17D-012 Massachusetts Department of Environmental Protection •
Bureau of Waste Prevention • Air Quality [100088897
BVVP AQ 06 Decal Number
Notification Prior to Construction or Demolition
C. General Construction or Demolition Description (cont.)
6. a. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos
containing material (ACM)?
❑ Yes Q No
If yes, who conducted the survey?
b. Surveyor Name
c. Division of Occupational Safety Certification Number
7. Construction or Demolition: 06/08/2009 06/12/2009
a. Start Date (mm /dd /yyyy) b. End Date (mm /dd /yyyy)
8. a. For demolition and construction projects, indicate dust suppression techniques to be used:
❑ seeding ❑ paving
Q wetting ❑ shrouding b. If other, please specify:
❑ covering ❑ other
9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency?
'a. Name of DEP Official
b. Title
c. Date (mm /dd /yyyy) of Authorization
d. DEP Waiver Number
D. Certification
I certify that I have examined the Johanna Savage i
o above and that to the best of my a. Print Name
0 knowledge it is true and complete.
The signature below subjects the b. Authorized Signature
signer to the general statutes Demo Coor
o regarding a false and misleading c. Position/Title�
o statement(s). Associated Building Wrecker, Inc.
d. Representing
(o e. Date (mm /dd /yyyy)
0
0
-
ag06.doc • 10/02 BWP AQ 06 • Page 3 of 3 U
•
d
Massachusetts Department of Environmental Protection _.�______ ■;
Bureau of Waste Prevention • Air Quality 100088897
BVVP AQ 06 Decal Number
Notification Prior to Construction or Demolition
General
Statement: If B General Project Description (cont.)
asbestos is found
curing a 4. General Contractor:
Construction or
Demolition Associated Building Wrecker, Inc.
operation, all _ _....
responsible parties a. Name
must comply with 352 Albany Street
310 CMR 7.00, b. Address
7.09, 7.15, and —
Chapter 21E of the Springfield MA 101105' j
General Laws of C . City/Town own d. State e. Zip Code
the Commonwealth. 413 732 -3179 j
This would include, f. Telephone Number (area code and extension) q. E -mail Address optionaI1,
but would not be
limited to, filing an Andrew Mirkin
asbestos removal h. On -site Manager Name
notification with the
Department and /or
a notice of
release /threat of C. General Construction or Demolition Description
release of a
hazardous
substance to the 1. Construction or demolition contractor:
Department, if
applicable. [Associated Building Wrecker, Inc.
a. Name
352 Albany Street
b. Address
Springfield MA 01105' 1
c. City/Town d. State e. Zip Code
(413) 732 -3179
f. Telephone Number (area code and extension) g. E - mail Address (optional)
Andrew Mirkin
h. On -site Manager Name
2. On -Site Supervisor:
William Babcock
On - Site Supervisor Name
3. Is the entire facility to be demolished? 12 Yes LJ No
N
0 4. Describe the area(s) to be demolished:
o Entire existing fire damaged structure.
° 5. If this is a construction project, describe the building(s) or addition(s) to be constructed:
n/a
Q
ag06.doc • 10/02 BWP AQ 06 • Page 2 of 3
A �
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention • Air Quality 1 1 , 00088897
BVVP AQ 06 Decal Number
Notification Prior to Construction or Demolition
Important: A. Applicability
When filling out pp y
forms on the
computer, use
only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or
to move your residential building with 20 or more units is regulated by the Department of Environmental Protection
us - not
use e th e return (DEP), Bureau of Waste Prevention - Air Quality Control Regulations 310 CMR 7.09. Notification of
th
key. Construction or Demolition operations is required under 310 CMR 7.09 (2) ten (10) days prior to any
work being performed. The following information is required pursuant to 310 CMR 7.09.
B. General Project Description
tallf
1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner - occupied
Instructions residence of four units or less? ❑ Yes A No
1
1. All sections of b. Provide blanket decal number if applicable:
this form must be Blanket Decal Number
completed in order
to comply with the 2. Facility Information:
Department of Meadowbrook Estates
Environmental
Protection a. Name
notification ,491 Bridge St.
requirements of b. Address
310 CMR 7.09
!Northampton MA 01062
c. City /Town d. State e. Zip Code
f. Telephone Number (area coda and extension) 1. 9, E -mail Address (optional)
1 0,000 2
h. Size of Facility in Square Feet i. Number of Floors
j. Was the facility built prior to 1980? 51 Yes El No
k. Describe the current or prior use of the facility:
former Meadowbrook Estates
I. Is the facility a residential facility? el Yes LI No
6
m. If yes, how many units?
o Number of Units
° 3. Facility Owner:
N Preservation of Affordable Housing ^ ^
O a. Name
0 40 Court St., Ste. 650
b. Address
[Boston MA 02108
c. City/Town .. tat - e. Zip Code
o 1(617) 449 -0863
f. Telephone Number (area code and extension) a. E - mail Address (optional)
d Alexandra Dailey
h. Onsite Manager Name
ag06.doc • 10/02 BWP AQ 06 • Page 1 of 3 1
•
w
c Commonwealth of Massachusetts l
" -- 100088896
g
Asbestos Notification Form ANF -001 Decal Number
B. Facility Description (cont.)
5 IBaystate Contracting Services, Inc. I 1352 Albany Street
a. Name of General Contractor b. Address
(Springfield 1 101105 I 1413- 781 -0820
c. City/Town d. Zip Code e. Telephone Number (area code and extension)
'Liberty Mutual ( 1WC231S332797039 I (02/01/2010
f. Contractor's Worker's Comp. Insurer q. Policy Number h. Exp. Date (mm/dd /yyyy)
110000 I 12
6. What is the size of this facility? a. Square Feet b. Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos - containing material from site to temporary storage site (if necessary):
I / 1 1n /a I
Note: Transfer a. Name of Transporter b. Address
Stations must In/a 1 1 1 1 _
comply with the c. City/Town d. Zip Code e. Telephone Number
Solid Waste
Division 2. Transporter of asbestos - containing waste material from removal /temporary site to final disposal site:
Regulations 310
CMR 19.000 ICCDS, Inc. 1 (185 Carolina Nooseneck Road
a. Name of Transporter b. Address
!Wyoming 1 (02898 1 (401) 539 -8518 � 1
c. City/Town d. Zip Code e. Telephone Number
3. In /a I In/a
a. Refuse Transfer Station and Owner y b. Address
n/a I 1 I 1
c. City/Town d. Zip Code e. Telephone Number
4. 'MINERVA ENTERPRISES INC I (Permit #54288
a. Final Disposal Site Location Name b. Final Disposal Site Location Owner's Name
(9000 MINERVA ROAD 1 !WAYNESBURG
c. Final Disposal Site Address d. City/Town
(OH 1 144688 1(330) 866 -3435
e. State f. Zip Code g. Telephone Number
m
°
D. Certification
∎ N
The undersigned hereby states, under the (Johanna Savage
° penalties of perjury, that he /she has read the a. Name b. Authorized Signature
■............° Commonwealth of Massachusetts regulations ICOOrdinator 1 I
.-- for the Removal, Containment or c. Position/Title d. Date (mm /dd /yyyy)
Encapsulation of Asbestos, 453 CMR 6.00 and ( (413) 781 - 0820 (Baystate Contracting
310 CMR 7.15, and that the information
contained in this notification is true and correct e. Telephone Number f. Representing
_ o to the best of his /her knowledge and belief. 1352 Albany Street
o q. Address
(Springfield (01105 __..
h. City/Town i. Zip Code
�z
Q Go To Top
II an oc • 10/02 Asbestos Notification Form • Page 3 of 3 III
,
ci Commonwealth of Massachusetts III 1100088896
Asbestos Notification Form ANF -001 Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
encapsulated:
0 1 (1232 1
a. Total pipes or ducts (linear ft) b. Total other surfaces (square ft)
c. Boiler, breaching, duct, tank
(1 Insulating cement 1
surface coatings Lin. ft. Sq. ft. d. Lin. ft. Sq. ft.
e. Corrugated or layered paper
1
pipe insulation Lin. ft. Sq. ft. f. Trowel /Sprayer coatings ( 1
Lin. ft. Sq. ft.
g. Spray -on fireproofing Lin. ft. ( 1 Sq. ft. 1 h. Transite board wall board [ Lin. ft. 1 ;;11:1
i. Cloths, woven fabrics ( • 1 1 j. Other, please specify: 1 111232 1
Lin. ft. S ft. i �,,�� Lin. ft. Sq. ft.
k. Thermal, solid core pipe la of asb deb
insulation Lin. ft. Sq. ft. I. Specify
14. Describe the decontamination system(s) to be used:
(Remote 3 -stage decon.
15. Describe the containerization /disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
(To be thoroughly wetted, double bagged, labeled and properly disposed of. 1
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
( a. Name of DEP Official ( b. Title
1 1
c. Date (mm /dd /yyyy) of Authorization d. DEP Waiver #
1 e. Name of DOS Official ( ( f. DOS Official Title
1 1 1
■—..... g. Date (mm /dd /yyyy) of Authorization h. DOS Waiver #
■ N
0 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A —F apply to this project? (❑ Yes p No
° B. Facility Description
■ N
=o 1. Current or prior use of facility: (Meadowbrook Estates
0
— 2. Is the facility owner - occupied residential with 4 units or less? ❑ Yes FA No
(Preservation of Affordable Housing 1 140 Court St., Ste. 650
3' a. Facility Owner Name b. Address
_ ( 102108 1 16174490863
o c. City/Town d. Zip Code e. Telephone Number (area code and extension)
— . u _ 'Alexandra Dailey /Preserv. of Aff Housing 1 40 Court St., Ste. 650 1
4 ' a. Name of Facility Owner's On -Site Manager b. On -Site Manager Address
�
(Boston 102108 1617 449 - 0863
— Q c. City/Town d. Zip Code e. Telephone Number (area code and extension)
• anf001ap.doc • 10/02 Asbestos Notification Form • Pa.e 2 of 3 III
Go To Top
,
r
Commonwealth of Massachusetts ■
"� 1100088896
-1 Asbestos Notification Form ANF -001 Decal Number
Important: A. Asbestos Abatement Description
When filling out P
forms on the
computer, use 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner - occupied
only the tab key residence of four units or less? ❑ Yes El No
to move your
cursor - do not b. Provide blanket decal number if applicable: Blanket Decal Number
use the return
key. 2. Facility Location:
A ll (Meadowbrook Estates 1491 Bridge St.
a. Name of Facility b. Street Address
WA !Northampton 1 (MA 1 101062 1 1
c. City/Town d. State e. Zip Code f. Telephone Number
INSTRUCTIONS 3. Worksite Location:
1. All sections of this 1Meadowbrook Estates 1 1 1 throughout !
form must be a. Building Name /Building Location b. Building # c. Wing d. Floor e. Room
completed in order
to comply with 4. Is the facility occupied? ❑ Yes ril No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and the Division
of Occupational IBAYSTATE CONTRACTING SERVICES INC 1 1352 ALBANY STREET
Safety (DOS) a. Name b. Address
notification !SPRINGFIELD 1 101005 1413- 781 -0821
requirements of 453
CMR 6.12 c. City/Town d. Zip Code e. Telephone Number
1AC000021 Contract Type:
f. DOS License Number g. yp Q Written ❑ Verbal
Alexandra Dailey 'Manager of Assets
h. Facility Contact Person i. Contact Person's Title
'FRANCIS C MASON 1 IAS070548
6. a. Name of On -Site Supervisor /Foreman b. Supervisor /Foreman DOS Certification Number
'Unknown at this time In /a
7 ' a. Name of Project Monitor b. Project Monitor DOS Certification Number
'Unknown at this time 1n /a
8 ' a. Name of Asbestos Analytical Lab b. Asbestos Analytical Lab DOS Certification Number
0
-
9.
106/08/2009 1 106/12/2009
a. Project Start Date (mm /dd /yyyy) b. End Date (mm /dd /yyyy)
= 17-4P hone
�
N c. Work hours Mon -Fri. d. Work hours Sat -Sun.
■ o 10. a. What type of project is this?
-0 D Demolition ❑ Renovation
0 Repair ❑ Other, please specify: b. Describe
11. a. Check abatement procedures:
0 ❑ Glove bag ❑ Encapsulation
��o ❑ Enclosure ❑ Disposal only
_ � exte
❑ Cleanup GI Other, specify: rior
❑ Full containment b. Describe
- z
� Q 12. Is the job being conducted: ❑ Indoors? Ea Outdoors? Go To Top
• anf001ap.doc • 10/02 Asbestos Notification Form • Page 1 of 3 U
• •
Commonwealth of Massachusetts
II I
100088894
- , Asbestos Notification Form ANF -001 Decal Number
B. Facility Description (cont.)
5 (Associated Building Wrecker, Inc. 1 1352 Albany Street
a. Name of General Contractor b. Address
(Springfield 1 101105 1 1413- 732 -3179
c. City/Town d. Zip Code e. Telephone Number (area code and extension)
(American International Group 1 16986797 [02/01/2010
f. Contractor's Worker's Comp. Insurer g. Policy Number h. Exp. Date (mm /dd /yyyy)
6. What is the size of this facility? (10000 (2
a. Square Feet b. Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos - containing material from site to temporary storage site (if necessary):
1n /a 1 (n /a
Note: Transfer a. Name of Transporter b. Address
Stations must Ink 1 1 1 1
comply with the c. City/Town d. Zip Code e. Telephone Number
Solid Waste
Division 2. Transporter of asbestos - containing waste material from removal /temporary site to final disposal site:
Regulations 310
CMR 19.000 [CCDS, Inc. ( 1185 Carolina Nooseneck Road
a. Name of Transporter b. Address
'Wyoming 1 102898 1 1(401) 539 -8518
c. City/Town d. Zip Code e. Telephone Number
3. 'n /a 1 1n /a
a. Refuse Transfer Station and Owner b. Address
in /a 1 1 1 1
c. City/Town d. Zip Code e. Telephone Number
4. 1MNNERVA ENTERPRISES INC (Permit #54288
a. Final Disposal Site Location Name b. Final Disposal Site Location Owner's Name
(9000 MINERVA ROAD 1 'WAYNESBURG
c. Final Disposal Site Address d. City/Town
10H 1 144688 1 1(330) 866 -3435
e. State f. Zip Code g. Telephone Number
M
...............
D. Certification
.—....—N
The undersigned hereby states, under the !Johanna Savage
° penalties of perjury, that he /she has read the a. Name b. Authorized Signature
......° Commonwealth of Massachusetts regulations [Demo Coor 1 1
for the Removal, Containment or c. Position/Title d. Date (mm /dd /vvvv)
Encapsulation of Asbestos, 453 CMR 6.00 and 1 (413) 732 - 3179 1 [Assoc Bldg Wreckers
310 CMR 7.15, and that the information
contained in this notification is true and correct e. Telephone Number f. Representing
°
- to the best of his /her knowledge and belief. [352 Albany Street
° q. Address
- � [Springfield 1 01105
h. City/Town i. Zip Code
.._._
Q Go To Top
• anf001ap.doc • 10/02 Asbestos Notification Form • Page 3 of 3
Commonwealth of Massachusetts •
L 1100088894
Asbestos Notification Form AN F -001 Decal Number
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or
encapsulated:
0 11232 1
a. Total pipes or ducts (linear ft) b. Total other surfaces (square ft)
c. Boiler, breaching, duct, tank
surface coatings Lin. ft. 1 S . ft. d. Insulating cement ) Lin. ft. ) Sq. ft.
e. Corrugated or layered paper I I f. Trowel /Sprayer coatings 1 1
pipe insulation Lin. ft. S�ft. Lin. ft. Sq. ft.
g. Spray -on fireproofing h. Transite board, wall 1 1;1
Lin. ft. S , ft . ranse oard, wa board 1 Lin. ft.
i. Cloths, woven fabrics ,• 1I j. Other, please specify: 1 11232
L. ft. S ft. Lin. ft. Sq. ft.
k. Thermal, solid core pipe � 1 Icy of asb deb
insulation Lin. ft. Sq. ft. I. Specify
14. Describe the decontamination system(s) to be used:
(Remote 3 - stage decon.
15. Describe the containerization /disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
1To be thoroughly wetted, double bagged, labeled and properly disposed of.
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
l a. Name of DEP Official l b. Title
c. Date (mm /dd /yyyy) of Authorization d. DEP Waiver #
) e. Name of DOS Official 1 1 f. DOS Official Title
1 II
g. Date (mm /dd /yyyy) of Authorization h. DOS Waiver #
N
— 0 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A –F apply to this project? ❑ Yes Q No
B. Facility Description
■.■ N
o 1. Current or prior use of facility: 'former Meadowbrook Estates
—o
2. Is the facility owner- occupied residential with 4 units or less? ❑ Yes NI No
'Preservation of Affordable Housing 140 Court St., Ste. 650
...--- 3 ' a. Facility Owner Name b. Address
� o
)Boston 1 102108 16174490863
o c. City/Town d. Zip Code e. Telephone Number (area code and extension)
� � 4 'Alexandra Dailey /Preserv. of Aff Housing 1 140 Court S t., Ste. 650
a. Name of Facility Owner's On -Site Manager b. On -Site Manager Address
z
1Boston 102108 1 16174490863
Q c. City/Town d. Zip Code e. Telephone Number (area code and extension)
1 anf001ap.doc • 10/02 Asbestos Notification Form • Pa .e 2 of 3 ■
Go To Top
Commonwealth of Massachusetts ��'` ■
M . 1100068/894
j Asbestos Notification Form ANF -001 Decal Number
Important: A. Asbestos Abatement Description
When filling out p
forms on the
computer, use 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner - occupied
only the tab key residence of four units or less? ❑ Yes 19 No
to move your
cursor - do not b. Provide blanket decal number if applicable: Blanket Decal Number
use the retum
key. 2. Facility Location:
' IMeadowbrook Estates 1 1491 Bridge St. 1
a. Name of Facility b. Street Address
'Florence 1 (MA 1 101062 1 1
I i ii c. City/Town d. State e. Zip Code f. Telephone Number
Ammo. ..........................
INSTRUCTIONS 3. Worksite Location:
1. All sections of this 'Meadowbrook Estates 1 I throughout 1 1
form must be a. Building Name /Building Location b. Building # c. Wing d. Floor e. Room
completed in order
to comply with 4. Is the facility occupied? [] Yes 4 No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and Division
of Occupational 1BAYSTATE CONTRACTING SERVICES INC 1 1352 ALBANY STREET
Safety (DOS) a. Name b. Address
notification SPRINGFIELD 1 101005 1 1413- 781 -0821
requirements of 453
CMR 6.12 c. City/Town d. Zip Code e. Telephone Number
IAC000021
f. DOS License Number g. Contract Type: r/ Written 0 Verbal
'Alexandra Dailey (Manager of Assets
h. Facility Contact Person i. Contact Person's Title
'FRANCIS C MASON 1 1AS070548
6 ' a. Name of On -Site Supervisor /Foreman b. Supervisor /Foreman DOS Certification Number
'Unknown at this time 1n/a
7 ' a. Name of Project Monitor b. Project Monitor DOS Certification Number
'Unknown at this time 1n/a
8 ' a. Name of Asbestos Analytical Lab b. Asbestos Analytical Lab DOS Certification Number
__-0 9 106/08/2009 I 106/12/2009
a. Project Start Date (mm /dd /yyyy) b. End Date (mm /dd /yyyy)
o 17-4p 'none
■.........cV c. Work hours Mon -Fri. d. Work hours Sat -Sun.
o 10. a. What type of project is this?
"moo Q Demolition ❑ Renovation
Repair 0 Other, please specify: b. Describe
11. a. Check abatement procedures:
0 ❑ Glove bag Encapsulation
—mo 0 Enclosure A Disposal only
= ❑ Cleanup to Other, specify: exterior
Full containment b. Describe
- z
— Q 12. Is the job being conducted: ❑ I ndoors? A Out doors? Go To Top
1 anf001ap.doc • 10/02 Asbestos Notification Form • Page 1 of 3 1
r
• Be on site for the entire project duration.
• The PM has complete authority to direct the Contractor to perform all abatement work
according to all Federal and State regulations and to the satisfaction of the DEP.
• The PM will notify the DEP should any problems arise during the abatement work.
• The PM will notify the DEP prior to commencement of the abatement work.
• The PM will notify the DEP at the end of the abatement work.
• The PM will submit all air samples results and Waste Manifests to the DEP at the end of
the abatement work.
F. Owner's Responsibility:
1. Provide the Contractor with access to electrical power and service (if needed).
2. Provide water hook -up to supply the Contractor with water for decontamination facilities
and abatement activities.
3. Restrict access into the abatement work area.
G. Contractor's Responsibility:
1. Contractor is responsible for maintaining the safety of workers on this project.
2. Loose ACM will be transported and disposed of in double 6 -mil poly bags with the
labeling affixed to them as required by Federal and State regulations. The Contractor
will have on site Tined dumpster for storage of ACM.
3. The Contractor will consult the Owner for electrical and water locations. The water must
be shut off at its source on a daily basis.
