18 Notification of Deleading 1993 ark
In accordance with Chapter 773 of the Acts of 1387, Massachusetts General Laws
C. 111 5197, 454 CMR 22.00 and 105 CMR 460.000, notice of the date and methodic.
removal or covering of paint, plaster soil or other accessible material contain
dangerous levels of lead, is to be provided to the following persons at Least '.
days prior to the beginning pf deleading.
1. Occupants sf the dwelling unit
2. All other occupants of the residential premises, if any
3. Director, Childhood Lead Poisoning Prevention Program
Department of Public Health, 305 South Street, Jamaica Plain, MA 02130
4. Lead Removal Program, Bureau of Technical Services
Department of Labor and Industries, Division of Industrial Safety
100 Cambridge Street, Room L101, Boston, MA 02202
5. Local Board of Health/Code Enforcement Agency
6. Massachusetts Historical Commission
(if premises is listed on the State Register of Historic Places)
The undersigned hereby states, under the penalties of perjury, that s/he has beer
and understood the Commonwealth of Massachusetts Deleading Regulations, 454 C=
22.00, and Lead Poisoning Prevention and Control Regulations, 105 CMR 460.00 , am
that the information contained in this notification is true and correct to the o
of his/her knowledge and belief.
Date
Signed: ( []®/!1/sc,fr
Title: Contractor
Company: Affordable Contracting
Office Use Only
0034B/6
rev 11/L6/F
DEPARTMENT 0149UBLIC HEALTH/DEPARTMENT OF LABOa/^INDUSTRIE t r nrJrn
r: .
NOTIFICATION OF DELEADING WORK
JAN 271992
All sections of this fora must be completed in order to comply 111Jhh ��� � U
the notification requirements of M.C.L. C. 111 5197 iii
FILE NUMBER
Lead Paint Inspector Gus Karoubus Date of Inspection 8/4/92
Contractor performing project Affordable Contracting License 6 DC000613
Address of Project
Building Name (if any) Floor 1 st
Street Address 18 Michaelman Ave . Apt. No. 2
City Northampton Zip 01060
Deleading Method: Qin`SCRAPING) (HEAT GUN ) ENCAPSULATION DEMOLITION
(circle all that apply)
2OWER SANDING CAUSTICS REPLACEMENT OTHER
If "other' selected, please explain
Check one: dwelling is Multi-family x single family
Start data 1/30/93 Completion Date 1 /30/93
When will work be done: am X pm weekends? x
project Supervisor Name Edward Truehart License 100000613
property Owner Recoil Management
Address 1 Washington Mall 3rd Floor
City Boston State MA. Zip 02108
Telephone None
In case of emergency, contact what person:
Pauline M Cadiero
Phone: Area code required day ( 508 ) 249-6332 evening came
(OVER)
00348/5
rev 11/16/89
to accordance with Chapter 773 of the Acts of 1387, Massachusetts General Laws
C. 111 5197, 454 CMR 22.00 and 105 CMR 460.000, notice of the date and methods
removal or covering of paint, plaster soil or other accessible material contain
dangerous levels of Lead, is to be provided to the following persons at least '.
days prior to the beginning _of deleading.
1. Occupants of the dwelling unit
2. All other occupants of the resrdent:al premises, if any
3. Director, Childhood Lead Poisoning Prevention Program
Department of Public Health, 305 South Street, Jamaica Plain, MA 02170
4. Lead Removal Program, Bureau of Technical Services Safety
Department of Labor and Industries, Division cf Industrial y
100 Cambridge Street, Room 1101, Bost,n, Mv\ 02202
5. Local Board of Health/Code Enforcement Agency
6. Massachusetts Historical Commission
(if premises is Listed on the State Register of Historic Places)
The undersigned hereby states, under the penalties of perjury, that s/he has rezu.
and understuwd the Commonwealth of Massachusetts Deleading Regulations, 454 C.MR
22.00, and Lead Poisoning Prevention and Control Regulations, 105 CSR 460.00 , am
that the information contained in this notification is true and correct to the pt
of his/her knowledge and belief.
Date
Signed:
Title:
Contractor
Company: Affordable Contracting
19 Central Street
Athol, MA 01331
(508) 249 6332
Office Use Only
00340/6
rev 11/16.
DEPARTMENT a■pUBLIC HEALTH/DEPARTMENT OF LABOBemik INDUSTR.-i D (r70n^E'�8.-
NOTIFICATION OF OELEADING WORE
All sections of this form muet be completed in order to compl
the notification requirements of N.G.L. C. 111 5197
PILE NUMBER
Lead Paint Inspector Gus Karoubus Date of Inspection 8/4/92
Contractor performing project Affordable Contracting License v DC000613
Address of Project
Building Name (if any) Floor 1st
Street Address 18 Michaelman Ave . Apt. NO.
City Northampton Zip 01060
Deleading Method: ORY CRAPING `SEAT GUN ENCAPSULATION DEMOLITION
(circle all that apply) J
POWER SANDING CAUSTICS REPLACEMENT oTRER
If "Other' selected, please explain
Check ones dwelling is Multi-family x single family
start date 1/30/93 Completion Date 1 /30/98
When gill work be done: am X pm weekends? g
Project Supervisor Name Edward Truehart License
Property Owner Recoil Management
Address 1 Washington Mall 3rd Floor
•Dc000613
City Boston
Telephone None
State MA . zip 02108
In case of emergency, contact what person:
Pauline M. Cadiero
Phono: Area code required day ( 508 ) 24g-6332 evening
00348/5
.l
rev 11/16/89