HomeMy WebLinkAboutShawmut Ave. #59-61 apt 1&2 - 5/20/1998Department of Public Health/ Department of Labor & Workforce Development
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NOTIFICATION OF DELF,ADINC WORK
All sections of this form must be completed in order to comply with
the notification requirements of M,C.L. C. 111§197,
(� 454 CMR 22.00 and 105 CMR 460.000, as most recently amended
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Contractor performing project Paint BY NudberstIrr License is - D.C.000021 Exp. Date 1/7/99
Lead Paint Inspector Jack Katie Date of Inspection 5/25/2/98 _, License 0 Mi1`H . Rxp, Date
PROPERTY OWNER ( If owner or unlicensed owner's agent will be performing low -risk deleadine work, complete the following):
Property Owner.
Add
Telephone Number__(_____) -
I certify that 1 have complied with the training requirements of the Commonwealth of MAssAchuselts Lead Poisoning Prevention and Control
Regulations, 105 CMR 469.175, for owner/agent low -frisk 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): I.,
applying liquid encapsulant capping baseboards removing doors, cabinet doors, shutters
applying exterior vinyl siding covering surfaces
I certify that all the information contained in this notification is true and correct to the best of my knowledge and belief.
Aa te�l/A Signed N/A
ADDRESS OF PROJECT:
Street Address 59-61 9xian t AUe Apt. Number 1 & 2
cityIvi-r, M 02048
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Property Owner So tt Dan Address Mansfield rY3 0204E
Telephone Number 78( 1 ) 784-3076
Deleading Method: et/Dry Scraping Heat Gun Li uid Encapsulant
Demolition Caustic$ Re acement
Covering Other P
If"Other" selected, please explain___
--heck one: Dwelling is multi -family X Single-family
Other
start Date 5/11/98
Completion Date 5/20/98
When will work be done: AM X PM X (,Specify times on site) Weekends?
'roject Supervisor Name icin M3rbS,Ml a ]3js4l° & AdEin 91 a License pMM51 rEs3413 r E3 p Date9/3/98,1/21/99 &3/25/99
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