rof m knowledge and belief. that all the information contained in this notification • Y capping baseboards covering surfaces Date: REV 10/12/95 rue and correct to the PyTg OF MASSACEUSET, COtt4 ...1 nt of Puyiid a nt o£ Labor 6 industries and Departure .s� f j ING WORK - �',1 epastme OF DELEAO JUL � rjl :J NOTIFICATION o ted in order to comelx --� sections the of form quit me completed be requirements £ M.G.L. c amended Oq All 454 the 2.0notification d OS 460.000 as most recently 1iHA"d PTO u5E1 RD OF HEALTH 454 Cm 22.00 and P,GEN FILE MOVER' Insulation & Contractin License* DC16 � of performing PfojeclAccuT ech Exp.date 04/ License 1_24,,12.16.___ Date of Inspection - — performed, complete the following line: Agent(s) ?aint Inspector ,w-risk deleading work is being arty owner�— ess of pro'ect ding Name (if any eet Address leading Method: quid Encapsulant "Other" selected, please dwelling is multi-family peer one: Completion date Start date � 8:00 P.M. When will work be done: A.M. cN Northampton Heat Gun -- Demolition Covering explain Floor Apt. No. \ -- Zip 01060 Caustics single family Project Supervisor's name Property Owner -- 49 Old South Street Zip _3510.60---- Address state `� -� N�sth�mPtoa—� City 413 584_4030 Telephone ,7 enkins In case of emergency contact Keith evening 413 665-2372 (413) 592-5326 phone: day (over) Other Weekends? License i In accordance with of the accordance and Massa coos -s General Laws c containing dangerous of temoval C. 311 4 197 s� persons, gerous le is of lead covering OR st er at least tan (le) days p rims is to be g of paint, plaster or ' 105 Cth 460.000 low no Provided and ocher accessible mat tn beginning of deleading be received by the following 1. Occupants of the dwelling unit r g 2. All other occupants of the id ntial premises, if any 3. Director, Childhood Leading Poisoning prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries 11006,-100 Cambridge Street Boston, MA 02202 - . . , 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadin Contractor n Fax (617) 753-84] Fax (617) 727_756E (if premises is listed on the State of pietoric Places, Re made stop receipt of this notificationg must Violations or at an Order to Correct must et 30 days prior to initiating preventiv deleading) Fax (617) 727-5128 The undersigned hereby states, under thhenwainsh of of perjury, he/she has read and understood the Co penalties o Regulations, Ssq Pains and Regulations, CMR 22.00 and Leading f Mventcousatts ontroingha Regulations, 105 CMR 460.000, that toesinfor Prevention a true and correct ohth the information ed Control rrect to the,b contained in fJ t of his/her knowledge this Date —��_qb 4 and belief Signed: .+�� C �) Title: Company: Provo ty Owner (If -. u s � •• -�� owner or unlicensed owner's agent will be I certify e performing low-risk deleading work) I certify thatfl have complied with the training r ) 105 onR al460.175,f Massachusetts Lead Poising g Lionrand eCon of the further certify for owner/agent g batementon tue her cent y that I of llsb aperfori and ntrol Aegulatio g:low-risk actin ties I hl ee ircle ct apply) : 1 ns, , .. lvities (I have circl edr all applying li did .. - that aPP1Y1 : 9 encapsulant applying exterior vinyl siding capping baseboards P8moving doors, cabinet doors, shutters covering su daces I certify that all the information contained best of my knawled belie , ge antl f +n tM1is no ti Ei cation is true and correct to the Date: Signed: REV 10/12/95 CO ALTH OF I+IDSACIIUSE' T�IOP iepartment of Labor 6 Industries and Department of Public Health 1 NOTIFICATION OF DELEAD ING woB1 JUL 5 I9gR comply requirements E M.G.L. a 111 4 197. 1 sections of this form must be completed <60 000 as most recently amended the notiEicetion (pGEN PILE NUMBER: rG ectAccuTech Insulation 6 Contractin License # DC1 for pertonnin9P I Exp.date 04/27/99 ad in order to ::URYHA'w PTON BOARD OF HEALTH All 22.00 and 105 Q�1 Ly USE) asa aa1 zz. Paint Inspector na-risk deleading work arty owner t ding Name lif any) Bet Address Y -ending Method: guid Encapsulant selected, please "Other" License p n7a Date of InspectionR.\CM is being performed, complete the following line: Agentls) Northampton, MA Covering explain neck One: Mart date Floor Apt. No. � rt -) Zip 01060 Heat Gun Caustics Other Replacement Demolition duelling is multi-family X Completion date 5 00 single family ghen will work be done: A.M. 80 project Supervisor's name - Property Owner N 49 Old South Street zip XIl6�� Address Stated— City 84-4030 Telephone 413 5 In case of emergency contact Keith Jenkins (413) 592-5326 evening 413 665-2372 phone: day (over) P.11. Weekends? N — License I, In accordance with Massachus of the date and methods General Laws C. 111 g containing methods(s) ° leads i covering of pa g tlleast is levels of lead is to eg nning provided a persons, at least ten f10) daw 1 t beginning of d 1. Occupants of the dwelling unit 2. All other occupants of.the residential premises 3. Director, Childhood Leading Poisoning Pre.ention Department of Public Health, 470 Atlantic Avenue 1. Director, Asbestos a Lead Program Department of Labor 6 Industries Room 11006,' 100 Cambridge Street Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor -. 197 04R 22.00 int, plaster o, her acc n ssible notice.her mat nd must be received by the following eci als eleading if any Program , Boston, MA 02110 • Fax (617) 753-8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5120 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. o4 his/her knowledge and belief. Signed: ' I I, ^, bAL- Administrative Assistant AccuTech Insulation & Contracting, Inc. Property Owner (If owner or unlicensed owner's agent will be performing low -risk-risk del eading 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 doors, shutters best of my I certify that all the information contained in this notification is true and correct to the .knowledge and belief. Date 8/28/98 Company: capping baseboards covering surfaces Date: Signed: REV 10/12/95 • COMrEALTH OF MASSACHUSE11014 Department of Labor Si Industries and Department of Public Health Al sections of this foam must be completed in order to comply Q S Yla 4 with the notification requirements of M.G.L. c.111 S 19'1, 454 OM 22.00 and 105 Clip. 460.000 as most recently amended NOTIFICATION OF DELEADING WORK Doctor pedOnning proles{ 2d Paint Inspector low-risk deleading operty owner tdress of Pro Aiding Name (if any) treet Address ity leleading Method: liquid Encapsulant if "Other" selected, act FILE NUMBER: AccuTech Insulation & Contractin Behz-d • II work is being License # Exp.date License (AGENCY USE) DC1600 4/27/99 0_11=17.26,_ Date of Inspection - performed, complete the following line: Agent(s) Floor _�-- Apt. Zip _-010bD 0e 2.110 22 UL Heat Gun Caustics Scraping Replacement Other Wet/Dry Cheek One Start date When will work be done: Project supervisor's name Owner Northam. on Hous 49 Old South Street Northampton 413-584-4030 Covering Demolition please explain dwelling is multi-family R single family 98- 4a. ss Completion date -9,144/48- No A.M. &dli P.M. (ln License N DS3232 9/9/98 Kirk Jasko Property Address city Telephone In case of emergency contact Keith Jenkins 413-665-2372 413-592-5326 evening (over) Au hori State MA Zip 01060 Phone: day ^ emm In accordance with MaSS2ChUS of the date and methods(SI o ' General Laws C. 111 g 197 containing amoval or covering 22.00 105 Qffi 460.000 persons, g dangerous levels of lead is to be provided de pand[must a be er ce .deb athesfolle iate�tals at least Gn to nninof and must received i t beginning [ del eadi ng. d by the following I 1. Occupants of the dwelling unit 2. All other occupants of_the residential premises, if any • 3 Director, Childhood Leading Poisoning Prevention Program D partm ne of Public Health, 470 Atlantic Avenue. Boston, MA 02110 8410 Fax (617) 75s- Department 53- 4. Director, Asbestos 6 Lead Program Department of Labor c Industries Fax (617 Room 11006,7100 Cambridge Street • ) 727-7568 Boston, MA 02202 - - 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadino Contractor (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 das prior initiating preventive deleading) to Fax (6171 727-5128 The undersigned nd penalties of he/she has ead and eUnderstood the oCommonwealthaof Massachusetts Deleading hat Regulations,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. Date _ 8b8/gA Signed: �� n ,(-) Tide Administrative Assistant- company: AccuTech Insulation & Contracting, Inc. Prop erg owner If owner or unlicensed owner's agent will be performing low-risk tlel ea ding 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 perforinino the following low-risk activities (I have circled all that apply) : applying ligdid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true best of my.knowledge and belief. . .. and correct to the capping baseboards covering surfaces Date: REV 10/12/95 CON- _ EALTH O IIASSACHUS ' S lic Health Department of Labor S industries and Department of Pub NOTIFICATION OF DELEADLNG WOEX /ryy'�,da{�� this form must be completed in order to 19mp1Y () .1.)k. 2� K All sections thens tE is of M.G.L. c.11l. 5 197, 454 Q . 22.00 notification d105 Gal 460.000 as most recently and (AGENCY USE) FILE NUMBER: ,•actor perfonnmg project AccuTech Insulation & Contractin Licena # C/Z600 Exp. �- License Yr` M_177f - d paint Inspects, Behza Date of Inspection low-risk deleading work is being performed, complete the following line: Agent(s) operty owner (dress of Project aiding Name (if any) treet Address i ty Scraping leleading Method: Wet/Dry Demolition Liquid Encapsulant Covering If "Other" selected, please explain 101, 1.1016 ul Heat Gun Check One: Completion date _ 9/9/98 Start date e M, 2_ When will work be done: A.M. ___&;110- Kirk Jasko Project Supervisor' s name — Property Owner Northampton Housinr Au hr 49 Old South Street Address State Northampton city Telephone 413-584-4030 In case of emergency contact Keith Jenkins 413-665-2372 413-592-5326 evening (over) dwelling is niu lc i-f Floor Apt. No. 1'3- zip _o1.60---_ Caustics Replacement Other single family Weekends? No License 0 DS3�32 Zip 01060 Phone: day Amok In accordance with Massachus of the date and methods(s) o General Laws n 1of g containing dangerous levels leads i Cr covering persons, at least tan (10) da fs lead is to be nning provided pd 1 t beginning of d Occupants of the dwelling unit All other occupants ofthe residential premises, if any Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 ^ 197 CMR 22.00 . int, plaster o. 105 CMR 460.000 notice Mer nd must be received by accessible the following material eleading. Director, Asbestos c Lead Program Department of Labor c Industries Room 11006,'100 Cambridge Street Boston, MA 02202 . • . . ..__. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, HA 02125 Oeleading Contractor Fax (617) 753-8410 Fax (617) 727-7568 (of premises is listed on the State Register C Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading PoisoningnPrevention sand Control that Regulations, 105 CMR 460.000, and that the information contained s in notification is true and correct to the best o his/her knowledge andhbelief. Date Signed: title: Administrative Assietant' company: AccuTech Insulation & Contracting, Inc. Pro erty Owner If owner or unlicensed owner's 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-risk activities (I have circled all ,that apply) : applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters • I certify that all the information contained in this notification is true best of my.knowledge and belief. -_ - and correct to the capping baseboards covering surfaces Date: Signed: REV 10/12/95 ALTH OF NIASSACHIISES oral COM. tic Health Department of Labor 6 Industries and Department of Public a�anB NOTIFICATION OF DELEADING MORE must be completed in order to comply irementf of M.G.L. c.111 5 191, sections of this form recently amended All the 22.00 notification 105 Q 460.000 as cost 454 69l a (AGENCY USE) FILE NUI�En' w ct AccuTech Insulation & Contract License ti D61600 tor peAoEmin9P role Exp.date 4/2 License It ' Ty Inspector Behz d Date of Inspection 2g - Paint line: Low-risk deleading work is being performed, complete the following Agent(s) perty owner tress of project Floor — 2-� ilding Name (if anyl Apr, No. �� Address Zip —0 reet A .. ..n• •• Caustics Heat Gun -ty Scraping Other !quid• dln4 Method-. Wet/DCY Replacement sul ant Covering Demolition Liquid Encap :f "Other" selected, please explain single family duelling is multi-family X ^ '^clyq aa\^1(1i — Sta• One: -4% . '° 0 Completion date 9/9/98 Weekends? N= Start date p n0 P.M. 5..f0 will work be done: AM' DS3232 When License N Kirk Jask=� project Supervisor's name _ property Owner Northampton 11 49 Old South Street Address Northampton State City Telephone 413-584-4030 In case of emergency contact Keith Jenkins 413-665-2372 413-592-5326 evening —� phone: day lover) NA Zip 01060 Inaccordance with Ma ssa chaos of the date and methods(s) General Laws c. 111 5 197 y 22.0o :� contain,containing[dangerous levels f lead is to be epovided plaster c. her accessible least tan (30) da a Paint, QW d60.000 not': ' o riax to beginnin and must be received by mated 9 of tlelea ding. Y Me following 1. Occupants of the dwelling unit 2. All nth er occupants of_the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006, '100 Cambridge Street Boston, MA 02202 .._ 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadinc Contractor tax (617) 753-5410 Fax (617) 727-7568 (If Historic Isa listedh on the State Register of Historic made upon receipt of an notification must b n Violations or 30 day to iorr tot initiating preventive deleading) or to Fax (617) 727_5128 The he/sheundersigned has head hereby states, the under the and of di that Regulations, 454 CMR 22.00 and Leading Poisoning Prevention sand perjury, Regulations, Massachusetts Deleading 105 CMR 460. 000, and is true and nd that the info and Control nd correct to the best o this/he contained in this . . .- , . { his/her knowledge and belief. Date _ g/ I Signed: Title: -fir Administrative Assistant" company: AccuTech Insulation & pro ern Ow (If Contracting, Inc owner or unlicensed owner's agent will be certify that I have complied with the training performing requirements of teleadinq work) Commonwealth of Massachusetts Lead Poising Prevention and Control Re 105 CMR 460. 175, for owner/agent low-risk abatement Sand containment.tfy low-risk I artmyi best will be e Regulations, performing all I '. . (I have circled all ,that apply) : applying liquid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet duots, covering surfaces shutters t certify that all the information contained in this nofif icat ion is true best of my knowledge and belief. and correct _._ .. .. .._._. . _ :.. to the Date: Signed: REV 10/12/95 /�yg ALTH OF MASSACHUStI of L3 O & Department of public Health apartment of Labor L industries and Dep DELEADING WORK (�l�� Cf,,-a'a4i$ NOTIFICATION OF to complyp Eosin meat be completed in order 191, cements of M.G.L. c.111 5 of this recently amended All sections notification d 15 eegsi CSaha..¢ 22.00 and 105 a6F C6o.UB a: most (AGENC'r USE) FILE NUMBER: :o AccuTech Insulation & Contractin license # DC1600 r performing project Exp.date 4/2 License M Inspector Beh ad Date of Inspection � -- Paint Insp line: being performed, complete the following Agent(s) w-risk deleading work is erty owner ess a£ pro'eet Lding Name (if any) eet Address :y Heat Gun Leading Method: Wet/Dry Scraping Demolition Covering quid ulant lease explain "Other"er" s selected P dwelling is Rol_cl-family neck one: When will work be done:g/g/98 Weekends? Start date �� P M �+ — A.M. DS3232 License Kirk Jasko Floor _— Apt. No. Zip _11LBb0- Caustics Other Replacement single family Completion date No ect Supervisor's name P ro3 HoUS1 Ant Property Owner Northampton 49 Old South Street Northampton 413-584-4030 Address city Telephone In case of emergency contact 413-592-5326 Phone: day State Zip 01060 Keith Jenkins evening 413-665-2372 lover) In accordance with Massachus/on of the date and methods(s)us f levels of emovalror covering lof 5 197 22'00 :^105 persons,containing dangerous f lead is to be paint,tan (I07 da plaster o, .her accessible mate not at u s rigs eo beginning of deleading.be received by the following 1. Occupants of the dwelling unit 2. All other occupants of.the residential Premises, 3. Director, Childhood Leading poisoning Prevention Department of Public Health, 470 Atlantic Avenue 4. Director, Asbestos 6 Lead Program Department of Labor 4 Industries Room 11006, '100 Cambridge Street Boston, MA 02202 ..___ 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, HA 02125 Deleadinv Contractor if any Program Fax (617) 753 , Boston, MA 02110 841( Fax (617) 727_7566 (If of Historic Placesremises is ethos notificae Registe made upon receipt of an Order fto Correctst violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727_5128 The he/sheundersigned has Bead and hereby understood the under Commonwealth and of Massachusetts Deleading Regulations, 454 penalties of perjury, tha Regulations, CMR 22.00 and Leading Poisoning Prevention and Control notification is true and correct to the best,information contained in this .. _ , o� his/het knowledge and belief. Date 8 8/98 Signed: if Administrative Assistant_, • Company: AccuTech Insulation 5 Contracting, Zr, Property (M (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealth of Massachusetts Lea Control R 105 CMR 460. 175, for owner/agent low-riskgabatementoandncontainment Iations, further certify that I or my agent will the following low-risk activities I ee performing ( have circled all _that applying liquid encapsulant applying exterior vinyl siding capping basrfac[ds covering surfaces removing doors, cabinet doors, shutters I certify m that all the information contained in chit notification is true best of my knowledge and orlati. and correct to the Title: apply) : Date: Signed: REV 10/12/95 ...WEALTH OF MASSACFIUSE' A Ca. Public?artment of Labor & Industries and Department of Health DELEADING FORE f�� q_2a-c14 NOTIFICATION OF order to eumply1/4-4$ at be completed in on 111 5 191, All sections ti this onr qu requirements L M.G.L. dad fora tt01 22.00 and 105 ate 460.000 as most recently amen with the notification requires' 454 ' FILE In eER:-_� AccuTech Insulation & Contractin License # DC1600 r perfartnu)9 project Exp.date 4/2�� License I M 1725_ (AGENCY USE) tint Inspector fl a -risk deleading work :ty owner�- ss of project Ling Name (if any) at Address Date is being performed, complete the Agent(s) of Inspection following line: ading Method: Wet/Dry Scraping Demolition aid Encapsulant Covering "Other" selected, please explain Floor Apt. NO Zip _01A6D-� Heat Gun Caustics Replacement other oak One, :art date len will work be done: roject Supervisor's name Northam on 49 Old South Northampton 413-584584-4030 dwelling is mul 9/9/98 single family g4-2,/9e Q-Wkt Completion date Weekends? No 4 DS3232 g DO P.M. _4fl0— A.M. Kirk Jasko ho ,roperty Owner Address �- city _- Telephone License In case of emergency contact 413-592-5326 Phone: day state Keith Jenkins 413-665-2372 evening (over) In accordance with Massachus'\ of t date and mh Mass(s) o General caws c containing dangerous levels of am°val c. III 4 19] of the h persons, least lead or covering of plaster ;� at uen ChM 4fo lop ng (10) da Is Co be provided paint, o 105 a rlor to beginnin and must be 'her accessible mat 1. Occupants 9of dal easing. received d by the following of the duelling unit g I 2. All other occupants of.the residential prmises, if any J. Director, Childhood Leading Poisoning ppeyention Department of Public Health, 470 Program Avenue, - - - Atlantic Boston, MA p2110 4. Director, Asbestos Fax tfil>)..�s3 841 Department abo 6 Lead Program - - - Room 110061'100 or Asf Labors Industries Boston, MA 02 Cambridge Street Fax fiB 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston,Morrissey 02125 hoof Premises is of Historic Places,listed on the State made upon receipt of this notification must Violations or an Order tiro must initiating preventive deleading) Correct at least 30 days prior to Fax (617) 727-5128 The undersigned hereby states, under the Penalties of he/she has read and understood 454 C pains and Regulations, MR 22.00 and Leading Commonwealth of Prevention Control that Regulations, 105 CMR 460. 000, and that the Massachusetts is Deleadyn Date is true and correct to tithe tbestnof.his/her kntwledg nd be g 8 8 � % r knowledge and belief. Signed: `7 ` ^ Deleadin Contractor Title: _ - Administrative Assistant— • Company: AccuTech Insulation PraPett & Contracting, (If owner or unlicensed owner's Inc wner's agent will be performing low-risk certify that I have risk del radio Commonwealth of complied with the g work) 105 CMR 460. Massachusetts Lead hs tgaPrevg tj requirements an further 0CMR 175, for owner/agent Poising atemett on dnc the certify that I or myagentowillb abatement and containment.Control Regulations, the following low-risk activities L' be Performing 1 i- - (I have circled all applying liquid enca - - that apply) : psulant applying exterior Vinyl siding capping baseboards removing doors cabinet doors, shutters covering v er nq surfaces 1st offm that all the information b ° of my tknowledge l t and belie() m t inea in this notification is true and correct . -- to the Date: Signed: REV 10/12/95 MpSSACI{USE'1 /�1 TI{ OF of Public Health COM and Department of Labor S. Industries MORE qaa�� artment DELEADING ��` NOTIFICATION DF 1 td in order to comply All see notification form pp as M. recently. c.11l'n�nd7, must completed sections a p�UPNCf USE) • with the zZ,pp and las 454 a� r1rP mrtmPn: License# DC16 � Insulation 6 Contractn 4/27/99 project Accul ech txp.date�--- pedoTmmh Pfol License Date of Inspection '�� inspector Behz.• line: .int the following being performed, complete r-Y19k del eading work is Agent(s) Yty owner F1oot � ss o£ Pro act • . Apt. No.�1�� ding Name (if any) ._"• .j.. Zip JJill6O-- :et Address • e. • Caustics �• • Neat Gun Other Y Wet/Dry Scraping Replacement Method: Demolition eading Covering *lid Encapsulant lain "Other" selected, please ex? duelling is mu1C i'fa heck One Start date When will work be done: A.M Project Supervisor's name Darin: A ho u Property Owner Northam ton Street 49 Old South Address Northampton City 413-584-4030 Telephone emergency cpntact In case of 413-592 9/9/98 single family l ��p{{ 'yTL5, '- No Completion date _ P.M. —4--fi0-- Kirk Jasko Phone' day Weekends? License N DSO State Keith J e evening (over) 413-66 yip 01060 In accordance with Massachus .ea of the dal and methods(s) o General Laws C. 111 pertaining dangerous leve,saat lead aisoto rbe ep�vided at least ten 10 s tier to beginning of 1. Occupants of the dwelling unit 2. All other occupants of.th residential premises, if any 3. Director, Childhood Leading Pgisonin' r-.encion Program Department of Public Health, Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,"100 Cambridge Street Boston, MA 02202 5 197 Q17 22.00 ems} Paint, plaster 0. hat �essiible 0mat deleading be received by the following 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Oeleadina C tractor Fax (617) 753-84] Fax (617) 727_756E (If premises is of Historic Places,edhis notificationg must Videa Lions receipt or of an Order to Corrects[ Violation r at least 30 days prior to 9 preventive deleading) Fax (617) 727-5128 The undersigned hereby states, under the pains and he/she has read and understood the Commonwealth of Regulations, 454 CMR 22. 