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10D-040 (2) File # BP- 2011 -1048 t :g8A afl- APPLICANT /CONTACT PERSON HENRY J SOUZA U� ADDRESS/PHONE 62 SOUTH MAIN ST FLOREN CE (413) 949 -3431 PROPERTY LOCATION 99 WATER ST MAP l OD PARCEL 040 001 ZONE URB(I 00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: DEMOLISH SFH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 087984 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION P SENTED: 0 u SE AT(0)J Approved Additional permits required (see below) ©(L �� CZ �"� H 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 /J-� 6 /f6 Signature of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health, Conservation Commission, Department of public works and other applicable permit granting authorities. * Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning & Development for more information. City of Northampton F Building De 212. Main E EwE� Room Qb Northampton MA 01 A phone 413 - 587 -1240 Fa 41 -1 vim APPLICATION TO CONSTRUCT, ALTER, ays DE OLISH A ONE OR TWO FAMILY DWELLING SECTION 1 SITE IMF,RMATION 1.1 Property Address Thi&sectio" -to, be compteted by office qq W a. 5�- . IVIap Lot [lntf l.•ra.sl� cM�. Ol o S S 3 zone O�rerlay4�str(ct EkSt o13U3at. y� _. _ u,. GCB DtstrlcE SECTION '2 - PROPERTY'OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record Lt- G 6� wo n �Vbuh a��. f�' o.•e � Name rint Cur Mail Address: Telephone Signat 2.2 Authorized Agent: — own �-I `J& Zct, _Moot - - Z Igj n VUIa., Sj Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUGTIOf4;COSTS Item Estimated Cost (Dollars) to be Official Use Only completed b permit a licant 1. Building (a} Building Permit Fee - t3 0 0 0 2. Electrical (b) Estirria #ed Total Co §t of Construction from 6 3. Plumbing Building Permit Pee 4. Mechanical (HVAC) 5. Fire Protection - 6. Total= (1 +2 +3 +4 +5 T7 9 Check This Section For Official Use Oni Building Permit Number: Date Issued Signature: Building Commissioner /Inspector o.f Buildings Date v Section 4. ZONING All Information Must Be Completed. Permit Qn R Due To Incomplete Information Existing "" proposed -1 Required by zoning This column to be filled in by { Building Department Lot Size ������ ' t Fronta a i Setbacks Front r --- Side L: - = --- R: L: R:= Rear Building Height (- --1 Bldg: Square Footage % Open Space Footage / (Lot area minus bldg & paved p arkin g) # of Parking Spaces Fill: 1 volume & Location A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DONT KNOW YES 0 IF YES, date issued: e IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW F — �YES 0 IF YES: enter Book Pag and /or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 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 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 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 0 NO Q IF YES, then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5- DESCRIPTION OF''PROPOSED WORK (check all aoaltci tel New House ❑ Addition Replacement Windows Alteration(s) Rooting ED Or Doors E3 Accessory Bldg. El Demolition New Signs [0] Decks [Q Siding [p] Other [o] Brief Descnp�ion of Propos d Work: VQMn\t�� Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 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? d. Proposed Square footage of new construction. Dimensions 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 k. Will.building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a - OWNED AUTHORI7.ATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APRLIES FOR B[ JI[DING I ' as Owner of the subject property hereby th ze to act o m behalf, in all ative to work authorized by this building permit application. Slg atu of Owner Date 7 OUZ.0" , as Owner /Authorized Agent fiereby heclare 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. v,h A n 7 Is Print Name t C ut Sign of Owner /A ent Date SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor Not Applicable ❑ Name of License Holder o fey, L. � V' .JZ� 0 � Z c ( 8 — 1. License Number Address Expiration Date - 3 Li et at re Telephone ep Not Applicable ❑ -1 Sa✓?A —t �d j t 3 _Company Name Registration Number cep 5OVA� �P� WAvL. Address Expiration Date Telephone Lt L3 4lf4 ^3`f3 S.ECTION'{0 WQ�tICERS' COMPENSATION INSt1RAMCE AFFIDAVIT (M.