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29-002 BayStartOGas A NiSource Company October 24, 2003 Associated Building 352 Albany St Springfield, ha 01101 Dear Associated Building, The address listed belov has had the gas service(B) disconnected and is now ready for demolition. ADDRESS: 210 Florence Rd TOWN Northampton STATE Massachusetts Sincerely e rey%DMaInnhei'm Senior Distribution Clerk 20259oosevP1t.Avenuo R.O. 6ox2025 7pringfield, ,,1x101102-2025 4'13-781,0200 Fax; 413-781-0222 jjZ--� Orchard Electric [nc. FAX NC. : 4135862492 Nov. 05 2003 11:29AM P2 Massachusetts Electric A WOMOnst QVid 00116 WY Oc:obcs 30,2003 Koch Holding Co.,Trnc. 2 10 Florenc©Rd, Florence,MA Dcar Sir: This is to verify that Tvfassachusetts:64-4tric has removed the clectric service at 210 Florence Rd,in Florcncc,Massachusetts effective October 24,2003 far building demolition. Sinccr¢ly, J f Jiro Nichols Supervisor Distribution Design N"/j a Po e�So7 Northampton,MA 41962-0507 ai8.5Ba.?:� 1Q;+23i200nlb:UJ nCLG11L1U t5KUi MRINL N +V WnR r4X•41 • I _ • r 352 any Street, P.O. Box 2851 Springfi d,Massachuseaos 01101-2851 Tel, 3) 732-3179/{800}448-2822 Fix, (413)734-6224 I DA`I'S: October 20, 2008 7 p TO: DAVE BINCHEY ;� FAX # 425568-6f26 OF: AT&T BROADBAND PHONE # 413-662-992,3 X286 I PLEASE CUT ALL SERVICES AT 9 LOCATION OF 210 Florence Rd,, Northampton,MA, AS IT IS BE G SCHEDULED FOR DEMOLITION. l ONCE DISCONNECTION HAS EEN COMPLEITD, YOU MAY EITHER SIGN BELOW AND FAX IT TO ME A 413-734-6224 OR YOU MAY FAX ME NOTIFICATION ON YOUR CO ANY LE`rTERHEAD. I I THANK YOU VERY MUCHTOk YOUR ASSISTANCE. I SINCERELY, P ASSOCIATED BUILDING WRE KERS, INC. I JOANIE SAVAGE DEMOLl'I'ION COORDINATO1 SERVICES AT: 210 Florence Rd�, Northampton,MA i HAVE BEEN DISCONNECTED 5 OF _ T� 3-03 41 I IN'T NAME: . L SIGNATURE: MARKS. IF ANY- I i r 352 A lbany Street,P.O.-130v 2B5i Springft Id,Massachusetts 01101-2851 ' Tel: (4 3)732-3179/(800)44 8-2522 ° Fax:(413)734-6224 DATE: October 20,2003 TO: CHARLIE � FAX# 4I3-587-1576 OF: WATER DEFT. PHONE # 413-587.1098 FLEASE CUT ALL,SERVICES AT THE LOCATION OF 2 I o Florence Rd., Northampton,MA,AS IT IS BE NG SCHEDULED FOR DEMOLITION. ONCE DISCONN£C nON HAS i�EEN COMPLETED,YOU MAY EITHER SIGN BELOW AND FAX IT TO ME A7413-734-6224 ORYOU MAY FAX ME N07IFICATIoN.ON YOUR COPANY LE'I rERHEAD. T13ANK YOU VERY MUCH FO� YOUR ASSISTANCE, 1 SINCERELY, ASSOCIA`IED BUILDING WRE�KERS,INC. JOAN1E SAVAGE DEMOLITION COORDINATOR I i SI:RVIC'ES AT: 210 Flounce Rd.,Northampton,MA HAVE BEEN DISCONNECTED�s O P9tINT NAME: d IGNATURE R,;MARKS, IF ANY: i i j -d '?LSILBSEIb MdQ elv :OT ED LE X00 NOV 06 2003 21 12 FR BELL ATLANTIC CSC 413 780 3143 TO 97346224 P.09./01 •4 . 14 PR 46J 1..7w..1 L G.: G3 1V i �Jw YGuLl o LVav r v cr c. IJ1.ly., ��1� �,KtK;i !-aX: l -r�34�52if1 Oct 20 2005 10:03 P.N J 352 Idbany Saeet,P.O.Sam 2451 s 01101--2851 Td: 13)732..3179!(804)) 449-2822 I Fax:(413)'134-6224 DATE: October 20, 2003 TO. BOB MIL FAX# 413-781-1980 OF; VEXIZON a PHONE # 413-750-3501 4 PLEASE CUT ALL SERVICES A THE I.00Amm OF 210 Florence Rd., r-Kwr' 3u` 4 Narthxmpton,MA,AS IT YS $ G SCHEDULtV FOR DEMOLMON_ ONCE DISCONNECTION HASfBEEN COMPLETED,YOU MAY II'T UR sliaNI' BELOW AND FAX IT TO ME w 413-7,°,4-6224 OR YOU MAY M ME NOTMCAITON ON YOUR CO'I MPANY LETIERHF..AD- THANK YOU VERY MUCH FO*YOUR ASSISTANCE. SINC,EItELY, P a-i FLceo1U • �tkM o'L r ASSOCIATED BUWINr, WMicKW, INC. JOANIE SAVAGE UEMOLMON COORDINATO SERVICES AT: 210 Florence W .,Nort lam HAVE BEEN DISCONNEC'T'ED PRINT NAME: az SiGNANRE'_ I DC7 20 '03 10:52 413 734 6220 v 5.01 * TOTAL PAGE,01 Y 1 y �• M J H y rn y p� pppp pppp ' \ OO 00 o ° m om a � a CD coo CA t7 n EEEEEEENE� o o � O O. p' D z n 3 m z m CD O m D n Q 3 O A . z fl. z cn m cn � z c cr CD <D O (D o C ?z �_ cDn D w o N D m m 1 N A N A p 3 z m m z m z w o a O D D O N n � �. � D m 0 c CD Si m O N= z v m o z n O m D ' 3 ^*, m 'o, z O C W p1 fy z O y O O m w N ' O 7 o eo t rt m r- N 3 N °w r+ p1 ,� -9' m 3 cD z (D z o N n 5 r CD 0 w Q T V 4 O r z Lf L---j L--j Ll r O M O O C N !U p � rt � t Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality L11 1y BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos containing material (ACM)? ® Yes ❑ No If yes,who conducted the survey? Zane Mirkin Name AI-70628 Dept.of Labor and Industries Certification Number 7. Construction or Demolition 11/10/2003 01/05/2003 Start Date End Date 8. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paring If other, please specify: ® wetting ❑ shrouding ❑ covering ❑ other 9. For Emergency Demolition Operations, who is the State or Local official who evaluated the emergency? N/A Name Title Authorization Date of Authorization DEP Waiver# D. Certification I certify that I have examined the Johanna Savage above and that to the best of my Print me knowledge it is true and complete. qm WIL The signature below subjects the A thorized Signature signer to the general statutes Demolition Coordinator regarding a false and misleading Position/Title statement(s). Associated Building Wreckers, Inc. Representing October 20, 2003 Date 202970 P.E.# ag06.doc•10/01 BWP AQ 06•Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality BWP AQ 06 Notification Prior to Construction or Demolition B. General Project Description (cont.) 3. General Contractor: Associated Building Wreckers, Inc. Name 352 Albany Street Address Springfield MA 01105 City/Town State Zip Code 413-732-3179 none Telephone Number(include area code and extension) E-mail Address(optional) Brian Pollard On-site Manager C. General Construction or Demolition Description General Statement:If 1. Construction or demolition contractor: asbestosis found during a Associated Building Wreckers Inc. Construction or Name Demolition 352 Albany Street operation,all Address responsible parties must Springfield MA 01105 comply with 310 City/Town State Zip Code CMR 7.00,7.09, 413-732-3179 None 7.15,and Chapter 21E of Telephone Number(include area code and extension) E-mail Address(optional) the General Laws of the 2. On-Site Supervisor: Commonwealth. This would William Babcock include,but Name would not be limited to,filing 3. Is the entire facility to be demolished? ® Yes ❑ No an asbestos removal notification with 4. Describe the area(s)to be demolished: the Department and/or a notice of entire existing structure release/threat of release of a hazardous substance to the Department,if applicable. 5. If this is a construction project, describe the building(s)or addition(s) to be constructed: unknown ag06.doc- 10/01 BWP AQ 06-Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality BWP A Q 06 Notification Prior to Construction or Demolition A. Applicability A Construction or Demolition operation of an industrial, commercial, or institutional building, or residential building with 20 or more units is regulated by the Department of Environmental Protection (DEP), Bureau of Waste Prevention -Air Quality Division, under Regulations 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. Facility Information: vacant house Name 210 Florence Rd. Address Instructions Northampton MA unknown City/Town State Zip Code 1.All sections of N/A None this form must be Telephone Number E-mail Address(optional) completed in order to comply with the Size: Department of Environmental 810 2 Protection Square Feet Number of Floors notification requirements of Was the facility built prior to 1980? Yes 310 CMR 7.09 Y p ® ❑ NO 2. Submit Original Describe the current or prior use of the facility: Form To: Commonwealth of vacant house Massachusetts Asbestos Program P.O.Box 120087 Is the facility a residential facility? ® Yes ❑ No Boston,MA 02112-0087 If yes, how many units? 1 2. Facility Owner: Brian Pollard &Sons Excavating Notification# Name 17 Masonic Avenue Received Date Address Turner Falls MA 01376 Receiver City/Town State Zip Code Permit 1-413-772-5865 none ❑Approved Telephone Number(include area code and extension) E-mail Address(optional) ❑Denied unknown On-site Manager Decision Date ag06.doc•10/01 BWP AQ 06•Page 1 of 3 • DESCRIPTIONS (Continued from Page 1) BRIAN POLLARD & SONS EXCAVATING AND TOWN OF NORTHAMPTON ARE INCLUDED AS ADDITIONAL INSUREDS AMS 25.3(07/97) 2 of 2 #S89799/M89564 . � Client : 7186 ASSOBUIL DATE(MM/DDNY) ACOR . CERTIFICATE OF LIABILITY INSURANCE 10/20/03 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GENATT ASSOCIATES, INC . ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 3333 NEW HYDE PARK RD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SUITE 400 . NEW HYDE PARK, NY 11042 INSURERS AFFORDING COVERAGE INSURED— INSURER A: STEADFAST INSURANCE COMPANY_ ASSOCIATED BUILDING WRECKERS, INC. NisuRERe: ROYAL INDEMNITY COMPANY 352 ALBANY STREET --- INSURER SPRINGFIELD MA 01101 - — - � I INSURER D: j INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR TYPE OF INSURANCE �— POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LT, DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY GPL 5 4 019 0 2 0 0 02/01/03 1 0 2/0 1/0 4 EACH OCCURRENCE $�0 0 0 , 0 0 0 �I COMM ERCIALGENERAL LIABILITY FIRE DAMAGE(Any one fire) $ 100 , 000 CLAIMS MADE Ilk OCCUR MED EXP(Anyone person) $ 10 , 00 0- PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2 0 0 , 0 0 0 GEN'L AGGREGATE LIM ITAPPLIES PER: rPRODUCTS_COMP/OP AGG $2 , 0 0 0 0 0 0 POLICY jECT LOC F AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) - AUTOS BODILY INJURY NON- (Per accident) $ NON-OWNED AUTOS - - --- PROPERTYDAMAGE I$ - (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ -- - ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS LIABILITY I P 2 HN 0 2 0 211 02/01/03 0 2/01/0 4 EACH OCCURRENCE $10 0 0 0,00 0 X OCCUR CLAIMS MADE AGGREGATE $1 0 0 0 0 0 0 DEDUCTIBLE $ c RETENTION $ WC S;TATU- OTH- WORKERS COMPENSATION AND ITORY LIMITS I ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ ' E.L.DISEASE-EA EMPLOYEE $ _ E.L.DISEASE-POLICY LIMIT $ OTHER I DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS PRIMARY & NON-CONTRIBUTORY COVERAGE APPLIES CONTINGENT UPON ADDITIONAL INSUREDS POLICY BEING EXCESS OF OTHER PRIMARY INS. PER PROJECT AGG. APPLIES WAIVER OF SUB. APPLIES RE : 210 FLORENCE ROAD, NORTHAMPTON MA CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: _ CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BRIAN POLLARD & SONS EXCAVATING DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TOMAIL3.0DAYSWRITfEN 17 MASONIC AVENUE NOTICETOTHE CERTIFICATE HOLDERNAMED TOTHE LEFT,BUTFAILURE TODOSOSHALL TURNERS FALLS, MA 01376 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURE R,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV ACORD25-S(7/97)1 Of 2 #S89799/M89564 JSF © ACORD CORPORATION 1988 O��ttAMP�O b 8 GZt� of wart4alltptalt ID L $ B Wassachasetls DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street a Municipal Building ' Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (Iicensee/permittee) with a principal place of business/residence at: (phone#) (street/city/stafrJap) do hereby certify, under the pains and penalties of pedury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: aus ranm Company) (Policy Number) (EXpirallon Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Compairy/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additioml shed if necenary to include information pertaining to all ooatraanrs) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing alt the work myself. NOTE-plea be aware that whilo homeowners who employ persons to do maintmance constrvttioa or repair work on a dwdliag of not mee than throe uaits is which the homeowner raided or on the grounds appurtenwA thereto am not generally 000idered to be employers under the worker's compensation.Act(01,152,ss 1(5)�application by a,homeowner for a license or permit may evidcaoe tho legal status of an employer under the Work eet compenw6oa Act. I understand that a copy of this ctstemrat may be forwarded to the Depart nm of Industrial Aoddan&Office of Inv warm for the coverage va i cidioa and that failure to see=coverages under section 25A of MOL 152 can lead to the imposition of miminal Naaldcs ooasisting of a fine of up to S1,500.00 and/or imptisomreat of up to one year and civil penalties in the form of a Stop Work Order and a firm of 5100.00 a day against mo. For department"use only Permit Number Mao I.ot# Si9mbare of Liccasee/Permittee Date - DATE(MWDDNY) j ACORDTM CERTIFICATE OF LIABILITY