00 and penalties and perjury,of tha Regulations, Leading Poisoning Massachusetts Deleading Regulations, is5ttue 460.000, and that the g ation conn a correct information ed Control to the best of� his/hercknowl knowledge in this Date 8/7g/qg 4 and belief Signed: r, Administrative Assistant- Company: AccuTech Insulation & Contracting, Pro err s (If owner or unlicensed work) II owner's agent will be performing to I certify that I w-risk deleading wor k) commonwealth of have complied with the training 105 onR 460.175,f Massachusetts Lead Poising Prevention and of the further certify for owner/agent low-risk abatement and Control Re the r nt y that I or my agent will nd containment,Regulations, following low-risk activities be performing (I have circled all that apply applying liquid encapsulant applying exterior vinyl sidin g capping baseboards siding removing doors, cabinet doors, covert^g surfaces shutters I certify that all the Information contained i best of my knowledge and belief. In this notification is true Date: REV 10/12/95 and correct to the CON MATH MASSACAUSE'• TH OF of public Health artment of Labor & Industries and Department NOTIFICATION OF DELEADING wo?l( (�� -M, q- c65 < be completed in °Eder to comply ck,c; nts of M.G.L. c. 1 S 197, of this form mna amended All sections and 10S QSA 4E0.000 as most recently (AGENCY USE) with the notification zegnis 454 Q91 22.00 a FILE NUMBER: Insulation S Contractin License # DC16� sited AccuT ech Exp.date 4/2 peAortnin9 P �� License A��""u��+�-- r gehza Date of Inspection U int Inspector being performed, complete the following line: -risk deleadin9 work Agent(s) ty owner :s of Fro'ect ing Name (if any) ;t Address �- • •' Caustics Scraping Heat Gun other Method: Wet/Dry Replacement ailing ple Demolition Covering lid Encapsulant explain "Other" selected, please Floor Apt. Zip ,alt One: single family_ dwelling is multi-tam(Y/_� family q completion date 9/9/98 js�A_ Weekends? No �� P.M. License N DSO :art date hen will work be done: ,roJect Supervisors name Property Owner Northa Street 49 Old South Address Northampton City 84_4030 Telephone 413-5 In case of emergency contact 413-592-5326 phone: day Kirk Jasko h MA State Keith Jenkins evening (over) Zip 413-665-2372 01060 In accordance with Massachusilm‘ of the date and methods(s) o ' General Laws n loo/ containing dangerous levels leads i or e § 197 pit 22.00 re ^lv5 Persons, at least Len (10) ant lead is to be paint, plaster o, her 460.000 nc provided and din be receive accessible mat g rigs to beginning of deleading. d by following I 1. Occupants of the dwelling unit 2. All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoning prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, 4. Director Asbestos 6 Lead Program Room x11006,'100 cambridge Street •Labor Boston, MA 02202 Fax (617) 727-7561 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 02110 Fax (617) 75 3-84: Deleading contra tor (If premises is listed on the State Regist I f Historic Places, this notification m s made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-512s The undersigned hereby states, under the pains and he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, Penalties of perjury, th, Regulations, 105 CMR 460.000, and the at hat sinformation contained in this notification is true and correct to the best o Poisoning Prevention/ and Control his her k- Date 8/98/98 Signed: 1 .. ••��<uge and belie/ Title: "' ". Administrative Assistant-' t-' Company: AccuTech Insulation 6 Contracting, I Propert y owner (If owner or I certify have unlicensed owner's agent will be performing low-risk deleading work) Commonwealth that oflMassachusetts dLead hPoising aPrevention and Control Regulations 105 CMR 460. 175, for owner/agent low-risk abatement of Band econtainment. 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 sidin capping baseboards g covering surfaces removing doors, cabinet doors, shutters I certify that all the dnfbeief. contained in this notification is true and bect of my knowledge and orlati � - co deco to the Date: Signed: REV 10/12/95 car y',.,`�.t�•G•E-'ALTH OF MASSACHUSE: S arfinent of euhlie Ilealth artf6ent of Labor 6 Industries and Dep TION OF DELEADING WORN ��,�,� G-aaa� NOTIFICATION this completed in order to compix sections then of this form requirements of M.G.L. i 6 191, All 460.000 as most recently with the 22.00 a notification 4tiR (AGENCY USE) 454 Ma and VILE NUMBER: Insulation 6 Centrect'n license # DC1600 fojed AccuT ech Exp-date 4/2 r peAormin9 P '" '-r�f. License I—N=-1��2F-6-- Inspector Behz•d S ° Inspection 1- _-33:25--- _ int Insp Date of Insp s being performed, complete the following line: Agent(s) -risk deleading work :ty owner ss of Pro ect (if any) Apt. No.�� ing Name (� - ;t Address Zip -II10611-�� .. 1.11. •' Aril Encapsulant Coveting Caustics Neat Gun Other Method: Wet/Dry Scraping Replacement :ailing Demolition "Other" selected, please explain single family dwelling is multi-family 0, ck One: date -94-F: =A- D Completion No 9/9/98 �� Weekends? art date ,. R 0� P.M. len will work be done: License k 053232 Kirk Jask-- roject Supervisor's name ,roperty Owner Northam.to Nousi 49 Old South Street Address City Telephone In case of emergency contact Keith Jenkins evening 413-665-2372 North 413-58 4�0 Auth State MA zip 01060 phone: day 413-592-5_326 (over) in accordance with Massachus".t of the date and methods(s) o. General Laws o containing land methods(s) of emoval or covering provided 5 197 !� Persons, at least lead is to be paint, 22.00 105 CM (30) da a bier to beginning adi aster o ..her accessible 460.000 nc 9mning of del ea din be receiver(t I. Occupants of the dwelling elling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Lea tling po isonin. . J..en'ion pro gram Department of Public Health, 470 Atlantic Avenue, Boston, • Director, Asbestos & MA 02110 Department of Labor & tresm - Lead s Room 11006,"100 Ca Industries mbci Boston, MA 02202 dge Street 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 [Masadino Contractor Fax (610) 753_841 Fax (617) 727-7568 (if of premises etises is listed on the State Re made upon receipt this notification g must Violations eceipt of an Order to must Violations preventive t 30 days iorrtot deleadingj`io` to Fax (617) 727-5128 The undersigned hereby states, underO the henpaa Penalties of he/she has read and understood Regulations,has Commonwealth and Regulations, MR 22.00 and Leading ntn of Massachusetts perjury, the Regulations, 1505 ChM 960.000, and that toes onfor Prevention cont Deleading true and correct to tithe the Information contained Control Date (y - f e(s, of his/her knowledge in this\_1L' �, qe and belief. Signed: C . . k.kL Title: '- Company: Pro ty pan � ^ - 7 '• er (If owner or unlicensed owners agent will be performing low-risk I certify that 1 have complied ink tile&din Commonwealth of Plied with the training work) 105 Commonwealth alt. Massachusetts Lead Poising ton and Con of the 105t CMR certify for owner/agent low-risk g patemetton the r rtify that 1 activities will be abatement and n col Regulations, following low-risk circled apply) : containment. (L have circled all .that apply applying liquid en capsulant applying exterior vinyl siding capping baseboards shutters removing doors, cabinet doors, covering ove ri ng surfaces 14erooffm that a the information contained best my that all'knowledge and belie(. in this notification lion is true "- -. and correct to the Date: Signed: REV 10/12/95 CO�,�pNWEALTII OF MASSACHUSE LT artment of Public apartment of Labor & Industries and Department NOTIFICATION OF DELEADING WOR& must be completed in order to comply to of M.G.L. 111 5 141. 211 sections OM2 of this form amended and 105 Q41 460.000 as most recently �n with the notification requirements 656 QN1 22.00 a .M lE1nos 4s OATHAMPTON BOARD OF y_-NC£ USE) FILE NaM '�- ACCUSech Insulation 6 Contractin License #IL or pede�N9 Project Exp.date 0404/ License # — Inspector Date of Inspection t saint ZnsP following line: u-risk deleading work is being performed, complete the Agent(s)� arty owner ess of Proect ding Name (if any) eet Address Y Leading Method: quid Encapsulant Covering "Other" selected, please explain Northampton, NA Floor Apt. No. Zip 0 Caustics Neat Gun Demolition Replacemen Peck One Start date 5:00 When will work be done: A.M. C\Z-■ dwelling is multifamily single Completion date 5.00 s name Project Supervisor Property Owner -. 49 Old South Street yip �],Q6Il� Address State City 584-4 Telephone 413 In case of emergency contact Keith Jenkins evening 413 (413) 592-5326 )over) P.M. Other Weekends? �— License Phone: day 6655 of accordance with Massachus� f the date and methods(s) o_ General Laws c, of the dat dangerous meth " '^oval covering g 197 Cpm st r [/� persons, at least levels of lead is to be provided 9 de paint, plaster c 10b qh 460.000 fo low ten (10) da s tier to beginning and must '`her accessible no 9rnm ng of deleading. received by the following 1. Occupants "in9 pa nis of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisonin ealth, 9 Prevention Program Department of Public H 470 t a tic Avenue, Boston,---""- n MA 02110 4. Director, Asbestos s Lead Program Department of Labor c Industries Room 11006,'100 Cambridge Street Boston, MA 02202 _ . . . 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadino Contractor ex (617) 753'84: Fax (617) 727_756! (If premises is listed on the State Regist made of Historic Places, this notification must Viola bons receipt of an Order to Correct initiating preventivetdeleading)ptio[ to Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Commonwealth of penalties of perjury, Regulations, Pains and Regulations, 454 CMR 22. 00 and Leading Poisoning Massachusetts ontrodingh6 Regulations, 105 CMR 460.000, r ationnconn true and that the information and Control and correct to the Ali t of contained in 1\.�% f his/her knowledge e this Date q and belief Signed: f Title: Company: A h ezotert rrier (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training of Massachusetts Lead Poising 105 CMR 460.175, g requirements of the further CMR certify for owner/agent g Prevention and Control me Regulations,my abatement the following low-risk activities will be performing I U have circled all that apply) : applying ligtid encapsulant applying exterior Vinyl siding removing doors, cabinet doors, shutters st roof fm that all the infbelief. I contained cc my knowledge and belief. in this notification is true and correct to the capping baseboards covering surfaces Date: Signed: REV 10/12/95 partment must be completed in order to comply C this notification requirements rements of H.G.L. 111 4 All sections a t recently emended with the 28.00 Ind 105 (!m 460.000 as me asa CUR ' FILE HUMBER' NWEALTH OF 14ASSACHUSE'P a Or 6 Industries and Department of Public Hes] NOTIFICATION OF DELEADING WORK AccuTech Insulation & Contractin ,r pe)tom)in9 pralect aint Inspector i-risk deleading work is being rty owners f� ling Name (if any) et Address wading Method: uid Encapsulant Covering "Other" selected, please explain JUL 15A 'O THAMPTON BOAFD OF HEALTH (AGENCY USE) License # DC1600 Exp.date 04/ License 11_16,4226_ Date of Inspection performed, complete the following line: Agent(s) Nor hampton, Floor Apt. No. �S-\)) Zip 01060 Heat Gun Caustics Demolition Replacement) Other ;ck One: 1 ii"1D :art date hen will work be done: A.M. 8:00 dwelling is multi-family e ■ro]ect Supervisor's name •- •• •• single family Completion date Weekends? License 9 koS622)- ?‘ Y.M. 5.00 Property Owner 49 Old South Street Zip Address State-� city Telephone 413 584-4030 In case of emergency contact phone: day (413) 5 Keith Jenkins evening 413 665-2372 (over) of accordance wimethods(s)h Massachus f the date and �N General Laws C. loll of then dat dangerous levels amoval 4 i9t D l st r ,�1 contain, of lead is to covering of paint, plaster ce 10b Cth 1f lloo n at least Len (30) dads i t beginning and be Sher accessible mat ginning of deleading, received by the following 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,"100 Cambridge Street Boston, MA 02202 - . . . 02110 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading C ontractor ax (617) 753-84. Fax (617) 727_756. (If premises is listed on the State Regist of Historic Places, this notification mus made upon receipt of an Order to Correct Violations or at least 30 s prior to initiating preventive deleading ) Fax (617) 727_512E The undersigned hereby states, under the pains and he/she has read and understood the Commonwealth of Regulations, 454 CMR 22. 00 and Leading Poisoning Prevention and perjury,Control the Regulations, Massachusetts Del eading 105 CMR 460.000, and that the r Ptionnconn ine notification is true and correct to information contained and b the of his/her in this /her knowledge and belief Date Signed: �1 . Company: Ac ll Ptacetty O`w —� (If owner or unlicensed owner's agent will be performing to I certify that I have complied with the low-risk deleading work) Commonwealth of Massachusetts Lead Poising trequirements ro the 105 CMR 460.175, for owner/agent g batementon and Control to further certify that I or my ga low-risk abatement and Regulations the following:low-risk activities I will be performing containment I ,_ - (I have circled all that apply) : applying liquid encapsulant applying exterior Vinyl sidin capping baseboards g removing doors, cabinet doors, shutters covering surfaces I certify that all the information contained in this notification best of my knowledge and belief. Date: Signed: REV 10/12/95 rue and correct to the CO j 1 WEALTH OF MASSACHUSE artment of Public "'alth partment of Labor ` tries and Dep JUL F BOOR O NOTIFICATION OF DELEADING WOW( tents of e M.G.L. rer1 9 1S'1. >.,^,nTFAMPTON dOAkD Of HEALTHi sections of this form must be completed in order to comply d ion reel irement as most .erectly amended 5 101.105�45th M 22ooa motion CMG 46 A54 690 a^ (AGENCY nS2) FILE om ersu License # n�16�0 r peAelmin9 protect pccuT ech Insulation & Contract in Exp.date 04/ License 3I 26 L lint Inspector Date of Inspection "fit = -risk deleading work is being performed, complete the following line: Agent(s) sty owner ss of PrO ect ling Name (if any) at Address .ailing Method: lid Encapsulant Covering Demolition "Other" selected, please explain Northampton, Floor Apt. No. V-5---t_ zip 01060 Caustics dwelling is multi-family X single family Other ck one: date D�� Completion art date P M 5y_ Weekends? be done: A.M• 8:00 �n� Ten will work wv' License N 4� �\ reject supervisor's name •• ?roperty Owner 49 Old South Street Zip 960 Address Stated X City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) of accordance With containing hods(5) �^4 General Laws C. 1031 y 197 g tlandemets levels emova1 r covering of 22.00 at least eve lead provided and must plaster Dived b CMR 460.000 n< persons, Len ) da or tinistoobegi°^o^9 of del ea di ng, received by the mat and must be aher accessible 1. Occupants of the followin< dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program of Public Health 470 Atlantic Avenue, Boston 4. Director Boston, MA 02110 Department of Labor c Lead Program Room 11006, '100 0a Car c Industries Boston, Cambridge Street • MA 02202 _ . 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical 220 Morrissey Blvd. C°mmissi on Boston, MA 02125 Deleadin Contractor The undersigned hereby states, under the he/she has read and understood the Regulations, 454 CMR Palls and penalties tt Regulations, 22. 00 and the Co Poisoning of Massachusetts notification 105 CMR 460.000, Leading Poisonin tts Control perjury, is true a and that tnofrhis/oercontained Ci ntrol and correct Co Date -1-_llf� his/her k�� n this Fax (6171 753-84: Fax (617) ]2]-756E (If premises is of Historic Places, this is the State made upon receipt tans ect Violations oreatt of an Order must initiating at least 30 days prior Correct 9 preventive del eadingj nor [° Fax (617) 727-5128 Signed: edge and belief, e Company; Pr'operty Ow (If owner or unlicensed owner's agent will •• - •. - - I certify that be performing low-risk deleadin Commonwealth of Massachusetts have complied with the g work) 3o5 CMR alth of Massachusetts Lead Poising Prevention rd Con ro the of further certify owner/agent ton and the her cert y that r/yg towirls b abatement Control Re glow-risk activities agent ix will hav be ircledmall and containment.apply) : Regulations, - have circled all .that apply ap?lyrng liquid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces I certify that all the information c best of my knowledge and belief. °°tailed th in Date: Signed: REV 10/12/95 notification is true and correct to the ALTli OF 14ASSACHUSE r � COL abo nt of publLa _.__ i p Industries and Departure 15a r . .partment of Labor ING FORK .�--. NOTIFICATION OF DELEAD in order 111 5 19�1y ^"IHAMPTONEOHkGOFNE- of this fan completed mnsc 0 as M.G.L• dad All sections es recently amen --.._°._.�_-.. Sth the 22.00 notification Q� 460.000 as most (AGENCY USE) 454 G4 a FILE SEA' ectAccuTech Insulation 6 Contractin license # DC lD 60�- or Pe�(utming proj Exp•date 04/27/99 License F__sa'2,6_ Inspector : -.� •' Date of Inspection ?aint Insp line: s being performed, complete the following Agent(s) w_risk deleadin9 work arty owner e55 of Pro ect ding Name (if any) eet Address Y - leading Method: sulant Covering quid EnC P lease explain "Other" selected, P Northampton, Floor Apt. No. �5' Zip 01060 Caustics Heat Gun Other Replacement Demolition dwelling is mule i-fa heck one Start date P.M. x00 be done: A.M. When will work - single family Completion date project Supervisor' s name Property Owner 49 Old South Street Zip D1n5L)� Address State�- City 584-4 Telephone 413 contact Keith .Jenkins In case of emergency 665-2372 evening 413 (413) 592-5326 Phone: day (over) Weekends? License In accordance with Massachusas General Laws c of the date and methods(s) 0. containing dangerous levels of moval or covering lof 5 197 CpR 22.00 contain, at least us level days lead is to be provided paint, plaster 105 Cth C f011oW nc rilof deleading.must be of -"her accessible mat and tbegr"^rng of received by the following 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Fax (6171 753-84. Director,rrec[or, Asbestos s Lead Program - - Department of Labor s Industries Room 11006,'100 Cambridge Street Fax (617) 727_756, Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deloadin Contractor (If of premiseted on the State Regist s Places, { this notification muse ofde upon cePli Violations or R of an Order to Correct Violation at least 30 days prior to 9 Preventive deleading) Fax (617) 727_5120 The hereby under the pains and Regulations, 9d9 CMR 22.00 Commonwealth of penalties of perjury, ghe and Leading Poisoning Prevention ands ontroi notification is true and correct to the b g Prevention and Control Regulations, 105 CMR 460. 000, and that the information contained in this �yy(f',,.� ( \t of his/her knowledge and belief Date i-g�—`-lb r Signed: V�-CC ' Title• Company: ACLU Fropett Owner (If owner or unlicensed owner's agent will be performing low-risk certify that I have complied w-risk deleading work) Commonwealth of Massachusetts dLeadhpoisinrainin 105 CMR 460. 175, training Prevention Centro the further 0 CMR 46 . 17 for owner/agent low-risk Patemett on dnd Coale t. the certify that I or llsb aberfmrnt and containment. ens following low-risk activities (I will be performing lent. I (I have circled all that apply applying liquid encapsulant capping baseboards applying exterior vinyl siding removing doors, cabinet doors, shutters I certify that all the information contained i best of my knowledge and belief. in this noti Pica covering surfaces Date: Signed: REV 10/12/95 on is true and correct to the �,,�[�NWEALTH OF MASSACHUSES C�LabT Public Heal apartment of Labor Si Industries and Department of P°h NOTIFICATION OF DELEADING WORK 5199R _J ! All sections of this form must be completed in order to comply ,...� is of N.G.L. 0.111�ana� ORTHAMPTONBOAnDOFNEALTHI hewn a most recently with AR 22.00 and 105 460.000 as ass sal (AGENCY USE) FILE WU,MER:- Li g nr) 600 or performing PY°)act AccuT ech Insulation b Conuactin Exp date 04/277/99 License R )yy4 paint Inspector . -� - ' .0 u ection Date of Insp w-risk deleading work is being performed, complete to [he following line: Agent(s) ,rty owner sss of Pro'act ding Name (if any) !et Address eading Method (uid Encapsulant "Other" selected, please Northampton, MA Covering explain Floor Apt. No. Ab' A Zip 010 Heat Gun Caustics Demolition Replacement ) Other eck one: tart date hen will work be done: Nh S ?roject Supervisor's name Property owner 49 Old South Street zip �1R60� Address S tate_SM City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 (413) 592-5326 Phone: day (over) d welling is multi-family Y' Completion date A.M. 5:00 P.M. 500 single family Weekends? License # of accordance with Massachuoss a f the date and methods(s)of the date dangerous _ General Laws c, lot y 197 persons, at least levels of leadais or covering of paint, plaster r .her ten (10) da rior toobee provided and must°beer or .her accessible nc ginning of deleading, received by°the 1. Occupants of the following dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Pro Department of Public Health, 470 Atlantic Avenue, Program Fax 4. Director, Boston, MA p2110 (617) ]53-84: Department of Labor c Lead Program Depm tment, Labor s Industries Boston, MA 02202 Cambridge Street Fax (61] - • - . ) ]2]-]SfiF 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadin Contractor (If of Historic Places,listed his notification on made upon receipt of ect Violations an Order to must initiating or at least 30 days Correct 9 pre ven[ive deleading)prior to Fax (61 ]2]_5128 The undersigned hereby states, under the he/she has read and understood the Commonwealth Regulations, 454 CMR pains and penalties of Regulations, 22.00 and Leading of eventc Century, the Regulations, 105 CMR 460.000, and that toesinfor ationnconta Red in this g is true and correct to the information contained and Control the( of his/her ntained in this Date _ �_\- --Ct= - knowledge and belief. Signed: b( 1-A.A2 1 Title: Company: Property pwner owner(If � •, or unlicensed owner's agent will be performing low-risk deleading work/a. I certify that I have complied with the training of the Commonwealth of ` � 105 CMR a1t,1 o5 Massachusetts Lead Poising Preve tioni end Cos further CMR certify for owner/agent low-risk abatement ne y that I and Co the following low-risk activities� t will be circled all and containment.t apply) : Regul ate Regulations, (/ have circled all that aPPl Yi ng liquid en ca psulanc apply) : capping baseboards applying exterior vinyl siding removing doors, cabinet doors, shutters I st rof fm that all the information contained best ce ti my hat all t and belief.. _ ... b in this notification is true and correct to the Date: covering surfaces Signed: REV 10/12/95 pooh OF MASSACFIUSE cor�tp 'Public apartment of Labor 6 Industries and Department of NOTIFICATION OF DELEADING WORK meet be completed in order to comply to of M.G.L. c.111 55 197, tF. pt F,7 F Al4', . All sectionnotification of this form as most recently -- -°" with the 22.00 105 460.000 454 Q41 22.00 a W,GENCY USE) SIZE mn�' Dc1600 ec[ACCUTech Insulation 6 Contractin license 4�� ap penGfminy proj Exp.date 04/ Paint Inspector License R J?�f= ' -, ' Date of Inspection W-risk deleading line: work is being performed, complete the following Agent(s) orty owner 5 leg JUL AUL ass of Pro act ding Name (if any) let Address y ending Method: �- Demolition quid Encapsulartt Covering "Other" selected, please explain Northampton, MA Heat Gun dwelling is multi-family 'eck One: Floor - Apt. Nc. \\Q- Zip 01060 Caustics Replacement single family Completion date ;tart date p.M. be done: A.M. Alien will work Project Supervisor' s name �- n Property Owner 49 Old South Street Zip _0 Address State - citY 84-4 Telephone 413 5 In case of emergency contact Keith Jenkins evening 413 665-2372 (413) 592-5326 Phone; day lover) 5.00 Other Weekends? 0S3?fl License # - in accordance With Massachuos/� of the date and methods(s) General Laws nl of the niat dangerous meth levels moval in 111 4 i9] contain, at least ten of lead t covering of paint,� be'received^105 (101 tla is to be provided oof and plaster p ,ryer essible0ma� s 0100 to beginning of del sad must be veceived by the foll • 1. Occupants of the dwelling unit oWr n<, 2. All other occupants of the residential if Premises, 3. Director, -. any Childhood Leading PoisoningipgaVention Program of Public Health, 470 Atlantic Avenue gram S. Director Boston, MA 02110 Fax (617) 752-84, Director, Asbestos G Lead Program - _ ' , Room dent,of Labors Industries Boston, MA 022002 Cambridge Street Fax (61] - 1 727-756. 