� L. c. 152,.§ 2SC(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...... ❑ 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 Official 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 The Commonwealth ofAlassachusetts Department oflndustrial Accidents Office of InvestigationS 600 Washington Street Boston, MA 02111 { www.mass gov/dia -Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibIy Name (Business orgmizadon/Individual): 1 1 5 C V-Z- Address: •n- CityJStateJZip: %.e A!1.. OA o(ooZ Phone_ #: Are you an employer ?.Check the appropriate'boz: Type of r project ._ ai general contractor and I p ] ( eQ!m' =. L ❑ I am a employer with 4 ❑ I a 6. [] New copstcuction, employees (fall and/or part-time). * have Mired the soli- contractors listed on the sheet 7• 2_�.I am a •sole piop etor or pmt=- Remade ❑- . � ship mod. have to �pioye These std- contractors have 8. Demolition working for me in any capacity euloyees- and.lsave wo>3rs'. a�dioin [Na worlds' etF iasiaance _ . aaup. incrrranrr # : _ - :..... required l] 5 . ❑ We are a corpoiation and its 10 [� Electacai repairs or additions 3. ❑ I am a homeowner doing all work officers havrxercised their I1.[] Plumbing repairs or additions myself- [No workcis' comp. right t3f exemption per MGL 12 1Loof a Q. rep irs - insurance required .1 t c: 152, §1(4), and'we have no . curployees. [No workers' 13.[] Other comp. insurance required l. •Any agplirrnt ahat clteda box #1-mustolso fin out the section blow showing tb**ork='- on polecy i*rmatioa - t Homeowaers �vho submit this affdai it:indicatmg they am doing all wrack and they -hire outside contractors must submit am affilavit mdicatmg su Zcontractors that cbeck this box mvstattached an additional sbeetshowmg the== of the sub - contractors and stattwhcd=arnotaam- emit. have employees. If the sub - collectors bane employees, they must provide d= vvmiazs' comp..po5cy namber J am an employer that s providing workers' compensation insurance for m employees Below is the policy and job site informoxion. h aurancc Company Name: . Policy # or. Setif ins. Lic # — _ Expiration Daw. Job Site Address: City/StafcJZip: . Attach a copy of the workers'' compensation policy.declarai�on p e'(showing the ppLcynumber aad:ezpiratioa date). es Failure . tb secure coverage.as required nrider,Seafivn "23A ofmu c_' J 'S2 can Igad to me mositiori "of ctimi�I penalti of a fine up to S 1 and/or on e-year as, well as civil .penalties in the .foffi of t STOP NKQ ands a L e of up ta.$250.00 a day against the violator. Be advised that a copy of tlus statement array b foi�varded to the d�o herel5y certify under the earns an�fponaltieswo pegwy.that the informatwn provtdedsibav _a 0 Phone #: (4 ( 9 V 31 Fealt e ant Do xot write in this area, to be co feted b or t own a rcraL y y � ff wn: Pexmit(Lfcense.# thority (circle one): Health I Building Department 3. City/Town Clerk . 4• Electrical Inspector 5. PIumbing Inspector son: Phone #: HOME OWNER EXEMPTION ACKNOWLEDGEMENT 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 owns a parcel on which he/she resides or intends to be, a one or two family dwelling, attached 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." The building. department for the City of.Northampton wants persons) who: seek to use the fionre owirer eXemption;4 act as own constraction supervisor to` be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection. process requires that.the.building department be called to inspect work at various stages, which include foundation /footings (before backfill), sonotube holes (before pour), a rough building insvection.(before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure. to secure these insuections can result in hil re to obtain a certificate of occupancy until the work can be insyected. If the homeowner hires other trades to perform: work (electrical, plumbing & gas) -the homeowner will be responsible to make sure that the trades hired secure their proper 11 �ierints inc onjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made understand the above. .(Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued tome: Date Address of work location Nv�,�,..�.- ► `fi a � si �"+ � '� � r f ' � LoT tv � -ado Lo o 17 fi t 7 t 3a 4l-� r . L ! 0 Ito Pro ?O - sx,C1 1 � i i r ! too r , qo L10 Mai Green Environmental Consulting, LLC 296 Sylvester Road • Florence, MA, 01062 • Tel /Fax (413) 341 -3418 June 2, 2011 Donna Hoener 99 Water Street Leeds, MA 01052 Re: Pre - demolition Asbestos Survey 99 Water Street Leeds, MA Dear Mrs. Hoener: At your request, Green Environmental Consulting, LLC (GEC) performed a pre - demolition asbestos survey of the building located at 99 Water Street in Leeds, Massachusetts (hereafter referenced as the "building "), Fieldwork associated with the survey was performed on May 24, 2011. Background The building consists of a one - story, residential structure with a crawlspace below. Interior finish materials include linoleum sheet flooring, pressboard ceiling paneling and wall paneling. Exterior finish materials include vinyl windows, pressboard siding and asphalt -based roofing shingles. GEC understands that 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. 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 by weight are considered to be asbestos - containing materials (ACM's). Refer to Attachment No. 1 for laboratory results, including detailed description of sampling locations, as well as chain -of custody records for samples collected. No asbestos - containing materials (ACM's) were identified during GEC's inspection. GreenEnvironmentalConsulting .corn Pre - demolition Asbestos Survey 99 Water Street, Leeds, MA Page 2 The following materials were sampled and determined not to be asbestos - containing materials (less than one - percent asbestos by weight): Material Location(s) Representative Semple(s) White Linoleum and associated 1st Floor- Kitchen 00396 -01A, 01B, 02A & 02B Adhesive Brown Construction Adhesive Throughout 1st Floor- 00396 -03A & 03B associated with Wall Paneling Pressboard Ceiling Throughout 1st Floor 00396 -04A & 04B Sheetrock Garage 00396 -OSA & 05B Joint Compound Garage 00396 -06A & 06B Roofing Shingle -Layer 1 Roof 00396 -07 Roofing Shingle -Layer 2 Roof 00396 -08 Roofing Shingle -Layer 3 Roof 00396 -09 Roofing Shingle -Layer 4 Roof 00396 -10 Roofing Paper Roof 00396 -11 Pressboard Sheathing Exterior -under Siding 00396 -16A White w /Blue Linoleum 1st Floor -Bath 00396 -17 Pre - demolition Asbestos Survey 99 Water Street, Leeds, MA Conclusions /Recommendations No asbestos - containing materials (ACM's) were identified during GEC's inspection. Any suspect asbestos - containing material that is discovered during building 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 Adam Lesko MA Inspector Lic #A1073071 Pre - demolition Asbestos Survey 99 Water Street, Leeds, MA Page 3 Limitations This report is intended for the sole use of Donna Hoener. 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 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. Other unidentified ACM's may be located within walls, ceiling cavities, below flooring or grade, and other non - accessible areas. Caution should be used during any 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. GEC's asbestos inspection was also limited to include analysis of samples using only Polarized Light Microscopy (PLM). 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. 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. EMSL Analytical, Inc, 200 Route 130 North, Cinnaminson, NJ 08077 Phone: 1800) 220 -3675 Fax: (856) 786 -5974 Email: westm ontasblab ( , EMSL .com Attn: Adam Lesko Customer ID: GECL78 Green Environmental Consulting, LLC Customer PO: 296 Sylvester Road Received: 05125/11 11:50 AM Florence, MA 01062 EMSL Order: 041113004 Fax: (413) 341 -3419 Phone: (413) 341 -3418 EMSL P rot: Project: 99 WATER STREET, LEED, MA/00396/PRE- DEMOLITION ASBESTOS SURVEY Analysis Date: 513112011 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 00396 -01A KITCHEN - White 30% Cellulose 65% Non - fibrous (other) Noce Detected 041113W4-0001 WHITE Fibrous 5% Glass LINOLEUM Heterogeneous 00396.016 KITCHEN - White 30% Cellulose 65% Non - fibrous (other) None Detected 041113004.0002 WHITE INOLEUM Fibrous 5% Glass Heterogeneous 00396 -02A KITCHEN - Tan 100% Non - fibrous (other) None Detected 04 1 1 13004-0003 LINOLEUM Non - Fibrous ADHESIVE Homogeneous 00396 -02B KITCHEN - Tan 100% Non - fibrous (other) None Detected 041113004-0004 LINOLEUM Non - Fibrous ADHESIVE Homogeneous 00396 -03A LIVING ROOM - Brown 100% Non - fibrous (other) None Detected 041113004 -0006 BROWN Non - Fibrous CONSTRUCTION Homogeneous ADHESIVE 00396 -03B HALL - BROWN Brown 100% Non - fibrous (other) None Detected 041113004 -0006 CONSTRUCTION Non - Fibrous ADHESIVE Homogeneous 00396 -04A LIVING ROOM - Tan 98% Cellulose 2% Non - fibrous (other) None Detected 041113004-0007 PRESSBOARD Fibrous CEILING Homogeneous Initial report from 05/31/2011 22:15:21 Analyst(s) Nancy Staaer (20) Stephen Siegel, CIH, Laboratory Manager or other approved signatory EMSL maintains liability limited to the cost of analysis. This report relates only to the samples reported above 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. The test results contained within this report meet the requirements of NELAC unless otherwise specified. Samples received in good condition unless otherwise noted. Samples analyLed by EMSL Analytical, Inc. Cinnaminson, NJ NVLAP Lab Code 10104", AIHA-LAP, LLC -IHLAP Lab 100194, NYS ELAP 10872, NJ DEP 03036 Test Report PLM- 7.23.0 Printed: 5/31/2011 10:15:21 PM 1 EMSL Analytical, Inc. 200 Route 130 North, Cinnaminson, NJ 08077 Phone: 1600) 220 -3675 Fax: (856) 786 -5974 Ernail: west Attn: Adam Lesko Customer ID: GECL78 Green Environmental Consulting, LLC Customer PO: 296 Sylvester Road Received: 05/25/11 11:50 AM Florence, MA 01062 EMSL Order: 041113004 Fax: (413) 341 -3419 Phone: (413) 341 -3418 EMSL Proj: Project: 99 WATER STREET, LEED, MA/ 00396/ PRE - DEMOLITION ASBESTOS SURVEY � p� Is Date: 5/31/2011 Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R- 93/116 Method using Polarized Light Microscopy Nort- Asbestos Asbestos Sample Description Appearance % Fibrous % Non - Fibrous % Type 00396 -04B SOUTHEAST Tan/White 90% Cellulose 10% Non - fibrous (other) None Detected 041113"-"B BEDROOM - Fibrous PRESSBOARD Homogeneous CEILING 00396 -05A GARAGE- Brown/White 20% Cellulose 80% Non - fibrous (other) None Detected 041113004 -0009 SHEETROCK Fibrous Heterogeneous 00396 -05B GARAGE- Brown/White 20% Cellulose 80% Non - fibrous (other) None Detected 041113W4-0010 SHEETROCK Fibrous Heterogeneous 00396 -06A GARAGE- White 100% Non - fibrous (other) None Detected 041113W4 SOUTH WALL - Non - Fibrous JOINT Homogeneous COMPOUND 00396-06B GARAGAE- White 100% Non - fibrous (other) None Detected 041113004-0012 NORTH WALL - Non - Fibrous JOINT Homogeneous COMPOUND 00396 -07 ROOF - LAYER 1 - Black 30% Cellulose 70% Non - fibrous (other) None Detected 041113004 -0013 ROOFING Fibrous SHINGLE Heterogeneous Initial report from 05/31/2011 22:15:21 Analyst(s) Nancy Stater (20) Stephen Siegel, CIH, Laboratory Manager or other approved signatory EMSL maintains liability limited to the cost of analysis. This report relates only to the samples reported above 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. The test results contained within this report meet the requirements of NELAC unless otherwise specified. Samples received in good condition unless otherwise noted. Samples analyzed by EMSL Analytical, Inc. Cinnaminson, NJ NVLAP Lab Code 101048-0, AIHA -LAP, LLC -IHLAP Lab 100194, NYS ELAP 10872, NJ DEP 03036 Test Report PLM- 7.23.0 Printed: 5/31/2011 10:15:21 PM 2 EMSL Analytical, Inc. 200 Route 130 North, Cinnaminson, NJ 08077 Phone: (800) 220 -3675 Pax: (856) 786 -5974 Emai4 w estmontasbfab40 ,115Lcom Ann: Adam Lesko Customer ID: GECL78 Green Environmental Consulting, LLC Customer PO: 296 Sylvester Road Received: 05/25/11 11:50 AM Florence, MA 01062 EMSL Order: 041113004 Fax: (413) 341 -3419 Phone: (413) 341 -3418 EMSL Proj: Project: 99 WATER STREET, LEED, MA! 003961 PRE - DEMOLITION Analysis Date: 5/31/2011 ASBESTOS SURVEY Test Report: Asbestos Analysis of Bulk Materials via EPA 600/R- 931116 Method using Polarized Light Microscopy Non - Asbestos Asbestos Sample Description Appearance % Fibrous % Nan- Fibrous % Type 00396 -08 ROOF - LAYER 2 - Black 30% Cellulose 70% Non -fibrous (other) None Detected 041113004.0014 ROOFING Fibrous SHINGLE Heterogeneous 00396.09 ROOF - LAYER 3 - Black 25% Cellulose 75% Non - fibrous (other) None Detected 041113004 -0015 ROOFING Fibrous SHINGLE Heterogeneous 00396-10 ROOF- LAYER 4 - Black 25% Cellulose 75% Non - fibrous (other) None Detected 041113004-0016 ROOFING Fibrous SHINGLE Heterogeneous 00396 -11 ROOF - Black 65% Cellulose 35% Non-fibrous (other) None Detected 041113004 ROOFING PAPER Fibrous Homogeneous 00396 -16A EXTERIOR Brown 98% Cellulose 2% Non - fibrous (other) None Detected 041113004 -0018 EAST - Fibrous PRESSBOARD Homogeneous SHEATHING 00396-16B EXTERIOR Brown 98% Cellulose 2% Non - fibrous (other) None Detected 041113004 -0019 NEST - Fibrous PRESSBOARD Homogeneous SHEATHING 11nitial report from 05(31(2011 22:15:21 l� Analyst(s) Nancy Staker (20) Stephen Siegel, CiH, Laboratory Manager or other approved signatory EMSL maintains liability limited to the cost of analysis. This report relates only to the samples reported above 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. The test results contained within this report meet the requirements of NELAC unless otherwise specified. Samples received in good condition unless otherwise noted. Samples analyzed by EMSL Analytical, Inc. Cinnaminson, NJ NVLAP Lab Code 101048 -0, AIHA- AP, LLC -IHLAP Lab 100194, NYS ELAP 10872, NJ DEP 03036 Test Report PLM- 7.23.0 Printed: 5/31/2011 10:15 :21 PM 3 EMSL Analytical, Inc, 200 Route 130 North, Cinnaminson, NJ 08077 Phone: (800) 220 -3675 Fax: (856) 786 -5974 Email: westmontasblabCg'EMSL.conn Ann: Adam Lesko Customer ID: GECL78 Green Environmental Consulting, LLC Customer PO: 296 Sylvester Road Received: 05/25/11 11:50 AM Florence, MA 01062 EMSL Order: 041113004 Fax: (413) 341 -3419 Phone: (413) 341 -3418 EMSL P Project: 99 WATER STREET, LEED, MAI00396/ PRE- DEMOLITION ASBESTOS SURVEY Analysis Date: 5/31/2011 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 00396 -17 BATH - WHITE White/Blue 10% Cellulose 60% Non - fibrous (other) None Detected 041113004-W20 W/ BLUE Fibrous 30% Synthetic LINOLEUM Heterogeneous Initial report from 05/31/2011 22:15:21 Analyst(s)� Nancy Stater (20) Stephen Siegel, CIH, Laboratory Manager or other approved signatory EMSL maintains liability limited to the cost of analysis. This report relates only to the samples reported above and may not be reproduced, except in full, without written approval by EMSL. EMSL beam 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. The test results contained within this report meet the requirements of NELAC unless otherwise specified. Samples received in good condition unless otherwise noted. Samples analyzed by EMSL Analytical, tnc. Cinnaminson, NJ NVLAP Lab Code 101048-0, AIHA -LAP, LLC -IHLAP Lab 100194, NYS ELAP 10872, NJ DEP 03036 Test Report PLM- 7.23.0 Printed: 5/31/2011 10:15:21 PM THIS IS THE LAST PAGE OF THE REPORT. 4 041113004 4V1113OOY Pa 1 of 3 lysis Type: Asbestos Chain of Custody r Record rumaround Time: -Week Green Environmental Consulting, LLC 296 Sylvester Road Florence, MA 01062 Protect Info: Send Results To: project Name: Invoice to: Resu to: 9 Water Street, Leeds, MA dam Lesko do Lesko Number. alum Samples?. Emai to: 0396 o ieski agecenviro.com Project Description: comments/Special Mon, Instructions: 413) 41 -3418 Pre-demolition Asbestos Survey Fax: 413) 41 -3418 Sample Number Sample Location Sam . Description 00396 -OIA Kitchen White UnoleLn 00396 -01B Kitchen White Linole 00396 -02A Kitchen Linoleum Ad sive 00396 -02B Kitchen Linoleum Ad siveR?' 00396 -03A Living Room Brown Constr iction AdMEsive 00396 -03B Nall Brown Constriction Adhesive 00396 -04A Living Room Pressboard C4 iling 00396 -04B Southeast Bedroom PressbdWId FO 00396 -OSA Garage Sheetrock Sa I By: Date: Received By: Date /Time: << / Reli fished By: Date /Time: Received in Lab By: Date/Time: 041113W4 PaGe2of 3 r ul� lysis Type: Asbestos Chain of Custody Record r urnaround Tune: -Week Green Environmental Consulting, LLC 296 Sylvester Road Florence, MA 01062 Project Info: Send Results To: Project Name: Invoice to: Resu to: 9 Water Street, Leeds, MA dam Lesko do Lesko oject Number. etum Samples?: Emal to: 0396 o lesk ecenviro.com Project Description: Comments /Special Phon : P re-demolition Asbestos Survey Instructions: 413) 41 -3418 Fax 413) 41 - 3418 Sample Number Sample Location Sam I Description 00396 -OSB Garage Sheetrock 00396 -06A Garage -South Wall Joint Compou id C= 00396 -06B Garage -North Wall Joint CompoL id -r 00396 -07 Roof -Layer 1 Roofing Shin 00396 -08 Roof -Layer 2 Roofing Shin Cr 00396 -09 Roof -Layer 3 Roofing Shin 00396 -10 Roof -Layer 4 Roofing Shing e t =- y ,1 00396 -11 Roof Roofing Pape —i U' r 00396 -16A Exterior East Pressboard St Bathing r' Z Sam I By: ate: Received By: Date /Time: �F Reli shed y: a /Time: Received in Lab By: Date/Time: 1V , N 041113M Pa 3 of 3 0�1i // 3 0o y Nsis Type: Asbestos Chain of Custody LM Record T urnaround Time: -Week Green Environmental Consulting, LLC 296 Sylvester Road Florence, MA 01062 Project Info: Send Results To: Project Name: Invoice to: Resu to: 9 Water Street, Leeds, MA dam Lesko do Lesko Number. etum Samples?: Emal 0396 To lesk gecenviro.com Project Description: Comments/Special Phon : Pre-demolition Asbestos Survey instructions: 413) 41 -3418 Fax: 413) 41 -3418 Sample Number Sample Location Samok i Description 00396 -16B Exterior West Pressboard St eathing 00396 -17 Bath White w /Blue Linoleum , C") �. Mt zz CIt - C!' C/) Zy D rt n U: DCn r a . ; Z -k n Sa By: ate: Received By: Date/Time: m : J Reli fished y' 4at e�T im e: Received in Lab By: Date /Time: nationaigrid 40 Sylvan Rd Waltham MA 02451 May 23, 2011 Donna Hoener 99 Water St Leeds, MA RE: Service Removal for Building Demolition. Dear Mrs. Hoener, This letter is to confirm that, per your request, National Grid has confirmed that there is no electrical service going to the building located at 99 Water St Leeds, MA as of 5/20/11. If you have any questions or need further assistance, please feel free to contact me at (508) 357 -4519. S'rf erely, i ngelic utler Order Processing Representative Customer Order Fulfillment ph # 508- 357 -4519 fax # 315- 460 -9149 angelic.butler @us.ngrid.com CDlumffi Gas- of Massachusetts A NiSource Company 2025 Roosevelt Avenue ' P.O. Box 2025 Springfield, MA 01102 -2025 i i Date: w i ; To Whom It May Concern: �! �i i The address listed below has had the gas service(s) i disconnected and is now ready for demolition. i u ADDRESS: CIC7 iC;?� 1 TOWN: i STATE: Massachusetts Sincerely, 1 i 1 Maintenance Administrator Integration Center Columbia Gas Of Massachusetts 413 -781 -9200 Ext 2115 i i CITY OF NORTHAMPTON, MASSACHUSETTS DEPARTMENT OF PUBLIC WORKS 125 Locust Street Northampton, MA 01060 -2066 413 - 587 -1570 Fax 413 - 587 -1576 Edward S. Huntley, P.E Director June 14, 2011 Louis Hasbrook, Building Inspector Municipal Office Annex 212 Main Street Northampton, Ma 01060 Dear Mr. Hasbrook: The water service at 499 Water Street has been shut at the curb stop and the water meter has been removed from the premises as of 10/23/2002. Please contact me if you have any questions. cerely, David Sparks Superintendent of Water Cc: Ned Huntley, Director of Public Works Jim Laurila, City Engineer CITY OF NORTHAMPTON Construction Debris Affidavit In accordance with the provisions of MG.L. c. 40 § 54, all debris resulting from any work covered by a Building Permit shall be disposed of in a properly licensed disposal facility, as defined by M.G.L. c. 111 § 150A. Address of Work: u L , , S � Q. kc" The debris will be transported by: W a- ' �4 V', -e VkQ cA4 The debris will be received at: Ooz�L Uu &� Signature of Permit Applicant } t/ Date Building Permit Number: l 7 f9 T . x i L o J C? K 4-1 0 PO