HomeMy WebLinkAboutSchool St. #315 - 2/19/1993Phe-j" me 1'Un1.1c nr;Al,rn'llla'r. OF I,A110H a IN01111WRINU
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1)1 sections of this form uui:;t be filled out in o der to Comply
W th the notification rc`-luiI"vnents of M.G.L.C. 11 197.
Pile Number
Lead Paint Inspuctor Storch Home Inspections !pate of InSpeCtion
COnCra:�gr performing project.:l',titj by Numbers
fame (if any)
Street .Address 315 School St.
City Mansfield MA.
Inc. License #D.C.O,^ 000022�1_
Floor
-�`, Apt . #—.-----
'Lip Code 02048
Deleading Method: DRY SCRAPiN`% IIEA'L GUN ENCAPSULATION DEMOLITION
(CrQie all that apppyyj'— �-\
POWER SAN011j,' CAUS'1'1CS 1tEPLACE ENT OTHER
If OTHER selected, please expl,,iil
Check Oiler DWELLING 1S: Multi I.uui 1y Si9yle family X
I
START. P#►T90 2/15/93 I)HPLETIGN DATE: 1 2/19/93
Wi�$1{ �j�+j, WORK DE DONE: .nu x pm 1 weekends
1 Y ----
SOtS: James Dultur License 8 D.S.000L27
Richard Mcl.,in,ill iu-1,icunse it D.S.000100
Mark Reynuld: License # D.S.000 26
Francis McUrii, License 11 D.S.000�39
PRQP94TY OWNER: Attorney James Coogan c/o Jack Clagg
AAPRRSS t
175 Lawndale Ave.
CITY; Mansfield, -- -- ISTATE: MA. ZIPi 02048
TRLTiP�QNE i 508-337-6176
IN CAS$ QP EMERGENCY, CONTACT WIlAl' I'I:RSON: Jack Clagg
TELEPHONE(AREA CODE REQUIRED) Dcl: same as above EVENT;
Ub f I(
003ys/5 rev,11/16/89
In accordance with the Chapter 773 of the Acts of 19B7, Massachusetts General Laws
C. Ill 9197, 454 61R 22.00 and 105 CMR 460.000, notice of the date and method (s)
of removal or covering of paint, plaster soil or other accessible material contain-
ing dangerous levels of lead, is to be provided to the following person at least
five days prior to the beginning of deleading. 1.
1. Occupants of the dwelling unit.
2. All other occupants of the residential premises, if any.
3. Director, Childhood Lead Poisoning Prevention Program
Dept. of Public Health, 305 South Street, Jamaica Plain, MA. 02130
4. Lead Removal program, Bureau of Technical Services
Dept. of Labor, & Industries, Division of Industrial Safety
100 Cambridge �t., Room 1101, Boston, MA. 02202
5. Local Board ofHealth/Code Enforcement Agency
6. Massachusetts historical Commisision
(if the premis,ds is listed on the State register of Historical places)'
The undersigned hereby states, under the penalties of perjury, that s/he read
and understood the Commonwealth of Mass. Deleading Regulations, 454 CMR 22.00
and Lead Poisoning Prevention and Control Regulations, 105 CMR 460.000 and that
the information coritained in this notification is true and correct to the best
of his/herknowledgjl and belief.
DATE: 2 l/93 Signed
/ ji
Title: President
Company: Paint by Numbers, Inc.
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0034B/6 rev 11�16/�9