4. The Contractor's personnel and other visitors will sign in and out on a daily basis. No
visitors will enter the work area.
H. Proposed Scope of Work:
The scope of work includes the total demolition of the building. The following is being
proposed to demolish the building. The scope of work will be performed by a
Massachusetts licensed asbestos abatement contractor in coordination with a trained
demolition contractor (operator).
1. DEP demolition notifications.
2. Mobilize onto the site and post OSHA required danger and keep -out signs at all access
points.
3. All salvaged items will be totally decontaminated prior to removal.
4. Comply with all OSHA regulations including workers protection.
5. Install runoff control such as hay bill or a control pit at the lower section of the Site.
Vacuum all water generated during demolition for proper disposal
6. Wrap the Dumpsters with 2 layers of 10 -mil liners. Label the Dumpsters in accordance
with federal and state regulations.
7. Perform demolition of the building using high volume water to control dust.
8. Place all demolition debris into the lined Dumpsters.
UEC:1290711PLAN.DOC Page 3 of 4
UNIVERSAL ENVIRONMENTAL CONSULTANTS
w
SCOPE OF WORK
A. Introduction:
As part of the renovation project of the Meadowbrook Apartment located at 491 Bridge
Road, Northampton, MA (Site) inspection for Asbestos Containing Materials (ACM) was
conducted on July 21, 2004 by a Massachusetts licensed asbestos inspector Mr. Leonard J.
Busa.
One of the buildings located at the Site was partially bumed due to a fire. The building was
determined to be structurally unsafe by the fire department.
B. Owner:
The Site is operated by the Preservation of Affordable Housing located at 40 Court Square,
Boston MA 02108.
C. Sampling:
Bulk samples were collected from various materials suspected to contain asbestos.
Samples results indicated that asbestos was found in the linoleum floor covering (20%
Chrysotile) and textured ceiling plaster (2% Chrysotile). Additional analysis was performed
of the textured ceiling plaster using Paint Count Method. Samples results indicated (<1%
Chrysotile). See attached bulk samples results.
D. Waiver Request:
UEC is requesting a waiver of the following Commonwealth of Massachusetts regulations
310 CMR. The building is unsafe to remove the ACM prior to demolition and containments
are not possible due to the size of the building.
• 310 CMR 7.15 (1) (c) 1.
• 310 CMR 7.15 (1) (c) 3(d),
• 310 CMR 7.151(e)1 a
E. Definition:
Project Monitor (PM) who has received training required by Federal and State regulations.
The PM has also successfully taken a NIOSH 582 equivalent course for PCM in accordance
the NIOSH 7400 Method, "A" rules.
The role of the PM is to:
• Conduct sampling required in 29 CFR 1926, 453 CMR 6 and 40 CFR 763. Use NIOSH
method 7400 for air sample collection and PCM analysis.
• Conduct general area and clearance air sampling.
UEC;1290711PLAN.DOC Page 2 of 4
UNIVERSAL ENVIRONMENTAL CONSULTANTS
cl
ASBESTOS ABATEMENT WORK PLAN
For
MEADOWBROOK APARTMENTS
491 BRIDGE ROAD
NORTHAMPTON, MASSACHUSETTS
SIGNED:
mrnar M. a -b, Project Designer
AD -9003 •
DATE: May 6, 2009
LABORATORY: Certification Number AA- 000177
Expires October 2010
Universal Environmental Consultants (UEC)
12 Brewster Road
Framingham, MA 01702
Submitted for Approval to:
Massachusetts Department of Environmental Protection (DEP)
Mr. Bob Shultz
UEC:1290711PLAN.DOC Page 1 of 4
UNIVERSAL ENVIRONMENTAL CONSULTANTS
Demolition Operation
491 Bridge Road, Northampton
Page 7 of 7
For the Asbestos Consultant:
(Please print or type your name, address & telephone number)
FinuEnti Name: Lin vcrs #/ an via/ .,L� �uG
Address: /Z % v a cir r, , A4 r ..)/7e-.)
Telephone Number: ,5 c>c; - ,Z
Name: r � 7 i c ' , � . . . __.
nature:
Date: 5/./3/0
> �r _
1sbesto -ect Monitor (P '1): j Sc.ri Sc:6 c_
PM License No.: / M 03 13.7 Expiration Date: It 71 2-0 10
AIFIA/NVLAP Accreditation Type: --•
Expiration Date:
MADOS Laboratory License No.: /9A — 6013 4 77
Expiration Date: r o 21 /2,007
Demolition Operation
491 Bridge Road, Northampton
Page 6 of 7
crorrincATioN
1 hereby certify that 1 have read the preceding five (5) pages of this (.p Ahpt<lypl for the
demolition of the third floor of 491 l3ridgc Road in Northampton, MA, as well as all attachments and
work plan provisions. 1 further certify that the firm or entity I represent will abide by all conditions
listed herein, all work practice requirements provided for this project as well as all applicable asbestos
handling regulations, and that lam authorized to sign this certification.
For the facility owner:
(Please print or type your name, address & telephone number)
J � i Z I�
I' inn/Entity Name. al--ea �� - fit?. A-44 / eeteie ,�1� c�. ✓)LdP.tIX ✓1 �
Address: yfii C.n
. i- Sl` . s�a { r j L, Sb
"Telephone Number: ( „'-/ y o r ' 3
Naive: / 1 '.u14i fit_ ,di , , J �r 1�ti
Sinature: . r T2, 4- 4 Date: 2l 67
For the General/Demolition Contractor:
(Please print or type your name, address & telephone number)
Finn/Entity Name: :' ` , c•,4k(.1- j ; 4 tt Wi keLte , .5
Address: 35a t .t j1.S 5PFd. 014 . O(Cc5',-
Telephone Number: Kt3 73a 317q
Name: At;l2 let tAi
Signature:
For the Asbestos Removal Contractor (if different):
(Please print or type your name, address & telephone number)
Firm/Entity Name: 1 /j_ t Ccrfl ac#,n ( )CP..),
Address: 352_ /4 li .h'i 6P r . , outs
Telephone Number: '16 7$1 - o8ao
Name: fr.., 11 -0e.v
Signature: / v <<- -- Date: 5- 2o--&1
Contractor's jcense No: C.. Expiration Date: \ . . y • zei
Demolition Operation
491 Bridge Road, Northampton
Page 5 of 7
17. Should asbestos become released, the property owner, the contractor, subcontractors and
consultants may be subject to enforcement action by the MassDEP and may be held liable for
abatement of the release.
18. This Conditional Approval applies specifically to the demolition of the building at 491 Bridge
Road in Northampton, MA. This Conditional Approval does not apply to any past or future demolition
or asbestos handling operations at the Site. All other MassDEP regulations are in effect for the
duration of this asbestos demolition and bulk loading operation.
19. MassDEP may, at its sole discretion, revoke this Conditional Approval.
20. The Conditional Approval set forth herein is intended solely as guidance for the owners and
contractors in the conduct of the subject asbestos removal activities. This Conditional Approval is not
to be relied upon to create rights or defenses, implied or otherwise, enforceable at law or in equity, by
any person in litigation with the owners or contractors. This Conditional Approval is not intended to,
nor does it, constitute "regulations" as that term is used in M.G.L. Chapter 30A. MassDEP does not
assume any liability in association with the performance of any activity in accordance with this
Conditional Approval.
21. The facility owner's representative shall distribute copies to each entity in the enclosed
Certification section prior to beginning the project. A copy of this Conditional Approval with the
signed Certification shall be kept at the Site for the duration of the project.
Should you have any questions or need further assistance with this matter, please contact Bob Shultz
of my staff at (413) 755 -2210.
Sincerely,
Date � Q 4 E
Loretta Oi
Environmental Engineer
Bureau of Waste Prevention
Enclosure
Demolition Operation
491 Bridge Road, Northampton
Page 4 of 7
without testing. Heating system components are not subject to the terms of this Conditional
Approval.
10. All of the waste generated at the Site with the exception of those facility components to be
recycled as described in Paragraph 9, above, shall be disposed of as asbestos waste. This material shall
be thoroughly wetted with water prior to bulk loading. All waste from the Site shall be live loaded into
trucks or roll -off dumpsters, which have been lined with a minimum of two (2) ten -mil (0.010 inch
thick) pre - formed poly liners. These liners shall be of sufficient size so that they can be sealed across
the top of the load in an overlapping manner. After sealing the exterior liner, it shall be properly
labeled.' None of the waste shall remain on the ground or in a dumpster in an uncovered state
overnight. The asbestos waste shall not be compacted.
11. If it is necessary to leave a partially filled asbestos waste roll -off at the Site overnight, then it
shall be wetted, covered and secured.
12. The contractor shall ensure that no water leaks from the trucks or roll -off dumpsters en route to
the landfill, and that the waste is covered during transport. The trucks or roll -off dumpsters shall be in
good condition with no holes or rusted out areas and with tailgates, which close tightly and are
lockable. USDOT Class 9 placards shall be affixed to the exterior of each dumpster or truck prior to
transport.
13. Following the removal of all of the asbestos waste material but prior to any further demolition
or excavation operations, the asbestos contractor shall collect, for disposal, all remaining waste, small
debris and detritus accumulated around the Site and in the cellar hole. This material shall be collected
with either HEPA vacuums or with wet methods and squeegees. Dry sweeping shall not be employed.
The remaining waste shall then be sealed into leak -tight and properly labeled containers for disposal as
asbestos waste.
14. Following the bulk loading operation of the asbestos wastes, but prior to any continued Site
work, excavation or backfilling, a final visual inspection shall be performed by the Asbestos Project
Monitor and Asbestos Site Supervisor to ensure that no remnant asbestos, commingled asbestos
demolition debris or asbestos — contaminated water remains in the cellar hole, on the ground around
the work site, at the loading site, as well as any other area at the Site. The results of this inspection
shall be recorded in their respective Site logbooks
15. All documentation regarding air monitoring results, visual inspections and waste disposal shall
be kept on Site for inspection by MassDEP personnel during the demolition operation. Copies of the
documentation are to be supplied to the MassDEP by the owner, contractor and consultant upon
request or within thirty (30) days of completion of the work if not requested earlier.
16. This Conditional Approval does not negate the responsibility of the property owner, the
contractor, subcontractors and consultants from complying with all other applicable federal, state and
local regulations.
1 Here and throughout the Conditional Approval "properly labeled" means pursuant to 310 CMR 7.15(1)(e)1.a. and 40 CFR
Part 61
•
Demolition Operation
491 Bridge Road, Northampton
Page 3 of 7
7. Ambient air monitoring around the circumference of the work area shall be performed on a
continuous basis during the demolition operation. Attention shall be paid to the downwind sector as
well as to all adjacent properties and walkways to ensure that circumferential monitoring points
coincide with these sensitive receptors. The consultant may be required to use more than four (4) air
monitoring stations to accomplish adequate monitoring. Analyses of the air samples shall be done on
the Site so that corrections in the work practices can be made immediately. If the air monitoring
results exceed the Massachusetts Division of Occupational Safety's clean air criteria of one - one
hundredth fiber per cubic centimeter (0.01 f/cc) of air, then all work shall stop. The work methods
shall be evaluated prior to continuing any further work and MassDEP shall be notified by telephone by
close of business (5:00 p.m.) on that same day. If the airborne fiber concentrations reach or exceed the
Occupational Safety and Health Administration ( "OSHA ") Permissible Exposure Limit ( "PEL ") of
one -tenth fiber per cubic centimeter (0.1 f/cc) of air, then work shall stop and MassDEP shall be
notified by telephone within two (2) hours. All air monitoring shall be performed by consultants who
are properly trained and licensed in the Commonwealth of Massachusetts ( "Commonwealth ") as
Asbestos Project Monitors. All sample analyses shall be performed by consultants who are properly
trained, are successful participants in the American Industrial Hygiene Association's Asbestos
Analytical Registry (AIHA's AAR), or alternatively, who work for a laboratory, which is licensed by
the Commonwealth to perform such analysis and is accredited with either the AIHA or National
Voluntary Laboratory Accreditation Program (NVLAP).
8. All perimeter air samples shall be collected in the breathing zone, which for the purpose of this
Conditional Approval, is located at a minimum of forty-eight inches (48 ") and a maximum of seventy -
two inches (72 ") above the ground level. Air samples collected utilizing low -flow pumps shall be
collected at a flow rate of five (5.0) liters per minute ( "LPM "). Low flow sample results shall be
calculated to reflect the eight -hour time - weighted average ( "8 -hour TWA "). Samples collected
utilizing high flow pumps shall be collected at a flow rate between eight and twelve (8 -12) LPM with a
minimum volume of 1080 liters per sample. All (low and high flow) air filter cassettes shall be
changed periodically to prevent particulate overloading. Each air filter cassette shall have the start and
stop time and associated start and stop flow rates recorded in the consultant's Site log for review by
MassDEP. Air monitoring series which repeatedly reveal samples that are overloaded with particulate
and cannot be analyzed, shall be considered to be in noncompliance with this Conditional Approval
and potentially subject the facility owners, and their contractors and consultants, to enforcement action
by MassDEP. The asbestos consultant shall provide two (2) sources of one hundred ten volt
alternating current (110v AC) for use by MassDEP personnel at the Site. These power sources shall be
protected by ground fault circuit interrupters (GFCI'
During the implementation of the work, all metal components, including but not limited to
structural beams, electrical conduit and other structural elements and utility components, shall be
treated as asbestos- contaminated waste and washed for decontamination purposes. Each component
shall be inspected by the asbestos project monitor, prior to its disposal or recycling, as appropriate. A
record of these inspections shall be maintained in the consultant's Site logbook. Heating system
components, including but not limited to insulated steam pipes, ducts and boilers, shall be thoroughly
wetted with amended water prior to any handling and shall be placed in a remote section of the Site
and covered pending analysis results and subsequent removal of the insulation in a sealed work area
with air cleaning. Alternatively, the material may be removed and disposed of as asbestos waste
•
Demolition Operation
491 Bridge Road, Northampton
Page 2 of 7
310 CMR 7.15 (1)(c)3.d. — Requires the capture and containment of fugitive dust by utilizing sealed work
area with air cleaning during asbestos removal operations.
310 CMR 7.15(1)(e) 1.a. — Requires that asbestos - containing waste materials be sealed into leak -tight
containers following removal.
Based upon MassDEP's inspection of the Site and a review of your submittal and the condition of the Site,
MassDEP hereby issues this Conditional Approval, which shall be strictly adhered to for the duration of
the project:
1. Any violation of any condition listed herein or of the submitted work plan shall be considered a
violation of the regulations from which the approval is sought and shall:
�. immediately revoke this Conditional Approval and
b. potentially subject the property owners, their contractors, subcontractors and
consultants to enforcement action by the MassDEP.
2. The demolition contractor shall submit a completed Asbestos Notification Form, (ANF -001), to
the MassDEP with the appropriate fees paid for the asbestos demolition operation. An emergency waiver
of the ten (10) working day notification period, if appropriate, will be granted by the MassDEP upon
request.
3. A licensed asbestos contractor shall be at the Site to manage all asbestos- containing material and
asbestos - containing waste material at the Site during the demolition operation. This asbestos contractor
shall submit a separate Asbestos Notification Form, (ANF -001), to the MassDEP with the appropriate
fees paid. An emergency waiver of the ten (10) working day notification period, if appropriate, will be
granted by the MassDEP upon request.
4. The work area shall be demarcated to prevent access by any personnel' who are not part of the
demolition and asbestos loading operation. All demolition operations shall be done with wet methods so
that no dust is generated.
5. Large capacity water hoses shall be used during all phases of the demolition and loading
operation to eliminate dust generation. Water runoff control shall be implemented to ensure the
capture and containment of all asbestos - contaminated water from the Site. Asbestos - contaminated
water must pass through filters capable of capturing and containing particles greater than or equal to
five (5) microns in size, before disposal to a sanitary sewer is permitted. If a lined collection pit is
utilized then following all demolition operations the liner shall be removed and disposed of as asbestos
waste and three (3) inches of soil shall be excavated from the pit and disposed of as asbestos waste.
6. The demolition contractor shall use equipment of sufficient size to ensure a controlled
demolition operation and to prevent the uncontrolled collapse of lower floors and walls. All equipment
and personnel associated with the demolition operation shall be fully decontaminated on a daily basis
and before being released to other service.
COMMONWEALTH OF MASSACHUSETTS
l' EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS
r, -
a Writ DEPARTMENT OF ENVIRONMENTAL PROTECTION
-, WESTERN REGIONAL OFFICE
t-- 436 Dwight Street • Springfield, Massachusetts 01103 • (413) 784 -1100
DEVAL L. PATRICK IAN A. BOWLES
Governor
Secretary
TIMOTHY P. MURRAY
LAURIE BURT
Lieutenant Governor
Commissioner
Ammar Dieb, President
Universal Environmental Consultants, Inc.
12 Brewster Road
Framingham, MA 01702 Re: BWP- Northampton
491 Bridge Road (the "Site ")
Alternate Work Practice Request
CONDITIONAL APPROVAL
Due to a fire at the residential apartment building at the above referenced Site in the Florence
subdivision of Northampton, MA, the structure is unsafe to perform asbestos removal prior to
demolition operations. The structural instability of the building has been exacerbated by the post -fire
exposure to the elements. Continued exposure to the elements may lead to the accumulation of
vectors and uncontrolled collapse.
The building has previously been inspected for asbestos- containing materials and asbestos - containing
materials are present in the ceilings and floors.
Your letter, submitted on behalf of the property owner, requests that the demolition contractor be
allowed to demolish the building without prior asbestos removal operations and that the material be
allowed to be bulk loaded into lined rolloffs for disposal as asbestos waste.
As part of your work plan you have submitted alternative work practices such as wetting, perimeter air
monitoring and decontamination of vehicles and personnel with regards to certain MassDEP asbestos
handling regulations in order to expedite the demolition operations, which are necessary to protect
public health and safety.
Massachusetts Department of Environmental Protection ( "MassDEP ") personnel have inspected the Site
and have reviewed your submittal and proposed alternative work practices.
The specific sections of 310 CMR 7.15, the MassDEP's "asbestos regulation" that this Conditional
Approval applies to are:
310 CMR 7.15(1)(01, — Requires the removal of any asbestos - containing material from a facility prior to
demolition/renovation operations.
This information is available in alternate format. Call Donald M. Gomes, ADA Coordinator at 617 - 556 -1057. TDD# 866 -539 -7622 or 617 -574 -6868.
DEP on the World Wide Web: http: / /www.mass.gov /dep
0 Printed on Recycled Paper
CITY OF NORTHAMPTON, MASSACHUSETTS
° ° ti DEPARTMENT OF PUBLIC WORKS
4,4k )/4 125 Locust Street
« Northampton, MA 01060 -2066
•.. » .
413 - 587 -1570
Fax 413 - 587 -1576
Edward S. Huntley, P.E
Director
June 3, 2009
Anthony Patillo, Building Inspector
Municipal Office Annex
212 Main Street
Northampton, Ma 01060
Dear Mr. Patillo:
The water service at building #21 Meadowbrook has been disconnected from the city
water main and the water meter has been removed from the premises as of 6/3/09.
Please contact me if you have any questions.
incerely, i i.44.4, 1
David Sparks
Superintendent of Water
Cc: Ned Huntley, Director of Public Works
Jim Laurila, City Engineer
'.i 06/04/2009 10:55 4135686625 COMCAST PAGE 01/01
6/4/09
Meadow Brook Apartments
491 Bridge Rd
Florence, MA 01062 -1083
RE: Building #21 Demolition •
To whom it may concern:
Comcast has disconnected mainline services to building #21. We have removed our
mainline equipment from the pedestal at the rear of the building. We have left the
pedestal in place to protect the mainline cable and conduit. We feel a grade level box
may get crushed and graded over. If this presents a problem please feel free to contact
me.
Sin - e . y,
7 . .
Raymond LaBorde
Project Coordinator
Comcast Cable Communication Inc.
1 110 East Mountain Rd
Westfield, MA 01085
413 -562- 9923x2295
Ray_LaBorde @cable.comca.st.com
veri on
Verizon
David Ulm
111 North Hatfield Rd.
Hatfield, Ma. 01038
Tel. 413- 247 -3266
June 3, 2009
Re: Telephone facilities removal for demolition permit
To whom it may concern,
Telephone facilities have been removed from the building located at 491 Bridge Rd.
Building 21, Northampton, Ma. as of June 2, 2009
Special Note to: Meadowbrook Apartments Management and associated contractors.
Telephone facilities exist on property. Dig safe and underground excavation and
heavy equipment precautions must be in effect to ensure Telephone equipment is not
damaged.
Respectfully
David Ulm
Local Manager for Verizon
national rid
June 1, 2009
Meadowbrook Apts
491 Bridge Rd. Bldg 21
Florence, MA 01060
To Whom It May Concern,
This is to verify that National Grid has only disconnected the UG service. The IJG
service was not removed.
Sincerely,
\f (C-ka
7 r ,
Jim Nichols
Supervisor
Distribution Design
JN /ekp
548 Heydenville Road, Leeds, MA 01053 ■ wwwMatIonal9rid.com
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
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� 47 _ _ = E! N , M ass. Date "� n t _
c c�� Permit #
�. "------- '► Building Location 1 /9 ' JV ftcita, ->; Owner's Name " e ^ -P. S' t'�'" -- t �� C
, -P (:0 o1 ; 2Y 1 T o f O ccupancy C2d-s
New 0 Renovation ` ReRta '' Plans Submitted: Yes!. No 0
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6TH FLOOR' •
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• Installing Company Name .7 ./ 4- e-- t � Chec one: Certificate •
Address ( ..C _S R4.4 ❑ Corporation
e_ (0, - ht e c' `' & ') ❑ Partnership
1 .1( Business Telephone 1 ' � 3 ,</V
Name of Licensed Plumber or Gas t=itter " / / .1 '
' INSURANCE COVE GE: •
1 have a current ' iility insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑.
If you have checked yes, please i 'f the type coverage by checking the appropriate box. '
A liability insurance policy Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws. and that my signature on this permit application waives this requirement.
Check one:
Owner❑ Agent 0
. Signature of Owner or Owner's Agent •
•
I hereby certify that all of the details and information 1 have submitted for entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations perforfned under the permit Issued for this application will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General ws.
By T ■• - •-Manse: / �f /
• umber nature of Licensed Pauym -i or Gas ittec,
Title m r: i f ( j t /r / C , ( ` � 1 �
• - ter License Number _
City/Town • Journeyman
APPROVED (OFFICE USE ONLY)
pat -Mop
DIG SAFE SYSTEM, INC.. - Create New Quick Ticket Page 1 of 1
Request Number: 20092303480 Date 06/02/2009 Time 08:04
Latitude: Longitude:
State: MASSACHUSETTS Municipality: NORTHAMPTON
Address / Intersection: 491 BRIDGE RD
Nearest Cross Street 1: N ELM ST Nearest Cross Street 2:
Additional Information: DEMOLITION OF FIRE DAMAGED STRUCTURE.
Nature Of Work: DEMOLITION OF FIRE DAMAGED STRUCTURE
Area Of Work: PRIVATE PROPERTY
Area Is Premarked: Y Start Date: 06/05/2009 Start Time: 08:30
Caller: JOANIE SAVAGE Title: DEMO CO ORDIN Return Call: BEF 430PM
Phone#: 413 - 732 -3179 Fax #: 413 - 734 -6224 Alt. Phone #:
Email Address: ABW_INC @COMCAST.NET
Contractor: ASSOCIATED BUILDING WRECKERS
Address: 352 ALBANY ST City: SPRINGFIELD State: MA Zip: 01105
Excavator Doing Work: ASSOCIATED BUILDING WRECKERS, INC.
Member Utility List
Code Abbreviation Name
AJ COMCAS COMCAST - SOUTH BURLINGTON
MC MASSEL MASS ELECTRIC COMPANY
ML MCI MCI
SP VERIZN VERIZON
WB BRKGAS BERKSHIRE GAS
WG BSTGAS BAY STATE GAS
ON ONTARG ON TARGET LOCATING
RJ IDM INNOVATIVE DATA MANAGEMENT
• There may be non - member utilities in the area that you need to notify.
• Electric and other companies may not mark lines they don't own or maintain. You may want to
contact them for more information.
• The excavator is responsible to maintain markings placed by member utilities...
DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES.
Create New ] ( Create From Existing ) Print Ticket ) ( Return To Menu ) ( Return To Home
http: / /digsafeform .digsafe.com /cgi- bin/dlcgi.exe 06/02/2009
•
May 20, 2009
Page 2 of 2
Preservation of Affordable Housing acknowledges thrlt they are the Owner of the property and
are not in bankruptcy or petitioning for bankruptcy.
Any balance that becomes past due for any reason will be charge -c1 a service charw of 1.3% per
month, 189 annually. If it should become necessary to turn this account over for collection,
the billed party agrees to pay all collection costs plus reasonable attorney's fees incurred.
Preservation of Affordable Housing is unaware of any hazardous materials or wastes on the
property and knows of no legal reason, regulation, or other circumstances, which might
prevent or in any way interfere with the right or ability of Associated I. ui1ding Wreckers, Inc.
to perform the above work if any hidden conditions cto exist on this job, they a re the owner's
responsibility.
Sincerely,
• iated Buildin; Wreckers, Inc. Agreed and Ac_mIed:
Al At By: ,6fia .AL(2- 6
Andrew Mirkin, Presiden Alexandra M. Dailey Date
Preservation of Affordable Housing
•
V: \cMcadowbrook\ Insurance \Fire 4- 13 -09\ Construction \ Demolition \ABM/ final bid 5- 20- 09.doc
ASMATELY BUILDING WRECKERS INC
352 Albany Street, Springfield, . Massachusetts 01105
Tel: (413) 732 - 3179/(800) 1'18 -2822
Fax: (413) 731 -6224
,June 5, 2009
Alexandra M. Dailey
Manager of Assets
PRESERVATION OF AFFORDABLE HOUSING
40 Court Street, Ste. 650
Boston, Massachusetts 02105 •
For the suns of and salvage rights, we offer to demolish Ilie. fire damaged Building
#22 as asbestos special waste at the Meadowbrook Estates located al 491 Bridge Road,
Florence, Massachusetts. The cost breakdown is as follows:
Asbestos:
' Demolition:
Associated Building Wreckers work includes:
1) Demolition of the building and removal of all debris as asbestos special waste, leaving
the slab in place. Care will be taken to protect the cement slab.
2) Trucking and disposing of tile. asbestos special waste to an approved landfill which can
accept asbestos. All loads will be manifested. Loads will be placed into trailers Iined
with 2-10 mil bladder bags.
3) Decontaminating any metals so that the metal can be recycled, as allowed.
4) Notifying Dig Safe and arranging for the disconnection of services.
5) Filing the state required ANF -001 DEP notification for asbestos and the l3WP AQ -06
DEP notification for demolition.
6) Taking out the demolition permit and furnishing a certificate for demolition general
liability and workers compensation insurance, upon request.
7) Using water for dust control, as needed.
8) Installation of hay bales at lower section of site to control potential run off.
Preservation of Affordable Housing will be responsible for:
1) Any salvaging of items to be retained by tenants, if required.
2) Any service disconnection charges, if any.
3) Obtaining any historical permits or special notifications, if required.
4) Any repair, to grass, landscaping, walkways, asphalt, or concrete slab damaged during
demolition in the work area.
5) Any damage to underground services that Dig Safe and /or Preservation of Affordable
Housing has not made us aware of (including, but not limited to, underground
sprinklers, roof drains and septic systems).
6) Cost associated with any hazardous materials found at the site.
7) Hiring and paying for a third party Industrial Hygienist to do the required air
monitoring during demolition and clean -up as well as a visual inspection of the
concrete slab /foundations and surrounding grounds, as required.
8) Marking out septic tank and /or well with stakes prior to demolition, if applicable.
9) Marking the property for Dig Safe.
10) Rodent control, if required.
11) Obtaining waiver numbers from the Mass DEP and Mass DOS, as required. Associated
Building Wreckers, Inc. will assist in this process.
12) Making payment in full upon completion within thirty (30) days.
Alexandra M. Dailey
V : \Mcadowbrook \Insurance \Fire 4 -13 -09 \ Construction \ Demolition \ABM' final bid 5- 20- 09.doc
Version1.7 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
L /1fi r h N I /,� 5 —') I' �' � COMIC
as Owner of the subject property
I, ..,.._._. ____....__._.. _..._. , ,__Sr ` ... _.•.__. _ ..__.___. ,._ -.....
' �" trfci�
hereby authorize 5 �? ULL i / 2j 1 r 74.� s 1/'' to
act on my behalf, in all matters relative to work authorized by this building permit application.
�✓�C X
afratilid Crit
Signature of Owner Date
11rt P_( TALL ii 1fP1 I' r (( t' 7 _ __ -,_,_ , as Owner /Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Si n ed under the�ains and�enalties,of perju , ,
0 i (.3 �',��c e,
I�
Print Va y -
Signatu e of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : . � � Ii1
License Number
`l 0 a m---(, f G fit
Address Expiration Date
171 7173(
S' • at 0 Telephone
CTION 3 - 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 110 No 0
Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION- SERVICES -.FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION.CONTROL PURSUANT' TO .780 CMR : 116 (CONTAINING MORE THAN 35,000 C.F., OF ENCLOSED SPACE)
9.1 Registered Architect:
I Not Applicable IV
Name (Registrant): I
a
Registration Number
Address I --
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
1
Signature Telephone Expiration Date
• I
Name Area of Responsibility
Address Re istration Number
Signature Telephone Expiration Date
.w._,
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
( . ____ ....... ,. .. 1111
Name Area of Responsibility
t
Address Registration Number
1 ----- ..__ _ ., .
Signature Telephone Expiration Date
9.3 General Contractor p f
- /Ci)/X4/ t(ww /dll ild tt ro/
') -kG, — Not Applicable ❑
Company Name: -
1 / � r �_ . _.. ,......____...— F
Responsible In Charge of Construction
L.�1 , A/ , cL4 I_ 4221 ' I; _... / O �
A s
Sign re Telephone
A
Versionl.7 Commercial Building Permit May 15, 2000
8 It RTHA PTON W1N+G
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Sizeu.�
Frontage _..__ _ _ _ *.. ..
Setbacks Front L-m.
Side L: _._. R:._.. ' L:__.. R �l _ .
Rear
Building Height L
Bldg. Square Footage
Open Space Footage g
(Lot area minus bldg " iiµ.. 6 & paved ' L L
parking)
# of Parking Spaces - `
Fill:
(volume & Locat ion)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW Q YES Q
IF YES: enter Book _..._ Pager and /or Document # , m
B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Q ,Date Issued:
C. Do any signs exist on the property? YES Q NO et
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
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
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
1
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE 1
Interior Alterations ❑ Existing Wall Signs ❑ Demolition L�J Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here. 1), in i ' f f f /) o f..erlffrt. 1//15//h4iftt(-fi 1/ it
Of Proposed Work
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 ❑
Institutional ❑ 1-1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential 6 R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B L ❑
U Utility ❑ Specify: '
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: .... -_.-__ i Proposed Use Group: __ ___--__..- -_. .__. _...____ _ .,_ .,,. --
Existing Hazard Index 780 CMR 34): __ �..,.. ,... Proposed Hazard Index 780 CMR 34): (� 1, „ - W N _ ,
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION E OFFICE USE, ONLY°
'
Floor Area per Floor (sf)
1 st 74
I `
{ '"”'
3rd __
__.._ 4 th
4 th
Total Area (sf) ► = Total Proposed New Construction sf
�t E -t a7 j
Total Height (ft) 1
Total Height ft r - ,. ..._ ..,i
7. Water upply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage sposal System:
Public ) Private El Zone ' Outside Flood Zone Municipal' On site disposal system❑
A
Versionl.7 Commercial Buildin: Permit Ma 15, 2000
as a� � �
City of Northampton J ;
Building Department qR
212 Main Street
Room 100 a 6 . i
i
009 .- Northampton, MA 01060 I,� � � � ' / ��
V" phone' 413 -587 -1240 Fax 413- 587 -1272 #, A 0. � ' ,, 1�� Y � ;: �
APPLICATION TO_ CANS - • , REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCYpF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION SITE! INFORMA' I ON
'S
1.1 PropertvAddress: � . , .. ...
/4q i ratist* ic ,110 lV M . Di r ct
.r
r �` • i 2R OB i t$ct
SECTION 2 PROPERTY. •OWNERSHIPIAUTHORIZED •AGENT
2.1 Owner of Record:
r K _ 06 Met c /0 -T./ ,, z 1 0 our .:,St tr. ` jl k7 z/�, 4
Name (Print) Current Mailing Address:
7 a / �/t /7 { QJ . 4y- /) < i
gnature /)Jfc rcitl /��/)C� c f f ( r �( M.C. L�( 1'r' I
Si
11111 � Telephone
2.2 Authorized Agent:
I A S icff9c! &l // Yi J h s)J/?C t3h5 / hr' In VSh}. SP/ In i/ /liA GLL
Name (Print` Current Mailin.�Address: V
Signature � \, Telephone
SECTIONi3_4STIMATED CONSTRUCT'.ION�CQST
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building 1� ;J . \ 1 , h o.o . 00 ( a ) Buildin .Permit F ee 1
2. Electrical ' (b).Estirnated Total.Cost:of. :
Cerietruetipnfrom (6) is i. ...__,1
3. Plumbing Build Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
CAI ////�� f _. Q/y
6. Total = (1 + 2 + 3 + 4 + 5) , 1) (J0 , LI Check Number 3 tt q dam( O&
. This Section For Officrat:Use OnIX _.
Building PermitNumber Date
' Is'sued:
Signature:
Building Commissioner /lnspector:of Buildings Date
{
File # BP- 2009 -1029
APPLICANT /CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC
ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413) 732 -3179
PROPERTY LOCATION 491 BRIDGE RD
MAP 17D PARCEL 012 001 ZONE URB(100) / /WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid id 3O 3 x00--
Typeof Construction: DEMOLISH BLDG #21
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 F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Penn it 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
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.
1
BP- 2009 -1029
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: demolition BUILDING PERMIT
Permit # BP- 2009 -1029
Project # JS- 2009 - 001458
Est. Cost: $31500.00
Fee: $200.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: ASSOCIATED BUILDING WRECKERS INC 062382
Lot Size(sq. ft.): 1169150.40 Owner: MEADOWBROOK PRESERVATION ASSOCIATES LTD PARTNERSHIP
Zoning: URB(100) / /WP Applicant: ASSOCIATED BUILDING WRECKERS INC
AT: 491 BRIDGE RD
Applicant Address: Phone: Insurance:
352 ALBANY ST (413) 732 -3179 Workers
Compensation
SPRI NGFIELDMA01105 ISSUED ON:6/9/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: DEMOLISH BLDG #21
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 6/9/2009 0:00:00 $200.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo