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13-073 (18) OrderID: 131506489 3 Page 3 c Analysis Type: Asbestos Chain of Custody PLM Record Turnaround Time: Hour Green Environmental Consulting, LLC 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Proiect Info: Send Results To: Project Name: Invoice to: Results to: Rockridge Garages Mory McCarthy Mary McCarthy roject Number: Return Samples?: Email to: 01507 ary@gecenviro.com roject Description: Comments/Special Phone: Pre-demolition Asbestos Inspection of Garages Instructions: (413) 341-3418 Fax: (413) 341-3418 Sample Number Sample Location Sample Description 01507-09A Stand-alone Garage NW Roofing Shingle 01507-09B Stand-alone Garage SW Roofing Shingle Samp By: Date: Received By: Date/Time: Relin fished By' Date/Time: Received in Lab By: Date/Time: OrderID: 131506489 Page 2 .°° na ysis Type: Asbestos Chain of Custody PLM Record Turnaround Time: Hour Green Environmental Consulting, LLC 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Proiect Info: Send Results To: Project Name: Invoice to: Results to: Rockridge Garages Mary McCarthy Mary McCarthy roject Number: Return Samples?: Email to: 01507 Mary@gecenviro.com roject Description: Comments/Special Phone: Pre-demolition Asbestos Inspection of Garages Instructions: (413) 341-3418 Fax: (413) 341-3418 Sample Number Sample Location Sample Description 01507-O5A Stand-alone Garage NE Gray Siding Paper 01507-O5B Stand-alone Garage West Gray Siding Paper 01507-O6A Stand-alone Garage Sheetrock 01507-O6B Stand-alone Garage Sheetrock 01507-O7A Stand-alone Garage West Wood Window Glaze 01507-O7B Stand-alone Garage NE Wood Window Glaze 01507-OSA Stand-alone Garage NW Roofing Paper 01507-08B Stand-alone Garage SW Roofing Paper Sa B y: Date: Received By: Date/Time: Y i I+L11 Reli uished B ate/Time: Received in Lab By: Date/Time: + + I--&L OrderID: 131506489 Pagel 1:7 3 na ysis Type: Asbestos Chain of Custody PLM Record urnaround Time: Hour 1 3 1 5 0 6 4 8 9 Green Environmental Consulting, LLC 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project Info: Send Results To: Project Name: Invoice to: Results to: Rockridge Garages Mary McCarthy Mary McCarthy rr,o—ject Number: Return Samples?: Email to:507 mary@gecenviro.com roject Description: Comments/Special Phone: Pre-demolition Asbestos Inspection of Garages Instructions: (413) 341-3418 Fax: (413) 341-3418 Sample Number Sample Location Sample Description 01507-01A Cottage Garage-SW Roofing Paper 01507-OIB Cottage Garage-North Roofing Paper 01507-O2A Cottage Garage-SW Roofing Shingle 01507-O2B Cottage Garage-North Roofing Paper 01507-O3A Cottage Garage-SW Sheetrock 01507-O3B Cottage Garage-NW Sheetrock 01507-O4A Cottage Garage-SW Joint Compound 01507-O4B Cottage Garage-NW Joint Compound Samp By: Date: Received By: + Relin shed By Date/Time: Received in Lab By: "'� f EMSL Analytical, Inc. EMSL Order: 131506489 7 Constitution Way,Suite 107 Woburn, MA 01801 Customer ID: GECL78 Tel/Fax: (781)933-8411 /(781)933-8412 Customer PO: http://www.EMSL,com/bostonlab @emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %.Non-Fibrous %Type 01570-08B STAND-ALONE Black, 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE SW- Fibrous 131506489-0016 ROOFING PAPER Homogeneous 01570-09A STANDALONE Black 30%Cellulose 70%Non-fibrous(Other) None Detected GARAGE SW- Fibrous 131506489-0017 ROOFING SHINGLE Homogeneous 01570-09B STAND ALONE Black 30%Cellulose 70%Non-fibrous(Other) None Detected GARAGE SW- Fibrous 131506489-0018 ROOFING SHINGLE Homogeneous Analyst(s) C — Kevin Pine(18) Alexander Maxinoski,Asbestos Laboratory Manager 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,VT AL998919,Maine Bulk Asbestos BA039 Initial Report From:11/03/2015 11:14:43 PLM-1.65 Printed:11/3/2015 11:14 AM Page 2 of 2 EMSL Analytical, Inc. EMSL Order: 131506489 7 Constitution Way, Suite 107 Woburn, MA 01801 Customer ID: GECL78 Tel/Fax: (781)933-8411 /(781)933-8412 Customer PO: http://www.EMSL,com/bostonlab @emsLcom Project ID: Attention: Mary McCarthy Phone: (413)341-3418 Green Environmental Consulting, LLC Fax: (413)341-3419 180 Pleasant St Received Date: 11/3/2015 9:26 AM 2nd Floor, Suite 213 Analysis Date: 11/3/2015 Easthampton, MA 01027 Collected Date: 11/2/2015 Project: 01507 ROCKRIDGE GARAGES Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 01507-01A COTTAGE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0001 ROOFING PAPER Homogeneous 01507-01 B COTTAGE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0002 ROOFING PAPER Homogeneous 01507-02A COTTAGE Black 10%Glass 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0003 ROOFING PAPER Homogeneous 01507-02B COTTAGE Black 10%Glass 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0004 ROOFING PAPER Homogeneous 01507-03A COTTAGE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0005 SHEETROCK Homogeneous 01507-03B COTTAGE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0006 SHEETROCK Homogeneous 01507-04A COTTAGE White 100%Non-fibrous(Other) None Detected GARAGE-SW- Non-Fibrous 131506489-0007 JOINT COMPOUND Homogeneous 01507-04B COTTAGE White 100%Non-fibrous(Other) None Detected GARAGE-SW- Non-Fibrous 131506489-0008 JOINT COMPOUND Homogeneous 01507-05A STAND-ALONE Gray 95%Cellulose 5%Non-fibrous(Other) None Detected GARGE NE-GRAY Fibrous 131506489-0009 SIDING PAPER Homogeneous 01507-05B STAND-ALONE Gray 95%Cellulose 5%Non-fiibrous(Other) None Detected GARAGE WEST- Fibrous 131506489-0010 GRAY SIDING Homogeneous PAPER 01570-06A STAND-ALONE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE- Fibrous 131506489-0011 SHEETROCK Homogeneous 01570-06B STAND-ALONE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE- Fibrous 131506489-0012 SHEETROCK Homogeneous 01570-07A STAND-ALONE Tan 100%Non-fibrous(Other) None Detected GRAGE WEST- Non-Fibrous 131506489-0013 WOOD WINDOW Homogeneous GLAZE 01570-07B STAND-ALONE Tan 100%Non-fibrous(Other) None Detected GARAGE NE- Non-Fibrous 131506489-0014 WOOD WINDOW Homogeneous GLAZE 01570-08A STAND-ALONE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE NW- Fibrous 131506489-0015 ROOFING PAPER Homogeneous Initial Report From:11/03/2015 11:14:43 PLA4-1.65 Printed:11/3/2015 11:14 AM Page 1 of 2 EMSL Analytical, Inc. EMSL Order: 131506489 7 Constitution Way, Suite 107 Woburn, MA 01801 Customer ID: GECL78 Tel/Fax: (781)933-8411 /(781)933-8412 Customer PO: M http://www,EMSL.com/bostonlab @emsl.com Project ID: Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 01570-08B STAND-ALONE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE SW- Fibrous 131506489-0016 ROOFING PAPER Homogeneous 01570-09A STANDALONE Black 30%Cellulose 70%Non-fibrous(Other) None Detected GARAGE SW- Fibrous 131506489-0017 ROOFING SHINGLE Homogeneous 01570-09B STAND ALONE Black 30%Cellulose 70%Non-fibrous(Other) None Detected GARAGE SW- Fibrous 131506489-0018 ROOFING SHINGLE Homogeneous Analyst(s) Kevin Pine(18) Alexander Maxinoski,Asbestos Laboratory Manager 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,VT AL998919,Maine Bulk Asbestos BA039 Initial Report From:11/03/2015 11:14:43 PLM-1.65 Printed: 11/3/2015 11:14 AM Page 2 of 2 EMSL Analytical, Inc. EMSL Order: 131506489 7 Constitution Way,Suite 107 Woburn, MA 01801 Customer ID: GECL78 Tel/Fax: (781)933-8411 /(781)933-8412 Customer PO: http://www.EMSL.com/bostonlab @emsi.com Project ID: Attention: Mary McCarthy Phone: (413)341-3418 Green Environmental Consulting, LLC Fax: (413)341-3419 180 Pleasant St Received Date: 11/3/2015 9:26 AM 2nd Floor, Suite 213 Analysis Date: 11/3/2015 Easthampton, MA 01027 Collected Date: 11/2/2015 Project: 01507 ROCKRIDGE GARAGES Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %,Type 01507-01A COTTAGE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0001 ROOFING PAPER Homogeneous 01507-01B COTTAGE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0002 ROOFING PAPER Homogeneous 01507-02A COTTAGE Black 10%Glass 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0003 ROOFING PAPER Homogeneous 01507-02B COTTAGE Black 10%Glass 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0004 ROOFING PAPER Homogeneous 01507-03A COTTAGE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0005 SHEETROCK Homogeneous 01507-036 COTTAGE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE-SW- Fibrous 131506489-0006 SHEETROCK Homogeneous 01507-04A COTTAGE White 100%Non-fibrous(Other) None Detected GARAGE-SW- Non-Fibrous 131506489-0007 JOINT COMPOUND Homogeneous 01507-04B COTTAGE White 100%Non-fibrous(Other) None Detected GARAGE-SW- Non-Fibrous 131506489-0008 JOINT COMPOUND Homogeneous 01507-05A STAND-ALONE Gray 95%Cellulose 5%Non-fibrous(Other) None Detected GARGE NE-GRAY Fibrous 131506489-0009 SIDING PAPER Homogeneous 01507-05B STAND-ALONE Gray 95%Cellulose 5%Non-fibrous(Other) None Detected GARAGE WEST- Fibrous 131506489-0010 GRAY SIDING Homogeneous PAPER 01570-06A STAND-ALONE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE- Fibrous 131506489-0011 SHEETROCK Homogeneous 01570-06B STAND-ALONE Tan/White 10%Cellulose 90%Non-fibrous(Other) None Detected GARAGE- Fibrous 131506489-0012 SHEETROCK Homogeneous 01570-07A STAND-ALONE Tan 100%Non-fibrous(Other) None Detected GRAGE WEST- Non-Fibrous 131506489-0013 WOOD WINDOW Homogeneous GLAZE 01570-07B STAND-ALONE Tan 100%Non-fibrous(Other) None Detected GARAGE NE- Non-Fibrous 131506489-0014 WOOD WINDOW Homogeneous GLAZE 01570-08A STAND-ALONE Black 80%Cellulose 20%Non-fibrous(Other) None Detected GARAGE NW- Fibrous 131506489-0015 ROOFING PAPER Homogeneous Initial Report From:11/03/2015 11:14:43 PL14-1.65 Printed: 11/3/2015 11:14 AM Page 1 of 2 Asbestos Survey Rockridge Retirement Community-Garages If you have any questions regarding this survey or the sampling and/or analytical techniques employed, please contact us at (413) 341-3418. Sincerely, Gr n nvironmen Consulting, LLC Adam Lesko President Page 3 of 3 Asbestos Survey Rockridge Retirement Community-Garages The following materials were sampled and determined not to be asbestos-containing materials (less than one-percent asbestos): lji:her ��Bit S r✓` t f L° L 4 ( f �tyw "S' tiT _+.�S,.r..�.�A.,z'.,..,oa..,.«,,,�...L,.ic»_era.-�......,!s w. ,..,._�..a_,_.... ,..r.._..... .. »..._,...,......,....a...a.tr............�s.�"�.us.L�ss� '�x: Roofing Paper Cottage Garage 01507-OIA & 01B Roofing Shingle Cottage Garage 01507-02A & 02B Sheetrock Cottage Garage 01507-03A & 03B Joint Compound Cottage Garage 01507-04A & 04B Gray Siding Paper Stand Alone Garage i 01507-05A & 05B Sheetrock Stand Alone Garage 01507-06A & 06B Wood Window Glaze Stand Alone Garage 01507-07A & 07B Roofing Paper Stand Alone Garage 1 01507-OBA & OBB Roofing Shingle Stand Alone Garage 01507-09A & 09B Refer to Attachment No. 1 for asbestos laboratory results, including detailed descriptions of sampling locations, as well as chain-of custody records for samples collected. Asbestos bulk samples were collected in a statistically random manner, per EPA guidelines. Limitations This report is intended for the sole use of New England Deaconess Association. 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. Caution should be used during renovation/demolition activities. Electrical systems and/or components were not included in GEC's survey due to the safety issues inherent with sampling such systems, Conclusions/Recommendations No asbestos-containing materials were identified during GEC's survey. 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. Page 2 of 3 Green Environmental Consulting, LLC 180 Pleasant Street 2nd door - Suite 213 tel/fax 413-341-3418 Easthampton, MA 01027 www.GecEnviro.com November 3, 2015 Charles Atencio New England Deaconess Association 80 Deaconess Road Concord, MA 01742 RE: Asbestos Survey Rockridge Retirement Community- Garages 25 Coles Meadow Road Northampton, MA Dear Mr. Atencio: Pursuant to your request, Green Environmental Consulting, LLC (GEC) performed a pre-demolition asbestos survey of two garages located at the Rockridge Retirement Community in Northampton, Massachusetts. Fieldwork associated with the project was performed on November 2, 2015 by Massachusetts-licensed Asbestos Inspector, Adam Lesko (License# A1073071). GEC understands that the garages are scheduled for demolition. In accordance with state and federal asbestos regulations, asbestos-containing materials (ACM's) are required to be identified and removed prior to disturbance. Asbestos Sampling/Results Eighteen (18) samples of suspect asbestos-containing materials (ACM's) were collected and submitted to an accredited laboratory for analysis using Polarized Light Microscopy (EPA/600/R-93/116). Materials found to contain greater than one percent asbestos are considered to be asbestos-containing materials (ACM's). No asbestos-containing materials (ACM's) were identified during GEC's sampling. Page 1 of 3 �- The Commonwealth ofMassachusetts Depar tmerat of fndu trial Accidents r Office of Inve tigatiorzs 600 Tfashingt n Street Boston, MA 02111 www.mass. ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibly Name (Business/Organization/Indivi dual): Address: Z© i 1 City/State/Zip: LJLS / %� .Y� P one# �l i3 Sr Are you an employer?Check the appropriate boa: Type of project(required): 1. I am a employer with 4. D I am a general contractor and I ❑ employees (full and/or part-time).* have hired the sib-contractors 6. New construction 2.7 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 for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp. insuranc .1 required.] 5. 7 We are a corporation and its 10.7 Electrical repairs or additions officers have exercised their 11. Plumbina re airs or additions 3.❑ I am a homeowner doing all work p• myself. [No workers' comp. right of exempt n per MGL 12.D Roof repairs insurance required.] t C. 152, §1(4), and we have no 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. Homeowners who submit this affidavit indicating they are doing all work and then h re outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name o the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'c mp.policy number. I am an employer that is providing workers'compensation insuranc e for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: i Job Site Address: City/State/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 of MGL c. 1.52 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the infornzation provided above is true and correct. Sienature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit,License# i 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#: I I 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 O No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 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 Signature of Owner Date m... as Owner/Authorized Agent hereby declare that the statements n the foregoing application true and curate,to the best of my knowledge and belief. Signed under the pains.and penalties of pert.._ j_.... Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ . . Name of License Holder: r2 - License Number Address Expiration Date ,S Sig 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 O No 0 r Version 1.7 Commercial Buil ling Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICE -FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility _..... ........... Address � � Registration Number Signature 4 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 Contractor lT� /�....,..�—�I� C1�a .....:..?.` r _ �" ...�..... .. --------- Not Not Applicable ❑ Company Name: Responsible In Charge of Construction ..... • 1'1/1.. rl� '�� � �, l.�/G�. ./.C. ✓�'... .... .. _, . I re re Telephone j Version 1.7 Commercial Building Permit May 15,2000 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 0 DON'T KNOW YES Q 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 DONT KNOW 0 YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? ... Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 Q NO pKN IF- IF YES,then a Northampton Storm Water Management Permit from the DPW is required. s Versionl.7 Commercial Bui ding Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ DemolitionA Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: . .. Vii! :.. yTc�v CZ �lOi J `'� ! "� 4- ,.,._ 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 ❑ 213 I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-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: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Propo ed Use Group: ... ..:_...._ ... ....... .. ...._..... Existing Hazard Index 780 CMR 34). Propo ed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st 1st 2nd 2nd 3rd 3rd __...._�_ _. ... _.. _. _....,.::.r_... _.,,. _. ....___......._. Orr, ; 4th Total Area (sf) Total Proposed New Construe ion(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone 7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system E] I I Versionl.7 Commercial Building Permit May 15,2000 Department use only: ity of Northampton Status of Permit: L -04 uilding Department Curb Cut/Driveway Permit - 212 Main Street Sewer/Septic Availability •6 2Q� Room 100 Water/Well Availability ort ampton, MA 01060 Two Sets of Structural Plans 3-587-1240 Fax 413-587-1272 Plot/Site Plans nof -Other Specify A (CATION 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 Map Lot Unit Zone Overlay District _... ......_..... ___._..- Elm St.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: ��►"`�3/�G C��t,� S�V�G,c�_T,NG. ;_�O.�i�';tl�'�-/a_..I�1!�,�vs��. ..�'''!9- Name(Print) Curr nt Mailing Address Signature Telephone SECTION 3-ESTIMATE STRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 7S-ov (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 __... 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) .. ...... .... .._.. -2 X R r-CESS 5. Fire Protection 6. Total=(1 +2+3+4+5) 5"66 Check Number Ltrl This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date 25 COLES MEADOW RD BP-2016-0642 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 13 -073 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2016-0642 Project# JS-2016-001072 Est. Cost: $7500.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: TRUCK CRANE SERV INC 074442 Lot Size(sq. 1): 501462.72 Owner: NEW ENGLAND DEACONESS ASSOC Zonine: Applicant. TRUCK CRANE SERV INC AT. 25 COLES MEADOW RD Applicant Address: Phone: Insurance: 20 FAIRFIELD AVE (413) 562-9465 WC WESTFIELDMA01085 ISSUED ON.11 1612015 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMOLISH (2) GARAGES 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 Sienature: FeeType: Date Paid: Amount: Building 11/6/2015 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner