HomeMy WebLinkAboutEddy St. #47 - 7/24/1996,;.COMMONWEALTH OF •MASSACHWETTS'
Department of Labor &,Industries and Department of Public Health
S
NOTIFTCATTON OF DELEADING: WOF2K 11
..
'All'seatione of'this •torm must be aomplotod in ordor to 'aoat�ply
J •.ii+.•.i Mi,th; the notilip0.Cion: Fequiracoonts of M. C:,I, 1a 111, $;197
� , .45A. �1•Ili ,22 ;OO, ar1c� }05 R9i 460. 000, ap most ;aaeatlY,
. .. FILE NIII•=: (AGENCY USE)
Contractor. performing project' Lead Source/Dennis Ranson;., Ucense#•DC000912
Exp.date 9/14/96
Lead Paint inspector Environmental Lead Detection License'#
Date Of I71s�reQ],On,
. '.1 A AEI ::', I. Ut hrl 4'p.. '. ••
If `.low risk?deleadrng'Iwoxk as -'being performed,' complete,tho following line:
Property',owner Mansfield Housing Auth. Agents) Fr,ancene Bragga
;Addresa'_oP' Project'„
a t`-•i' „ . Nxinsfield Housing Auth..
Building Nalne (ifNany)
Floor
strree��(Add>:ess" 47 �.il'�y .Streei
Apt �No .
,.
',City.
Dgleading.tdethod Wei/Dry, Scraping' Heat.Gun
Caystics
Llquld Enoa'psulant% overing Demolitidn
Replacement Other +•" ' '
If,tPOther!';selec ed,lp]ease,explain
tip...,
h,
Check One:,.;• >..dwelllnqjs Tulti-family
singlo,family XX
Start'date'I' 7/24/96 Completion
date 7/24/96
�When•will.plwprj ` tbe;;d'ope 4 P.M..
;Weekends!. No,
,i''.'A.M
Project Supervisors name Christopher Roy
License 11DS002126
Property owner Mansfield Housing Authority,
Address 22 Bicentennial Court
city Mansfield State MA
i.
Knightly
Zip
02048
evening 603-868-2396
(over)
In. accordance with Massachusetts, General Laws c. 111 5 197 CMR.22.00 and 105 CMR4460.000 notice
of the date and mothods.(s);i.f;,rempval or covering of paint, plastec,9�. other accessible following materials
containing 'dangerous °levalswoftload'Ss"t'o'be' provided and must+be:recebved by the following
persons, at loastt•n' (10Y,)?4aya prior to beginning of doloading.
iia A:i •iv it 1. i:'lf.! l: dt'J:'�i.i1f LY..:.•. .. ..,.•.. .i
1. occupants of the dwelling unit
2. All other occupanta,.,of,ttho,, rosldontial promises, if any'
•'•rod,.y,.Loa.'r ..,. (G17) 75J-043G
3. Director, Ch1ldhoding,Polsoning PM011 lei Program
Department'ofPublic, Health" 470 Atlantic Avenue, Boston, MA 02110
4. Director, Asbestos 4 Lead Program Fax (617) 727-7560
Department of Labor'4 Industries.
Room 11006,1't10,q.Ca ,ridge street.. ,;y,.-;toc � ol;; ;;:.'
... .ry �Rlb ... ............. :.. ..
"Boston,"MA>02202.':,,
5:-'Local'1130ard Of Health/Code Enforcement Agency
6. Massachusetts NlstorlcalCb'nunls'sion (If promises is listed on the State Register
;220;Mo;'xissoyi•Bl,ydi;,,!i• j:4� y. !;:;i madoof luponlc Places', receipt Oftansorder t at on Correctst be
Boston}.:MACO2125: •, ,,. Violations or al aeast.30''days; prior to
initiating prevent)Sye,dt,Xoading):
••Fax (617) 727-5120
Daleadlna'•ConCraator... ....
... _. __...:..... .... .... _. ......... '
The .uridersigned:,hexeby, states, under the pains and penalties -of -'perjury, that
hetshe!'has ,read andoundarstood the Commonwealth of Massjchusetts Deleading,
;Regulations,.454•;CMRi22 00: and'Leading Poisoning Prevention and Control
Regulationst 105YC:mg�460 000;"and that the information; contained.,in,this
notrficaEion true"and.correct-to •the best of his/her knowledge and belief.
.
Date 6%%96 signod:"� `'1
•:!,•,-,.;; r ..Title; President
Company; Lead 'Source; .;.,: ;.,•. '
:Property"owner '(IE"owner .bor''unliconsed owner's agent will be performing^low-risk doloading wock)
L Corti fy='tha1.t S ,gave/ co>g�113 ed• with the training re41u3,rements^ of ,the.
Co wealth', of°Massachusetts Lead Poising Prevention 'and Control`' Regulations,
105 ;CMR, ;,;W.
fo'r#pwne�/;atgeant; low -risk abatement and containment. , T
'furtherccert>fy thatI.Tior my agent will be performing
the following ,low grisk!''activities, . (I have circled all itha,t apply)
applying liquld.oncapsul'ant capping baseboards
applying extgrloryinylsiding covering surfaces
..-.-•-.-..--comoving•;doors;,:,cabi,npt.. doors, shutters .. .... .............. .
I-`'certl(y`that`all"the+informa,tlon contalna:l In this notification is 'true and corcact to the
beat of my' knowledgobelief.
Dated 6/25/96