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23A-068 (5) UIU-117115.fa Gas, of %massKlausects A NiSource Company 995 Belmont strut BroGkton MA 02301 Date: 81812014 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 100 Main St TOWN : Florence STATE : Massachusetts Sincerely, Lisa Buckley Integration Center Columbia Gas Of Massachusetts 508-580-0190 Ext 1298 Charlie Lawrence From: John Hall Uhall@northamptonma,gov) Sent: Tuesday,August 12, 2014 8:46 AM To: charlief@crockerbuilding.com Subject* 100 Main Street, Florence. Charlie: Once the building is demolished, cap the sewer service and call me to inspect it. I will then send a letter to the Building Inspector, telling him that I have inspected the house service cut off. John Hall Sewer Department Foreman (City of Northamp-.on E-:na.il i� a fecord except wi-er it fa' ls under one Of th,- sn,e---ific staLutory exeinp--4.ons. ) 1. ------------------ - "- .'' y� DEPAR R -�1 w 5 ;,. August 11,201 Louis Hasbrouck, Building Inspector ,N�lunicipal Office Annex 212 Main Street Northampton. Ma 01€}t Dear Mr.Hasbrouck: The water service at 4100 Main Streit in Florence has been ciisc.on1lected#ron—, flie city NA; ate•supply and =lie water meter has been removed froni the preinises as of February 6, 2012'. Please contact me if you have any questions. sincerel re N utteln-ja n ss. rintet3ent of Water Cc: Ned 11witley, Director of Public: NN;'o r s Jiro Lauriia,City Engineer verizon wownr 365 State Street Springfield, MA 0 1105 Date: 08/11/14 RE: Demolition Request This letter is to inform you and any interested parties that Verizon telephone services have been disconnected for the purpose of demolition of building/house located at the following location: 100 Main St, Florence, MA Sincerely, Lynn LaCasse -----------...... nationalgrid 40 Sylvan Rd Waltham MA 02451 August 12, 2014 1.00 Main St Florence MA RE; Service. Removal for Building Demolition. To whom it may concern. This letter is to confirm that, per your request,National Grid has confirmed electrical service and meters have been removed from 100 Main St Florence MA. The work was processed on work request 1761?146 and the meter was removed. If you have any questions or need further assistance, please feel free to contact me at(508) 357-4926. Sincerely, Jessy Hernandez Customer Order Fulfillment natianalgrid W712014 Cityof Northampton Mail-Demo at 100 Main St Demo at 100 Main St Louis Hasbrouck <Iasbrouck @northamptonma.gov> Thu, Aug 7, 2014 at 4:11 PM To: charnel @crockerbuilding.com Charlie, We need shutoff letters; verification from National Grid, Verizon, Northampton water and sewer departments and Columbia Gas that the utilities are disconnected. It's part of the code; IBC 3303.6 The water department phone is 413-587-1097 and the sewer department is 587-4316 (or 587-1570. 1 don't have numbers for the utility companies. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax hUps://niail.g oog le.corrVniai I/u/o/?ui=2&i k=ec5fl9a57e&uevv=pt&search=sent&th=147b2l89b68el48a&sirr1=147b2l89b68el48a 1/1 EMSL Analytical, Inc. EMSL Order: 131402922 7 Constitution Way,Suite 107,Woburn,MA01801 CUStomerlD: GECL78 Phone/Fax (781)933-8411/(781)933-8412 CustomerPO: httm//www.EMSL.com bostonlabaemsl.com ProjectlD: Attn: Mary McCarthy Phone: (413)341-3418 Green Environmental Consulting, LLC Fax: (413)341-3419 180 Pleasant St Received: 07/21/14 8:30 AM 3rd Floor Suite 7 Analysis Date: 7/22/2014 Collected: Easthampton, MA 01027 Project: 00993/Florence Mobil Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non-Fibrous %a Type 00993-09A Roof;North-Built Black 3% Glass 87% Non-fibrous(other) 101% Chrysotile Up Roofing Non-Fibrous 131402922-0017 Homogeneous 00993-09B Roof;West-Built Black 70% Non-fibrous(other) 30% Chrysotile Up Roofing Fibrous 131402922-0018 Homogeneous 00993-10A Exterior;North- Black 100% Non-fibrous(other) None Detected Black Window Non-Fibrous 131402922-0019 Caulk Homogeneous 00993-10B Exterior;West- Black 100% Non-fibrous(other) None Detected Black Window Non-Fibrous 131402922-0020 Caulk Homogeneous Analyst(s) f Fievel Lam(10) Steve Grise,Laboratory Manager Kevin Pine(10) or other approved signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced,except in full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST or any agency of the federal government. Non-friable organically bound materials present a problem matrix and therefore EMSL recommends gravimetric reduction prior to analysis. Samples received in good condition unless otherwise noted. Estimated accuracy,precision and uncertainty data available upon request.Unless requested by the client,building materials manufactured with multiple layers(i.e.linoleum,wallboard,etc.)are reported as a single sample.Reporting limit is 1% Samples analyzed by EMSL Analytical,Inc.Woburn,MA NVLAP Lab Code 101147-0,CT PH-0315,MA AA000188,RI AAL-107T3 and VT AL357102 Initial report from 07/22/2014 13:49:06 Test Report PLM-7.28.9 Printed:7/22/2014 1:49:06 PM THIS IS THE LAST PAGE OF THE REPORT. 3 EMSL Analytical, Inc. EMSL Order: 131402922 7 Constitution Way,Suite 107,Woburn,MA 01801 CustomerlD: GECL78 Phone/Fax (781)933-84111(781)933-8412 CustomerPO: http://www.EMSL.com bostonlabOemsl.com Projectl D: Ann: Mary McCarthy Phone: (413)341-3418 Green Environmental Consulting, LLC Fax: (413)341-3419 180 Pleasant St Received: 07/21/14 8:30 AM 3rd Floor, Suite 7 Analysis Date: 7/22/2014 Collected: Easthampton, MA 01027 Project: 00993/Florence Mobil Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non-Fibrous %TvDe 00993-05A Bathroom- Gray 15% Cellulose 85% Non-fibrous(other) None Detected Sheetrock Fibrous 131402922-0009 Homogeneous 00993-05B Office-Sheetrock Gray/Tan 10% Cellulose 88% Non-fibrous(other) None Detected Fibrous 2% Glass 131402922-0010 Homogeneous 00993-06A Bathroom- White 100% Non-fibrous(other) None Detected Ceramic Tile Non-Fibrous 131402922-0011 Adhesive Homogeneous 00993-06B Bathroom- White 100% Non-fibrous(other) None Detected Ceramic Tile Non-Fibrous 131402922-0012 Adhesive Homogeneous 00993-07A Bathroom-2x4 Gray 65% Cellulose 15% Non-fibrous(other) None Detected Ceiling Tile Fibrous 20% Min.Wool 131402922.0013 Homogeneous 00993-07B Office-2x4 Gray/W hite 50% Cellulose 20% Non-fibrous(other) None Detected Ceiling Tile Fibrous 30% Min.Wool 131402922-0014 Homogeneous 00993-08A Roof;North- Tan 95% Cellulose 5% Non-fibrous(other) None Detected Roofing Board Fibrous 131402922-0015 Homogeneous 00993-08B Roof;West- Brown 90% Cellulose 10% Non-fibrous(other) None Detected Roofing Board Fibrous 131402922-0016 Homogeneous Analyst(s) j Fievel Lam(10) Steve Grise,Laboratory Manager Kevin Pine(10) or other approved signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced,except in full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of lest results are the responsibility of the client. This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST or any agency of the federal government. Non-friable organically bound materials present a problem matrix and therefore EMSL recommends gravimetric reduction prior to analysis. Samples received in good condition unless otherwise noted. Estimated accuracy,precision and uncertainty data available upon request.Unless requested by the client,building materials manufactured with multiple layers(i.e.linoleum,wallboard,etc.)are reported as a single sample.Reporting limit is 1% Samples analyzed by EMSL Analytical,Inc.Woburn,MA NVLAP Lab Code 101147-0,CT PH-0315,MA AA000188,RI AAL-107T3 and VT AL357102 Initial report from 07/22/2014 13:49:06 2 Test Report PLM-7.28.9 Printed:7/22/2014 1:49:06 PM EMSL Analytical, Inc. EMSL Order: 131402922 7 Constitution Way,Suite 107,Woburn,MA 01801 CustomerlD: GECL78 Phone/Fax: (781)933-8411/(781)933-8412 CustomerPO: httD://www.EMSL.com bostonlabOemsl.com ProjectlD: Attn: Mary McCarthy Phone: (413)341-3418 Green Environmental Consulting, LLC Fax: (413)341-3419 180 Pleasant St Received: 07/21/14 8:30 AM 3rd Floor, Suite 7 Analysis Date: 7/22/2014 Collected: Easthampton, MA 01027 Project: 00993/Florence Mobil Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance % Fibrous % Non-Fibrous %Type 00993-01A Bathroom behind Gray 100% Non-fibrous(other) None Detected Sheetrock-Tan Non-Fibrous 131402922.0001 Construction Homogeneous Adhesive 00993-01 B Bathroom behind Yellow 100% Non-fibrous(other) None Detected Sheetrock-Tan Non-Fibrous 131402922-0002 Construction Homogeneous Adhesive 00993-02A Office-Grey Cove Gray 100% Non-fibrous(other) None Detected Base Non-Fibrous 131402922-0003 Homogeneous 00993-02B Office-Grey Cove Gray 100% Non-fibrous(other) None Detected Base Non-Fibrous 131402922-0004 Homogeneous 00993-03A Office-Grey Cove Yellow 100% Non-fibrous(other) None Detected Base Adhesive; Non-Fibrous 131402922.0005 White Homogeneous 00993-03B Office-Grey Cove Yellow 100% Non-fibrous(other) None Detected Base Adhesive; Non-Fibrous 131402922-0006 White Homogeneous 00993-04A Bathroom-Joint White 100% Non-fibrous(other) None Detected Compound Non-Fibrous 131402922-0007 Homogeneous 00993-04B Office-Joint White 100% Non-fibrous(other) None Detected Compound Non-Fibrous 131402922-0008 Homogeneous Analyst(s) / Fievel Lam(10) Steve Grise,Laboratory Manager Kevin Pine(10) or other approved signatory EMSL maintains liability limited to cost of analysis. This report relates only to the samples reported and may not be reproduced,except in full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP,NIST or any agency of the federal government. Non-friable organically bound materials present a problem matrix and therefore EMSL recommends gravimetric reduction prior to analysis. Samples received in good condition unless otherwise noted. Estimated accuracy,precision and uncertainty data available upon request.Unless requested by the client,building materials manufactured with multiple layers(i.e.linoleum,wallboard,etc.)are reported as a single sample.Reporting limit is 1% Samples analyzed by EMSL Analytical,Inc.Woburn,MA NVLAP Lab Code 101147-0,CT PH-0315,MA AA000188,RI AAL-107T3 and VT AL357102 Initial report from 07/22/2014 13:49:06 1 Test Report PLM-7.28.9 Printed:7/22/2014 1:49:06 PM Pre-demolition Asbestos Inspection 100 Main Street Florence MA GEC recommends that, prior to demolition activities, one sample from each homogeneous area of mastic and other non-friable organically bound (NOB) materials that originally tested negative by PLM undergo confirmatory analysis by TEM, utilizing ELAP-198,4 TEM Method for Identifying and Quantifying Asbestos in NOB bulk samples. Conclusions/Recommendations Asbestos-containing, non-friable, asphalt-based roofing materials were identified during GEC's inspection. Identified ACM's should be removed, handled, and disposed of properly, in accordance with applicable state and federal regulations. Any suspect asbestos-containing material that is discovered during building renovation/demolition that is not included in this report should be assumed to contain asbestos until further bulk sampling and analysis is performed. If you have any questions regarding this survey or the sampling and/or analytical techniques employed, please contact us at (413)341-3418. Sincerely, Green Environmental Consulting, LLC A Adam Lesko Asbestos Inspector Lic#A1073071 Page 3 of 3 r Pre-demolition Asbestos Inspection Inn Main Street Florence MA The following materials were determined to be asbestos-containing materials (ACM's): N ° Built-up Roofing Roof 650 Square 00993-09A&09B under rubber Feet roofing membrane The following materials were sampled and determined no o be asbestos-containing materials (less than one-percent asb . o ): Tan Construction Adhesive Bathrooms (behind sheetrock 00993-01A&01B walls) Gray Cove Base and associated Office and Garage Bay 00993-02A, 02B, 03A &03B Mastic(White) Joint Compound Walls and Ceilings 00993-04A & 04B Sheetrock Walls and Ceilings 00993-05A&05B Ceramic Tile Adhesive (Gray) Bathrooms (behind sheetrock 00993-06A&06B walls) 2'x4'Ceiling Tile Office and Bathrooms 00993-07A&07B Roofing Board Roof(under membrane) 00993-08A&08B Black Window Caulk Exterior Metal Windows 00993-10A &10B Limitations This report is intended for the sole use of Gaurang Patel. This report is not intended to serve as a bidding document nor as a project specification and actual site conditions and quantities should be field-verified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users, and use or re-use of this document,the findings, conclusions, or recommendations herein is at the risk of said user. Although a reasonable attempt has been made to locate suspect asbestos-containing materials (ACM's) in the areas identified,the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure and,therefore, all areas of potential ACM. Electrical systems and/or components were not included in GEC's survey due to the safety issues inherent with sampling such systems. The Massachusetts Department of Environmental Protection (DEP), as well as the U.S. Environmental Protection Agency (EPA)currently recognize Polarized Light Microscopy(PLM) analysis as an acceptable analytical method for determining the Asbestos content in non-friable,organically bound (NOB) materials. However,comparative studies between PLM analysis and Transmission Electron Microscopy (TEM)analysis have shown that PLM analysis may yield false negative analytical results for NOB's such as floor tiles. Page 2 of 3 r Green Environmental Consulting, LLC 180 Pleasant Street 3rd Floor- Suite 7 tel/fax 413-341-3418 Easthampton, MA 01027 www.GecEnviro.com July 22, 2014 Gaurang Patel 94 Maple Street Florence, CT 01062 RE: Pre-demolition Asbestos Inspection Former Mobil Station 100 Main Street Florence, MA Dear Mr. Patel: Pursuant to your request, Green Environmental Consulting, LLC(GEC) performed a pre-demolition asbestos inspection of the former mobil gas station building at 100 Main State Street in Florence, MA (hereafter referenced as the "building"). Fieldwork associated with the project was performed on July 19, 2014. Background The building consists of one-story automobile repair building built slab on-grade and consisting mainly of a small office, bathrooms and a garage bay. Interior finish materials include ceramic tile floors, ceiling tiles and sheetrock/joint compound wall and ceiling systems. Exterior finish materials include brick walls, metal windows and a rubber roofing membrane over built-up asphalt based roofing. GEC understands that the above-referenced building is scheduled for demolition. In accordance with state and federal asbestos regulations, asbestos-containing materials (ACM's) in the building are required to be identified and removed prior to any activity that would disturb the material. Asbestos Sampling/Results Twenty(20) samples of suspect asbestos-containing materials (ACM's)were collected and submitted to an accredited laboratory for analysis using Polarized Light Microscopy with Dispersion Staining (PLM/ DS). Materials found to contain greater than one percent asbestos are considered to be asbestos- containing materials (ACM's). Refer to Attachment No.1 for laboratory results, including detailed descriptions of sampling locations,as well as chain-of custody records for samples collected. Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality _ a„ 100203844 BWP AQ 06 Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this 000000 address is: This project j✓; Construction r Demolition is: 8/11/2014 12/31/2014 Project Start Date(MM/DD/YYYY) Project End Date(MM/DD/YYYY) 8. For demolition and construction projects,indicate dust suppression techniques to be used 1—, Seeding F Wetting F- Covering J—, Paving r Shrouding F Other-Specify: 9.For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? Name of MassDEP Official Title Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally CHARLES L LAWRENCE examined the foregoing and am Print Name familiar with the information contained in this document and Authorized Signature all attachments and that,based PROJECT MANAGER on my inquiry of those Position/Title individuals immediately CROCKER BUILDING COMPANY INC responsible for obtaining the information,I believe that the Representing information is true,accurate,and complete. I am aware that there Date(MM/DD/YYYY) are significant penalties for submitting false information, including possible fines and P.E.# imprisonment.The undersigned hereby states,under the penalties of perjury,that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised:03/17/2014 Page 3 of Massachusetts Department of Environmental Protection i Bureau of Waste Prevention •Air Quality BwP AQ 06 00203844 Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3.General Contractor: CROCKER BUILDING COMPANY INC 186 STAFFORD ST Name Address SPRINGFIELD MA 011040000 4137377803 CityfTown State Zip Code Telephone CHAR &%4.�� 41'933TTStj`3' y General Contractor's On-site Manager/Foreman Telephone C. General Construction or Demolition Description General 1.Construction or demolition contractor: Statement:If asbestos is found DIETZ CONSTRUCTION 165B NORTHAMPTON ST during a Construction Contractor Name Address or Demolition operation,all EASTHAMPTON MA 010270000 4135272695 responsible parties Cityfrown State Zip Code Telephone must comply with 310 DAVID DIETZ 4135272695 CMR 7.00,7.09,7.15, and Chapter 21 E of Construction and Demolition On-site Manager Telephone the General Laws of the Commonwealth. 2.Licensed Contractor Supervisor: This would include, but would not bw CHARLES L LAWRENCE CS-003398 limited to,filing an asbestos removal Supervisor Name License Number notification with the Department and/or a 3. Is the entire facility to be demolished? F Yes F No notice of release/threat of 4.Describe the area(s)to be demolished: release of a hazardous 1800SF FORMER AUTOMOTIVE SERVICE STATION substance to the Department,if w' applicable. 5.If this a construction project,describe the building(s)or addition(s)to be constructed: NEW 2 STORY 7100SF(3550 PER FLOOR)OFFICE/RETAIL 6. Were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? Yes r No 7.Was asbestos containing material(ACM)found? R_Yes F No If yes,who conducted the survey? GREEN ENVIRONMENTAL CONSULTING,LLC AL 073071 Name Department of Labor Standards Contractor Number Revised:03/17/2014 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 100203844 Notification Prior to Construction or Demolition Asbestos Project Number# 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(MassDEP), 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)working days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09.Is this a fee exempt notification(city, town,district, municipal housing authority,state facility,owneroccupied residential property of four units or less)? Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? F Yes F' No Type of Notification: r— Revision of an Existing Form Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.All sections of this 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: form must be completed in order to Approval ID# comply with the Department of B. General Project Description Environmental 1.Facility Information: Protection notification OM BHAVYA 100 MAIN ST requirements of 310 CMR 7.09. Name of facility Street Address NORTHAMPTON MA 010620000 4136588184 2.Submit Original City/Town State Zip Code Telephone Form To: � Commonwealth of GAURANG PATEL Massachusetts Facility Contact Person Contact Person Title Asbestos Program 4136588184 GUARANGPATEL80 @HOTMAIL.COM P.O.Box 120087 Boston,MA Facility Contact Person Telephone Facility Contact Person Email 02112-0087 Facility Size: 1800 1 Square Feet Number of Floors Was the facility built prior to 1980? F Yes F No Describe the current or prior use of the facility: AUTOMOTIVE SERVICE STATION-CURRENTLY VACANT Is the facility a residential facility? r Yes F No If yes,how many units? 2.Facility Owner: GAURANG PATEL 95 MAPLE ST Facility Owner Name Address FLORENCE MA 010620000 4136588184 City/Town State Zip Code Telephone GAURANG PATEL 94 MAPLE ST On-Site Manager/Owner Representative Address Florence MA 01062 4136588184 City/Town State Zip Code Telephone Revised:03/17/2014 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality � BWP AQ 06 Notification Prior to Construction or Demolition F This is a revision to an existing form. Project ID for existing form to be revised: F- This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: I r This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 r Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: SETHPCROCK Transaction ID: 670427 Document: AQ 06 -Construction/Demolition Notification Size of File: 218.66K Status of Transaction: In Process Date and Time Created: 7/25/2014:11:49:50 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. f Charlie Lawrence From: eDEPConfirmation @massmai1.state.ma.us Sent: Friday, July 25, 2014 12:00 PM To: scrocker @crockerbuilding.com Cc: charliel @crockerbuilding.com Subject: eDEP Submittal Confirmation for DEP Transaction ID: 670427 Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message, this email address will not receive messages. For assistance with eDEP Online Filing, please email the EEA Help Desk at mailto:helpdesk.eeaoamassmail.state.ma.us or call 617-626-1111. MassDEP is interested in how we can serve you better. To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts-and-feedback.html. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. ************************************************************************************** DEP Transaction ID: 670427 Date and Time Submitted: 07/25/2014 11:59:57 ************************************************************************************** Form Name: AQ 06 - Construction/Demolition Notification AQ 06 - Construction/Demolition Notification( ) Payment Information DEP code: 96659 Date: 7/25/2014 11:57:35 AM Amount ($): 100 Payment Detail: CROCKER SETH --AccountType -- AccountNumber ****1797 ConfirmationNumber: ************************************************************************************** EMAIL ID OF THE USER: SCROCKER(CROCKERBUILDING.COM ************************************************************************************** EMAIL ID OF THE OTHER USERS: charliel(lcrockerbuilding.com ************************************************************************************** 1 MSactltr C*ti par"ent of Public Safety Board of Building Regulations and Standards t„nstruGlrrat� `+cipa ri i+��rr License: C$ e CHARLES L esLA g 93 ARR:E Q East Lnng�RdV Expiration Co"w"s slootq OMW2016 CROCK-1 OP ID: PM ACORL7° DATE(MM/DDNYYY) �..� CERTIFICATE OF LIABILITY INSURANCE 06/20/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CT Patricia Mahoney PHILLIPS INSURANCE AGENCY INC PHONE 413-594-5984 (FAX, 41 97 CENTER STREET ac No E::: Alc No: 3-592-8499 CHICOPEE,MA 01013 E-MAIL Chris Rivers ADOREss:patty@phillipsinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:The Hartford 29459 INSURED Crocker Building Company Inc INSURERB: 186 Stafford St Springfield,MA 01104 INSURERC: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�TR TYPE OF INSURANCE DL UBR POLICY NUMBER MM/DDY/YEYW MM/DDIIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTE9___ A X COMMERCIAL GENERAL LIABILITY 08UUNQT9436 04/01/2014 04101/2015 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE FxI OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY (CEO MBINED dent S INGLE LIMIT 1,000,00 _ $ A ANY AUTO 08UENOT9437 04101/2014 04/0112015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS PER ACCIDENT $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,00 A EXCESS LIAB CLAIMS-MADE 08RHUQT9439 04/0112014 04/01/2015 AGGREGATE $ 5,000,00 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION x( I WC STATU- OTH- AND EMPLOYERS'LIABILITY T RY LIMITS ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A 08WEQT9438 04/01/2014 04/01/2015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,00 A Rented/Leased Equi 08UUNQT9436 04101/2014 04101/2015 Rented Eq 200,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) RE: Construction of New Two Story Retail and Office Building 100 Main Street Florence, MA OM BHAVYA, Inc. is included as additional insured when required by contract. CERTIFICATE HOLDER CANCELLATION BHAVAYA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN OM BHAVYA,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. Aft:Gaurang Patel 94 Maple Street AUTHORIZED REPRESENTATIVE Florence,MA 01062 �,�, , J„� P&A _ ©1988-`2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 640 Washington Street wi Boston,AM 02111 www. ass.govfdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apglicant Information Please Print Le ibl Name(Business/Organization/Individual); � t � 't�#• ti i Address: tt,` ,€ . Ciryfstate/Zip: Phone Are ygjw an employer?Check the appropriate box: Type of project(required): 1.VI am a employer with._J-5-- 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet. * 7, remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working or me in an capacity. workers'comp.insurance. 9 $ Y ap ty- F1 Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MCiL 11.❑ Plumbing repairs or additions myself,[No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers"compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. /Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp,policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self ins.Lic.4: art' _ Expiration Date: r Job Site Address: CityiState/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 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 may be forwarded to the Office of lnvestigations f the °1A for insuran coverage verification. I do here rt' 'u der t pa' a enalties of perjury that the information provided above is true and correct. Si Date: ° 1 EVV -7/ :�2 Official use only. Do not write in this area,to be completer/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.Plumbing Inspector 6.Other Contact Person: Phone#: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. �'�2 0 r � Address of the work: /� >�a�� � 04 The debris will be transported by: Jl� � (�►s�►' The debris will be received by: !�► C ��- q P-4 Building permit number: Name of Permit Applicant ( 'A'C f 6 Wit-- /tw Date Signature of Permit Applicant L Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-'STRUCTURAL PEER:REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes 0 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property s. .._ ..e_ hereby authorize --- - -. -.--.,-. . . ..._ 'to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I `! Tq � L as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. its Print Na Sig re Own r/A a Date SECTION 12 CONSTRUCTION SERVICES 39.1 Licensed Constructi u ervisor Not Applicable ❑ Name of License Holder License Number Addr s Expiration Date .... si(n Odr4kvl Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) 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 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 36,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant). Registration Number Address .— A Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): w. Name Area of Responsibility ..._.. _.. w..__.__. . ._..,_.............. .. Address Registration Number i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date �..®._, a... .�..m... ,,. Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor 14q !lay -14a Not Applicable ❑ Compan Name: Responsible In Charge of Construction Addr Sigkfiurev t Telephone Versionl.7 Commercial Building Permit May 15,2000 $. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage '_z ........... Setbacks Front Side L. ,.. R:4 b L. R ., Rear Building Height r Bldg. Square Footage Open Space Footage sa w, % -- (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 Q DON'T KNOW 0 YES IF YES, date issued IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page; and/or Document#' B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 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 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO Q IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Brief Descriptiot1 jEn a brief description here. Of Proposed Wb SECTION 5 USE GROUP AND CONSTRUCTION TYPE 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 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I 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 El Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34). ­1­1­1­11-­-, Proposed Hazard Index 780 CMR 34): . n SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) St 1 5' s, _ .. . ... 2nd 2nd rd rd 4« 4m Total Area(sf) Total Proposed New Construction,(§f) u Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public El Private E] Zone' Outside Flood Zone❑ Municipal E] On site disposal system❑ Version 1.7 Commercial Building Permit May 15,2000 { �p r City d, rthampton tagsYb ��'MR,� �?Pe i �� a i rta ` < .. ZMAluildi epartment 212 Mal Street S� �ripfi� anbi � � sp0 100t$T 'at11 r w & 6 � � eiectric,o t p On, MA 01060 'Marl one 413-587-1240 Fax 413-587-1272 Plolite`PI �s � .r �� �� ` Ofhr 5peclfy APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office l 1 YID s r 1 Map Lot Unit LG""Q _411,I-d vYt �} �} Zone Overlay District i Elm 5t.District CB District SECTION 2--PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2 2 Authorized Agent Cv a- I Name(Print) Current Mailing Address: L11 Signatu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS 1. S C 4tv lr 9,i,/L '9/ Item Estimated Cost(Dollars)to be Official Use Only coin letad by ermit applicant Building (a)Building Permit Fee .. .. -- 2. Electrical _ (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection " 6. Totai=(1 +2+3+4+5) Check Number a b This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/inspector of Buildings Date File#BP-2015-0165 APPLICANT/CONTACT PERSON CROCKER BUILDING CO INC ADDRESS/PHONE 186 STAFFORD ST SPRINGFIELD (413)737-7803 PROPERTY LOCATION 100 MAIN ST-FLORENCE MAP 23A PARCEL 068 001 ZONE GB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 0 0."? Fee Paid Typeof Construction: DEMOLISH SERVICE STATION BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 003398 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9AMATION 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 Commission Permit DPW Storm Water Management Demolition Delay 12 i Signature of uilding 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. 100 MAIN ST-FLORENCE BP-2015-0165 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A-068 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categoa: Building BUILDING PERMIT Permit# BP-2015-0165 Project# JS-2015-000124 Est.Cost: $15000.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: CROCKER BUILDING CO INC 003398 Lot Size(sq. ft.): 20865.24 Owner: 100 MAIN ST FLORENCE LLC zoning. GB(100)/ Applicant: CROCKER BUILDING CO INC AT. 100 MAIN ST - FLORENCE Applicant Address: Phone: Insurance: 186 STAFFORD ST (413) 737-7803 Workers Compensation SPRINGFIELDMA01104 ISSUED ON:811212014 0:00:00 TO PERFORM THE FOLLOWING WORK.DEMOLISH SERVICE STATION BUILDING 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 Occupancy Signature: FeeTyge: Date Paid: Amount: Building 8/12/2014 0:00:00 $200.00 212 Main Street, Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner