HomeMy WebLinkAboutPratt St. #342 apts1&2 - 12/3/1993DEPT. OF PUBLIC HEALTH/DEPT. OF LABOR & INDUSTRIES
NOTIFICATION OF DELEADING WORK
All sections of this form must be filled out in order to comply
with the notification requirements of M.G.L.C: 111 197.
File Number
Lead Paint Inspector Robert McDonough
#2
Contractor performing project: #1
Paint by Numbers, Inc.
License #
Address of Project
Date of inspection
10/14/93
D.C. 000021
Building Name (if any) Floor
Street Address 342 Pratt St. Apt. # 1 6 2
City Mansfield, MA. Zip Code
Deleading Method: DRY SCRAPING) HEAT GUN ENCAPSULATION DEMOLITION
(circle all
that apply) POWER SANDING CAUSTICS REPLACEM T OTHER
If OTHER selected, please explain
Check One: DWELLING IS: Multi -family x Single-family
START DATE: 1 1 / 15 / 9 3 COMPLETION DATE 12 / 3 / 9 3
WHEN WORK WILL BE DONE: am x pn X weekends
SUPERVISORS: James Bolter License # D.S. 000127
Richard McLaughlin License # D.S. 000100
Mark Reynolds License # D.S. 000126
Steve Cappiello License # D.S. 000843
Arnold Thomas License # D.S.
PROPERTY OWNER: Doug E Eindy Stinchfield
342 Pratt St. #2
ADDRESS:
CITY: Mansfield STATE:
TELEPHONE: (508) 339-5072
MA.
ZIP: 02048
IN CASE OF EMERGENCY, CONTACT WHAT PERSON: owner,
(508)
TELEPHONE (AREA CODE REQUIRED) DAY: 3 3 9 - 8 0 0 0 EVENING:
0034B/5 (over) rev.11 16/89
In accordance with the Chapter 773 of the acts of 1987, Massachusetts General
Laws C. 111 § 197, 454 CMR 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 containing dangerous levels of lead, is to be provided
to the following person at least five days prior to the beginning of
deleaaing.
1. Occupants of the dwelling.
2. All other residents of the premises, if any.
3. Director, Childhood Lead Poisoning Prevention Program
Dept. of Public Health, 305 South St. Jamaica Plain, MA. 02130
4. Dept. of Labor & Industries, Lead / Asbestos Program
1001 Watertown Street
West Newton, MA. 02165
5. Local Board of Health/Code Enforcement Agency
6. Massachusetts Historical Commission
(if the premises is listed on the State register of Historical places)
The undersigned hereby states, under penalties of perjury, that s/he read
and understood the Commonwealth of Mass. Deleading Regulations , 454 CMR
22.00 and Lead Poisoning Prevention & Control Regulations, 105 CMR 460.000
and "at the information contained lr���.his n)tifica 6n is true and correct
to the -best of his/her knowledge d be of ),
Date: 11/8/93
Title: President
Company: Paint by Numbers, Inc.
003411/6 rev 11/16/89