HomeMy WebLinkAboutDeleading Notification - Miscellaneous - 59 ADAMS AVENUE 2/27/2024 Department of Public Health- Childhood Lead Poisoning Prevention Program
Deleading Notification
Please complete all sections of this form clearly.Incomplete or illegible forms will be returned.
Lead Paint Inspector MathewMarroehello License# 1-4307 Inspection Date 2/16/24
Property Owner Andy Meekel
Property Owner's Address 17 pinewood dr Stratham NH Zip Code 03885
Authorized person performing work: Andy Meekel Lic#/Auth.# 35791-OL
Address of authorized person 17 pinewood dr Stratham NH Zip Code 03885
Telephone Number(97�-836-6433
Address where the work will be done:
Building Name (if any) Floor
Street Address 59 Adams Ave. Apt No.
City North Andover MA Zip Code 01845 The property is a multi-family X single family.
Deleadine Method(s):
❑ Making paint intact(high risk) ❑ Making paint intact(moderate ❑ Applying vinyl siding on exterior
❑ Demolition risk) ❑ Component removal (low risk
❑ Scraping ❑ Liquid encapsulant components)
❑ Component removal/replacement ® Covering ❑ Other:
❑ Dipping ❑ Capping baseboards
The work will begin on 3//3/24and will finish by 3 /3 / 24The work will be done in the am_pm or X weekends.
In Case of Emergency Contact Kathleen Meckel
Daytime Phone 603-686-3285 Evening Phone
The Property Owner must complete and sign the following information:
I certify that only authorized persons who have complied with the training requirements of the Massachusetts Lead Poisoning
Prevention and Control Regulations, 105 CMR 460.000,will conduct deleading work. I further certify that the authorized
person(s)will not exceed the scope of his/her authority/id will be performing only those activities indicated above. All of the
information contained in this document is true and co e to the best my edge and belief.
Date 2/25/24 Signed
The following people/agencies must be notified ten day before beginning work:
1. Occupants of the dwelling unit
2. All other occupants of the residential premises, if any work will be done in the common areas
3. Childhood Lead Poisoning Prevention Program, DPH Fax (781) 774-6700
MWRHO
5 Randolph Street, Canton, MA 02021
4. Asbestos and Lead Program, DLS
19 Staniford St, 1"Floor,Boston,MA 02114 Fax(617) 626-6965
5. Local Board of Health/Code Enforcement Agency
*If the home is on the State Register of Historic Places,call the MA Historical Commission at(617)727-8470.