HomeMy WebLinkAboutMiscellaneous - 72 JEFFERSON STREET 4/30/2018IV
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LOMassachusetts Department of Environmental Protection
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k eDEP, Transaction Copy
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Username: NANCYT
Transaction ID: 943340
Document: AQ 04 - Asbestos Removal Notification Form ANF -001
Size of File: 236.03K
Status of Transaction: submitted
Date and Time Created: 7/25/2017:10:10:50 AM
Note: This file only includes forms that were part of your
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF -001) PreForm
Asbestos Notification Form
r This is a revision to an existing form.
Project ID for existing form to be revised:
This job is being conducted under a Blanket Permit.
MassDEP assigned Blanket Authorization ID:
r This job is being conducted under a Non Traditional Abatement Work Practice Permit.
MassDEP assigned Non Traditional Work Practice Authorization ID:
r This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards
because (please check one box below):
i This job involves breaking, shearing or slicing of non -friable asbestos -containing material only (e.g. cement
shingles/panels, cement pipe, asphalt roofing or siding, vinyl floor tiles, etc.) in a manner that does not generate
asbestos dust or render the material friable, as allowed by the Department of Labor Standards (DLS) at 453 CMR
6.13(2)(a)5. All work must be done in compliance with the applicable regulations at 310 CMR 7.15; or
This job involves work on asbestos containing material that is classified by the Department of Labor Standards
(DLS) as a `Small -Scale Asbestos Project,' an `Asbestos -Associated Project', or an `Asbestos Response Action'
by qualified `in-house' personnel as allowed by the Department of Labor Standards (DLS) at 453 CMR 6.00, and
will be performed in accordance with all the requirements of 453 CMR 6.13 (1)(a), 453 CMR 6.13 (2)(a)1. and 3.,
and 453 CMR 6.14 (1)(a), as applicable. All work must be done in compliance with the applicable regulations at
310 CMR 7.15.
F None of the above conditions apply, generate a new form.
Revised: 11/13/2013 Page 1 of 1
Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF -001)
Asbestos Notification Form
A. Asbestos Abatement Description
100269395
Asbestos Project #
r"i Project Revision
r Project Cancellation
Revised: 11/13/2013 . Page 1 of 4
1. Facility Location:
ERIK WEN
72 JEFFERSON ST
Instructions 1. All
a. Name of Facility
b. Street Address
sections of this form
NORTH ANDOVER MA
01845 6178380097
must be completed in
order to comply with
c. City/rown d. State
e. Zip Code f. Telephone
MassDEP notification
ERIK WEN
OWNER
requirements of 310
CMR 7.15 and
g. Facility Contact Person Name
h. Facility Contact Person Title
Department of Labor
Worksite Location:
FIRST AND SECOND FLOOR
Standards (DLS)
notification
i. Building Name, Wing, Floor, Room, etc.
requirements of 453
2. Is the facility occupied? [iia. Yes r b. No
CMR 6.12
3. Is this a fee exempt notification (city, town, district,
municipal housing authority, state facility, or
owner -occupied residential property of four units
or less)? rj a. Yes r b. No
MassDEP Use Only
4. Blanket Permit Project Approval, if applicable:
Date Received
Approval ID #
5. Non -Traditional Asbestos Abatement Work Practice
Approval,
2. Submit Original
if applicable:
Approval ID #
Form To:
Commonwealth of
Massachusetts
6. Asbestos Contractor:
P.O. Box 4062
Boston, MA 02211
AIR SAFE INC
22 WILLOW STREET
a. Name
b. Address
CHELSEA MA
02150 9783395361
c. City/Town d. State
e. Zip Code f. Telephone
AC000464
h. Contract Type: r 1. Written r'' 2. Verbal
g. DLS License #
7. NELSON J RODRIGUEZ
AS000882
a. Name of Contractor's On -Site Supervisor/Foreman
b. DLS Certification #
8 KATTIA LOPEZ
AM900491
a. Name of Project Monitor
b. DLS Certification #
9 ASBESTOS IDENTIFICATION LAB
AA000208
a. Name of Asbestos Analytical Lab
b. DLS Certification #
10.
817/2017
8/9/2017
a. Project Start Date (MM/DD/YYYY)
b. End Date (MM/DD/YYYY)
7AM-6PM
NA
c. Work Hours - Monday Through Friday
d. Work Hours - Saturday & Sunday
11. What type of project is this?
r -i a. Demolition r b. Renovation 11— c. Repair r d. Other - Please Specify:
Revised: 11/13/2013 . Page 1 of 4
Massachusetts Department of Environmental Protection
BWP AQ 04 (ANF -001)
Asbestos Notification Form
100269395
Asbestos Project #
r- Project Revision
F Project Cancellation
A. Asbestos Abatement Description: (cont.)
12. Abatement procedures (check all that apply):
r". a. Glove Bag r7i b. Encapsulation r: c. Enclosure F d. Disposal Only r' e. Cleanup
F, f. Full Containment ri g. Other - Please Specify:
13. Job is being conducted: r, a. Indoors r-. b. Outdoors
14 a. Total amount of each type of asbestos Containing materials (ACM) to be removed, enclosed, or
encapsulated:
15. Describe the decontamination system(s) to be used:
THREE CHAMBER DECON
16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
6 MIL POLY
17. For Emergency Asbestos Operations, the MassDEP and DLS officials who evaluated the emergency:
a. Name of MassDEP Official
b. Title of MassDEP Official
c. Date of Authorization (MM/DD/YYYY) d. Waiver #
e. Name of DLS Official f. Title of DLS Official
g. Date of Authorization (MM/DD/YYYY) h. Waiver #
18. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A -F apply to this r- a. Yes r b. No
project?
Revised: 11/13/2013 Page 2 of 4
1000
1. Linear Feet (Lin. Ft.)
2. Square Feet (Sq. Ft.)
b. Boiler, Breaching, Duct,
c. Transite Pipe
Tank Surface Coatings
1. Lin. Ft.
2. Sq. Ft.
1. Lin. Ft. 2. Sq. Ft.
d. Pipe Insulation
e. Transite Shingles
1. Lin. Ft.
2. Sq. Ft.
1. Lin. Ft. 2. Sq. Ft.
f. Spray -On Fireproofing
g. Transite Panels
1. Lin. Ft.
2. Sq. Ft.
1. Lin. Ft. 2. Sq. Ft.
h. Cloths, Woven Fabrics
i. Other - Please Specify:
1. Lin. Ft.
2. Sq. Ft.
j. Insulating Cement
VAT
1000
1. Lin. Ft.
2. Sq. Ft.
1. Lin. Ft. 2. Sq. Ft.
15. Describe the decontamination system(s) to be used:
THREE CHAMBER DECON
16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)
(g):
6 MIL POLY
17. For Emergency Asbestos Operations, the MassDEP and DLS officials who evaluated the emergency:
a. Name of MassDEP Official
b. Title of MassDEP Official
c. Date of Authorization (MM/DD/YYYY) d. Waiver #
e. Name of DLS Official f. Title of DLS Official
g. Date of Authorization (MM/DD/YYYY) h. Waiver #
18. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A -F apply to this r- a. Yes r b. No
project?
Revised: 11/13/2013 Page 2 of 4
.. Massachusetts Department of Environmental Protection Project Cancellation
100269395
BWP AQ 04 (ANF -001) Asbestos Project #
Asbestos Notification Form r- Project Revision
B. Facility Description
1. Current or prior use of facility: RESIDENCE
2. Is the facility owner -occupied residential with 4 units or less? PF a. Yes r b. No
3 ERIK WEN 72 JEFFERSON ST
a. Facility Owner Name b. Address
NORTH ANDOVER MA 01845 6178380097
c. Cityrrown d. State e. Zip Code f. Telephone
A ERIK WEN 72 JEFFERSON ST
a. Name of Facility Owner's On -Site Manager
NORTH ANDOVER
c. City/Town
1Z NA
V . a. Name of General Contractor
b. Address
MA 01845 6178380097
d. State e. Zip Code f. Telephone
NA
b. Address
NA MA 01845 1111111111
c. City/Town d. State e. Zip Code f. Telephone
NA
g. Contractors Worker's Compensation Insurer
NA 12/31/2017
In. Policy # i. Expiration Date (MM/DD/YYYY)
6. What is the size of this facility? 1400 2
a. Square Feet b. # of Floors
C. Asbestos Transportation & Disposal
1. Transporter of asbestos -containing waste material from site of generation:
ri a. Directly to Landfill or rv_ol b. To Temporary Storage Location/Transfer Station
Revised: 11/13/2013 Page 3 of 4
AIR SAFE INC
22 WILLOW STREET
c. Name of Transporter
d. Address
Note: Temporary
storage of Asbestos
CHELSEA
MA 02150 9783395361
containing waste
e. City/Town
f. State g. Zip Code h. Telephone
material is only
allowed at the place
of business of a DLS
2. If a temporary storage location/transfer station is used, list name of transporter of asbestos containing
licensed Asbestoswaste
contractor or a transfer
material temporary storage location/transfer station to final disposal site:
l ftp �'tora g
station that is
permitted by
SERVICE TRANSPORT GROUP
58PYLESLANE
MassDEP and
a. Name of Transporter
b. Address
operated in
compliance with Solid
NEW CASTLE
CE 19720 8779999559
Waste Regulations
c. City/Town
d. State e. Zip Code f. Telephone
310 CMR 19.000
Revised: 11/13/2013 Page 3 of 4
Massachusetts Department of Environmental Protection 100269395
BWP AQ 04 (ANF -001)
Asbestos Project #
Asbestos Notification Form r Project Revision
L
r Project Cancellation
C. Asbestos Transportation & Disposal: (cont.)
3. Name and address of temporary storage location/transfer station for the asbestos containing waste
material:
AIR SAFE INC 22 WILLOW STREET
a. Temporary Storage Location Name b. Address
CHELSEA MA 02150
c. City/Town d. State e. Zip Code
9783395361
f. Telephone
4. Name and location of final disposal site (asbestos landfill):
MINERVA LANDFILL MINERVA ENTERPRISES
a. Final Disposal Site Name
9000 MINERVA DRIVE
c. Address
WAYNESBURG
d. City/Town
A Certification
" I certify that I have personally
examined the foregoing and am
familiar with the information
Note: Contractor must contained in this document and
sign this form for DLS all attachments and that, based
notification purposes on my inquiry of those
individuals immediately
responsible for obtaining the
information, I believe that the
information is true, accurate, and
complete. I am aware that there
are significant penalties for
submitting false information,
including possible fines and
imprisonment. The undersigned
hereby states that I have read the
Commonwealth of
Massachusetts regulations
governing asbestos abatement
(453 CMR 6.00 promulgated by
the Department of Labor
Standards and 310 CMR 7.15
promulgated by the Department
of Environmental Protection),
and that I am aware that this
permit application or notification
shall not be deemed valid
unless payment of the
applicable fee is made."
b. Final Disposal Site Owner Name
CH 44688
e. State f. Zip Code
1. Name
VP
3. Position/rifle
9783395361
5. Telephone
23 WYCHWOOD DRIVE
7. Address
MA
9. State
3308663435
g. Telephone
2. Authorized Signature
7/25/2017
4. Date (MM/DD/YYYY)
AIR SAFE INC
6. Representing
LITTLETON
8. City/Town
01460
10. Zip Code
Revised: 11/13/2013 Page 4 of 4
Date ...`.6.../3/.//,3... ...........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ................�-!
has permission to perform ......k...,
.?.! J . rvm Q
....—/.7j
wiring in the building of............ .2.'...............................................................
at ...,/. ......� l..P. e?J'q, ......................... North Andover, Mass.
Fee... ! �� ........... Lic. No.&�; .. :.. ........... ..... .
ELEcmcALINSPECTOR
Check #
11627
Commonwealth of Massachusetts Official Use Only
Department of Fire Services Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NEC), 527 CMR 12.00
(PLEASE PRINT ININK OR TYPE ALL .INFORMATION) Date: �'3 /- / 3
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notiqe of hispr her intention tyq p4orm the electrical work described below.
Location (Street &
Owner or Tenant—
Owner's Address
Is this permit in conjunction with a building permit? Yes
[17 -
Purpose of Building �UltJ�C.L �.11.� �—•�
Telephone No.
No ❑ (Check Appropriate Box)
Utility Authorization No.
- Existing Service Amps / Volts Overhead ❑ Undgrd ❑
New Service Amps / Volts Overhead ❑ Undgrd ❑
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
No. of Meters
No. of Meters
, C'mmnlPtinn nftha fnllnwino tnhlo — ha ,univo.l l,.. A. itio ../., —ru/'r
No. of Recessed Luminaires.r—
No. of Ceil: Susp. (Paddle) Fans
No. of Total
Transformers KVA
NQ. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
No. of Luminaires
Swimming Pool Above ❑ In- ❑
rnd. rnd.
o. o mergency Ug mg
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS No. of Zones
No. of Switches
No. of Gas Burgers
No. of Detection and
Initiatin Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
g
No. of Waste Disposers
Heat Pump
Totals:
Number
Tons
KW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers l
Space/Area Heating KW
Local ❑ Municipal ❑ Other
Connection
No. of Dryers
�+
No. of Water KW
Heaters
Heating Appliances KW
No. of No. of
Signs Ballasts
Security Systems:*
No. of Devices or Equivalent
Data Wiring:
No. of Devices or Equivalent
No. hydromassage Bathtubs
No. of Motors Total 11P
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
Attach additional detail if desired, or as required by the Inspector of 07res.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:)
I certify, tinder the pains and penalties of perjury that the information on this application is true and complete./
FIRM NAME:. is 4/� 2 JJ%� LIC. NO.: 63,6
Licensee: S4 Signature W LTC. N0.:1 % f4l i
(Ifapplicable, enter "exem t" in � _the •license ember line.) Bus. Tel. No.• 4e
Address: / d C RX,—.�, , 1. ! / �J Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61, security work requires Depa ent of Public Safety "S" License: Lic. No.
�
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent.
Owner/Agent
Signature Telephone No. PERMIT FEE: $
-)U
❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑
❑ Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass
Failed'❑
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTION:
Pass 0
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
rt
Inspectors Signature:
Date:
PARTIAL ROUGH INSPECTION:
Pass 0
Failed
Re- Inspection Required ($.) ❑
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH SP CTION:
Pass M
Failed ❑'
Re- Inspection Required ($.) ❑
Inspectors Co ments:
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass ❑'
Failed 0
Re- Inspection Required ($.) ❑
Inspectors Comments:
r
Inspectors Signature:
Date:
U
DEB WEINHOLD ... TOWN OF MERRIMAC, MA. .......dweinhold@townofinerrimac.com
The Commonwealth oflYlassachusetts -
Department of IndustriglAccidents
Office of Investigations
600 Washington Street
.Boston, MA 02111
www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name
&-b W�I-X -N
Address:
Y � l O
-
City/State/Zip:
y,M-20 Phone #:
Are you an employer? Check the appropriate box: -
Typp of project (required):
L ❑ I am a employer with
4. ❑ I am a general contractor and I
6. ❑ New construction
employees (full and/or part-time).*
�am a sole proprietor orpartner-
have hired the sub -contractors
listed on the attached sheet.
7• E] Remodeling
ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working for me in any capacity.
workers' comp. insurance.
9, El Building addition
[No workers' comp. insurance
5. El We are a corporation and its
10.❑ Electrical repairs or additions
required.]
3. ❑ f am a homeowner doing all work
officers have exercised their
right of exemption per MGL
11.❑ Plumbing repairs or additions
myself. [No workers' comp.
c. 152, §1(4), and we have no
12. ❑ Roof repairs
insurance � ired. re q u
employees. [No workers'
13.[:] Other
comp. insurance required.]
4Any applicant that checks box#1 must also fill out the section below showing their workers' compensation policy information.
Y Homeowners who submit this affidavit indicating they a're doing all work and then hire outside contractors must submit anew affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy anal job site
information.
Insurance Company
Policy # Cr Self -ins. Lic. #: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well.as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert,' rider thepains andpenalties of erjury that the information provided above is true and correct. -
Simafore: Date: `~
Phone #: v -
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector
6. Other - - -
Contact Person: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...everyperson in the service of another under any contract ofhire,-
express or implied, oral or. written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
Of the foregoing engaged in a j oint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required"
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants e
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom M
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permithicense number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only. submit one affidavit indicating current
policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwcalth,ofMussachw tts
Dapadmextt of Industdal .Accidents
Office ofIavestigatiiona
600 Wa.shiVoa Street
BostuMA02111
Tel, #617-727-4900 oxt W oar 1.-877,MASSA .
Revised 5-26-05 Fay ,# 617-727-7749
September 20, 1977
Kew Mortgages
8ibornis Savings Bank
263 Washington Street
Boston, Massachusetts
NC" JLSSOCFATES
UQd'A9 Load Paint Tvs:ing Fina in England
HIGH STREET
MILTON, 14ASSACHUSETTS
PRONE #698.9763 02187
Reference: Lead paint Inspection - 72 Jefferson St, Village Creon,
N. Andover, baso.
Gentlemen:
Enclosed is a copy of the reoulta of may impaction of the above
referenced property. pleace note that all toots r*re negative.
As of this date, it is my opinion that the ho= at 72 Jefferson
Street, Village Green, N. Andover, Mass. is not in violation of
Mace Gen Lap Chapter III See 190-199,
If you have any questions, please call rs.
Very truly,
Barnard Lynch
BL:ofb
Due.
cc: lir. Joseph Scalera
203 Pleasant Street
N. Andover, Bass. 01895
Julius Kay, M.D., Director
North Andover Board of Health
Torn Building
,y N. Andover, 11A 01895
Dr. Charles Calkins
140my
UC,1,307 11"04 ba
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