HomeMy WebLinkAboutMiscellaneous - 30 SARGENT STREET 4/30/2018 (2) 30 SARGENT STREET
210/018.0-0053-0000.0 :E T
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UkXAric' MM 0!•RELIC'HEALTH/DEPARTMENT.Ol Y LA80R'i INOt18TAIF.l3 n
NOTIFICATION O! DELUDING WORit
All sections of this tors sw®t be eaeplstid'in order to coMpiy with
the notification requirements of M.G.L.'C. 111 1197
FILE NtJ!! o
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Lead paint inspector .,S �,c1A1 8'04,577 Pau of inspection
Contractor
performing project License 1
Address of Project
Building Nese (if any
rloor
street Address 3 O •S��. " 7 .; f . . :: :....«a
Apt. No...
City_ � ocle(- —Ivor -�Up
Deleading Hathods
_pis car ali t a _ ,__ _�._ BivAT ON -..., lOfC"x=TION D 'LMGLITIQN
pp^1 y)
• POWER SAWN MSTICs REPS OT8F1t
If 'Other* selected, please explain
Check ones dwelling is Multi-easily' Bingle family
_ . .�...... , .
Start date -- lbu 9,0 I CG I s °-
>.., Completion Date
When will work.be,Oones _a � J DO �ekends?
Project supervisor Name___�c�4•r 1� �Go (e�f; License
Property Owner Ve.Y) r\-r �N G Ce f,n
,r.
Address /9 Or 1-p h ��� � r
city till
uc L state. . At sip0l8 1
Telephone
In case Of emergency, contact what persons J O r (� c b -e
Phones Area code required day-- 6-0k w$ -16 U _ evening 10 9" /60�
00342/S
rev 11/16/89
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In accordance with Chaptei',773''at tiht .'Acts of 1997, Massachusetts Cenecal taws
C. 111 1197, 434 CMR 22.00 and AOS CMR 4604000*, notice of the date and mothodo
removal or covering- of paint; plaster'soil' Or'othec'aeceaslble material eontaii
dangerous' levels of lead, a to be provid6d',to the following persons at least 1
daYs Prior to the beginning pf•deleadiep.
1. Occupants of the dwelling ani!•
2. ,All other occupanta' of the residential premises, it any.
3. Director, Childhood Lead Poisoninq.pre'"ntion program
Department of public Realth;'•3b3 South'Stteett Jamalca plain, MA 02130
4. Lead Removal program, Bureau of Technical'Servicei .`..
Department of Labor and Industries, Division of industrial Safety
100 Cambridge Street, �P
Room 1101,.�ostoq, 02202
S. • Local Board of Real
th/we Raftrcemint Jlgincy. .: t
r w
4. • _ Massachusetts UstoricalVAMIssion
fAt Premises is listed an 'the Stab Risister of VI' to'rio places).
.. '¢-+ .
? . The 'undetsigned hereby autos,, under lhe,penalties of perjury;-that s/he has to
and understood the Com m"alth of Massachuuetta'Deleading Regulations, 434 CM
22.00, and Lead Poisoning. Prevention'iind Control•Regulatlons, 103 CMA 460.00, a
that the information Contained in this Aotifioa n true d oorr ct to the
*of his/her knowledge acid:belief.
.• Date _ //-..9= 9� . �.., � e_igaeee t - .
u,.. "7
Title i P�PA Pr p✓► rac o
Romparyt' Zr� S f�-,1 PN ea S fafe
2,nS e�f�oh
Of f iei us* Only .. -
0034a/6
rev 11/16,