INSURANCE 10/20/2003 ':PRODUCER Seria(# B4991 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION NORTHGATE INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O BOX 3182 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. SPRINGFIELD,MA 01101-3182 INSURERS AFFORDING COVERAGE FINSURED ASSOCIATED BUILDING WRECKERS,INC. INSURER A: TRAVELERS INDEMNITY INS CO. 352 ALBANY STREET INSURER B: AMERICAN HOME ASSURANCE CO. SPRINGFIELD,MA 01105 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ POLICY PRO LOC JECT AUTOMOBILE LIABILITY A5-8105054A78A 2/1103 2/1/04 COMBINED SINGLE LIMIT $ 1,000,000 A ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND X I TORY LIMITS OER B EMPLOYERS'LIABILITY WC1-31S-332797-012 2/1103 2/1/04 E.L.EACH ACCIDENT $ 1,000,000 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS JOB: 210 FLORENCE RD, NORTHAMPTON,MA. TE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 'OLLARD&SONS EXCAVATING DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN AVENUE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL MA 01376 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE VE oACORD CORPORATION 1988 Awo=W W, k-DWI&9-21 demn, 352 Albany Street, Springfield, Massachusetts 01105 Tel: (413) 732-3179/(800)448-2822 Fax: (413) 734-6224 September 24,2003 Brian Pollard BRIAN POLLARD&SONS EXCAVATING 17 Masonic Avenue Turner Falls,Massachusetts 01376 For the sum of and salvage rights,we agree to demolish the house located at 210 Florence Road in Northampton,Massachusetts. Associated Building Wreckers work includes: 1) Demolition of the house and removal of all debris to an approved facility,including foundations. 2) Notifying Call Before You Dig and arranging for the disconnection of services. 3) Taking out the demolition permit and furnishing a certificate for demolition general liability and workers compensation insurance,upon request. 4) Leaving the cellar hole open and slant grading with soil on premises. 5) Asbestos removal of exterior transite siding meeting all new EPA,DLI,DEP and OSHA requirements for asbestos abatement. Brian Pollard&Sons Excavating will be responsible for: 1) Any service disconnection charges,if any. 2) Obtaining any historical permits or special notifications,if required. 3) Any repair to trees,asphalt,grass,or landscaping damaged during demolition in the work area. 4) Any damage to underground services that Dig Safe and/or Brian Pollard&Sons Excavating has not made us aware of(including,but not limited to,underground sprinklers,roof drains and septic systems). 5) Cost associated with any hazardous materials found at the site,other than specified above. 6) Marking the properties for Dig Safe. 7) Making job accessible to work. 8) Rodent control,if required. 9) Any fill. 10) Securing cellar hole. 11) Making payment in full upon completion. Brian Pollard&Sons Excavating acknowledges that they are the owner of the property and are not in bankruptcy or petitioning for bankruptcy. Brian Pollard&Sons Excavating to pay 18%interest per annum on the unpaid balance,plus reasonable attorney fees and all other costs of collection,in the event payment is not made in accordance with the schedule. Brian Pollard&Sons Excavating is unaware of any hazardous materials or wastes on the property and knows of no legal reason,regulation,or other circumstances,which might prevent or in any way interfere with the right or ability of Associated Building Wreckers,Inc.to demolish the wooden structure,if any hidden conditions do exist on this job,they are the owner's responsibility. Sincerely, ASSOCIATED BUILDING WRECKERS,INC. mui-I , i Andrew Mirkin President AM/jks Accepted by: �G Brian Pollard Date Brian Pollard&Sons Excavating F:\Msword\DEMO-CTRTS-2003\210_Florence-Rd-Northam-oton.doc ` Versionl.7 Commercial Building Permit May 15,2000 stcrioNo- � RApjlv '� cnn� tl.1 ) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SE TIt�N 1 4iagUflt EMAU, 1 Z TKA10 " Q E CQMP3LE`1�C W�iEN as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signatu Date as-9wNer/Authorized Agent hereby declare that the skatements and information 6n the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. l a/raGv fYfa lip Prnt Name Signature of Owner/Agent Date 10.1 Licensed Construction Supervisor: f . Not Applicable ❑ Name of License Holder . Al re!V k `�°°M �r`�-r,4') License Number lG" r�l A)4)04 3 , A I t On I i 0. / A ress a/ f ///r� Expiration Date /GI GIIL gnature Telephone •,�i 3' P 3 !N � 3� � 3 �� (d .� �3 3 3 33 3� Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ Versionl.7 Commercial Building Permit May 15,2000 s>�OutcES Fcsui>rpitGr iriIcTi .�l �c arc 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): NIA Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General /Contra�ct�orr / F1"i" u! Not Applicable ❑ Company Name: 1� (� W IT,1 0 tu, Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7. Waterupply(M.G.L. c. 40, §54) 7.1 Flood Zone Information: 7.3 Sewage isposal System: Public 67 Private ❑ Zone: Outside Flood Zone ❑ Municipal On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW V YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW V/ YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued`:/ C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 IT SEC7ON4 �� at� if �©JCT�I. S=TF1NrJ,b�Q 3 t�"' X l T V'� 'Gh Mw Interior Alterations Existing Wall S' ns Existing Ground Signs Additions ❑ Roofing ❑ Exterior Alterations Demolition New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] 1A k fA �j AJIA USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi Rh Hazard ❑ 3A ❑ Institutional ❑ 1.1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: 17K v 19-�,3 Tl Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) 15t 2nd 1 st 3rd 2nd 4th 3rd 4th Total Area(sf) Total Proposed New Construction (sf) ................................... Total Height(ft) Total Height ft -------------------- Versionl.7 Commercial Building Permit May 15,2000 it re ,Northampton t �i Department Main Street NOV — 6 2003 =I3 'o iom 100 NortHamp�ton, MA 01060 oes�T of a �7-1 40 Fax 413.587-1272 NRRTNA fi?TQN,YA R;^6R APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING 1FQI�lNI��I"�Ql��g �w 3; 1.1 Property Address: Me �gp x.. I'lfG`1�l?Q,�3t�t��c., tits T ✓y 8 �F 3f 3 .x 2.1 Owner of Record: Name(Print) Current Mailing Address: i G7 'kid°f �� lf -_!� Signature Telephone 2 2 Authorized Agent: i! �- �X 1ci tt i,�, I'r 4 -) f � c�%��r �Il ti7� Cf D Name(Print) Current Mailing Address: fji, Signa ure Telephone Item Estimated Cost(Dollars)to be Mmz- completed b ermit applicant 1. Building d f'd��l��1��. ,, l��.�'(j a) nl i Pert N 2. Electrical u/� K 3. Plumbing A///A 4. Mechanical(HVAC) ME 5. Fire Protection /V//, 6. Total =(l + 2 + 3 +4+ 5) he �imbr � v "0 e , r1 '.�. � x 3� MR 3,a �h c L3 File#BP-2004-0571 APPLICANT/CONTACT PERSON Associated Building Wreckers Inc ADDRESS/PHONE P O Box 2851 (413)732-3179 PROPERTY LOCATION 210 FLORENCE RD MAP 29 PARCEL 002 001 ZONE URA/WSP THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Typeof Construction: DEMOLISH PRINCIPAL STRUCTURE New Construction Non Structural interior renovations Addition to Existing_ Accessory Structure Building Plans Included• Owner/Statement or License 062382 3 sets of Plans/Plot Plan THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF RMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Co ssion L Zo Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of Planning&Development for more information. �w 210 FLOUN �� BP-2004-0571 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2004-0571 Project# IS-2004-0801 Est. Cost: $10279.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Associated Building Wreckers Inc 062382 Lot Size(sa.ft.): 127630.80 Owner: KOCH HOLDING CO INC Zoning:URA/WSP Applicant: Associated Building Wreckers Inc AT. 210 FLORENCE RD Applicant Address: Phone: Insurance: P O Box 2851 (413) 732-3179 SPRINGFIELDMA01101 ISSUED ON.11113103 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMOLISH PRINCIPAL STRUCTURE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupangy Sisnature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 11/13/03 0:00:00 13731 $35.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo