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17C-023 hoc- et7og ?Mal ILI CAROLINA CHAIN OF CUSTODY RECORD ENVIRONMENTAL, INC. ASBESTOS/LEAD ANALYsiS 107 New Edition Coon, Cary, NC 27511 0 Tot 446.441.1412; Fas: 914481.1442 m 71 Sr Client: — 2 wE a j' 'eCT Protect i./cS gif y 3 Address: p f w(Q , /4 Phone: 1 113-7e/ -0 40k0 Rut: Yti • '73(1-6414) y EMeit: al efeidr y.Sipe Ave • aim ASBESTOS LEAD PAINT PO �i : p I 0 of OGi 1 TURNAROUND TI PROJECT PROJECT lila I kliik 1 DESCRIPTION a CODE 1 1 ! ! ! . rZT a a u 4i i 1 Lilo! (b 4 I�fack sac. INi*'er C4 N ru ...- {fit.��. , . 17 ti< or Ce + (1 a ► 1 0 3 DAYS I j Q VOWS 1 A ( 4 HOURS* 0 4 HOURS* ' CUM' ID# m w w soon la 6. siermid .110 dari REMARKS: 0 Accep s slim imatiON Wm cillorsis 0 MOW Samples reffaIRMA Refill qu[shed B1r,.( S r j1 j pste G9' , :60 °'� DSN!Time: 0 Relinquished gy , Revoked ay: Mee /Tim: m rct Cha *1 'won 1 urocw , -.ramp I q.....v ill 40g - k70 e d► X181 o q /� �L 17�• /� 4tC.14Q CAROLINA CHAIN OF CUSTODY RECORD ' ru ENVIRONMENTAL, INC. ASBESTOSILF_AD ANALYSIS CD CD t D7 New Ed'itbn Court, Cary, NC 27511 ? ul let a6a•461• Fax; 919 - 461.1442 ' m O count: 7 &td e// S'Aet � 1Sea, ry . 9 Address: F/o(4 vCe 1 /+i Of. Phan.: 'l /3— - ?K1– 00clo . Fax: 5 113- 73q- Y Elio: c� ite4 1 ' ySRP�o L . <W''LASBESTOS LEAD PAINT Poi: 070/ o 4 e 1 TURNAROUND PROJECT PROJECT ii t 1 k )111a1 DESCRIPTION CODE tawTK�r 401 blectl; Poctz , .<<+i.ltes f X fi dr rriptif sy 1 n # L ! 1 1, ' - r+' " - 0 5 DAYS $3 LiFty OaJ GI- i -foi e' Yk.J`' PitWf 0 3 DAYS 4/ q 414i.k float) 3`6 Les CX dr Le Fr i V . . i 0 a9 RS w mot HOURS* its' /,��✓ fag F.N peer d �1 au r-, +arc iv ur e 4r I 0 4 Hauls . N OS tc-O z yt,41rt :v AV, t ✓ cuENrr Di ul ill s'>vt 1AZ 4'X �� is fT 1 t 41441 , IN r/'� (t: 1 r s.ompl.t wIN a dipo..e.f ao cloya ' ' REMARKS: „ Accept &mots 'a". aw% win d. eat.mi.. 1 rewsele Reject Relinquished BY' . 1 At • 7 j . • '41° I , : Rac�rad 1 MO i Thor ul R•iin By: Received BY: Ogee /Tom: m I'ct crunaa .•ann q 44Cocu4M *wino I Q—A) • • JUL -10 -2009 15:01 From: 4137346224 To:4132530799 P.4'6 The foaming de/Widens apply to the abbreviations used In the ASBESTOS BULK ANALYSIS REPORT: CHRY - ClMyioliis CELL * Ceikaose DEER s Debris AMOS s Amelia FBGL s Fibroma Gies BIND Hinder CROC = Credible cACO • Calcium Carbonate 8ILI • Mates TREM s Transom SYNT = 9yntinlice CiRAV s Gravel ANTH Mlhaphyite WOLL - Wolleslortts MAST : Mastic ACTN s AeGiroils CERWL IF Caemla WOO' PLA$ • Plaster N 0 = None Detected NTREM * Non Adis taken PERI. IN Pe Bile NANTH ` FOGY Trainees n RtBR Rubber Anesophylas VER =Vermiculite cLtr NT: Armed Building Wreckers PROS 7 Bardwel Si., Florence, MA co LAS cooe A09 -4708 3teraoaacaiC microscopy and polarized ligfd ;Maracay /coupled silty dispersion Seining is Moe analytical technique used for sample Men on. The percenlape of sad' component is vainlyesllrrlaled by vobnns. These results pertain only to the samples anatyaed. The samples were an■nynsd as aubmtlled by the client and may not be repnesereelhe of Bye larger material in dtues•on. Unless wafted it wrulap lo return samples„ Camino Environmental, Yet: win discard al bulk samples after 30 days. Many vinyl floor Nes have been n miiacl reed using pallor lien 1% asbsslos. Often Bas asbestos was milled to a Ibex steer below the detection indt of paiwked 101 microaccgy. Thsrrforu a "None Detected" (ND) rowing an vinyl weer Elm doss not necessarily side Mee prosaic* of esbsslOs. Tranenission Sadiron on microscopy provides a more sonclrliays farm al analysis for vinyl Roar class. It is codified by Ms signalise below that Camihm EnvlonnaL Inc. is accredited by the National Voluntary Accreditation Program (NVLAP) for the analysis of asbestos in bulk married& The accre iced test mired is EPA / 600 / M482 1 020 for the analysis of a lbedo& in building and rfed& Procedures described in EPA/600 /FM / 118 Moe been incorporated where applicable. The &Median Emil toe that melted is 0.11E (Mace armed). Carotene Envhxmaenm, inr~Rs NVLAP accreditation number is 11017660 This mood is not lo be used lo dam product endowment by NVLAP or ant► agency oldie U. S. GorsrraMOIli. WS report and its canards am o IIy veld %Haan r produced in FM Pust and soil analyses for asbestos wing PI.M ere not unwed under NVLAP>tocreditoBora., ANALYST 65r. eaf°1° 4 Tlaybeyo Bat, PhD. labrnalory End of Report j JUL -10 -2009 15:01 From: 4137346224 To:4132530799 P.3/6 CAAOLSME ITA1,lC Project: 7 Bardwell St- Florence, MA 197 NEN ErllanCout, CA% PC 271911 fI n x 915481.1413 RE: 91ae1 - 4442 Lab Cods: A094708 CEI CLIENT m ID HOMOCIEN frTY DESCRIPTION tAB ASBESTOS 7 A926184 SVEINME121 ND Homogeneous. Ton, Fibrow, Bound CELL 100 8 A926185 WIMQ2 G AZi ND Homogeneous, WNW. NarM>ro s. Loosely Barad CAULK 08% CELL 2 % 9 A926186 NONLOYSIAZINC NO Homogeneous, While, Nan4Raous. Loosely Bound CALL X 985 CELL 2 10 A926187 INALLEMBR NO Homogeneous. Whits. Fibrous. Loosely Bound GYPSUM 065 CELL 55 i 1 A926188 k!!aLLIEtBR ND Homogiou one. Whits: Fibrosis. Loosely Bound GYPBIJM 555 CELI. 8 �G 12 A925189 ROOF TOP ROLLED ROOFING ND homogeneous. Block, Fibrous, Bound TAR 011 S CELL 16 % 13 A926190 =Man= ND Homogeneous, Tan, Fibrous,,, Bound CELL 100 Page 2 JUL -10 -2009 15:01 From: 4137346224 To:4132530799 P.2'6 CAROIDIABNIROMINTIN,NIC. LABORATORY REPORT VA Km EdNoriCast. Oini 021611 AS.EIESTOS BULK ANALYSIS Filogirpel svrea 4 462 Client Associated Building Wreckers CEI Lab Cods: A004708 352 Albany Street Becalmed: 074949 Springfield . MA 01101 Analysed: 07 -10.09 R.portsd: 07 -1040 ProJect: 7 BardweIl SL, Florence, MA Analyst: G Thomas CUBIT m w NQAW�NE1TYDESCRIPTION 1 A926178 BQ4f: SHINGLE ND Homogeneous., Neck, Fibrous. Bound TAR 75 % CELL 20 % GRAV 6 7G 2 A926179 ROOF sH9IGLE ND Homogeneous, Btack, Red, Fibrous. Bound TAR 75 % CELL 20% GRAV 57r. 3 A926180 WINDOW GLAZING ND Homapan.ous, While, Na►4bmus, Loosely Bound CALA.K Os % CELL 2% PAIN' 276 4 A926181 LiSIQUItitIME NO Homogeneous, Grey, B1■ck. Moue. Bound TAR 78% CEI.I. 20 % GRAV 676 5 A926182 BB ND Homogeneous, Ton, Fibrous, Barad TAR 41 % CELL 100 % 6 A926183 SMEMIlliga ND Homogeneous. Gray. Bleck Fibrous, Barad TAR 75 % CELL 20 % GRAV 676 Pap JUL - 10 -2009 15:01 From: 4137346224 To:4132530799 P.1 /6 ;rya;; i. , Associated Building Wreckers, Inc. `_ 352 Albany Street, Springfield, Massachusetts 01105 Jul , big T (413) 732-3179 X22 / (S00) 448.2822 X22 byill.10X ; `)�- FAX: (413) 734 -6224 r � .� .. \ 07/10/2009 1 EMA.U� Jbeaudrysr@aol.com FACSIMILE TRANSMITTAL SHEET TO, PROM: James Beadle James A.. Beaudry COMPANY: DATE: Eagle Crest Property Management JULY 10, 2009 PAX NUMBER.: TOTAL. NO. OP PAM] INCLUDING COVI!R: (413) 253 -0799 6 PHONE NUMU R: (413) 256 -3442 um 7 Bardwell Street Florence, Ma. ( ASBESTOS SURVEY ) 0 URGENT [IPOR REVIEW ['PLEASE COMMENT ❑ PLEASE REPLY ❑ PLEASE RECYCLE NOTES /COMMENTS: ATTACHED YOU WILL FIND A COPY OF ASBESTOS SURVEY ON THE ABOVE PROJECT. IF YOU HAVE ANY QUESTIONS OR REQUIRE ADDITIONAL 1 t 0 RMATION, PLEASE FEEL FREE TO CONTACT ME o CTLY ANKS ames A. Beau The document(s) accomp g this telecopy transmission contain information from the office of Associated Building Wreckers, Inc., which is confidential, and/or legally privileged. The information is intended only for the use of the individual or entity named on this transmission sheet. if you are not the intended recipient, you are hereby notified char any disclosure, copying, distribution, or the taking of any action in reliance on the contents of this transmittal is strictly prohibited and that the document should be returned to this Company immediately. C,\ Doctnncnta and Sctrfipp \JamcsUkalctnplABVAAIlW_FAXCOVi RSHVIET,doe • • JAMES FLEMING Invoice Electrical Contractor 7 Meadowood Drive Number: 4931 South Hadley, MA 01075 (413) 533 -5076 Date: July 21, 2009 Bill To: Work At: Eagle Crest Property Management 5 -7 Bardwell St. 73 Main St. Northampton, MA Amherst, MA 01002 JUL U 2009 Job Name Terms Project Issue Number 4883 10 Days minor electrical Description Quantity Price Each Amount Service call to assure that all electrical power to garage has been disconnected first hour labor rate 70.00 additional labor hours 1.00 50.00 50.00 You may allow this invoice to serve as confirmation that power has been disconnected to garage. Thank you Total $120.00 r dt ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDD/YYYY) 6/19/2009 PRODUCER phone: 413 - 538 - 7444 Fax: 413 - 536 - 6020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION James J. Dowd & Sons ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 14 Bobala Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 1300 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Holyoke MA 01041 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURERA:Commerce Insurance Company 34754 Associated Building Wreckers, Inc. INSURERS: 352 Albany Street Springfield MA 01105 INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE DATE (MM/DD /YYl DATE (MM/DD /YYl GENERAL LIABILITY EACH OCCURRENCE $ DAMAGETO RENTED -- COMMERCIALGENERALLIABILITY PREMISES(Eaoccurence) , $ _ CLAIMS MADE OCCUR MED EXP (Any one person) $ PERSONAL &ADVINJURY _ $ GENERALAGGREGATE _ $ GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS - COMP /OPAGG $ _ — POLICY PRO- LOC JECT A AUTOMOBILE LIABILITY ZP4610 4/22/2009 4/22/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1, 0 0 0, 0 0 0 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) X Broadened PROPERTY DAMAGE Pollution (Peraccident) $ GARAGELIABILITY AUTOONLY- EAACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACH OCCURRENCE _ $ OCCUR CLAIMS MADE AGGREGATE _ $ _ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU- OTH- TORYLIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPRIETOVPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L DISEASE - EA EMPLOYEE $ If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS Job: Garage Demo, 7 Bardwell Street, Florence, MA Eagle Crest Property Management & City of Northampton are Additional Insureds on the Auto Policy per written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER Eagle Crest Property Management WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE 73 Main Street CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Amherst MA 01002 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIV ," 4007, /II* , ACORD 25 (2001 /08) 0 ACORD CORPORATION 1988 • . ; ti IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 -S (2001/08) 2 of 2 #S55303/M51750 ' ' Client#: 27633 ASSBU1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE NYYY) 6/19 /2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chittenden Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1391 Main Street, 3rd Floor HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield, MA 01101 413 781 -6871 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Steadfast Insurance Co Associated Building Wreckers, INC INSURER a American International 352 Albany ST INSURER C: Springfield, MA 01105 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRC DATE (MM /DD/YY) DATE (MM /DD/YY) A GENERAL UABIUTY GL0586686404 03/15/09 03/15/10 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $100 000 PRFMISFS (Fa occurrence) _ CLAIMS MADE n OCCUR MED EXP (Any one person) $10, _ X PD Ded:10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 7 POLICY n JECT [1 LOC AUTOMOBILE LIABILITY — COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT_ $ _ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY SE0903618301 03/15/09 03/15/10 EACH OCCURRENCE $5,000,000 _ Id OCCUR I 1 CLAIMS MADE AGGREGATE $5,000,000 _ $ _ DEDUCTIBLE _ $ _ X RETENTION $ 10000 $ B WORKERS COMPENSATION AND 005855045 02/01/09 02/01/10 WC ! IMIT oTH- T ORY I IMITR X Ffl EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $1 ,000,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $1,000,000 II yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT _ $1 ,000,000 A OTHER Pollution CPL903860902 03/15/09 03/15/10 $1,000,000 each claim $2,000,000 total all claims DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS RE: garage demo, 7 Bradwell ST, Florence, MA Certificate Holder and the City of Northampton are named as additional insureds under general liability as required by written contract for work performed by insured subject to terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION 10 Days for Non - Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Eagle Crest Property Management DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL an DAYS WRITTEN 73 Main ST NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Amherst, MA 01002 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REP ACORD 25 (2001/08) 1 of 2 #555303/M51750 !�. (2/'o MEH 0 ACORD CORPORATION 1988 AIIIIIIIIIIIIPIIIIIIIIIIIIIIIW . The Commonwealth of Massachusetts o f• Department of Industrial Accidents Office of Investigations • • • *:\....j'e 600 Washington Street Boston, Mass. 02111 www.mass.'ov /dia Workers' Compensation Insurance Affidavit: General Businesses Applicant information: Please PRINT legibly - Business / Organiz Name: A�_ 5oc� /c? f �'l l / /(Ii»y 11 /firl ' ilMc: Address: }O.. �! /t �% �Cli /v 7 r/ /x 4 P///- ' - ., 1 _ . City /State /Zip: �� '� Phone # �/-�" %.�.. ---; 1 4 Are you an employer? Check the appropriate box: Business Type (Required): 1. L I am an employer w k - ) employees (full and/or 8. ❑ Retail part- time)* 2. 9. ❑ Restaurant /Bar /Eating Establishment 3. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. 10. ❑ Office and /or Sales (incl. real estate, auto, etc.) [No workers' comp. insurance required] 11. ❑ Non -profit 4. ❑ We are a corporation and its officers have exercised their right of exemption per c. 152, § 1(4), 12. ❑ Entertainment and we have no employees. [No workers' comp insurance required] ** 13. ❑ Manufacturing 5. 6. ❑ We are a non - profit organization, staffed by 14. ❑ Health Care volunteers, with no employees. [No workers' comp. insurance required] 15. ❑ Other 7. *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. * *If the corporate officers have exempted themselves, but the corporation has other employees, a workers' compensation policy is required and such an organization should check box #1. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company name: 4/2/ / /'d1? lY/ 72/ /i YV/ (..:; I/O m Insurer' s Address: - ,h � t �h f ff O W Alt)" fyi_My, Ail �` ✓ff�51- - City /State /Zip: Policy # or Self -ins. Lic. # ' I f � f Expiration Date: // l'` 9/1 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 $250,000 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 certi under the pains and penalties of perjury that the information provided above is true and correct. Signature f s t ! £ /L' ,, t.,� G,- �(✓ Date Print Name ✓ �.?(.iI " �/��C t L� Uc, Phone # f /. ✓ 1 f � Official use only. Do not write in this area to be completed by city or town official City of Town: Permit/license # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact person: Phone # ‘ • 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 I, s.. � /11.< tcrni ki t 4, ius_ ....__.. __. �.._...__ as Owner of the subject property hereby authorize ' ?�i//C �C � 7// /2/i /�i/87 / -5,r 1f1 _ =_. ,... ._._,_.. __ . __ _ ,._ _.. .r_ _ .... to act on my behalf, in all matters relative to work authorized by this building permit application. r1 l/ rim C (broz c�� iti urn '�'g fty y� t rr �c , _ �� . r �� _ .m. �. w___ Signature of 0 rimy Date 1,14 5. 1-I4 ! .,C 41_11(// _M_CC .II,e04 .1I JC ._..__.w_ .... � ....._ ._ . ...._,_ .__. „_,.. _I I , as (CQn /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 ap ins and enalties of,erury� ,,_ _„,,,_,_ _____ Ct .- r..w.».nrn+� l + w. �mwwr. �.. v.. w..,..., nvw�« «..«+..�+.r- .»a�,......v�.w.w .. ...�..�.v,..w.�.«eve» .., .-..-.-. w..«.._. rrrm.» �«.,.«. ww..»»; n....,,. �.:.<-... w.. r. �...... .. .v..�ro�.,wn++.. ..... ....v... .uv ,. .dmvm.wmz.... ..rw.v.- .�..- .v..wamn ».m«rc.. Print a e I ___ 17 , 279 ,, 71 --_------- n } — . ...,, .,...w_, ... Signature of 9wQe !Agent Date SECTION 12 - CONSTRUCTION' SERVICES 10.1 Licensed Construction Supervisor: _ Not Applicable ❑ Name of License Holder : � i� / f I 1'.-l- " ;;0__ <,.... ,�..�.,,_w.,.��. ,P,.�. �,. �._ �...,,. �., License Number m . 4 k Add - Expiration Date Signature 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 0 #r • • 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 115.(CONTAINING MORE THAN 35,000! C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: _.. -� ... Not Applicable �w Name (Registrant): s.. --- _. 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 Telephone Expiration Date k _ £ l Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility __. I Address Registration Number ET Signature Telephone Expiration Date 9.3 General Contractor F }< 4L,J J 1/ 14' l / 5, Not Applicable ❑ Company Name: - nairi / i7/4 foi2'2/ . Responsible In Charge of Construction ` rn\ Tfl t d Addr: s Signature Telephone _ . ' ` . Versionl.7 Commercial Building Permit May 15, 2000 8 - 'NOWII,AIVRIUSLZOT Existing Proposed Required by Zoning This column to be fihled in by Building Department [ v ) Lot Size Frontage — - ��---- Setbacks Front �—� - F-- �_� � �-- �- 1 �-- Side ��--� ll��---/ L��___� > Rear Building Height �-- F--� [--i Bldg. Square Footage F---� - [ % �- � F---7 �--- �� Open Space Footage Y� (Lot area minus bldg &»meu ---\ F F --- 1 T F parking) #ofParking Spaces Fill: � / | ' � { (volume Location) -~ — ' ----` --------` ° A. Has a Speciat Permit/Variance/Finding ever been issued for/on the site? 0 0 NO �� DON'T KNOW ��/ YES �~� IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? 0 NO DONT KNOW ES �� u / m , IF YES: enter Book P -. and/or Document ��N �� B. Does the site contain a brook, body of water or wetlands? NO 0 �� DONT KNKNOW YE5 n�� IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained »�� Obtained »p~, Date �_� x�� ' . �� 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 ^m IF YES, describe size, type and location. E. WilI the construction activity disturb (clearing, ring, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO �� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. t . . 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 Description Enter a brief description here. Of Proposed Work �� • 1��t?Gll f C} L� � ,� - �t� C�, f l � iinL1 CILS� y 0/ ,,J / / f itl y / SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑ A -4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B 1 ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential [2( R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B I ❑ U Utility ❑ Specify: 1---- - M Mixed Use ❑ Specify: S Special Use ❑ Specify: I COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: L_m.. _. .... _,_... Proposed Use Group: __. . __ Existing Hazard Index 780 CMR 34):1_ Proposed Hazard Index 780 CMR 34)::___ .w �., .,., ,_ __'',,. SECTION 6 BUILDING HEIGHT' AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE IISE ONLY Floor Area per Floor (sf) 1st ,., m _ 1 3rd 4 th L ______ ___ . __ Total Area (sf) - 0, - 7/1 ! Total Proposed New Construction isfL� moo, 1 .) _ , , .... __ ___.,... ,. __ a Total Height (ft) f Total Height ft 1_,_ 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone,lnformation: 7.3 Sewage Disposal System: Public El Private ❑ Zone L„ _ ___] Outside Flood Zone❑ Municipal ❑ On site disposal system ❑ . . . .. Version1.7 Commercial Buildin: Permit Ma 15, 2000 • ,.;.,....,,,,- ,:'„, ,:,-.. City of i\lorthanipton !,$ .,,,,,, --. IroW"...e't , ,, , ,,,, , ,,,,L4 . ,:,;' , ;:t, 1. i',ZY:';.:''' ,4.,,, .._d•fx Building Department .e 4'44:0:Fi. 2;514" 0' .0.:" )r0t - i 7 r , i;.,rip;` , ..i , igiii., , itto. ,,, . 212 Main Street Pi,.., ,,, iiff '44 N q 4:y ,.,° 4( ,,, ' -,, 444; ::14.---4-1 - ,, Room 100 pi , , :fi •.b; ,04 j' s - 4.4 ,9,44 4 , fc ' tg : t 7,A 1*. '. 1 ; 0 1 tAr- 4 **:'44rV..,4: ' ' ' ' ) C:i'e'. 4 r- 4 . • ,:, ,,. r'... z;: r , .7. ,..,.4 ,4.' ' ' F4 ' Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 , tragi7„,1„( ; ;;;;,.:; 4 1443triL,Itr-.: : „,tt ;ii, APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY9F, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING ;. SECTION 1" Sri% iNFortiViAtioN . . , . . 7 f5 .:= ,..,-'- ' ' 1.1 Property Address: i ,-- -----7"-- .•!'grlit- A 414' L" - )12 '1 &i , :ft , t, .'=, ,''1'.!„* ,F f'' • : ct f ., 7)4/1 4 i IC17 SECTION 2 - PROPERTY OWNERSfilP/AuTHORIZED AGENT 2.1 Owner of Record: tiMff r 1-7-, - / f - L- / ' / - 7 , 7 - ., ) ir ii — 771 . - r - /2- --- / 4 —1 - /- - .2 /- _,...._.„ Name (Print) Current Mailing Address: —. 1 i ,si. . Lq/-1) 2) (7' —,—)44,,1 —1 Signature feltirrii(./CitrC)(1120 C12.71P/dcf' Telephone 2.2 Authorized Agent: I ,') i , ) - t - 1 Atu ' 1/1 ' /4/11 ' _I/X, I 1 45) „4 / /. ( LY 2 V --r i- '‘,42LLa 11 Al4 iijil )) „ . V ' Y - Name (Print) Curre Mailin• Address: 4 /- -. ,, Signature Telephone ...--- ... . ', . •> , ., , . , _ . • _. SECTION 3.- ESTIMATED CONSTRUCTIONCGSTS: Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant . , 1. Building ain kin r) 1 .1/ g oii5 co — a.)`Builcling Permit Fee _ ----- I LIE/i/t/ .A - • „., 4. ....,.......,............,, ..,,,,,,,«1 m ..,....... *-,...,—,--, 2. Electrical (b) Estimated Total Cost of 1 'r t : Qonetruction .. from (6) r . 3. Plumbing ' .. Building -Pernik Fee _ "-----" 4. Mechanical (HVAC) r — , 4 5. Fire Protection . ------ f I/ i- 6. Total = (1 + 2 + 3 + 4 + 5) ,lb 00 Check Number .. , ThiS-Section For Official Use Only Building Permit Number 'Date . Issued Signature: Building Commissioner/inspector of Buildings Date a File # BP- 2010 -0119 APPLICANT /CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413) 732 -3179 PROPERTY LOCATION 7 BARDWELL ST MAP 17C PARCEL 023 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ve Q i Fee Paid o /�J / $.4A0 — Typeof Construction: DEMOLISH DET GARAGE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 062382 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION PRESENTED: A pproved 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 .� 9 p aD 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. BP- 2010 -0119 GIS #: COMMONWEALTH OF MASSACHUSETTS : CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit # BP- 2010 -0119 Project # JS- 2010- 000135 Est. Cost: $8195.00 Fee: $20.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 062382 Lot Size(sq. ft.): 17119.08 Owner: SHEBEK PETER M JR MAIL TO: HARLOW PROPERTIES Zoning: URB(100)/ Applicant: ASSOCIATED BUILDING WRECKERS INC AT: 7 BARDWELL ST Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732 -3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON: 7/31/2009 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLISH DET GARAGE 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: FeeType: Date Paid: Amount: Building 7/31/2009 0:00:00 $20.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo