HomeMy WebLinkAboutGilbert St. #165 - 5/7/1993DEPARTMENT OF PUBLIC HEALTH/DEPARTMENT OF LABOR AND INDUSTRIES
NOTIFICATION OF DELEADING WORK
All sections of this form must be completed in order to comply with the notification requirements of
M.G.L. C. 111 5197.
File #: 005-93
Lead Paint Inspector:
Contractor Performing
CLIPPERSHIP
Address Of
Building Name (If Any):
Date of Inspection:
A -
Floor:
12/10/92
Street Address: 165 Gilbert_at.. Apartment: N/a
City: Manstfeld State: MASS Zip Code:
Deleading Method:
(Dryscraping) (Replacement) (Encapsulation) (Demolition) (Power Sanding) (Caustics) (Other)
If Other, Please
Check One: Dwelling is: Multi -Family ( ) Single- Family ( X)
t
Start Date:5 /I / 93 Completion Date: 5 /4^7/ 93
When will Work Be Done: AM (x ) PM (x ) Weekends (
Project Supervisor Name: Miguel L Cadete.
Property Owner: MR. and MRS. _Nicholas C. Harris
Address: P.O. Box 654 anton, Ma 02021
City: Cant -on State: MASS Zip Code: 02021
Telephone Number:_ (61 7) 828-4087
In Case Of Emergency, Contact: Maria Cadete
Phone: (gog) 747-2360
In accordance with Chapter 773 of the Acts of 1987, Massachusetts General Laws F.
1115197 CMR 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 persons at least five (5) days prior to the
beginning of deleading.
1. Occupants of the dweling unit.
2. All other occupants of the residential premisis, if'any.
3. Director, Childhood Lead Poisoning Prevention Program, Department of
Public Health, 305 South Street, Jamaica Plain, MA 02130
4. Lead Removal Program, Bureau of Technical Services, Department of Labor
And Industries, Division of Industrial Safety, 100 Cambridge Street, Room
1101, Boston, MA 02202
5. Local Board of Health/Code Enforcement Agency
6. Massachusetts Historical Commission (Only if premisisi is listed on the State
Register of Historical Places)
The undersigned hereby states, under the penalties of perjury, that she/he has read
and understood the Commonwealth of Massachusetts Deleading Regulation 454 CMR
22.000, and the Lead Poisoning Prevention and Control Regulations, 105 CMR 460.00,
and that the information contained in this notification is true and correct to the best of
his/her knowledge and belief.
Date:-4 Z 26 / 9 3 Signed:
Title: Contractor
Company: n - Lea d r ; c# DC dd1 afro