HomeMy WebLinkAboutWarren Ave. #47 apt. 2 - 11/3/2012UM Zb rZ U9:44p HAMMOND DREADING & CONST 5088800947
Deparhuent "Public Health & Department of Labor
NOTmCATION OF DELEADING WORK
All scetlons of this form must be completed in order to comply with
�• �.��ttienotifiicatimr.equircmentsofM,G.L.C.111§197,
454 CMR.22.00 and I0.5,CMR 460.000, as most meentiy. amended
Contractor performing project Hammond Deleadin
9 License trDC1D68 Lrxp.Date6/1812011
Lead Paint Inspector Date oflnspec6on _
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Date
Number___`___
Property Owners_ �(^ P P ` '�'—'--
Address
Telephone Number. - /1 —�� S--���`•U
Defending,'Vethod:[]N'6'ef/Dry Serapiag '
[]Demolition ❑Heat Gun [j L-fqpfd Bncopsuleat
ocoverin ❑ C sties
g Othor placement
If"Other' selected, Please explain ran �'Y,)"e&d-1 -
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Checkout: DwcOing ismuili��� Singlo-family�
O her
Start Datc ?
o Completion Date
When Will Iveek be done: AIDT� PM q
(Specify times on site) Weekends? YES
PrajectSupervisar Name Daniel Bettencou t
License 4 DS3718 xp, Date3i20` �a
Worker's Compensation PolieyNumker VWC6009514012009
Carrier AIM MUTUAL INS Ca.
In ease of emergency contactJOHN HAMMOND
(Contrac�or'a Represenmtivo) Tel. = 50(. � 243-1668
DEL ADM .CONTRACTOR
The undersigned hcrchystom,, ander the pains and penalt, of hiassackusetfs Detcading Regulations 454 C p my t of he/she
that the information co tamed in thir-not� u2.00, an the Lea m Wing Prcv,
1 C) 1')CIi is traoa dcorr ita ebr ofh'.
Date I
HAMMOND DELEADING & CONSTRUCTION
19
Telephone Number 50"21-7684
OVER—>
p.1
and understood the Commonwealth of
trot Regulations, 105 CIVIR 460.000, and
,wled nd belief.