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32A-072 (11) 19 UNION ST BP-2016-1511 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:alock: 32A-072 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category:demolition BUILDING PERMIT Permit# BP-2016-1511 Project# JS-2016-002578 Est.Cost: $10000.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DANIEL HEWINS 049714 Lot Size(sq. It.): 9365.40 Owner: MCDERMOTT BRIAN&ZOE PAPPENHEIMER Zoniogl URC(l00)/ Applicant: DANIEL HEWINS AT: 19 UNION ST Applicant Address: Phone: Insurance: P O BOX 186 (413) 582-9929 C H ESTERFI E LDMA01012 ISSUED ON:6/24/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMOLITION/REMOVAL OF GARAGE/BARN 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 U 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: FeeTvoe: Date Paid: Amount: Building 6/24/2016 0:00:00 $65.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner File 4 BP-2016-1511 APPLICANT/CONTACT PERSON DANIEL HEWINS ADDRESS/PHONE P O BOX 186 CHESTERFIELD (413)582-9929 PROPERTY LOCATION 19 UNION ST MAP 32A PARCEL 072 001 ZONE URC(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid CX.0.L Li i 6g Building Permit Filled out Fee Paid Typeaf Construction: DEMOLITION/REMOVAL OF GARAGE/BARN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 049714 3 sets of Plans/Plot Plan THE FLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN MATION 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 /1"--2------1) GPz3/1 6 Signare 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. lrDepartment use only • City of Northampton Status of Permit it Ic Building Department• Curb Cut/Driveway Permit212 Main Street Sewer/Septic Availability _ '. Room 100 Water/Well Availability _._ Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 PicNSite Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: (' This section to be completed by office kit/ 10r/ al r, Map Lot Unit Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Pg. / Ad M` DER, ^loir s of PAPnEJNEIr1E/Z St.�.E Name(Print) Current Mailing Address: (5//' 'kcal? Telephone Signature ql7) s3Q _ s6Lz 2.2 Authorized Agent: pAr-'l &L, 146vtf 1'o9ot Ie6 CHESTER;iEaDy /NA Name(Print) 'p'� Current Mailing Address: -i- - t14))) 1- • I46) b1 on - Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building O r Dao i (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit Fee [� 4. Mechanical (HVAC) J 5 Fire Protection 6. Total=(1 +2+3+4+5) f oy 000 — Check Number 19,14-5 L This Section For Official Use Only Building Permit Number: Date Issued: Signature:Signature: Building Commissionerllnspector of Buildings Date Section 4. ZONING ALL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column:o 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 _. parkins) _.. #of Parking Spaces - — Fill: (volume&location) - - A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW '� YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW O YES IF YES: enter Book Page and/or Document ft B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW O YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO IF YES, describe size, type and Location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO er IF YES, describe size, type and location: E. WII the construction activity disturb(clearing,grading,excavation, or filling)over 1 acre oris it part of a common plan that will disturb over 1 acre? YES © NO ®' IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House n Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ ,--,( Sr Doors O Accessory Bldg. 0 Demolition I New Signs [C] Decks IP Siding[C] Other[CI Brief Description of Proposed � Work lrnoLlrlor'J R&nto VAL OF GAQPGE ' C Alteration of existing bedroom Yes ✓ No Adding new bedroom Yes. ✓ No Attached Narrative Renovating unfinished basement Yes it No Plans Attached Roll -Sheet ea. If New house and or addition to existing housing, complete the following: a. Use of building: One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? r I A d. Proposed Square footage of new construction. Dimen •ns e Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade It Will building conform to the Budding and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, Pg I Ari "CDERhDl1 as Owner of the subject property t , hereby authorize EL N f"t'i PIS to act on my behalf, in all matters relative to wo panZEO-may is building permit application. Gto I l6 Signature of Own II11 �� Dae S ]/ M/ I EL r E w/1'11 TAas Owner/Authorized A,geent 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. DANIEL HE 'l, 1fS Print Name \ 1 ' 6 -a- / 16 Signature of OwnerrAgent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: ( Not Applicable/ ❑ D Name of License Holder: ARIq L r 1 r�Ewl PI J 0'F q 7 ( 4 License Number p. o . Aaf 196 GAtESI ep c1ELy 0i0,1 512.o /( 9 Address Expiration Date SignatureTelephone n ---7 .\71 =7 1" Co 1461 9. Registered Home Improvement Contractor: Not Applicable 0 ( 77 691 Company Name Registration Number PArtift_ HE " ir4$ 112,4 II9 Address Expiration Da SF ^` `` Telephone SECTION 10-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 I17 No C 11. — Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is.or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner'shall submit to the Building Official,on a form acceptable to the Building Offieial,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature N/( A The Commonwealth of Massachusetts e Department of Industrial Accidents -;I Office ofInvestigations I Congress Street, Suite 100 �— Boston, MA 02114-2017 twww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ' 1 Please Print Legibly Name Business/Organization/lndividual) DI Pr I F L Li E wl t'1 S Address: f Bo$ City/State/Zip: CHfSr6/LFfELP ova Phone#: 1S0 • [ il61 Are you an employer? Check the appropriate box: Type of project (required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I loyees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. 11] Remodeling 2.lirraTs a sole proprietor or partner- ship and have no employees These sub-contractors have g. by Demolition j Bat4Dttl G workingfor me in capacity. employees and have workers' any P 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5, ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152,§1(4),and we have no employees. [No workers' I3.111 Other comp..insurance required.] *Any applicantthat checks box 41 must also till out the section below showing their workers compensation policy information. 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 sub-contractors and state whether or not thoseentities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam 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. #: Expiration Date: 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. 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 Investigations of the DIA for insurance coverage verification. Ido hereby certifyt�t r theeppaains and penalties of perjury that the information provided above is true and correct. Signature: C/) / \ T Date: 6 3 1 r6 Phone#: ZSO. 1ki6 ) Official use only. Do not write in this area,to be completed 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. Address of the work: g Vhi Sr The debris will be transported by: P, H E w i +C/ 5 The debris will be received by: %/PL LE y R E Cy 0 L E Building permit number: Name of Permit Applicant _ P !l E L k E `'I? c Chi / I Date Signature of Permit Applicant City of Northampton Massachusetts i ; - rt.:4% J DEPARTMENT OF BUILDING INSPECTIONS ® c W 212 Main street • Municipal Building Northampton, !A 01060 rM' 11 INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME O WN ER.EXEMPTION ACKNO W I EDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. The state defines "Homeowner"as, " Person(s) who own a parcel on which he/she resides or intends to be, a one or two family dwelling, attached or de - ed structures accessory to such use and/or farm structures. A person who constructs mo - than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any p- on(s)who seek to use the home owner exemption, to act as their own construction supervisor, t• •e aware that by doing so you become responsible for compliance with state building •des and regulations. The inspection process requires that the building department be called t• spect work at various stages, which include foundation/footings (before backfill). sonotube hal: (before pour), a rough building inspection (before work is concealed), insulation insoecti• • (if reauired)and a final building inspection The building department requires these inspectio' before the work is concealed, failure to secure these inspections can result in failure too• .in a certificate of occupancy until the work can be inspected If the homeowner hires other trades to p. orm work (electrical, plumbing & gas)the homeowner will be responsible to make sure that the trad: hired secure their proper permits in conjunction to the building permit issued, and that they get the r required inspections. Failure of the individual trades to secure the permits and inspections as re.sired can MAY the project until such time as the proper permits and inspections are made understand the above. (Home owner/reside. 's signature requesting exemption) I will call to schedule al equired building inspections necessary for the building permit issued to me. Date Address of work location : 1 A Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as an individual, partnership, association. corporation or other legal entity, or any two or more of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that""every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and. if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under"Job Site Address"the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 7-2013 www.mass.gov/dia Green Environmental Consulting, LLC 180Pleasant Street 2nd 2nd Floor-Suite 213 tel/fax 413-341-3418 Easthampton,MA 01027 www.GecEnviro.com May 27,2016 Dan Hewins Dan Hewins Construction PO Box 186 Chesterfield. MA 01012 RE: Pre-demolition Asbestos Survey 19 Union Street(Garage) Northampton, MA Dear Mr.Hewins: Pursuant to your request, Green Environmental Consulting, LLC(GEC) performed a pre-demolition asbestos survey of the garage located at 19 Union Street in Northampton,Massachusetts, Fieldwork associated with the project was performed on May 10, 2016 by Massachusetts-licensed Asbestos Inspector,Adam Lesko (License# A1073071). GEC understands that the garage is 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 Nine(9)samples of suspect asbestos-containing materials(ACMs)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 ACMs. The following materials were determined to be asbestos-containing materials(ACMs): Table No.1, Asbestos-containing Materials (ACMs) Material Location Estimated Ouatity Reference Sample Notes Number(s) Rolled Roof 1 Low Roof-East Side 1200 Square Feet 01642-02A&02B Page 1 of 3 Pre-demolition Asbestos Survey 19 Union Street Northampton MA SGaraoe) The following materials were sampled and determined not to be asbestos-containinq materials(less than one-percent asbestos): Table No.2, Non-Asbestos Materials Material Location Reference Sample Number(s). Roof Flashing Tar At Junction of Low Roof and Exterior Wall 01642-01A&O1B Stucco Siding Exterior 01642-03A, 03B & 03C Sheetrock Interior of Garage .01642-044&04B Refer to AttarhmentN9. 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 Dan Hewins Construction. 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. Conclusions/Recommendations Asbestos-containing materials(ACMs)were identified during GEC's inspection. Identified ACMs should be removed. handled, and disposed of properly, in accordance with applicable state and federal regulations,prior to disturbance. 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 Pre-demolition Asbestos Survey 79 Union Street, Northampton,MA (Garage) 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 AL Adam Lesko President Page 3 of 3 EMSL Analytical, Inc. EMSL Order. 131602150 EMSL 7 Constitution Way,Suite 107 Woburn,MA 01801 Customer ID: GECL78 TeVFax:(781)933-8411/(781)933-8412 Customer PO: httplh.nw.EMSL.com/bostonlab@emsl.com Project ID: Attention: Mary McCarthy Phone: (413)341-3418 Green Environmental Consulting, LLC Fax: (413)341-3419 180 Pleasant St Received Date: 05/112016 9:20 AM 2nd Floor,Suite 213 Analysis Date: 05/16/2016 Easthampton,MA 01027 Collected Date: 05/102016 Project: 01642/Nhamp sampling garage demo 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 01642-01A Al Junc4an of Lox Black 4%Cellulose 96%Non-fibrous(Other) None Detected Roof and Exterior Fibrous 131602150-0001 NY[-Roar Flashing Homogeneous 01542-018 At Junction of Low Bleck 4%CSulose 96%Non-fibrous(Other) None Detected Roof and Exterior Non-Fibrous 1316021500002 V.el-Roof Flashing Homogeneous 01642-02A Low Roup-East Side- Black 6%Cellulose 92%Non-fibrous(Other) 2%Chrysote Rolled Roof Fibrous 131e021504003 Homogeneous 01642-02B Low Roof-Westside- Black 5%Cellulose 93%Nonfibrous(Olher) 2%Chrysote Rolled Roof Fibrous 13104215000= Homogeneous 01642-03A Exterior-East-Stucco Gray 100%Non-fibrous(Other) None Detected Siding Non-Fibrous 131421300005 Homogeneous 01642-038 Exterior-Southeast Gray 100%Non-fibrous(Other) None Detected Caner-Stucco Non-fibrous 1316021500000 Siding Homogeneous 01642-03C Exterior-Nath- Gray 100%Non-fibrous(Other) None Detected Stucco Siding Non-Fibrous 13f6021004003 Homogeneous 01642-04A East Side Interior of Brown/WM% 896 Cellulose 92%Nonfibmos(Other) None Detected Garage-Sheetrak Fibrous 13fem150ao Homogeneous 01642-046 South Side Interior of Brown/White 6%Celulose 90%Non-fibrous(Other) None Detected Garage-Sheetrock Fibrous 2%Glass num r5o04ne Homogeneous YC— Matystts) / Michael Mink(9) Steve Grine,Laboratory Manager or Other Approved Signatory EMBLmbMMr meaty oalledbmppeeor a. toe mecnmliiswYybthe pMHea mµNM and mrynx4ae thrSudsibity Moe diem TwNenrtmli eye usedot be se EMSL bunts repud ce.t asmleaa .or end steen1 by%VYmMT limitations.regInterpretationthefal%comse letlreMeveIaryv*,bonnredlea%mem a Pedeimatixby W ,"°a Merit to claim recordend greengxrduerrAaananyys. Sam,es reeivery%gory c NeoNeilnhercfce et sti organic*,W.rprgnonanpatenapotlemma le nwreMe EMSL recommends edet%JIM%materials en s erMac mSdM to mbple M good anle60.wiseso.t,t)Wet Estimated a a VNq,plea ep tit T1 1%data evekede�10yart[Vest requested by the lent dabrp melenYsma'ulWurad IN mlEpb layers kw kMcm.w4�aN,etc)ere reporteda a single svrWe.9epodrg4rA is 1% Samples analyzed by EMSL MIyti al,he.Woburn,MA NV AP Lab Cine 101147-0,CT PH 0315.M4 MWJ1ea RIARL107T3,VTALO19919,Mane Burk Asbestos M0.19 Initial Report From:05/172016 07:5513 Printed:5/17/2016 7.55 AM Page 1 of 1 OrderlD: 131602150 1 3 1 6 0 2 1 5 0 P 1 c ' -1 Analysis Type:age Asbestos Chain of Custody I PLM Record 1 Turnaround rime: - 966 Hour Hour Green Environmental Consulting, LLC 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Protect Info: Send Results To: Project Name: Invoice to: Results to: Nhamp sampling garage demo Vary McCarty cry McCadhy >roject Number: Return Samples?: Email to: 01642 Maryl*gecenviro-com >roject Description: Comments/Special Phone: Instructions: (413) 341-3418 Garage demolition Analyze all Samples Fax: (413) 341-3418 Sample Number Sample Location Sample Description 01642-01A At Junction of Low Roof and Roof flashing Exterior Wall 01642-018 At Junction of Low Roof and Roof flashing Exterior Wall 01642-024 Low Roof-East sloe Rolled root 01642-028 Low Roof-West side Rolled roof 01642-03A Exterior-East Stucco Siding 01642-033 Exterior-Southeast corner Stucco Siding 01642-03C Exterior-North Stucco siding 01642-044 East side interior of garage Sheetrock 1 11#51 ,C4e : 79 5 i Y4/9 / &4't/ rerilli �_ Sampla�ey: Date' Received By: I t _. t lei I -_ CI 4.ole ;;. 11 . --- Relineuished y: Date/Time. Received in Lab By. Date/Time: -4 q,/, (.2. By kl,C, ��__ 14 1- Page 1 Of 2 / of C Or'deriD: 131602150 1 3 1 6 0 2 1 5 0 •, Page 2 tt .4 4nalysls Type: Asbestos Chain of Custody PLM Record ` Turnaround Time: \`` 96 Hour Green Environmental Consulting, LTC 180 Pleasant Street-suite 213 Easthampton, MA 01027 Project Info: Send Results To: Project Name: I Invoice to: Results to: Nhamp sampling garage demo an;McCarthy may McCarthy Project Number: eturn Samples?: Email to: 01642 oryragecenvrocom Project Description: Comments/Special Phone: Instructions: Garage cemohbon (413) 341-3418 Analyze all Samples Fax: (413) 341-3418 Sample Number Sample Location Sample Description 01642-04B South side interior cf garage Sheetrock SamPl Y. Date Received By. D.l4 In leile1rif. ,7 4_+1I 1,t^ _ Reim ished B (� ate,/Time: Received in Lab By 1Date7Tiene:J ) IIC)f6(9l /(�,�By • moi' vnu Page 2 Of 2