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HomeMy WebLinkAboutMiscellaneous - 59 Coachman's Lane 59 Coachman ' s Lane Address Title of Hie P.age- of Date File Open: ----_ Date fide Closed: Doc Document/Action Title Date of action 6tefer to other Purpose of DOCUrne ttm /Action and notes Num. Document/ docurnent/ ---- Action De artrnent Board of Appeals — Board of Heal h Planning Board ; Cons erua>yion Com MISsIon - Building Departrnen;t ■ �'a-x .. • may_-_� , ISM fi H 01F An U1wr��T M Department of Labots 4 t6ldMotgtli+l' and v4pariftnt of Publio Health w « M O TT u OF MMyyr�MAD n WORK All 40049hi of this got* must be aan0+�rted in or4or to a ay with the nottlioation t�u lose of M.o,L, 0.111 434 CM 21.00 and 108 Ct4it 4 60. 00 to most recently wended rlLx NtJMralCRt WINCY USX) iContrutor pelform{ng protect License Exp.d a t e__� --�. .Laid Taint ._ / Date of Inspeotion If low-rink deleading work is being performed, complete the following line; property owner quix4iol, 04me (if any) floor ...�..,.�,....-.- t Apt, No. city _..._�.�.., w. zip _......_... y. sort� n Neet Gun •ti Liquid Encapsulant C. vein -emq;��ion �Ral1aae ent Other If 0000j(r selectedf pao&ae exprairt - Chork Anal r)wel ill�g is mutt)-temliY_..._ ._ single rainily_ _..•.,,,,.., ...._ zol 8t*rt date ..,..� Com )alien date A.M. P.M. --- Weekend*? When will work be done Project sopervi.sor's name __L Property Owner Address City ... ...__ . --- state • _w _... zip Telephone T_ _.. K�....�.__..._ .. _._ 11010- I (�, n peso of emergency contact _..__..l Le4 4_ .�_T__ Phonet day . -5 0 1-3 �.-2 evening l � (over) I U lf► aerotclanuw with Mauaaohu�ytte (W1101'81 Law$ C. 11 �, 107 x of the dote and methe,detai of remnval or rnverlhg.o ,pelnt, laeta00nAftc�the� n��e,selb30at)materleia contelnie)q de nyert)ua Idyl118 of lead !s to be t)rovida.l and moat be tacolvara by the fallc+wing pare no, At leapt f beginning of deI©ading, 1. CccteNants of the dwelling unit 2. All other occupants 'of the rasidtantlal prontteee'e If any Director J. CikIiLhp4atiirin posApartmentofPblcHealt , 70Atlnr Avenue, Bt n, MA 02110 Fax {617? 753�812d 4. oltoctute Aebeeto$ a Lead qtsq rain �llptrthent cat Labor i tndulttrl�a Fax (617) 727-75e9 Robe 11006, 100 Cokbr;idge 8t ON. ,! � 8011tan, MA 02202 5. .jgcal Board of llealth/Code Enforcement Agency e, Maeaaehusatto Hietorloal comJnlesion 220 Morrissey Blvd, I1[ remise$ is tlat*U on tilt state Reylotor Boston, KA 02125 of historic places, this notification Not be made uppgn receipt of an Order to Correct Vlolatlgqne or at 1}�sat " daye prior to lhitiating preventive d$loadtnp) Pax (617) 727-5129 The undersigned hereby states, under the pains and penalties of per wryy that he/she hes read and understood the Cammanwealth of Massachusetts Doles ng Regulations, 454 CMR 2.2,00 and Leading Poisoning Prevention and Control Rsgulations, 105 CMR 460,000, and that the infarmstion contained in this notification is t``rue and correct to the best of his/her knowledge and belief, Date WJ Title Ccfty�anyt L. t f p ° ,Nn (i[ owner or untlCensed owner's agont w111 be performing low»rlak delesdiny wutk) � 1 certify that I have complied with the training requirements of the Commonwa,s th, of. M seaahusetts Lead Poising Pr ve> io and Control Regulations; 105 CMN 46"75, -tor owner/agent low-risk aba;. iht nd, cor�tpinment. I further tett !yy that I or my agent will be sr ormin the tollowinry law-risk activities li have circled al that apply) , at�plylny 11quld envapsulanr aappinq basebuards ab�i:elyin exterior vin 1 al,llne. ,�'' 9 y J ��nvat ln.t e.tt fti�,�y tr/1Irr,Vln9 O.-Ls, cabinet ,.IC,r,At3e 8l,uttaeh t .:ertlfy that all the lnfotmatinn In this nut ificar,lnn ind i1:4 true nnn °e,rt )rr to the 1>er;t e,+t. +� kl'i.,t+lnitgt, helie�., 5 kEv 10/12/9!,