5. Local Board of Health/Code Enforcement Agency • 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, HA 02125 Deleadinv Contractor ctor (If premises is listed on the State of Historic Places, this notification made upon receipt of Correct Violations or an Order to Corrtots( initiating r vt least el 9 preventive deleadi ng prior to Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Regulations, 454 pains and penalties of Regulations, CMR 22.00 and Leading Commonwealth of eventions Massachusetts o 105 CMR 460.000, that Poisoning Deleading the notification and that r prevention ding is true and correct to the information and Control Date the b t of his/her contained in this — - 373- .� , knowledge and belief -� Signed: �°Wk.tiut', A e: Company; Ac Property Owner u x •• (If owner or unlicensed owner's agent will be performing low-risk deleading certify that I have complied with the Commonwealth of Massachusetts g world 105 CMR Commonwealth 75, Lead training requirements of the CMR certify that owner/agent low-risk abatement Prevention Control Regulations, the following I or my agent will be aperformi ntrol Re u g low-risk activities performing containment. I (I have circled all that applying liquid encapsulanc _ t a applying exterior vinyl siding capping baseboards covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained best of my.knowledgeand belief. in the Date: Signed: REV 10/12/95 notification is true and correct to the yIASSACEL7SE COI+�(Q �'TE OE d Department of P�111 ;pertinent of Labor L Industries an Itm NOof 5 MR NOTIFICATION OF DELEADI in order to comply =f this form must he °91R of M.G.L. .111 5194, _THA O'BOARD OF HEALTH }11th t sections and as most .L. 0.1Y 191, Jam. 454 the 22.00 notification nd 105 as 460.000 USE) 454 cm FILE Sm:'��: Insulation 4 Contractin License # nang-- - Grpedortnin9ProLe�AccuTech Exp.date 04/ License ' "' Date of Inspection Mint. Inspector line.: being performed, complete the following w-risk deleading work is Agent(s) :rtY owner ass of Pro act ding Name (if any set Address Y Leading Method: sulant Covering Demolition quid Encap lease explain "Other" selected, P dwelling 15 multi-family neck One date Completion Weekends? Start date Y.M. be done: A.M. When will work 7. \Se Project Supervisor's name License #-, .. Northampton, Floor Apt. No. \\Cre.. Zip 01060 Caustics single family Other Property Owner - 49 Old South Street Telephone 413 5 Zip X1960 Address State City 64-4030 contact Keith Jenkins In case of emergency 665-2372 evening 413 Phone: day (413) 592-5326 (over) In accordance with Massachus+� of the date and methods(s) o. General Laws c.f da in 111 4 197 Cpl 22.00 containing dangerous levels of lead a is or to covering of paint, plaster 02 _her Cth 460.000 at least ten (10) daY crior to be rnn' provided and -her accas sible0 nc r g +n9 of del ea ding be received by the following 1. Occupants of the dwellin g 9 unit 2. All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Department of Public Health, 470 Atlantic Avenue, .. . Program - - Boston, rrector, Asbestos [ Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street Boston, MA 02202 _ . . , 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical. Commission 220 Morrissey Blvd. Boston, MA 02125 Daloadino Contractor 02110 ax (617) 753-84] Fax (617) 72]_756( (If premises is listed on the State RegistE of Historic Places, this notification must made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive del ea di ng Fax (617) 727-5126 The undersigned hereby states, under the he/she has read and understood the Commonwealth of penalties of perjury, Regulations, pains a Regulations, 105 CMR 22.00 and Leading Poisoning Massachusetts t y- the notification is true 460. 000, and that the r ainn cont Del this rue and correct information and Control to the b t of contained in this Date _GACC. f ) his/her knowledge and belief Signed: i_i_a_A-kA ( Title: Company; tjccll'1' Pteoer` Owner (If owner or unlicensed owner's agent will be performing low-risk I certify that f delea ding work)the Commonwealth of Massachusetts have complied with the training CMR 460.175,f Massachusetts Lead Poising requirements Con r further certify for owner/agent low-risk abatement Patementoa and Control t the r rt y that I or my agent will be aperfornt and containment.Regulations, following low-risk activities performing (I have circled all that apply applying ligdid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces best of my I certify that all the information contained hat allga and orlati, in this notification is true and correct to the Date: Signed: REV 10/12/95 CO NWEALTI1 OE' MASSACHUSE artment of public; apartment of Labor L Industries and Dep NOTIFICATION OF DELEADING WORK All form must be completed in order to yorply eh theme this requirements of M.G.L. c.lii 5 191 454 the 2notification nd 105 O 460.000 as most recently 454 oa FILE NUMBER:-- ectAccuTech Insulation & Contractin License# DC1600 xpeAomdn9pfOl Exp.date 04/ License 5 ) ?F mint inspector Date of Inspection , , a-risk deleadin9 wo s being performed, complete the following line: rk i Agent(s) rtY owner ess o£ project Floor - anY) Apt. No. -� ding Name (if � 01060 Zip et Address ton, Northamp MA - Caustics p ! ing Heat Gun Other a Method: Wet/Dry Scrap Replacement Demolition sulant covering paid E ncap explain "Other" selected, please JUL 15 1998 )�u _ k T,.aMP?ON BOARD OF H (AGE14CY USE) dwelling is multi-family X eck one: �� then date Weekends? tart date Y.M. 5 p be done: A.M. @P en will work License � single family project Supervisor' s name Property Owner Address 49 Old South Street N ojSlle+uY`-'- City 13 584-4030 Telephone In case of emergency contact day (413) 592-5326 Phone: State MA Zip _10bi---- Jenkins evening 413 665-2372 (over) In accordance with ^` of the date and MassachL .s General Laws C. 111 1 containing methods(s) of removal or covering § 197 persons, t tlande rots levels of lead paint, 22.00 at least ten (10) da is to be provided st be plaster or ether aQth esfollowing o a rior to beginnin and muss be received b g of del eatltng. Y the following Occupants of the dwelling unit 2. A11 other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Department of Public Health, g Prevention Program Avenue, 470 Atlantic - - Boston, MA 02110 Fax (617) ]53-84] 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 11006,'100 Cambridge Street Boston, MA 02202 - Fax (617) ]2]-75fi6 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadino Cootractos It Premises is listed on the State Re of Historic Places, this notification must made upon receipt ectts Violations or at of an Order {p iorrtot initiating vt tivet el days prior to 9 deleading) Fax (617) 727-5126 The undersigned hereby states, under the pains and penalties of per' he/she has read and weans a Regulations, 454 CMR 46.000 and Leading go Prevention Massachusetts perjury, tha notification 105 C and that the Poisoning Del this is true and correct information ❑d Control to the b t of his contained in this Date —2� SS - /her knowledge and belief, � Signed: ^ih.LA.42 Title: - Company: Acc_ Proper( owner . 'e , (If owner or unlicensed owners agent will be performing low-risk deleading work) I certify -;- -t hat l have complied with the training Le qu irements of the Commonwealth o fMhaseccosplisLeipt g Prevention and Reg ul ations,105 nR 60.I75 for owner/agent low-risk abatement and containment. I certify that I or my agent will be performing fue following low-risk activities have circled all that apply applying liquid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces best of my knowledge and belief. I certify that all the info[mief. contained i^ tM1is notification is true and correct to the Date: Signed: REV 10/12/95 CotipQNWEALTA OF MASSACAUSE epartment of Labor S Industries and Department of public Health .,l� c� ING WORN \ NOTIFICATION OF DELEAD OR � �,- ,.-q�a N�('' All sections of this fora must be completed 0 111 to co sly \ ^l0 with the notification 105 CMS. 460.000 requirements as most recently amended 454 22'00 and (AGENCY UM PILE NUMBER: AccuTech Insulation 6 Contractin License # DC16 :or peAonnai9 Proled Exp.date 04/27/999 License A ,ne,n1IO.6 Date of Inspection -\y�Q. saint Inspector ' "� ,w-risk deleading work is being performed, complete the following line: Agent(s) ?tty owner ess of project ding Name (if any) eet Address :eading Method: Covering quid Encapsulant "Other" selected, please explain swelling is multi-family_ tack one Northampton, MA Floor - Apt. No. \mil Zip 01060 Heat Gun Caustics Other Demolition Replacement ;tart date Olen will work be done: A.M. --S.0) License ame \C project Supervisor's n ,. Property Owner 49 Old South Street Zip �1060� Address State��M City 584-4030 Telephone 413 In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) single f Completion date P.M. 5.00 itcvtg Weekends? In accordance i^ In the accordance with Massach:. -CS General Laws C. 111 5 19"1 22.00 w1 of the date methods(s) Of contain, at dangerous levels of lead is or plaster ca 'ceder to ten 30 _ QW 4fi0, 0 n 1. Occupants� - s io= W beginning of deleading.e received by the accessible folwym'�og of the dwelling unit 2. All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, ___._. gram _-.- 4• Director, - - Boston, MA 02110 Fax (617) 753-84] Department Asbestos 6 Lead Program - -Room tment of Labor s Industries Boston, MA 02202 Cambridge Street - - Fax (617 ..__ ) 727-7566 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadina Contractor etpP (If premises is listed of Historic Places, is the State n made upon receipt this notification ect Violations or tt of an Order to must initiating ° v[ least el days , of trot 9 preventive deleading) Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Co Regulations, 454 pains and penalties of Regulations, CUR 22.00 and Commonwealth of evestc Century, the Regulations, is 05 CMR 460.000, Leading Poisoning Prevention contained in this g true and ctd that the information and Control correct to the,b t of his/her cknowl edge landhbe Date -1711_11_______±. signed: 7 n, lief. Title: Company: P=ape=t h _ � Owner (If owner or unlicensed owners agent will be performing low-risk deleading work I certify that I have complied with the training of ) 105 CUR 460-.175,f Massachusetts Lead Poising Prevg requirements Control certify for owner agent low-risk brtveenion and of the lfy that I or owner/agent aberformi Control Regulations, the following low-risk activities (/will land ct apply) t, be performing (I have circled all that apply applying liquid encapsula nt - applying exterior Vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces bestrof fy that all the contained in this my knowledge belief, no[ifica on is true and correct -"" - to the Date: Signed: REV 10/12/95 COyw.PNWEALTH OF ISSSACHASE^ apartment of Lab or L industries and Department Aof R Public Heal th All sections of this form must completed in order to °=am1x9iL\S - _ p NOTIFICATION OF eETEADLNG with the notification requirements e L M.G.L. c.11l y% ns 454 aal 22.00 e^ 105 O A60.000 as most recently amended "S FILE 1»MS' (AGENCY USE) ectAccuTech Insulation & Contra tin License N DC1fi0 [or i>eAGrtnm9 p ro L Exp.date 04/ License M nY actor Date of Inspection Paint SnsP line.: >w-risk deleading work is being performed, complete the following Agent(s) erty owner ass of Project lding Name (if any eet Address ? leading Method. We Demolition quid Encapsulant Covering "Other" selected, please explain Northampton, MA Heat Gun heck One: start date When will work be done: Project Supervisor's name Property Owner 49 Old South Street yip _01.0.5.0.--_ Address StateM City 4030 584- (413 � duet li ng is molt i-famity A.M• Floor �^� (- Apt. No. �^� (� Zip 01060 Caustics single family Completion date 8:00 P.M. 5.00 CN\i-■, ♦C Other j �Q r1 {1D , Weekends? License # Telephone In case of emergency contact Keith Jenkins 413 665-2372 (413) 592-5326 evening Phone: day (over) In accordance with of the date and Massachc -..emovnl or covering G 1 containing a^d methods(s) of s General caws 111 g 197 persons, least of st r at levels da lead is to be provided depaint, plaster or ether accessible no + tier Le beginning of de/ea tli ngbe received by the following ow' receiv le mei 1. Occupants of the dwellin 1ng 9 unit ii 2. All other occupants of.the residential premises, if any 3. Director, Childhood Leading Poisoninq prevention Pro Department of Public Health, 170 Atlantic Avenue, Boston, _..__. . Program _ 4. Director, _ MA 02110 Fax (61]) ]53-841 Department of Labor 6 Lead Program - -Room 11006/'y0Labor 6 Industries Boston, MA 02202 Cambridge Street - Fax (61] ) ]2]-]569 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. on Boston, MA 02125 (If premisic is listedhis the State egiste upon receipt Places, notification of o Violations or an Order to io must initiating r vt least days tree[ Deleadin Contractor 9 preventive del el eatli ngPUOr to Fax (617) ]2]_5128 The undersigned hereby Z states under the of of perjury, he/she has read and understood the Co Regulations,read pains and penalties Regulations, and Leading 2OlSOnn f eVentihusad 1 y� the', notification 105 CMR 460.000, and that Poisoning Del Baden is true and the information Prevention and Control t n. correct to the b t rma[i on co of his/her ntained in this Date - r knowledge and belief. Signed: V/' —L v Title: Company: P r rvowner (If owner or unlicensed owner's agent will be Performing alow-risk del ea di ng work) I certify that I have complied with the Commonwealth of Massachusetts requirements 105 CMR 460.1 o5, Lead Poising oatr further certify.17 for owner gent t batemettoa of the that a low-risk and Control the following I or my agent will be abatement and containment.Regulations, ng low-risk activities performing y) I (I have circled all that applying liquid encapsulant apply) ' applying exterior vinyl siding capping baseboards covering surfaces removing doors, cabinet doors, shutters Ise certify that all eheinformation be cc f m h wall and e contained in this notification is true belief. and correct to the Date: Signed: REV 10/12/95 COtraFtMALTE. OF MASSACHIISEAS epar<ment of Labor L Industries and Department of Public NOTIFICATION OF DELEADING NOR% form must be completed in order to comply sections of this _tents of M.G.L. c.111 S 191 �lith the notification 305 �60.000 as rest recently <sa aal 22.00 and FILE HUMBER.- ctAccuTech Insulation 6 ;or perfommn9 prole Paint Inspector >w-risk deleading wo erty owner ;ess of Pro•ect Lding Name (if any) eet Address .y leading Method: sulant Covering .quid Encap explain "Other" selected, please dwelling is multi-family Contractin ealth �0ilL �b \ �1�Ely USE) License# DC16� Exp.date 04/2 License ay -�F Da Inspection �� to of rk is being performed, complete the following line: Agent(s) Northampton, Floor Apt. No.___\ -ea Zip 01060 Neat Gun Caustics Replacement ) Other Demolition single family q-A .neck one' start date -" �5cK^ b\ Completion date P.M• �0� When will work be done: A.M. 8.00 ♦L♦() Project supervisor's name Property Owner Address state City 030 (413 584-4 Weekends? License # � � 49 Old South Street Telephone In case of emergency contact Phone: day (413) 592-5326 Zip . 1• --__ MA Keith Jenkins evening 413 665-2372 lover) of accordance Amk with Massacht f the accordance and th Mass(s) "s General Laws c. "', of then iat dangerous levels of removal or covering 111 5 197 CMR st.00 persons, at least us evel da lead is to be provided pandm plaster or other accessible th0 no ' for [o beginning of deleading be received by the following 1. Occupants of the dwelling unit - • 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Department of Public Health, 470 Atlantic Department Program _.-' Avenue, Boston, MA 02110 Fax 16171 753-841 4. Director, Asbestos ;. • .. Directment 6 Lead Program Room tment,of Labor i Industries Boston, 220 Cambridge Street - HA 02202 - 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadina Contractor ctos Fax (617) 727-7568 (If premises is listed on the State Re of Historic Places, this notification made upon receipt gists Violations tt of an Order to must initiating or at least el ad Correct 30 9 preventive deleading) ngj prior to Fax (617) 727-5128 The undersigned hereby states, under the henpainsh penalties of perjury, he/she has read and understood Regulations, 454 CMR pains and Regulations, 105 C 22.00 and Leading of eMassachusetts in d C rol tha notification is MR 460. 000, and that the sinfor information and Del this true and correct to the toffrhis/he co ed Control the b t of his/her contained in this Date -13aA.S knowledge and belief. �`� Signed. Title: Company: Accu. - Freperiy Owner f � (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training ` � 105 Commonwealth of Massachusetts Lead Poising Prevention o 960.175, for owner/agent low-risk g re f the further certify / agt e Prevention and Control Regulations, the following y that I or my agent will sbeabetement and 9 lotions, g low-risk activities P clerinall containment. I (I have circled all that apply applying liquid encapsulant - applying exterior vinyl siding capping baseboards LPmoving doors, cabinet doors, shutters covering surfaces best I certify o ytknowledge the and fbelief.rn contained in this notification i ' true and correct to the Date: Signed: REV 10/12/95 CON; °1straBALTE OF )rIASSACEUSETi'R lic aartment of Labor G Industries and Departmen t of Pub NOTIFICATION OF DELEADING NOAR of this fora must be completed in order to comply All sections then notification requir°�nts f H.G.L. .111 5 197 454 O 22'00 and 105 Oft 460.000 as most recently amended FILE )memER•�� Insulation & Contractin License # DC1 r peerlG�mNy projed AccuT ech Exp.date 04/27/99 —�� License k M_1958 . _ Inspector Date of Inspection s being performed, complete the following line: Agent(s) Health (p,GENCY USE r risk deLeading work cty owner ss of Pro ect ling Name (if any) et Address Northampton lading Method. uid Encapsulant "Other" selected, please exp dwelling is multi-family X gck One Covering Floor Apt. Zip Heat Gun Caustics Demolition AA p�J 01060 aim NN cart date , — 800 hen will work be done: A.M. ?reject Supervisor' s name Property Owner Address city Telephone In case of emergency contact (413) 5 Other Completion date P.M. 5:00 Weekends? License N No 49 Old South Street Northampton 584-4030 Phone: day State Keith Jenkins evening (over) Zip 01060 (413) 2 In accordance with Massa chr J1 of the rdland methods(s) of removal General Laws c. tll g 197 1 containing date dangerous levels of OM 22.00 105 OM persons, at least ten eve) da lead is to be covering of plaster Cr other accessible inn mat s tier to beginning el use . received b 1. Occupants of 9 of delta ding, by the following the dwelling g 9 unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading poisonings Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, (61> _ gram _... Fax 4. Director, MA 02110 (617) >53-84� Asbestos 6 Lead Program Department of Labor 6 Industries Boston, 02202 Cambridge Street - - Fax (6ll ) ]2]-]56E 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadino Contractor (If premises is listed on the State Registe of Historic Places, this notification made receipt of an Order to Correct Violations or at least 30 da must initiating preventive deleading) to Fax (617) ]2]_5128 The undersigned hereby states, under the he/she has read and understood the Regulations, 454 pains and penalties o Regulations, CMR 22.00 and Leading Commonwealth of evention ad perjury, 105 CMR 460,000, that the Del eaingha notification is true and and that t information Prevention nd correct be f hs and Control to the b contained in this Date �.�-��4, - - best of his/he//r�� knowledge and belief. _ Signed: r` (U.l.kP �' A title: Company: Preoert (If o .,. - � caner or unlicensed owner's agent will be performing loo-risk del ea din I certify that I have complied with the Commonwealth of g work) Commonwealth CMR alt. Massachusetts Lead Poising gaPrevg requirements oand furtfollowing r fy that Iwo mygagent low-risk w e abatement rming dnaontai Control tRegulati on s, activities 111 be ircledmi nment. I ' ' (I have circled all applying liquid once l ,that apply psulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces I best cerof tify that all the information contained in this notificati my knowledge and - is an-- - us... _ and correct to the Date: Signed: REV 10/12/95 QQT jALTH OF MASSACSUSE'AG tent of Public Health abor 6 Industries and Depa yl apartment of m 1 Zq,G k -1- �i�Q to omP Y L ING WORK NOTIFICATION OF DELEAD eras C this form must be sample H G1L. c.11i $ 19 . sections o 1 amended All 1i the notification 00 and 460.000 as most recently 05< CMS. 13.00 and 105 FILE SURBEA'��- its cASIENCE USE) License # DC1600 roe( tLAccuTech Insulation & Contra ctin or pedom)ingP Exp.date 0404/ License it saint Inspector .w-risk deleading work is being performed, Agent(s) Date of Inspection complete the following line: srty owner�� ess of Pro'ect ding Name (if any) set Address Y aading Method: Covering quid EncaPsulant lease explain "Other" selected, P Northampton, yA Floor - Apt. No. 155 Zip 01060 Heat Gun Caustics Other Replacement Demolition single family qrk dwelling is multifamily Y ' One: i Completion date Weekends? Start date P.M. 5.00 be done: A.M. When will work License £ project Property Owner 49 Old South Street Zip x]960- � Address Sta tee Supervisor's name City 584-4030 Telephone 413 In case of emergency contact _ (413) 592-5326 phone: day � Keith Jenkins evening 413 665-2372 (over) In accordance with Massachr of the date and methods(S) 's General Laws C. 111 containing dangerous levels of removal aisoto be provided of persons, at least tan f10) da a rior to beginning of 1. Occupants 2. All other occupants of.the residential premises, i 3. Director, Childhood Leading Poisoning Prevention Program of Public Health, 470 Atlantic Avenue, gram Direct Boston, MA 02110 4 197 Clay 22.00 105 paint, plaster or other a`ccccessible0 mat at deleading be received by the following f any 4 or, Asbestos fi Department of Labor 4LInd Program Room 11006, Cambridge Ca Industries Boston, MA 02202 dge Siree[ Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadyno Contractor Fax (617) 753-84] Fax (617) 727-7568 (If If premises Places, on the State made upon receipt this notification must Violations or pt of an Order to Correct Violation r at least 30 days prior initiating preventive deleading) to Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Commonwealth Regulations, 454 CMR pains and penalties of Regulations, 22. 00 and Poison of Prevention Massachusetts Cort the Regulations, 105 CMR 460. 000,id ndathat Poisoning ation cio 4 is true and correct to that the information frhis/on cknowled Control>_n rest ems Date _ � � fbefs.t of his/her knowledge in and hbelief. �— Signed: x/'‘,L.. i' ( Title: Company: Prvperi u♦ - (If owner or unlicensed owner's agent will be Performing low-risk deleading work) I certify that I have complied with the training requirements c Commonwealth of Massachusetts 105 CMR alt.1o5, Poising ren 105ther 460. for owner agent low-risk batemetton and f the certify that I or / li sb aberfmrnt Control Re the following.low-risk activities will and containment,Regulations, rvl ties be Performing I (I have circled all .that apply applying liquid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces best certify fmy tknowledgehand information contained in this nocific Date: Signed: REV 10/12/95 s true and correct to the CO "DNWEALTIi OE MASSACHUSE'S epertment of Labor & Industries and Department of Public Health OF DELEADING NUM NOTIFICATION homely completed in order to cmp £n r mast be of M.G.L. .111 4 d1 1.11 sections 22.00 e£ and 460.000s as most recently 'men 45th the 22.00 yndt 105 am 460.000 454 al and MAMMA:��- clAccuTech Insulation & Contractin License# DClb� tat performing P roje Exp•date 04/27/99 License k(`��(�'��' ' Paint ImsP motor Date of Inspection Mw-risk deleading work is being performed, complete the following line: Agent(s) erty owner :ass of Pro met )ding Name (if any) eet Address -y �- leading Method: sulant Covering ,quid Encap lain E "Other" selected, please exp OrMart USE) Northampton, NA Heat Gun Demolition ;heck One: Start date be done: A.M. When will work s name project Supervisor' \t- Property Owner 49 Old South Street Zip Address State City PrOa03� Telephone 413 584-4 In case of emergency contact _ Phone: day (413) 592-5326 dwelling is multi-family X Floor _____-_-------- No. .\ Zip 01060 Caustics single family Completion date P.M. 5000 Other Weekends? License # ` 1'�u -- Keith Jenkins evening 413 665-2372 (over) IIn accordance with MassaChk ,1 General Laws c. 111 f the date and methods(s) of removal or coverin containing dangerous levels 4 197 must 22 00 1 persons, at least ten (30) yf lead is to be covering of paint, 105 CMR 460,000 not rier to be Provided and deleading.plaster °° other accessible : , ginnin ust received by the mate 9 pf del ea di ng, following I. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisc Department of Public Health, 470 Atlantic Avenue, Boston, MA 02 O. Director, Asbestos 6 Lead Program Department of Labor r Industries Room 11006,'100 Cambridge Street Boston, HA 02202 Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadino Contractor Fax (617) 7 841( Fax (617) 727_7568 (If HIf Places,ted on the State Register made upon re this notification eipt of an Order to Correct Violations or must Violation t Least 30 days prior to 9 Preventive deleading) Fax (617) 727_5128 The undersigned hereby states, under the pains and he/she has read and understood the Commonwealth of Regulations, 454 CMR 22.00 and Leading Prevention and Regulations, Massachusetts perjury, that 105 CMR 960.000, and that thesinfor ationnconn ine phis notification is true and correct to Control information contained in this the of his/her knowl edtre Date Signed: lef. Company: Accu Pro aertV - f •• •• I certify (If I owner haver unlicensed owner's agent will be performing low-risk deleading work) Commonwealth atf complied with r ) 105 CMR Massachusetts Lead Poising tioni requirements of the further 0CMR 960.175, for ow 4 Patemenio certify that I or my ygag[ low-risk abatement Prevention and Control the following or iv tiest I will be ircle all and.that ct apply) : Regulations, 9 low-risk activities Q have circled all .that apply applying ligdid encapsulant applying exterior vinyl siding capping baseboards removing doors, cabinet doors, shutters covering surfaces I stroify that lee the dnfbelef. contained best of m that llge and ori ti in this notification is true and - correct to the Date: Signed: REV 10/12/95 corirmorravima OF MAS a1tIEEP 8 1998 ies and Department of Yul'+lie' sy AL is ��4�,i��0Qyy`�c�6 C4vi c1 9-u-0.`s iepartment of Labor 6 in NOTIFICATION OF DELEADING WORK < be completed in a comply order to 19] form must is f N.G.L. .111 4 All aecHF 2 of and recently amended with the notification requirements as most 454 � 22.00 and 105 � FILE NUMBER: etfAccuT BCh Insulation & Contractin license tF DCl6j 0� - totperf°fmmBP ro) Exp.date 04/2 License By°E� • of Inspection a Paint Inspector Date" ".. Dw work is being performed, complete the following line:deleadin9 Agent lsl eLty owner ct :ess of Pro Lding Name (if any) eet Address :y Heat Gun .qu Wet/pry Scraping Other q leading Method:d: AeplaceEnt Covering Demolition uid Encapsulant lain E "other" selected, please exp single family dwelling is multifamily X :heck One: Start date Completion date A.M. 8.00 4.M• Weekends? 5� 3a License B p (AGENCY USE) Northampton, MA Floor _ Apt. zip 01060 Caustics When will work be done: Project Supervisor' s name Property Owner N• a"a• •• 49 Old South Street yip 01[tfip, � Address State MA City 4030 413 584- Telephone In case of emergency contact Keith .Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) In accordance with Massach e^ of the date and thuds(s) _ General Laws C. persons,at dangerous levels of`emoval or covering 111 of § 197 st.rf r1 CMG at least ten (10) da lead is to be provided dmi, plaster o eche5 accessible notice o s ricer ce beginnin and must be received by the following g of deleading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos i Lead Program Department of Labor 6 Industries Roof 011006,-'100 Cambridge Street MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadl� r Contractor Fax (617) 753-8410 Fax (617) 727-7566 (If premises is listed on of Historic Places this State Register made upon receipt of notification must be Violations or an Order to Correct Violations at least 30 days prior to Initiating preventive deleading) Fax (617) 727-5128 The undersigned hereby states, under the he/she has read and understood the Commonwealth Regulations, pains and penalties of Regulations, 45q CMR 22'00 and Leading of Prevention ands Con Control that notification 105 CMR 460'000, and that the sinfor ationnconn ine Ci leading true and correct hat the information ntrol to the b t of his/her in this Date /her knowledge and belief. Signed: Title' Company: Accu Prapert - 'a• ` (If owner or unlicensed owner's agent will be performing low e• I certify that I have cum -risk deleading work) Commonweal t6 r.' MhasachusettsdLeadhPoisin g requirements of the 105 CMR 460.175, training CMR certify for owner/agent low-risk aid the r nt y that I or and Control Regulations, following low-risk activities iv agent /will be performing lnt containment. I ctivi ties (2 have circled al that apply applying liquid encapsulant applying exterior vinyl siding removing doors, cabinet doors, shutters I certify that all the information contained best my knowledge and belief. in this not Date: Signed; REV 10/12/95 capping baseboards covering surfaces on is true and correct to the Cr` mNWEALTH or Z,7ASSACAUSrS nt of Labor f Industries and Department of public Health ING WORN ��uk ,. A Departure OF DELE7ID �S'l�(1 NOTIFICATION 1 ted In order to comply t be completed 197. All sections of this ton requirements f M.G.L. 0.111 4 with the notification 105 �60.000 as most recently amended d5d (MR 12.00 (AGESCY USE1 TILE mcmEH. ro�eaACCUTech Insulation & Contractin license # DC1j 60� Con1r'a dor peAonningp Exp.date 04/2 Lead Paint License i 1??6— Inspector Date of Inspection work is being performed, complete the following line: Agent(s) If low-risk deleading Property owner Address of Pro'ect Building Name (if any) Street Address City Deleading Method: Cove Liquid Encap sulant If "Other" selected, please Northampton, MA Check One: Start date P.M. When will work be done: A.M. Project Supervisor's upe Niso['s name •• Floor — Apt. Zip 01060 Heat Gun Caustics :raping y Other Replacement g Demolition �n explain single family dvelLing is multi-tamily� Q Completion date ..3Se "? '�}.. Weekends? 5 License # y=am 4% Property Owner 49 Old South Street Zip Address y�tha� State�M -� City �� 584_4��Ogp Telephone 413 In case of emergency contact Keith Senkins evening 413 665-2372 Phone: day (413) 592-5326 (over) oak In accordance with Massach m s General Laws c of the date and methods(s) of removal or covering dangerous C. 111 g 197 CMR 22.00 gerous levels of lead is to be g of paint, plaster or Sob Cth gfo.o00 notice persons, at least Len provided 1 other accessible X10) da` to,beginning and must be received by the following 9 of deleading. 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Public ilood Leading Health,P oi c Avenue,soning.Prevention Program De par 'part 0 Atlantic Boston, MA 02110 4. Director, Asbestos " Department of 6 Lead Program Labor 11006, '100 Cambridge uStreet Boston, MA 02202 - - _ . _._. .r^ 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadinn Contractor 617) 7 8410 Fax (617) 727-7568 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to -initiating preventive deleading) Fax (617) 727-5128 The undersigned hereby states, under theenpainsh and nf y, that he/she has read and understood the Co Regulations, 454 CMR 22.00 and Leading Poisoning Prevention sand Control Regulations, Massachusetts Deleading notification 1 5ttue 4460.000,orean to the h- nd that the information contained in this _ t of his/her knowledge and belief. Date n Signed: l,Li_9 � ' Title: -..... Cd Company: A • Pro oerty (If Cr owner unlicensed owner's agent low-risk deleading work) I certify that I have h ant will be Commonwealth c of Mha Lead training 105 CMR 960.175, for owner/agent low-risk abatement requirements econtainmeflt. I further certify that I or my be Prevention and Control Regulations, the following low-risk activities (I will ee ircledmilg ( have circled all that app) applying liquid encapsulant y, • applying exterior vinyl siding capping baseboards covering surfaces removing doors, cabinet doors, shutters I certify m that all the information contained in this best of y'knowledge and belief. notification is true and correct to the Date: Signed: REV 10/12/95 COgALTH OF MASSACHUSE iment of public this-- S industries and Department ! .1 . Department of Labor JUL I F 199R NOTIFICATION OF DELEADING � �� ' this form must be completed in order to comply 1 All sections of requirements of M.G.L. c.111 x5 amended i�,,:,TCAM PTOr FJA C Or NEALTM with the 2 0ifandti0 O _ _ �I CSC Q,� pp,o0 and 105 flat 460.000 as most recently _._.._. )AGENCY USE) FILE 14714En'-� ectAccuTech Insulation & Contractin License# Contract°r performin9P ro 1 Exp.date 04/27/99 License M t��F Lead paint Inspector Date of Inspection If low-risk deleading work is being performed, complete the following line: Agent(s) property owner Address Building Name (if any) Street Address City Deleading Method: Liquid Encapsulant If "Other" selected, please explain Northampton, Covering Floor Apt. No. Zip 01060 Heat Gun Caustic Re lacement ) Other Demolition P - Check One: Start date 0" p.M. 5:00 Weekends? N - When will work be done: A.M. 8.00 License # dwelling is multi-family X Completion date single family Project Supervisor's name Property Owner 49 Old South Street Zip Ott Address State My City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 (over) Phone: day (413) 592-5326 In accordance with Massach 1mkx of the date and methods(s) _ s General Laws c. 111 S lead is to be containing dangerous levels of removal or cbeeprog of persons, at least tan (10) da beginning- 1 [ beginning of 1. Occupants of the dwelling unit 197 CMR 22.0( 4.4%105 04R 960.00 aint, plaster '. other accessible materials notice and must be received by the following trials deleading. 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Department of Public Health, 470 Atlantic Avenue 4. Director, Asbestos 6 Lead Program Department of Labor 6 Industries Room 110061100 Cambridge Street Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Delaadino Contractor Program Fa Boston, MA 02110 (617) 753 8410 Fax (617) 727-7566 (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5120 The he/shed has Bead andeunderstood and penalties of perjury,Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control that Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the b- t of his/her knowledge and belief. Date 'QS - r. Signed: Title: Company: Acoil' 'h Inc' 1 t Pzoparty owner (If owner or r unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. c.e 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 capping baseboards removing doors, cabinet doors, shutters covering surfaces I certify that all the information contained in this notification best of my knowledge and belief. Date: Signed: REV 10/12/95 ue and correct to the CORISONWEALTH OF MASSACHIISESS Department of Labor 6 Industries and Department of public Health NOTIFICATION OF DELEADING WORE �- lq� All sections of this form must be completed f M.G.L. to comply � �l�\(' L(4 qC6 with the notification requirements o W � -St ( 454 GMN 22.00 and 105 CM 4E0.000 as most recently amended {\Y,V,-,U, (WENC!USE) TILE NUMBER: roec{AccuTech Insulation fi Contractin License# DClfi�- CotATddorpertotmiD9P 1 date 04/27/99 Exp• � __ License R tows Lead paint Inspector Date of Inspection If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Address L Floor !- Building Name (if any) _ Apt, No. °A Street Address ton, NA Zip 01060 Northamp City Heat Gun Caustics Method: Wet/Dry Scraping ether Dele ading Replacement) Liquid Encapsulant Covering Demolition If "Other" selected, please explain �, single family dwelling is multi-family ,. r1. Cheek One: �" 1 �4�-F t�� e -x-f' o completion date Start date �— P.M. 5:00 Weekends? N When will work be done: A.M. 8:00 �� V ), \CAL` License # Project Supervisor's name �� Property Owner 49 Old South Street Zip Ott Address StateN City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 phone: day (413) 592-5326 (over) In accordance with the date and imh Massach .s General Laws c. of then dat dangerous removal or covering lof $ 197 22.0( contain, at least levels of lead is to be paint, sta beer c 105 accessible 4 fo.lo- notice t+n (i-) da rler to be rno provided and must be receivedeS c<essible materials �� g +^9 of deleading. by the following 1. Occupants of the dwelling unit 2. All other occupants of the residential premises, if any 3. Director, Childhood Leading Poisoning PCe ention Program Department _ Atlantic Avenue, Boston, rtme.. Fax ffil]l ar met of Public Health, 470 Allan[' MA 02110 4. Director, Asbestos c Lead Program Department of Labor c Industries •Room 11006,-100 Cambridge Street Fax (617) ]2]- Boston, MA 02202 727-7568 ]53-8410 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleadi^g Contractor r (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) ]2]_5128 The he/shed has Bead and eunderstood theeCOmmonwealth and of Massachusetts Deleading by states, Regulations, 454 CMR 22.00 and Leading Poisoning Prevention sand Control that Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the b- t of his/her knowledge and belief.--i-h3Qe5 _ r lief. Signed: _Lr Company: AC nT P2°peyOwner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the of Commonwealt;. c* Massachusetts Lead PoisingaPreventionlardeControl the Regulations, 105 CMR 460.175, for owner/agent low-risk abatement and containment. I further certify that I or my agent will be performi❑ the following low-risk activities (I have circled all g that apply) : applying liquid encapsulanc applying exterior vinyl siding apping baseboards g covering surfaces removing doors, cabinet doors, shutters I certify o that all ehz dnfbelief. contained in this n otification is true best of y knowledge and orati and correct to the Date: Signed: REV 10/12/95 CO1 WEALTH OF w$SACRUSE9^S Department of Labor L Industries and Department of public NOTIFICATION OF DELEBDING WORK of this form must be completed in order to ncmpl Cf of t4.G.L. 111 S 19'1. All sections 460.000 as most recently amended with the notification.naias a�r� Ma Max FILE MEER: edAccuTech Insulation 6 Contractin Licen nC1 se# 6 — Cont2dorperfomaua9P ro i Exp,date 04/ License M t'IO6 - Lead Paint inspector Date of Inspection _ If If low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Address Pro e<tf Floor —_ Name (if anY) Floor No. Q��Apt. Building Street Address m � yip 01060 Northampton City Heat Gun Caustics Liqu Method: Wet/Dry Scrap in9 - Other ding Covering Demolition Replacement Liquid Encapsulant If "Other" selected, please explain Health eARmA 713416 (�'5 (AGENCY USE) A1) C6'" Vir Check One: Start date When will work be done: A.M. 800 dwelling is multi-family X =r project Supervisor's name Property Owner 49 Old South Street Zip Address State 1� City Telephone 413 584-4030 In case of emergency contact Keith Jenkins evening 413 665-2372 Phone: day (413) 592-5326 (over) single family Completion date Weekends? _T�. License # P•M. X00 In accordance with s General Laws c. 111 g of the date and Massach containing dangerous removal or covering of p persons, g dangerous levels of lead is to be at least tan (10) dews provided 1 to beginning of Occupants of the dwelling unit All other occupants o( the residents 1 premises, if any Director, Childhood Leading Poisoning Prevention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director,Department Asbestos t of Labor a4LIndustriesm Room 11006,-100 Cambridge Street Boston, MA 02202 - - 197 OM 22.O( 105 CiR 460.00 0 notice materials aint, plaster a tither accessible and must be received by the following deleading. Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Oeleadinc Contra tor Fax (617) 953_8410 Fax (617) 727_9560 (If premises is listed on the State Register of Historic Places, this notification must be made rceipt of an Order to Correct Violations o initiatin or at least days prior to g preventive del eleading( Fax (619) 929-5120 The he/she dhas tread andeunderstood and penalties of perjury,Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control that Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the b t of his/her knowledge and belief. Date Z-l3-i Signed: 3 4 V�� Company: ACCT sUlm b — Pro ex CV Owner (If owner or unlicensed owner's is agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt). r.c 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 doors, shutters I certify that all the information contained in this notification i best of my knowledge and belief, is true and correct to the capping baseboards covering surfaces Date: Signed: REV 10/12/95 cote-NyEan OF r7ASSACHIISETJ!10 Department of Labor L Industries and Department of Public Health NOTIFICATION OF DELEADING WORE All 2a of this form mast be completed Sn order to temp: sections rementa of M.G.L. c.111 5 197, S�Cpy ZZ.00f1ndt10E 0414 60.000 as most recently amended the f112 NUMBER: uTech Insulation 6 Contractin license k nC1600 ContraEtor perfotmin9P ro 1 eCIAcc Exp.date 04/27/99 �— License i aa Lead Paint Inspector -- Date of Insp ection . following line: \"ccs\vls -7063 (AGENCY USE) If low-risk deleading work is being performed, complete the Agent(s) Property owner Address of Pro ct Building Name (if any) Street Address City Deleading Method: Liquid Encapsulant Covering If "Other" selected, please explain Northampton, MA Floor Apt. Zip _ Heat Gun Caustics Demolition Replacement ) No. \P / 01060 Check One: Start date When will work be done: A. \\/I Fi+ project Supervisor's name 'e X single family is nm tti-family =a � - Completion date M. 8:00 P.M. 3:2_ Cc:ier dwelling Property Owner 49 Old South Street Zip 0) � Address State My City Telephone 413 584-4030 Keith Jenkins In case of emergency contact Phone: day (413) 592-5326 evening 413 665-2372 (over) Weekends? License k In accordance with ,^ of the date and Massach s General Laws c. 111 AN containing methods(s) removal or covering § int CMR 22.0( 105 0141 460.000 dangerous levels o{ lead is to be paint, hater ce other accessible notice g of p persons, at least ten (10) da provided and must be received by the following materials 1 to beginning of deleading. 1. Occupants of the dwelling unit • 2. All other occupants of.the residential p emises, if any 3. Director, Childhood Leading Poisoning P[ ention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Fax (617) 753-8410 4. Director, Asbestos 6 Lead Program Department of Labor c Industries Fax (617) 727-7568 11006,'100 Cambridge Street - ]S6B Boston, MA 02202 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Easton, MA 02125 Deleadinc Contractor If premises is listed on the State Register made of Historic Places, this notification must be Violations roreatt least n30 Ordader s to Correct initiating preventive deleadingjrior to Fax (617) 727-5128 The undersigned he/she has ead and eunderstood the e Commonwealthaof MassachusettspDeleadinghat 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 b est of his/her knowledge and belief. Date --2-c-3- . . r\ `` K Signed: LU��y company: c uT ch T cu l Proaerty own (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealt:. c^ 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 capping baseboards • applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct of my knowledge and belief. o r tact to the Date: Signed: REV 10/12/95 CO"MEALTH OF MASSACW3SET6 Department of Labor & Industries and Department of Public Health NOTIFICATION OF DELEADING WORE 1�p�/C,. All sections of this form must be completed in Order to comply Ct`� C;h \ Z `U�ll'J with the notification requirements of M.G.L. e.113 S 197, . /` .\* 454 C4m 22.00 and 105 CMR 460.000 as most recently amended t��-.`,A`1y0-C3/4.% VA PILE =Rmex:-� ContiadorpedonningprojectArouTech Insulation 6 Contract in License # ^O1 60 Exp.date 04/27/99 License # N 096 Lead Paint Inspector Date of Inspection low-risk deleading work is being performed, complete the following line: Agent(s) Property owner Address of t Building Name (if any) Street Address City Deleading Method: Liquid Encapsulant If "Other" selected, please explain single family dwelling is multi-family .X Northampton, Covering Floor Apt. No. thtl..-- Zip 01060 Heat Gun Caustics P me Re la cent/ Other Demolition Check One — � Completion date Start date P.M. 5:00 When will work be done: A.M. 8:00 \C‘04,7; 'S� project Supervisor's name property Owner Address 49 Old South Street yip ntn°�_ State M�� City Telephone 413 584-4030 In case of emergency contact Keith 413 592-5326 evening C413 Phone: day (over) , . l. .. .. _ Weekends? License # �S In accordance with Massachue , General Laws c. 111 5 197 CMR 22.00 �~ of the date and methods(s) o amoval or covering of paint, plaster o 105 affi 60.000 notice containing dangerous levels of lead is to be s .der accessible lo materials persons, at least ten (10) days provided and ad must be received by the following Ya prlar to beginning of deleading. Occupants of the dwelling unit All other occupants of the residential premises, if any • Director, Childhood Leading Poisoning Pre4ention Program Department of Public Health, 470 Atlantic Avenue, Boston, MA 02110 Director, Asbestos 6 Lead Program Fax (637) 727_7568 Department of Labor 4 Industries Room 11006,'100 Cambridge Street - - - Boston, MA 02202 - " ' ---- --. Fax (617) 759-$410 Local Board of Health/Code Enforcement Agency Massachusetts Historical Commission 220 Morrissey Blvd. Boston, MA 02125 Deleading Contractor (If premises is listed on the State Register of Historic Places, this notification must be made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 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 o{ his/her knowledge and belief. Date 8/28/98 Signed: fl�,ill " C � `,n)TC�� Title: Assistant Company: AccuTech Insulation & Contracting, Inc. Property Owner (If owner or unlicensed owner's 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-risk activities (I have circled all that apply) : applying liquid encapsulant capping baseboards applying exterior vinyl siding covering surfaces removing doors, cabinet doors, shutters I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief. Date: REV 10/12/95 Signed: CON ATWEALTH OF MASSACRUSEr A Department of Labor 6 Industries and Department of ,ublic NOTIFICATION OF DELEADING WORK o All sections of this form mub �lfted in orc.111 to 19], 45th the 2.00 and[105 requirements 454 it anti notification 105 req 460.000 as most M.G.L.recently amended 5 FITS m1HnER: Contractor perfonnin9 prolectAccuTech Insulation 6 Contractin Lead paint Inspector If low-risk deleading property owner Address ro?eat Building Name (if any) Street Address _ City �- Deleadinq Method: Liquid Encapsulant If "Other" selected, please explain Health RtS\% tE t d-, 8 RoiSV6 et License # DC1600 Exp.date 04/27/99 License kyles� 6CC Date of Inspection work is being performed, complete the following line: Agent(s) Northampton, MA Covering Floor Apt. No. AT? Zip 01060 Heat Gun Caustics Demolition Check One: Start date When will work be done: project Supervisor's name dwelling is multi-tam we e y X A.M. Property Owner Address 49 Old South Street Zip 0�� State M City Telephone 413 584-4030 In case of emergency contact Keitins Phone: day (413) 592-5326 Replacement Other single family Completion date 8:00 P.M. 5`0 TALf6 .-- t ♦ 44 • , I ' • t. t> Weekends? License # evening (413 (over)