HomeMy WebLinkAboutLegal Notice - 64 MAY STREET 9/11/2015 Department of Public Health - Childhood Lead Poisoning Prevention Program
Deleading Notification
Please complete all sections of this form clearly. Incomplete or illegible forms will bereturned.
/ -
Lead Pai��upe License# J 14 Inspection Date
Owner as
Property Owner's Address ' — �� Zip Code
J'P'002_ S00
Authorized person performing work: �Sose-p*�, Lev Lic#/Auth.#jj��1 ,52-
Telephone Number
Address vvboze the work will bc dooc�
Building N (if any) Floor
Street Address 644 -S I Apt No._
[i gp [ Ihe proyudy ia a v multi-farnity____oioolo family.
Deleadina Method(s):
Li Making paint intact (high risk) o Making paint intact o Applying vinyl siding muexterior
El Demolition risk 0 Component removal (low risk
o Scraping o Liquid ez apnulant components)
;/Compooeu1reozov«Uroolaoeoucut o Covering o Other:
u Dipping o Capping boachouzds
|
The work will begin nu oud�viU �uiab6v Thovvodcvvil} hodoociutbc »/ »���*��u� xckcoda.
------ ' ------ —�— �����a������� |
/
lu Case ofEn ~�~�~� C`^~~` /
Daytime Phone Evening Phone
TO�NUFN�|TTMA@DOV[R
The Property Owner must complete and sign tbefuDowiogin0nrcoadon: HEAU||DEF�Rl�ENT
I certify that only authorized persons who have complied with the training requirements of the Massachusetts Lead Poisoninsz
Prevention and Control Ilc�ulaUona` l05C&�R46O.O0O, v/Ul conduct deleadingv/ock. lfu�bcrco)1ifv that the autbodznd
person(s)will not exceed the scope of his/her authority and will be performing only those a etivitics indicated above. All ofthe
infbuouhoucoo1uioodiodzisdocururutimtruouudcVoect8othebcstofuzyknovv|edgeaodho|icf.
Date Signed
The following people/agencies must be notified ten days before beginning work:
l. Occupants of the dwelling unit
2. All other occupants uf the residential pn:ruiscs, if any work will bcdone in the common areas
3. Childhood Lead Poisoning Prevention Program, DP£I Fax (78 �
` ' �
&4WRBO
5Roudolph Street, Canton, MA 07821
4. Asbestos and Lead Program,I)L3
l9S1aoiƒbzdSt, l«Floor, Boston, MA 82114 Fax (6l7) 626-6V65
5. Local Board ofBcukb/Codc Enforcement Agency
*If the home isouthe State Register ofHistoric P|aocm. call the MA Historical Commission at(6]7) 727-8470.