HomeMy WebLinkAboutAngell St. #101 apts.1&2 - 7/21/1995DEPARIMFNT OF PUBLIC 10 WIII/DEPARIMENI' OF LABOR & INDUSTR18S
NOTIFICATION OF DELEADING WORK
All sections of this form must- be filled out in order to comply with the
notifications requirements of M.G.L.C. 111 197.
MO
Contractor Performing Project: f%IN1' BY NUMBERS, INC. License N D.C.000021
Expiration Date: 1-10-96
Lead Paint Inspector Ri h id Ma 1 ry License H 11785
Expiration Date:
Date of Inspection: �/, asg5
if low -risk deleading work is being performed, complete the following line:
Property owner
ADDRESS OF PROJECT:
Building Name(if any
Street Address 1(
Agent(s)
Floor
Apt. No. 1 <& 2
City Mansfield MA. Zip Code 02048
DELEADING MME''10 L31/DRY SCRAP IN HEAT GUN LIQUID ENCAPSULANT
CWERI- 4G- DI__MI`1'ION CAUSTICS PLACEMENT) OTHER
if "otherl sel ce ted, please explain
Check one: dwelling is multi family xx single family
START
DATE 7/3/95
CUMPLETION
DA'iE
7/21/95
When
will work be done: AM
x PM
x
weekends xxx
supervisors:
Property Oonier:
Mark Reynolds
Steve Cappiello
Arnold Thomas
David Damon
Lic. N D.S.000126
Lic. N D.S.000843
Lic. H D.S.000854
Lic. N D.S.000907
Address:_ tricia Road
City:_ Mansfield state:---,, Zip 02048
Phone: (508) 339-5222
In case of emergency,conta& owner
Phone:Day( )�m Evening(
els of lead, is to be go;&W RA be remived
•• r.
ten •:qs prior to • - •a•I • of •- a:•
1. occupants of the dwelling unit.
2. All other occupants of the residential premises, if any.
Director of the Childhhod Lead Poisoning Prevention Program
Dept. of Public Health Fax (617)983-6931
305 South St. Jamaica Plain, MA. 02130 (617)522-8375
Director, Asbestos and Lead Program
Dept. of Labor & Industries
100 Cambridge St. Room 1106 Boston, MA
Fax (617)727-7568
02202
5. Local Board of Health / Code Enforcement Agency
6. Massachusetts Historical Commission (If premises
220 Morrissey Blvd. of Historic
Boston, MA 02125 be made upo
Violations
initiating
E • ••
true " oxrect to the best of hisAxr lm)wle�: = el A*
Date: 6/19/95 signed
Title: PRESIDENT
is listed on the State Register
Places, this notification must
n receipt of an order to Correct
or at least 30 days prior to
preventive deleading.)
Company: PAINT BY NUMBERS, INC.
ham circled all U-nk apply)
i certify that all Un hfanation ccntah� in this rctificaticn is true " oxrect to ft best
w my knowledge- .I • belief.
Date:
Signed:
rev. 4/95