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HomeMy WebLinkAbout1997 Apr 15 - Notification of Deleading Work 041,15/19�7 11:41 5083623393 HQMESTE�D CQNSTRUCT PAGE 02 - � bepar`ment vf A�-hlic Heatth und�epur4ue�at uf Lxbor ��Indusiries NO�'�CATIBN OF j'►�G�V�D�IC Lii ��' �'�'� I�� ; `�'V% �� �'.� A.113cctions of this form must be oompleted in order sn compty ��� � � ���� wich Rhe notificutian rsqairernencs o{M.G�Le a� [l i # 197 �.����_-�-�.,� ��r�;,�" _._.....___._....__.._..._�._�.,.....�_.�. FILE 1V�UMBEA: t Cantractor performing prc�jcct�_�Gld'Jl)' ��U'U��C�//UT����� License# ���C3�.�� � Exp. Uatr ���.�.�..� t,efd Faint 1na�ecrnr ��� � � '-'"`1�,� � �'j _ L'icense# �'2 ��� �atc of ins�cctio d Q Z�9 If iow-risk dcleading r�roxk is beir�g perf�r�ned, c�om�letr fallowing lin�e: property Uwner�.E�'� �(dI�R.F� f 11���d.1"Y �"if�l/l�E.��gent(s) -- �ddrr�s nf�ta�jr�t Buildiug Name(if any) � Floor.� Street Addres9 ����'!�-� � .�'k-LT .--- .--�--_.:.�►pt. No. __��— C�ty �,nt�.a U r6�,�C�l�� - - Zip ��� 1' .r - DeEes►ding Method: C_.. Wc�7 Sc�apit�g�`�� I�cat C�un Li�uid Ei�ca��ul��t Guv�rii��,� . 17�mout�on �ustics � p aceme�a r If"iJther" sciccted, please explatr�_ — ...y CCt�Ccck On�e: dwelling i.s n�ulti-family , si�g�k-f�„•��.___ Stsrt�tiC ��` +r��7 '�1 � Cotx�gl�tion D�te �� "C� �--� /� _ ._ � n wili work be dorat: auL_.L'�`.? pro }��� wr�krncfe7� Frnjr.rt Cupenri.sor's Narn� ���'``� 1� ��_��!�n'�/�` License �1�� �'� '�� ,r i 'n FCOpGi'ty�W�CI�YS"`3'`,' �` �f•.�7►�� O��,Y+�ll� .�w�- -- _ na�� �b� r�t,►4�'!V �rT �L-� G' �r .,�.__. c�t� ��-��t�V� �0?'�� _ s�acG� _z�p C��' �r� Tdephone ?�'" '�b� � � ��� In case of emergency contact �� ���. T?l�� • -- �,� - -�,,,..�- ,�..�...� �one:day—�z_� !1]�G?. '�-�j '� � evening.,..,,,,._—.� ��' ---,— (OVER) (3{/�IV� O�C�UP�P�-� QGtI�LL��a �Y�71�fG�/ /ylCMof�IJG' �'•t�T ��1911G' 1�/?�lLG�''�'�. �C�'DlyUG. 4t�UN�f� 1� 0�'P"�lV�� U�t..�-hO�NG �'a.�Vv��h�3 �t+��tl�� . IN�21�. �3�1NG r�C�,'$- �i� �JG�/ ���- ��2`3oN �" `7t�6F/V C�0U� Oc�s�1�'F��. . ���-C. P�� W���2��G DJ4�5, 4�.v�NrQ���, ��+v��o�. G�1�.I�K�.�U� � D�b � G�°r ra►� U,�a�� �a�1�. In accwdanc�wi�h MaaBachuBetts C►ener �Ws c. �11 � !97� 454 G'MR'l'I.UU and lU5 'K 4fat�.DOQ, noticc of the date and met�od(s)of tanoval or cuveting of pa��t,p�oe�r or athe[acctssi�la rnatorials containing dax�erous levels of Icac# is t� bc provided and musc be rexeivecf by thc following pe[suns�at IcBst�e�(.1111Q�11sy���io t�hc begit�f3tlg of deleading, 1, Q�ctapauts of the dwelling tuait 2. Afi atE�cr occuparets af thc rtsideutial prett�isos, tf Any �lli�- ° 3,E� irector, Ch'tldhaod Lead Poisoning Prcv�t►tion PFogram Fax(617)753-8496 "` bep�rteneru af PubIic H�s►Ith, 470 Atlat�tic Ave�.Hoskon, MA 02110 i�4�. �irector. A�bestos aild Lead program Fxx(d17)727.75b8 Departtiient af Labor and�tdustries koom i l(k5, 100 Cunhrietp�C:re.�r, Bastan, MA dZ�02 i GetJIU ����vu�l'f � [���T'b� ��- '��"` '— S}'1'r� �,1�l,klV -1��S�.d P ,��t�'��36� � �5.� Local Baard of AealtltlCale Enforce�nt Ag�ncyy (I,�/G f�,T�.g � .YA�- 4�-�6� 6. Massschu�etts Y-listarical Commissio , premises is listcd on the Statc E�egistet of Historic lPla�ees, this notific�tion 220 Morrisssoy 81vd � uat be made upon receipt of an OrdCr TO C;�rreu Violations ar at least 3p Bostcm, MA 02125 days prior initiating prcventive dele�ding.) � ��g �c�PpP • A�rr� �� ����r �9"�Ic� �ov�Mr t3�ro� N�VC�tI�- Fs�s t6�7��27�s�2$ �.o•� �1a�7 ����c� � ,�� c���c �a.x ��8-��.-� �[36 �]��q�l^.in�cfnr � The u�neersigncd hereby sta�es,unddGe trie pains and pensltics of perjury, thsd xiClahe ha4 read a�d�deratoad th�C�mmonwe�lth �f�ass�chusotta Delca�ling Regulationa� 434 CMR�2.OQ�aad L�ad poisaning Preventioa and�ontroi Re�ulauons. 1Q5 CM� �rr�,a,�, astia cnac:t�e,�ormat.on contaiar�ed i�this notifxcaticm ia true and currect to ttl�e bes�of hislhcr jrnQwledge and belief. ��t� �Q-�2�c. J +�_ t$�`e � sig�: �� !�- C��'�� .—, - - - - . �.�. z';ctc; C�w+u�P-� o P+�ttJt'rer�. ��,c�.t;a�+uG c��th-c ra CQmpany���_7�,h� �.'4�V S�' /�,/�f'� pr�..�(Tf awner or unlicensed owner'a agont witl be prefarming tow�ri$k deletting work) I certify that i l�ave camp4ieC witlx the trai�ning requirements�f the Commonweaith of Massach�setts Y,ead Poisot�,ing Prevention and Control Regulations. lOS CMR 460.1?S, far owner/age�t low-risk abat�meat and contaituncnt. I furcher c°,r.rcify chat I or my agent�vil!be perfornting the faliowing 1ow-risk�ctiviti�s(I have circled a11 that apply)s �„�......._. applying liquid enaspsul�tt,t � ing basebpacds uppl�ing czterior vtn�l slcti�t � ca�ring surfaces" � �� removlug dc�ra, aat�il�et dborrr►, shutters � I cer�xfy that all the informatibn caz�tained in=his t�oCi�cat�on�is true and correct ta the best of my lrnowlal�e arxi belicf_ Date: _ `� ` � " � Si�ned: t1u� _ __ C:�wPSmt,�p,pl49xtFORMSIDELNOT,FRM Rev.Iq145 �0 3Jt�� 1�(1�1SN0� Qti31S3WOH E6EEZ9�80� Ztr�Lt l66Z19I/b� .7qhn U 'F��url��; C�E�Fa f-iom�u��,��d C:uT1.:i�;Y�1C�.LQ1"1 a��rua.e�� 1�,� M�i n 5�,�rw�t , �t� 6� Yarmr�ut;f� l�a7`t; , MR a2675 TwJ_fF�x ( 5U8 ) 362�-�33�33 ��T� � Apt-i 1 ].5 , 1�97 Tt� R Mr . f37�i�n He�sli� 1"awr� �f Yarmou�.��� , f�Gpt . af h-1��1t h 1�1.�6 "�out;� 2E3 �outh Yarm�uth , MA Q2Gf��a ��x ( 508 ) 39�3-236a �ROM : Jc�l��n � 'F�our �« R� � �data.f i�c�t,ic�r� afi� Ue;��:�zr�a nc� �Jc�7�k F'r`�t:��a T[:7 �'OLI..(JW � `f�t�c� ( 2 ) Ci�h1P'i�N�f"5 : . . . . . . F��;r �h�: nca�.ifzc��ion tu 1�al.law , d�1Lc"3C�1T1� wca•rk wi;�1 b� ci�n� can �arop�rty at 16�3 Main Strc:�:�. , YarmraG�th F�c�rrt , M�a . WUY- �< i� bea.ng dan� di�r�c�J.y by �.h� hc�m�; c�wr-��:�r wl��a ha:� c�k�taa.n�d �.I��� r�quired tr�s.n�r�g , cert�.�icatic�n , �r�d l �c�:nsi ng wi th th� Gomrncanw��l�h caf M�s�achu�et�:� . P1��:�e c�11 me <�t 5Q8-362-3393 with ar�y q�.aesti�ar7s you m�; 1��au� �r�eg�rdin� tf�a.� no�ifiicatic�n o�r �.he; wc�rk th�t is �n ��� �c�r�� . �� !