HomeMy WebLinkAboutEddy St. #45 - 7/18/1996COMMONWEALTH OF ,MASSACHUSETTS;
' iari
'Department of Labor &,Industries and Department. of Public Health
.. NOTIFICATION OF DELEADING',' WORK
•�•` All aeathe.l tiapAs'Eorm quit me completed in order to comply
tha notiElpation: roq\jiromants of M. G:1, \q'ill S .197r
\) 454)CMR ;2 00.?4�10$, Q•IIi 460.000�a4 moat ;eaontly Rdod .. ,•„
FILE NUMBER: (AGENCY USE)
ContractonPedortning:project' Lead Source/Dennis Ranson;•r.ucense #•DC000912
Exp.date 9/14/96
Lead,Paint Inspector Environmental Lead Detection License•#
ui i.�uri n r.1 i r �.1:: i Date gf.Iri9Ferf ;(?n,
'.b1 Ilnu� ii.'Jt 411 4 '1.,.
If, low �ris�clSdeleadsngrwork"is'being performed,' complete the 'following line:
Property `,owner Mansfield Housing Auth.Agent(s) Fr,ancene Bragga
Address .of' Project.
Buil'din Name�(1'ENa'ny)" N4ajsfie,ld Housing Auth. Floor
o ttrp hun r n, r, r .
Stree �cldress' 45 }eddy $t'reef> Apt .:po
.,, y,i a.l: l IL \ �')�15 \t tl pt, � u \;. r . t ,, .. J �+`ll :il - �0 �It.p J p • ..:.
City.. MaAsi,01 d,...Mk� Zlp .
DgJeading tdethod Wei/Dry, Scraping HeatGuri Caustics
e Y .1 d r t v r :..:.
Liquid'EncapsulanC'. overing !Demolition Replacement Oth'er''•'
If.;•"Other,,!,;selec„Ye�1, rpj,ease expla}n
Check 0ne:q,' •% ling.. singlo,family XX
.
Start date 7/18/96 Completion daL•e
When•will,;work\1be,,,d'ope ;,:A.M .:'?tX P.M. Weekends:?., No.'
Project ,Supervisor's name Christopher Roy License 11 DS002126
Property owner Mansfield Housing Authority,
Address 22 Bicentennial Court
city. Mansfield " State MA ZIP. 02048
Telephone 508-339-6'890
In case,of•emergency,contact Scott Knightly
i
Phone: day 603-74979274; evening 603-8,68-2396
(over)
i
In accordance with Massachusetts, General. Laws C. 111 5 197 CMR 2200 and 105 CMRI(460.000; notice
of the date and methods(s);,.ofp,removal or, covering of paint, Plaster,or, other accessible' materials
containing dangerous;1Xev'els'x;f"'load'is • to be provided and must., ba:receSwed by the following
persons, at leash t•n`(10)`day rprior to beginning of doloading.
ti3.t ma:i ''iY.(c!t)''lk>:'d f4(.+:4.'•:. ..i.. •. ..
1. occupants of the dwo),ling, unit,•.
2. All other ogcuypants,:,of.,,the residentlal promises, if any',.
� n.
r,..I;J
3. Director, Child hooU Loading'Polsoning Prevontion Program Fax (617) 753-0436
Department'of' Public.'Health; ; 470 Atlantic wonuo, Boston, MA 02110
.........._...........................I
4. Director, Asbestos 4 Lead Program Fax (6l7) 727-756U
Department of Labor Industries.
,•�_. Room, 11006;4'CIQQc•CaaOridgo'. Street; p,,;•ifyt;� I/t;;
'Boston: MA 02202,` ._. .... .. ..
5:"'Local'9Board of Health./CO40 Enforcoment Agency
6. Massachusetts Hlstorical CAmMission (If promises Ss'l is tod on the State Register
220, Morrissey, Bl,vJ1'.11) -jo ,.: !;,i of Historic Places', this notification must be
• Bostort;. MA Oia 12$!,, ,J made upon receipt ;of an:Order:': to Correct
violations or at:Least,30'days:prior to
.. •, '. a.i%u;i, [:•;, o;!:I , ..... initiating prevene)ive, deleading)
Fax'(617) 727-5120
. Dal�adin4'Contraotor.......... _. •._....., .. .... ....... ......... .. .
The ,undersigned;;hereby�states, under the pains and penaltias•':of-perjury,'that
he(she! has•';readi`and.qunderstood the Commonwealth of Masgachuset is Deleading
;Regulations;.454Or;C1dR122 00 arid'Leading Poisoning Prevention and Control
Regulations4 105'+(Q1 A60 000,.and that the information; :contained.,in;this
notification as't:rue`and :c_orrect 'to -the best of his/her' -knowledge and: belief.
. Date 6/Z�J/•9s Signed: OK�l
Title: President
Lead 'Sourc.q;;:, • ,.,'
.. .. ... _.. ..... ...... ....:.. .a ,.,Company: .,.:...
`Property'Own. (If"oycaror'unlicansed owner's agent will be perfonning•low-risk deleading work)
I certify<'that 3 ;gave 'coiplilled with the training requiremarits"of the.
Commonwealth of°Massachusetts Lead Poising Prevention and Control Regulations,
105'CMR,A60 175„;forfi4owner+/argent:low-risk abatement and containment. ,I
"further•cert>Ey t}iat�I or my'agent"will be performing
the fol]owing low2iisk.activitlPe
S, (I have circled all that apply)
applying liqui,d.oncapsul'ant • capping: baseboards
app.1ying exterior,Fvi.nylsiding covering surfaces
-._•------- removing.;doors;.:cabi.net,..doors, shutter's •`
Icortl(y'that'All''thorinformatlon contalnod In oils notification is 'true and cocroat to the
best of my' knowlelgo,iAnd9'bollof.
Date. 6/25/96