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24B-077 Demo Permit % ProScience Analytical Services, Inc, Rush / <6 Hours Chemistry Chain of Custody Record /Metals - Turn Around Time Requested LABORATORY /HEADQUARTERS CONSULTING SERVICES p). jii 1 /2 AVYt 22 Cummings Park, Wobum, MA 01801 683 North Mountain Rd., Newington, CT 06111 1 Same Day Next Day 48 Hours I 72 Hours 1 4-5 Days T:781- 935 -3212 F :781 -932 -4857 T:860- 953 -1022 F: 860-953-1030 Client: 5 Element TYPE OF Address: Street , 5j I ref s/- ANALYSIS (Column 4) Town a}/t^ State2p AIR DUST V4 Cd Cr As Se Ag Ba Hg For Laboratory Use Project Site Line 1 5 c le- S A., -I•- Project PM10 SOIL Number 0i - 7 /Orl, PM SO TC Other (please specify) BATCH NUMBER line 2 more TSP WATER WIPES TS WA WI Contact: Phone QC 5 �1 . 1 C e (k / Alt/Pager FOR LABORATORY USE ONLY TYPE Air Sampling Information Wiped area ANALYSIS Date Field OF Start End Start End Volume length width Area Weight 1 I AA Lab Sampled W. Sample Description/Location ANALYSIS Time Time Flowrate Flowrate (liters) (inch) (inch) (sg in) (grams) `Dil'n Reading RESULT I.D. 9' 6 . 1 j _ i Relinquished By / Date: /WO 2 Time: Received By: �• �) Date: 1-q-10 Time: /0,70 t • V' - / h - - tk)..1-.9._ Comments: Log -out: i I Date t i (Wipes provided by ProScience Analytical PG OF ver 4.7 For complete information about our services and locations please visit us at www.proscience.net or call the numbers above. � ProScience Analytical Services, Inc. Telephone: 781 - 935 -3212 Kali 22 Cummings Park, Woburn, MA 01801 Facsimile: 781 - 932 -4857 Email: chemistryproscience.net Laboratory Report Contact: Chris Coelho Batch #: C 258922 Client: ECS, Incorporated Date received: 1/7/2010 Address: 588 Silver Street Date analyzed: 1/8/2010 Agawam, MA 01001 Date of report: 1/8/2010 Project # 01- 210189 AIHA Lab ID: 102754 P.O.# N/A Project Site: 300 King Street Lead Analysis In Paint Using SW846- 7420/3051 Results in weight percent on an "as received" wet weight basis Sample Detection Lab ID Client ID date Description Result Limit Comments C 355795 Pb -1 N/A White Str. Support - Pump Island 1 BDL 0.02 C 355796 Pb -2 N/A White Str. Support - Pump Island 3 BDL 0.01 Ira At A—A11 Dan Pine, hem'. try A . yst Stephen Chace, Technical Director Page 1 of 1 Unless otherwise indicated, all samples were received in acceptable condition. All result apply only to the samples as received and are accurate to no more than three significant figures. Unless otherwise indicated, all the quality control criteria for the method above have been met. BDL - Below Detection Limit Note on units: mg /Kg is the same as ppm by weight. ProScience Analytical Services, Inc. Rush / <6 Hours - Chemistry Chain of Custody Record /Metals - Turn Around Time Requested LABORATORY /HEADQUARTERS CONSULTING SERVICES Fries lima 22 Cummings Park, Woburn, MA 01801 683 North Mountain Rd., Newington, CT 06111 1 I Same Day X Next Day ' 1 48 Hours I 72 Hours 4 -5 Days T:781- 935 -3212 F:781- 932 -4857 T:860- 953 -1022 F: 860- 953 -1030 Client: S Element TYPE OF Address: Street 5 Sjltt }.: ANALYSIS (Column4) Pb Cd Cr As Town QState/Zip ,./FyV∎ State/Zip AAA( AIR DUST PANT , r Al Du • Se Ag Ba Hg For Laboratory Use Project Site Line 1 ?co Kt BPS c.-S- Project PM10 SOIL 6T OLP Number 0l •• zo / s7 00 PM SO T Other (please specify) BATCH NUMBER Line 2 more TSP WATER WIPES /) lJ A,S71t ep,,,�_ TS WA WI QC C r1 Contact: Phone / 3 �cD l FAX Alt/Pager FOR LABORATORY USE ONLY TYPE Air Sampling Information • Wiped area ANALYSIS Date Field OF start End Start End Volume length width Area Weight i I AA Lab Sampled I.D. Sample Description /Location ANALYSIS Time Time Flowrate Flowrate (liters) (inch) (inch) (sq in) (grams) ,Dil'n Reading RESULT I.D. -*C/1 COM f054c Sc►•I 4 ,3.5.51 `l . • _ I Relinquished By: Date: Time: Received By: t j,..' % C., t ,1-4......, Date: ) j Time: 1(, :10 Comments: Log -out I 1 Date . I Wipes provided by ProScience Analytical PG OF ver 4.7 For complete information about our services and locations please visit us at www.proscience.net or call the numbers above_ LIWM ProScience Analytical Services, Inc. Telephone: 781- 935 -3212 Wald 22 Cummings Park, Woburn, MA 01801 Facsimile: 781 - 932 -4857 Email: chemistry@proscience.net Laboratory Report Contact: Chris Coelho Batch #: C 258921 Client: ECS, Incorporated Date received: 1/7/2010 Address: 588 Silver Street Date analyzed: 1/8/2010 Agawam, MA 01001 Date of report: 1/8/2010 Project # 01 - 210189.00 EPA Lab ID: MA1042 P.O.# N/A Project Site: 300 King St North Hampton, MA TCLP Lead Analysis Using Methods SW846 1311/3051/7420 Results in mg /L Sample Detection Lab ID Client ID date Description Result Limit Comments C 355794 TCLP -01 N/A Composite Building Materials BDL 0.4 2 1_5 Dan Pin -, Chemistry Analyst \. Stephen Chact, Technical Director Page 1 of 1 Unless otherwise indicated, all samples were received in acceptable condition. All result apply only to the samples as received and are accurate to no more than three significant figures. Unless otherwise indicated, all the quality control criteria for the methods above have been met. BDL - Below Detection Limit Note on units: mg /L is the same as ppm (w /v). Procience Anaiyficai Services, Inc, ❑ RUSH Page Of PLM Asbestos Chain of Custody Record Turn Around Time Requested LABORATORY /HEADQUARTERS LABORATORY SERVICES 22 Cummings Park, Woburn, MA 01801 683 North Mountain Rd., Newington, CT 06111 ❑ Same da 24 Hour 48 Hour ❑ 72 Hour ❑ 5 Days T:781- 935 -3212 F:781- 932 -4857 T :860 -953 -1022 F:860- 953 -1030 Client: Environmental Compliance Services, ECS Relinquished by /date: - Address: Agawam - Received by /date: ___ � -=�l , 1 o - � Project Site & Number: 0 ,,tar" it &--3 ° - l t A w4<i b/'t, Samples received: Analyzed : Phone / FAX Number: 413 -7 9 -3530 / 413- 789 -2776 ` Faxed, E- mailed, Verbal by /date: Contact: (fit • apoi • ° on first sit' e: Yes No For tab Use> Batch Number Analyzed b • - e: fi I JO QC by /date: Stereo Scope Optical Properties Asbestos Percentage ( %) Non Asbestos Percentage ( %) co �¢ m / Circle Type - Field ID ° 5 E o N O N Lab ID Sampled Description /Location - �, m o so a. w " N Q `o ° 3 a a e o w 8 N h :Q c g R 5 LL date ° o 2 k a I. X r o m T •3 r o U 2 F- LL W to m 0. 11 1 U U Q u. M U S co O z IIIIIII, /to III MIN t l ( 6- c . 11 /a. - _ . NI . . m UN _ _ _ L Comments: Birefringence L. less than .010, M= .011 -.029, H= greater than .03: Microscope Olympus BH -2, Serial # circle 1- 242277, 229027, 235000, 230663 Laboratory uses the EPA or ELAP point count method as appropriate For complete information about our services and locations please visit us at www.proscience.net or call the numbers above. Revised on 4/7/09 u RUSH rage Of A PLM Asbestos Chain of Custody Record Turn Around Time Requested LABORATORY /HEADQUARTERS LABORATORY SERVICES 22 Cummings Park, Woburn, MA 01801 683 North Mountain Rd., Newington, CT 06111 ❑ Same da 24 Hour 48 Hour ❑ 72 Hour ❑ 5 Days T:781 935 - 3212 F :781 932 - 4857 T:860- 953 -1022 F:860- 953 -1030 Client: Environmental Compliance Services, ECS Relinquished by /date: Address: Agawam _....- Received by /date: f D C Project Site & Number. - le_ 300 n, S-1-, , -; k -11 n. Samples received: Analyz Y Phone / FAX Number: 413-19-3530 / 413- 789 -2776 r Faxed, E- mailed, Verbal by /date: Contact: (.tom' ..0, .. Sto • •n first p itiv : Yes No For Lab Use> Batch Number Analyzed • - . -. ' GX / X f to QC by /date: Stereo Scope Optical Properties I Asbestos Percentage ( %) Non Asbestos Percentage ( %) cn a ICircle Type i Field ID ° ca c E a Lab ID Sampled Description / Location -fl § e' 2 W F t o m'a o o , o 0 n n 2. ' w a o S d v. ¢ o o d Q i a = T L o date v u I t „m a II _L v ¢ v A ¢¢ u v x o z /0 a � � 1� `� toy w la 0 pj- ,... III M / I / ■,. If 6 6- G r iiii 1, i?4 . 4 lge) 0 it K f, Comments: Birefrin L= less than .010, M= .011 -.029, H= greater than .03: Microscope Olympus BH -2, Serial # circle 1- 242277, 229027, 235000, 230663 Laboratory uses the EPA or FLAP point count method as appropriate For complete information about our services and locations please visit us at www.proscience.nef or call the numbers above. Revised on 417/09 Pro Analytical Services, Inc. s ❑ RUSH Page Of - f PLM Asbestos Chain of Custody Record ` Turn Around Time Requested LABORATORY /HEADQUARTERS LABORATORY SERVICES - - il 22 Cummings Park, Woburn, MA 01801 683 North Mountain Rd., Newington, CT 06111 ❑ Same da 24 Hour 48 Hour ❑ 72 Hour ❑ 5 Days - T:781- 9353212 F:781- 932 -4857 T:860- 953 -1022 F:860- 953 -1030 Client: Environmental Compliance Services, ECS Relinquished by /date: Address: Agawam Received by /date: 1(7 1 o /y,„l , Project Site & Number: { � � � (� . �CJo � � - �,� µ� t1. Sample received: Analyzed: Phone / FAX Number. 413 / 413 789 - 2776 tJ Faxed, E- mailed, Verbal by /date: Contact: (( k.b --Sto first posi ive: -s No For Lab Use> Batch Number Analyzed / ; d QC b /date: Stereo Scope Optical Properties R r Asbestos Percentage ( %) Non Asbestos Percentage ( %) i a' Circle Type Lab ID escription / Location 1 to 1 t_.> l ui i - T. .? i i ill - 1- t 1 i.: 8 i g 0 7d ' gimmai6 • II ■■■■■■■ 0-76 r f 11.11111111111111t,.,, fji :.+iiii 111111111111111111111 - _ - MENNEN. 11111111111. ..,...inii o ` 5 0 i ■ raw iiiii�� 1111 �� oqt--7- rum a,. ..., IMI 0 ' o l .. Comments: Birefringence L= less than 010,1‘4 .011 -.029, H= greater than .03: Microscope Olympus BH -2, Serial # circle 1-242277,229027, 235000, 230663 Laboratory uses the EPA or ELAP point count method as appropriate For complete information about our services and locations please visit us at www.proscience.net or call the numbers above. Revised on 4/7/09 PLM Asbestos Chain of Custody Record Turn Around Time Requested LABORATORY /HEADQUARTERS LABORATORY SERVICES 22 Cummings Park, Woburn, MA 01801 683 North Mountain Rd., Newington, CT 06111 ❑ Same da 24 Hour 48 Hour ❑ 72 Hour ❑ 5 Days T:781- 935 -3212 F:781- 932 -4857 T:860- 953 -1022 F:860- 953 -1030 Client: Environmental Compliance Services, ECS Relinquished by /date: ]j � ,n Address: Agawam Received by /date: t° '," to 24/" t . Project Site & Number: 0 /rUZ ^ J l . 300 S-1-, ` at 4147/11711:11. Samples received: Analyzed: Phone / FAX Number: 413 -7119 -3530 / 413- 789 -2776 0 Faxed, E- mailed, Verbal by /date: Contact (.31 Le, . • p -n first ositi e: Yes No For Lab Use> Batch Number Analyz- 0 b �igW" ,� r l f D QC by /date: Stereo Scope Optical Properties RI Asbestos Percentage ( %) Non Asbestos Percentage ( %) c4 `o Circle Type I — Field ID e - FL 0 �, 8 W r °� o m a a o _ d E `o :c 2S w o e o a, c - Lab ID Sampled Description / Location ti date 0 0 m o 8 ° ° z: a L Iii o o c x l— �.. y 'm a I I 1 n l= ¢ a LL v x co o z 0 & RBI f r M A I 1111 III 1 ■ 0� ° 1, 1 ,die ' * 0 "f 0 , . ■IRIS ■ 111111 Ab ■ *1 . 1111 (76 1111 b S b - 06 6 0 ■Im ■ o - y _ ._ Comments: Birefringence L. less than .010, M= .011 -.029, H= greater than .03: Microscope Olympus BH -2, Serial # circle 1- 242277, 229027, 235000, 230663 Laboratory uses the EPA or Et.AP point count method as appropriate For complete information about our services and locations please visit us at www.proscience.net or call the numbers above. Revised on 417/09 ProScience Analytical Services, Inc. ❑ RUSH Page of PLM Asbestos Chain of Custody Record Turn Around Time Requested LABORATORY /HEADQUARTERS LABORATORY SERVICES 22 Cummings Park, Woburn, MA 01801 683 North Mountain Rd., Newington, CT 06111 ❑ Satne da ■ 24 Hour ■ 48 Hour ❑ 72 Hour ❑ 5 Days T:781- 935 -3212 F:781- 932 -4857 T:860 -953 -1022 F:860 -953 -1030 Client: Environmental Compliance Services, ECS Relinquished by /date: _ Address: Agawam s - Received by /date: a r 1 v 4 Project Site & Number: irti2, - At 1L�.30 .--1-: a, - 1 1t'h Y rz . Samples received: Analyzed: • Phone / FAX Number: 413-719-3530 1 413- 789 -2776 / Faxed, E - mailed, Verbal by /date: Contact: (247:>04 b : or on firs posi ive: Yes No For Lab Use> Batch Number Analyzed by :_ -- Att./ / X / 1 e QC by /dat Stereo Scope Optical Properties ( R?' A sbestos Percentage ( %) Non As estos Percentage %) ro o Cir Type Field ID >, L, E j � . 0 C c c c N 4 1 N 1 >. N N > N U 2 Lab ID Sampled Description / Location -° E o m - o c : N y o o x m ° c c o o 75 E c m at ? • m date o 0 o o X rn 5 t E 2 d c 5 n c 51 8 o O= f if w in n 0. U ¢ U -¢¢ LL U x cn O z 0 Ph ■ FF { l '`i III / ?t, . i/✓ 0.3 0 a- F 1 w NI � 111 _ 5" � 0 6 i � I■N 07, Iv W RIB. ‘ Comments: Birefringence L= less than .010, M= .011 -.029, H= greater than .03: Microscope Olympus BH -2, Serial # circle 1- 242277, 229027, 235000, 230663 Laboratory uses the EPA or ELAP point count method as appropriate For complete information about our services and locations please visit us at www proscience.net or can the numbers above. Revised on 4/7/09 Page of 5 SAMPLE NUMBER COLOR SIZE MATERIAL Black White 9 "x9" Joint Compound Floor Tile Cove Base Red Blue 12 "x12" Gypsum Board Mastic Ceiling Tile Green 1 Pipe Insulation 411110EM Deck Insulation Gray Brown I'x2' Duct Insulation Glazing Breeching Insulation I , an Beige 2 Skim Coat Plaster Cement Board Roofing Tar orange Cream 2 Basecoat Plaster Linoleum Backing Other: Other Glue Daub Fire Proofing Other. Sample ID Floor Room Sample ID Floor Room r Sample ID Floor Room: Basement Kitchen Basement Kitchen Basement Kitchen Ground Floor Bathroom Ground Floor Bathroom I Ground Floor Bathroom A ,st Floor Hallway 1st Floor Hallway 1st Floor Hallway 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor . Storage • 3rd Floor Storage a ... Other: Other: ^ Other: Other: Other 4� . Comments: Comments. Comments: r i��i(-g � lb s f SAMPLE Nl1MBER _ COLOR SIZE MATERIAL Black White 9 "x9" Joint Compound Floor Tile Cove Base Red • Blue 12 "x12" Gypsum Board Masti Ceiling Tile yx.,Ilow Green I'xl' Pipe Insulation at. Deck Insulation Gray Brown I'x2' Duct Insulation azing Breeching Insulation Tan Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar 3 / orange Cream 2'x4' Basecoat Plaster Linoleum Backing (Other: Other: Glue Daub Fire Proofing Other. Sample ID Floor • Room: Sample ID Floor: ? Room: I Sample ID Floor: I Room: Basement Kitchen Basement Kitchen I Basement Kitchen ////���� Ground Floor Bathroom Ground Floor Bathroom Ground Floor Bathroom . ' 1st Floor Hallway � 1st Floor Hallway I st Floor Hallway 2nd Floor Office ri `1 2nd Floor Office 2nd Floor Office 3rd Floor Storage �� 3rd Floor Storage 3rd Floor Storage Other Other. Other: — Other: Other. Other E4 fertOr erfrpor ( . Comments Comments Comments. • 1 SAMPLE NUMBER COLOR SIZE MATERIAL I Black White 9 "x9" Joint Compound Floor Tile Cove Base Red Blue 12 "x12" Gypsum Board M. tic Ceiling Tile yellow Green 1'x1' Pipe Insulation Deck Insulation r ,C Brown I'x2 Duct Insulation g Breeching Insulation I ( fi e/ an Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing Other Other: Glue Daub Fire Proofing • I Other: 1 Sample ID Floor: Room: Sample ID Floor: Room: Sample ID Floor: _ Room: Basement Kitchen Basement Kitchen 1 Basement Kitchen Ground Floor Bathroom Ground Floor Bathroom Ground Floor Bathroom 1st Floor Hallway 1st Floor Hallway ' 1st Floor Hallway 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage O er fOther Other: Other. I Other: Other: Comments: Comments: (Comments: f vm 9 is IAN :tom frill./ 1 5 144' Page of 2 SAMPLE NUMBER COLOR SIZE MATERIAL Black White 9 "x9" Joint Compound Floor Tile Cove Base Red Blue 12 "x12" Gypsum Board Mastic Ceiling Tile • Green 1'xl' Pipe Insulation Caulking Deck Insulation 9 Q� Brown I'x2' Duct Insulation Glazing Breeching insulation �1 f / an Beige 2,x^' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing Other Other: • _ Daub Fire Proofing ' Othe• .h . ` Sample ID Floor. Room: ' Sample ID Floor Room Sample ID Floor Room: Basement Kitchen Basement K Basement Kitchen lour Bathroom G loor i Ground Floor Bathroom /� &s1 Floor Hallway 1st Flo Hallway 1st Floor Hallway �f 2nd Floor Office -2nd Floor Office 2nd Floor Office i , 3rd Floor Storage YYY 3rd Floor Storage 3rd Floor Storage Other: Other:_ Other: Other: Other. Other: tN Comments: � j Comments: 7 f Comments: . H `r 1 �C SAMPLE NUMBER COLOR SIZE J MATERIAL Black White 9 "x9" Joint Compound Floor Tile Cove Base Red Blue 12 "x12" Gypsum Board Mastic Ceiling Tile Yellow Gr 1'xl' Pipe Insulation Caulking Deck Insulation /� Gray rown 1'x2' Duct Insulation Glazing Breeching Insulation ( / Tan eige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' .Basecoat Plaster Linoleum Backing Other: Other: Glue Daub Fire Proofing Other: ( J' kf Sample ID Floor: Room i Sample ID Floor: ; Room: J Sar{i pie 'ID Floor Room: Basement Kitchen Basement )Kitchen Basement Kitchen loor Bathroom Gr. . Floor Bat room I Ground Floor Bathroom 6 4., 1st Fl Hallway l st Floor . lo ,�{ i 1st Floor Hallway nd Floor Office n. Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other: Otthheer: Other: Other: Other: Other Comments: Commen Comments A 1 T^1 (7 eiG•t vc 1. SAMPLE NUMBER _ - COLOR _ SIZE MATERIAL Black White 9 "x9" Joint Compound Floor Tile Cove Base Red Blue 12 "x12" Gypsum Board Mastic Ceiling Tile Yellow Green I kl' Pipe Insulation Caulking Deck Insulation v Brown I'x2' Duct Insulation Glazing Breeching Insulation an Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing Other: Other: Glue Daub Fire Proofing Other: Le ykel vv0. G` u !r✓ { Sample ID Floor Room: Sample ID Floor Room: II Sample ID _ Floor: Room: Basement Kitchen Basement Kitchen 1 Basement Kitchen Ground Floor Bathroom . Ground Floor Bathroom I Ground Floor Bathroom 1st Floor Hallway 1st Floor 1st Floor Hallway 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other: Other Other: Other: Other: Other /Pi /A J I Comments: (Comments: l iComments. Uifrkil cbrAyyl 1c; rI coy' ill 1 P y /› 11 • PageAof ;/ _ SAMPLE NUMBER COLOR SIZE MATERIAL Blacl White 9 "x9" Joint Compound Floor Tile Cove Base ed Blue 12 "x /2" Gypsum Board Mastic et tog Tile 0 (‘'.7. Yellow Green 1'xl' Pipe insulation Caulking Deck Insulation Gray Brown 1'x2' Duct insulation Glazing Breeching Insulation Tan Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing Other (( Other: Glue Daub Fire Proofi ng Other Sample [D Floor: Room: Sample ID Floor: Room: Sample ID Floor, Room: Basement Kitchen Basement Kite. -. Basement Kitchen G . Fl Bathroom Gr Floor :at bro. • Ground Floor Bathroom 4 . Hallway st Hallway 1st Floor Hallway 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other Other,: Other Other. Other: Other. Ili 41 IComments Comments: Comments i i SAMPLE NUMBER COLOR SIZE MATERIAL Black White 9 "x9" Joint Compound Floor Tile Cove Base Red Blue 12 "x 12" Gypsum Board • tic Ceiling Tile Y el l Green 1'x1' Pipe Insulation Deck Insulation 1 0 q'- , Gray Brown 1'x2' Duct insulation Glazing Breeching Insulation Tan Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing I Other: Other: Glue Daub Fire Proofing Other: Sample ID Floor. 1 Room: Sample ID Floor: Room: Sample ID Floor. 7 Basement 'Kitchen Basement Kitchen Basement Kitchen Ground Floor Bathroom 6 Ground Floor Bathroom Ground Floor Bathroom 4. 1st Floor Hallway 1st Floor Hallway 1st Floor Hallway 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other: Other Other: Other: Other; Other: Comments: IComments: Comments. 1 4--,,,/e' 4. 111-95•0101(1- I I SAMPLE NUMBER COLOR SIZE MATERIAL Black White 9 "x9" Joint Compound Is Tile Cove Base Red Blue 12 "x12" Gypsum Board 111 Ceiling Tile Green 1'51' Pipe Insulation Caulking Deck Insulation I"�� Gray Brown I'x2' Duct Insulation Glazing Breeching insulation �./ Tan Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2`x4' Basecoat Plaster Linoleum Backing Other. Other: Glue Daub Fire Proofing Other: Sample ID Floor: Room: Sample ID Floor Room: Sample ID Floor: Room. Basement Kitchen Basement Kitchen Basement Kitchen Ground Floor Bathroom , Ground Floor Bathroom Ground Floor Bathroom 1st Floor Hallway lst Floor Hallway 1st Floor Hallway 2nd Floor I Office Storage 2nd Floor Office 2nd Floor Office 3rd Floor 3rd Floor Storage 3rd Fluor Storage Other Other: Other: Other: I Other: Other: Comments Comments; ; Comments ( 0/0&110::) Pagof SAMPLE NUMBER, COLOR SIZE :IAL Black White Joint Compound Floor Tile Cove Base Red Blue Gypsum Board Mastic Ceiling Tile Yellow Green 1'x1' Pipe Insulation Caulking Deck Insulation O Gra , Brown Tan Beige 1'x2' Duct Insulation Glazing Breeching Insulation 2' 2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing Othek Other: Glue Daub Fire Proofing 1 . Other: Sample 1D Floor: Room: Sample ID Floor Room: Sample ID Floor. _ Room. _ Basement Kitchen Basement Kitchen Basement kitchen " Isl Ground Floor Bathroom Ground Floor Bathroom Ground Floor Bathroom Floor hlallwa} 1st Floor Hallway ! st Floor Hallway n Fioor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other Other-: Other: Outer: Other: Other: Comments Comments Comments. g r)15) —. SAMPLE NUMBER COLOR SIZE r MATERIAL Black White 9 "x9" Joint Compound F se Tile Cove Base 4 Red Blue 12 "x12" Gypsum Board CO , Ceiiing Tile • Green I'xl' Pipe Insulation au ing Deck Insulation 0 „r Brown 1'x2' Duct Insulation Glazing Breeching Insulation ( f % y Tan Beige 2'x?' Skim Coat Plaster Cement Board Roofing Tar orange Cream 25c4' Basecoat Plaster Linoleum Backing Other: Other: Glue Daub Fire Proofing Other: Sample ID Floor. Room I Sample ID ( Floor: I Room' I+ Sample ID Floor Room: Basement Kitchen ( ` Basement ,Kitchen I Basement Kitchen Ground Floor Bathroom Ground Floor Bathroom ( Ground Floor Bathroom 6 1st Floor Hallway 1st Floor Hallwa} 1st Floor Hallway 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other: Other. Other: Other: Other: Other: Comments: Comments: IComments. /455 4 /034 h 0 SAMPLE NUMBER COLOR SIZE + RIAL Black White • Joint Compound loor Tile Cove Base Red Blue 12" Gypsum Board Mastic Ceiling Tile O Green 1'x 1' Pipe Insulation Caulking Deck Insulation Brown I'x2' Duct Insulation Glazing Breeching Insulation Tan Beige 2'x2' Skim Coat Plaster Cement Board Roofing Tar orange Cream 2'x4' Basecoat Plaster Linoleum Backing Other r y Othe Glue Daub Fire Proofing 4:, f7/ Other: ! Sample ID Floor Room: Sample ID Floor: — Room, 1I Sample ID Floor: Room. Basement Kitchen Basement Kitchen Basement Kitchen Ground Floor Bathroom Ground Floor Bathroom l Ground Floor Bathroom 1st Floor A Hallway 1st Floor Hallway I 1st Floor Hallway ll" /I / 2nd Floor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other'. Other: Other: Other: Other: Other. Comments: t Comments: • Comments: fatAlter4Pkeret/ IVO : ) I,' Page 1 of '''!' . Job #:(9/— 2/P/ tib° 588 Silver Street FOPMe.7 M l cs Agawam, Massachusetts 01001 Location:3 K;6 5-+. . Ph: 413 789.3530 'Fax: 413.789.2776 iv,)rtjagni SAMPLE NUMBER • COLOR • SIZE MATERIAL Black White 9 "x9" Joint Com d Floor Tile Cove Base Red Blue 12 "x12" ypsum Board Mastic Ceiling Tile Yellow Green 1'x1' Ptpe Insulation Caulking Deck Insulation / / Brown 1'x2' Duct Insulation Glazing Breeching Insulation an Beige 2x2' Skim Coat Plaster Cement Board Roofing Tar O orange Cream 2'x4'. BasecoatPlaster Linoleum Backing Other: Other: Glue Daub Fire Proofing Other: .. Sample ID Floor: Room: Sample ID Floor: Room: Sample ID Floor: Room: Basement Kitchen Basement Kitchen Basement Kit .-n Gro d Floor Bathroom , Floor oom d Fl :a hroom 1s ge t Flo Hallway 1 st Flo. • 1+i 1 st loo Hallway ..4 loor Office 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other: /j Ottheer: Other: Other: I Other: Other: " Comments: Comments: Comments: • SAMPLE NUMBER 4 SIZE MATERIAL Black 9'.'x9" Joint Compound Floor Tile Co • ::se Red Blue 12 "x12" Gypsum Board Mastic Yellow Green I'xl' Pipe Insulation Caulking Deck Insulation r Gray Brown l'x2' Duct Insulation Glazing Breeching Insulation 1 Z. Tan Beige ( Skim Coat Plaster Cement Board Roofing Tar v orange Cream 2'x4 t Basecoat Plaster Linoleum Backing( Other y Other: (Glue Daub Fire Proofing • Wn,tf e-S (Other: Sample ID Floor: Room: Sample ID Floor: Room: Sample ID Floor: Room: Basement Kitchen Basement Kitchen Basement n Greif- loor Bathroom /� Ground Floor Bathroom Ground Floor Bathroo 1st Flo Hallway /� •+ QHallwa ) tl .. Ha way 2nd Floor Office l 2nd Floor Office 2nd Floor Office 3rd Floor Storage 3rd Floor Storage 3rd Floor Storage Other: �Ottheer: Other: Other: Other: Other: ] Comments: Comments: Comments: Notes to Laboratory: Inspector Name/Nunber: Christopher A. Coelho/ AI072176 • / 1/ / Relinquished by /dat , .�/ ■ . . _ Analysis: L Received by /date: 2 _ Ar t-%t Turn Around Time Z /_7-16 /0;10 AO 6 4 ,(Ln L f 4 . APPENDIX A Laboratory Data 1 • Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 9 Laboratory test results did not indicate the presence of TCLP lead or lead in paint above EPA mandated limits as related to the composite building material and paint chip samples collected from the site structures. Items observed during the oil and hazardous materials survey which are listed in Section 3.1 may be removed (with appropriate handling methods) intact for proper disposal or reuse in accordance with label instructions, material safety data sheets, and/or regulatory guidance. Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 8 5.0 CONCLUSION Although no asbestos was detected in sampled building materials, roofing materials were presumed to contain asbestos. These materials should be handled in accordance with the Massachusetts Department of Environmental Protection (MassDEP) Policy #BWP -96 -012 concerning Non - Friable Asbestos - Containing Materials. At a minimum, this Standard requires the following: Roofing and /or siding work shall be performed in accordance with Massachusetts Department of Environmental Protection (MassDEP) Policy #BWP -96 -012 concerning Non - Friable Asbestos - Containing Materials. This Policy is outlined below: • Asphalt based materials consist of asphalt asbestos containing material such as roofing felts, roofing shingles, asphalt siding products and other asphalt paper products. • Notification to the MassDEP is not required for the renovation/demolition of asphalt based roofing and siding products if all the conditions and guidelines in this policy are strictly observed and followed. • Asphalt based roofing and siding products may be disposed of in a landfill permit by the MassDEP to accept solid waste and in accordance with the Solid Waste Management Facility Regulations 310 CMR 19.061(6)(b)(3)., "Requirements for Certain Classes of Asbestos Wastes," the landfill does not have to obtain a permit to accept special waste. • If the asphalt based roofing and siding products are in a deteriorated state and/or not handled in accordance with this policy or if the MassDEP has determined that asbestos fibers may be released during handling, removal, or disposal, then the materials must be disposed of in a landfill that has obtained a special waste permit to accept asbestos wastes in accordance with 310 CMR 19.061, "Special Waste." • The material must not be broken, sanded, sawed, ground or drilled. Sawing materials into pieces for ease of handling is not considered proper handling. Some alternate cutting method must be used. • The material must not be compacted or incinerated. • The materials must be disposed of in a MassDEP permitted solid waste landfill. • Any demolition involving these materials must comply with 310 CMR 7.09(3) and (4) (Dust, Odor, Construction, Demolition). • If the material is in a deteriorated state prior to commencing demolition/renovation operations, then 310 CMR 7.15 asbestos controls shall be complied with including notification the MassDEP. • If the material is in a deteriorated state and/or not handled in accordance with this policy, then the materials must be disposed of in a landfill that has obtained a special waste permit to accept asbestos wastes in accordance with 310 CMR 19.061, "Special Waste." Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 7 4.0 DISCUSSION AND INTERPRETATION 4.1 ASBESTOS No asbestos was detected in any of the building materials sampled at this location. Roofing materials were presumed to contain asbestos. Any materials discovered in the course of renovation or demolition activities which are not identified in this report should be presumed to contain asbestos until sampling shows otherwise. Section 1.1 Limitations details areas that were deemed inaccessible or were not included in the scope of work. Tables 3.1 and 3.2 detail locations and results of all samples collected. 4.2 LEAD Results of the TCLP lead and lead paint analysis are detailed in Tables 3.3 and 3.4. ECS collected a bulk building material sample for waste stream characterization and submitted this sample for TCLP lead analysis. ECS inspectors also collected two paint chip samples for total lead determination. Analytical results did not indicate the presence of lead above the levels of detection. 4.3 OIL AND HAZARDOUS MATERIALS Items detailed in Section 3.$ may require special handling, storage, and/or disposal Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 6 TABLE 3.3 TCLP LEAD ANALYSIS RESULTS 300 KING STREET NORTHAMPTON, MASSACHUSETTS Building Description Sample ID Substrate and location Result Mg /I Composite Former Mobile Gas Station Building TCLP -01 Various building materials throughout building BDL Materials and pump island Sample TCLP Lead analysis in paint using SW846- 1311/3051/7420 method. BDL= Below Detection Limit (0.4 mg /1) Note on units, mg /L is the same as ppm on a weight/volume basis. TABLE 3.4 TCLP LEAD PAINT CHIP ANALYSIS RESULTS 300 KING STREET NORTHAMPTON, MASSACHUSETTS Building Description Sample ID Substrate and location Result Mg /l Former Mobile Gas Station White Paint PB -01 Pump Island 1 - Structural Support BDL Former Mobile Gas Station White Paint PB -02 Pump Island 3 - Structural Support BDL Lead analysis in paint using SW846- 7420/3051 method. BDL= Below Detection Limit 3.1 OIL AND HAZARDOUS MATERIALS Observations of light fixtures/ballasts /transformers, various operating systems that may contain coolants /refrigerants, PCBs, mercury, and/or oils were also performed. Representative light fixtures were accessed and the ballasts were inspected for the presence of PCBs. Any mechanical systems encountered during this inspection were inspected for leaks or residual staining related to a potential leak of stored oils, PCBs and other internal fluids. Approximately 20 fluorescent light fixtures were observed containing 4 bulbs and one transformer in each fixture. These bulbs and transformers may contain measurable amounts of PCB's, mercury and/or oils. Two air conditioning units with potentially hazardous refrigerants were identified outside the building servicing the former convenience store. Two digital thermostats were observed in the facility. These thermostats may contain mercury switches. Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 5 TABLE 3.1 ASBESTOS CONTAINING MATERIALS 300 KING STREET NORTHAMPTON, MASSACHUSETTS Functional Material %latcrial Sample Friability & Condition Estimated Space (s) Description (lass Number Access Quantity Roofm ' Materials Presumed to Contain Asbestos NOTE: See Limitations Section for areas deemed inaccessible or not included in Scope of Work TABLE 3.2 SUSPECT MATERIALS WITH NO ASBESTOS DETECTED 300 KING STREET NORTHAMPTON, MASSACHUSETTS Functional Material Sample Space (s) Description Number Throughout Gray Gypsum Board O1A, O1B, Throughout White 2'x4' Ceiling Tile 02A, O1B, Throughout Dark Gray 12"x12" Floor Tile 03A Throughout Yellow Mastic associated with Floor Tile 04A, 04B Throughout Gray 12 "x12" Floor Tile 05A Throughout 4" Black Cove Base 06A, 06B Throughout Yellow Mastic associated with 4" Black Cove Base 07A, 07B Throughout Yellow Mastic associated with Fiberglass Wall Paneling 08A, 08B Bathrooms Gray Ceramic Tile Grout 09A, 09B Throughout Brown Paper Backing associated with Fiberglass Deck Insulation 1 OA, 10B Throughout Gray Leveling Compound associated with Ceramic Flooring 11A, 11B Exterior Gray Building Joint Caulking 12A, 12B Exterior Gray Sidewalk Caulking 13A, 13B Exterior Gray Caulking at Pump Islands 14A, 14B Notes - See Limitations Section for areas deemed inaccessible or not included in Scope of Work Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 4 3.0 RESULTS AND FINDINGS The results of this inspection are presented in tabular form. These tables summarize the nature, distribution, and quantity of ACM, and TCLP -Lead and lead paint found during this survey. Types, locations, quantities, and conditions of ACM are shown on Table 3.1. Suspect materials sampled and found not to contain ACM are found in Table 3.2. TCLP lead values for composite building materials are found in Table 3.3, while lead paint chip sample results are found in table 3.4. Observed materials containing OHM are listed in section 3.1. Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 3 Laboratories for TCLP lead analysis. One composite sample (TCLP -01) was collected from representative building materials ECS also collected 2 paint chip samples from representative painted surface to determine total lead concentration by weight. The OSHA Lead in Construction standard (29 CFR 1926.62) considerers any level of lead (values > 0.0 mg /cm to be potentially harmful to workers when disturbed during construction related activities. Various OSHA work practices and worker protection requirements are mandated depending on the nature of the disturbance. Lead paint chip samples were taken to identify painted components containing measurable amounts of lead. 2.3 OIL AND HAZARDOUS MATERIALS Observations of light fixtures/ballasts /transformers, various operating systems that may contain coolants /refrigerants, PCBs, mercury, and/or oils were also performed. Representative light fixtures were accessed and the ballasts were inspected for the presence of PCBs. Any mechanical systems encountered during this inspection were inspected for leaks or residual staining related to a potential leak of stored oils, PCBs and other internal fluids. Items that may contain mercury include fluorescent lights, thermometers, heating thermostats, and electrical switches. The majority, if not all, of these items are capable of being removed (with appropriate handling methods) intact for proper disposal or reuse. Fixtures observed typically contained between 1 and 4 fluorescent light tubes each. Fluorescent light tubes contain trace amounts of various hazardous substances including mercury, cadmium, lead, and antimony. Fluorescent light tubes may contain on average 45 milligrams of mercury. According to the EPA, fluorescent light tubes are presumed to contain hazardous materials requiring proper disposal unless otherwise demonstrated. Small capacitors in fluorescent lighting ballasts are identified as electrical transformers. Electrical transformers may contain insulating and non - flammable PCBs commonly used as dielectric fluids and lubricants. According to the Environmental Protection Agency (EPA), the manufacturing and distribution of PCBs was prohibited in October 1977. Nearly all fluorescent light ballasts manufactured prior to 1979 contained capacitors that contained PCBs. Ballasts installed as late as 1985 may contain PCB capacitors. Fluorescent light ballasts which are not labeled as "No PCBs" must be assumed to contain PCBs unless proven otherwise by quantitative analytical testing. Capacitors in fluorescent light ballasts labeled as non -PCB containing may contain di(2- ethylhexyl) phthalate (DEHP). DEHP was the primary substitute to replace PCBs for small capacitors in fluorescent lighting ballasts. DEHP is a toxic substance, a suspected carcinogen and is listed under RCRA and the Superfund law as a hazardous waste. Therefore, Superfund liability exists for landfilling DEHP ballasts. Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 2 2.0 METHODS AND MATERIALS 2.1 ASBESTOS Samples were collected in a statistically random manner using the Asbestos Hazard Emergency Response Act (AHERA) protocol (40 CFR 763.86). Samples were placed into plastic bags with an air tight seal. Labels were affixed to the sample bags with specific nomenclature. Bulk samples were analyzed by Polarized Light Microscopy (PLM) using the United States Environmental Protection Agency USEPA/600/R- 93/116 method. The analysis of samples was conducted by ProScience Analytical Services, Inc., 22 Cummings Park, Woburn, Massachusetts (NVLAP Accreditation 2000090 -0). There are six minerals grouped into the term "asbestos." Chrysotile, amosite, and crocidolite are the asbestos minerals most commonly found in building materials. ACM is defined as a material containing more than one percent (1 %) asbestos by weight. Materials found to be asbestos containing are listed in Section 3.0. Exact sample compositions are included in the laboratory reports or chains of custody found in Appendix A. Polarized light microscopy (PLM) is the root method used for the identification of ACM. The USEPA Office of Research and Development (USEPA/ORD) has reviewed data from performance audits of various laboratories performing PLM. The results of that review indicated an unacceptable number of false negatives and positives for visual estimation of materials containing less than 10% asbestos. On the basis of those findings the National Emissions Standards Hazardous Air Pollutants (NESHAP) regulations were amended on November 20, 1990 (Federal Register, V.55, N.224). The revisions state that if the analyst detects asbestos in the sample and estimates the amount to be less than 10% by visual estimation, the parties legally responsible (owner or operator) for the building may (1) elect to assume the amount to be greater than 1% and treat the material as ACM or (2) require verification of the amount by point counting. Point counting is a technique used to quantify the amount of asbestos present in a sample on which PLM has already been performed. ECS recommends point counting re- analysis for asbestos values less than 10 %, and where applicable those results are reflected in the report. In instances where client authorization is not received for this reanalysis, PLM visual results indicating a trace or 1% value will be reported as assumed ACM as required by item (1) above. A similar situation exists for matrix bound fibers such as those found in floor tiles, mastics, and asphalt based materials. The inorganic matrix of these bulk samples may interfere with the identification and quantification of asbestos mineral content. These types of samples are generally referred to as Non - organically bound (NOB) materials. Transmission Electron Microscopy (TEM -NOB) is a method that utilizes a combination of special sample preparation techniques and high magnification to more accurately quantify asbestos content. Currently only the State of New York has regulations requiring TEM -NOB re- analysis of suspect ACM for which negative or trace determination resulted from PLM analysis. Although additional cost is involved, ECS recommends TEM -NOB analysis under certain circumstances, as a state of the art means of evaluation. 2.2 LEAD CONTAINING PAINT In addition, a composite building material sample of the demolition waste stream (e.g. painted/unpainted wood, concrete, and other building materials) were collected and submitted to ProScience Analytical Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page 1 1.0 INTRODUCTION This survey was performed at the request of Mr. Carl Mercieri of Marios Construction Company (262 Old Lyman Road, South Hadley, Massachusetts) for the purpose of identifying Regulated Building Materials that may impact future demolition of the site building located on 300 King Street in Northampton, Massachusetts. The Occupational Safety and Health Administration (OSHA) Regulations (1926.1101) require that building owners determine the presence and location of asbestos materials and convey that information to any individuals who will conduct work that may disturb ACM. The Scope of Work included a combination of destructive and non - destructive sampling methods of suspect materials at the above mentioned building. 1.1 LIMITATIONS The term "non- destructive sampling method" refers to a method of collecting samples that does not significantly impact interior or exterior finishes of the building. Evaluations for the presence of ACM are therefore limited to those materials accessible by non - destructive sampling methods. ACM may therefore be present in materials not accessible by this sampling methodology, and may be encountered during renovation or demolition of the structure. The term "destructive sampling method" refers to the method of collecting samples that would require destruction of various building surfaces (i.e. wall cavities, wood flooring, plaster ceilings) for the purpose of locating hidden heating, plumbing, or other building components that may contain ACM. Destructive methods are strongly recommended for facilities slated for demolition. Additional limitations may exist for both destructive and non - destructive sampling methods. Certain portions of the building may be physically inaccessible, or because electrical, mechanical, structural, or other hazards exist in portions of the structure at the time of the survey. The following areas were not included in the scope of work at the time of this survey: • Below grade; • Interior of equipment, machinery, and electrical systems; • Roof Tops • Regulated Building Materials Survey Project No. 01- 210189.00/Document No. 38656 300 King Street January 11, 2010 Northampton, Massachusetts Page i EXECUTIVE SUMMARY Environmental Compliance Services, Inc. (ECS) has completed a Regulated Building Materials Survey (RBMS) that included bulk sampling of suspect asbestos containing materials (ACM), waste stream characterization sampling (toxicity characteristic leaching procedure (TCLP)) for lead, and visual observations of accessible building materials and operating systems that may contain polychlorinated biphenyls (PCBs), and/or mercury associated with the site building located on 300 King Street in Northampton, Massachusetts. The inspection was performed on building materials that may be disturbed during future demolition activities. On January 6, 2010 ECS inspectors, using a combination of destructive and non - destructive sampling methods, collected 28 bulk samples of suspect asbestos materials. Those materials have been analyzed using the required protocols at an accredited laboratory. A review of the laboratory results of building materials sampled indicate that ACM was NOT detected at this location. Roofing material samples were not collected and are presumed to contain asbestos unless laboratory testing proves otherwise. ECS also collected a bulk building material samples for waste stream characterization and submitted this sample for TCLP lead analysis. Analytical results did not indicate the presence of TCLP lead above detectible levels. ECS submitted two paint chip samples from painted portions of the pump island. These samples were analyzed via method SW846- 7420/3051 for total lead analysis by weight. Both samples yielded results below detectible levels. In addition, ECS conducted a visual inspection of various hardware, machinery, and building systems which may require special handling and/or disposal prior to renovation activities. This included light fixtures/ballasts /transformers, and various operating systems that may contain coolants /refrigerants, PCBs, mercury, and/or oils, at a minimum. A listing of items is provided in Section 3.5. Types, locations, and quantities of ACM and TCLP data are presented in tabular form in Section 3.0 of this report. Analytical data sheets for all samples collected are provided as Appendix A. Inspector Signature: ekt 6,./L„ Christopher A. Coelho Project Manager/MA Asbestos Inspector #AI072176 ' 717a/2 , (. Mark A. Haynes President and COO TABLE OF CONTENTS EXECUTIVE SUMMARY 1.0 INTRODUCTION 1 1.1 LIMITATIONS 1 2.0 METHODS AND MATERIALS 2 2.1 ASBESTOS 2 2.2 LEAD CONTAINING PAINT 2 2.3 OIL AND HAZARDOUS MATERIALS 3 3.0 RESULTS AND FINDINGS 4 3.1 OIL AND HAZARDOUS MATERIALS 6 4.0 DISCUSSION AND INTERPRETATION 7 4.1 ASBESTOS 7 4.2 LEAD 7 4.3 OIL AND HAZARDOUS MATERIALS 7 5.0 CONCLUSION 8 APPENDICES: Appendix A Laboratory Data . . . Massachusetts Department of Environmental Protection • ,. L __ Bureau of Waste Prevention • Air Quality 100101070 BWP 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)? Q Yes ❑ No If yes, who conducted the survey? [ENVIRONMENTAL COMPLIANCE SERVICES b. Surveyor Name CHRISTOPHER COELHO c. Division of Occupational Safety Certification Number • 7. Construction or Demolition: 03/15/2010 03/15/2011 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 p paving ❑ 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 CARL MERCIERI — o above and that to the best of my a. Print Name � o knowledge it is true and complete. [CARL MERCIERI The signature below subjects the b. Authorized Signature � N signer to the general statutes VICE PRESIDENT I — o regarding a false and misleading c. Position/Title —.1. statement(s). 'MARDIS CONSTRUCTION COMPANY, INC d. Representing 02/09/2010 INNIIIIIIIMINIIIIIMI■ e. Date (mm /dd /yyyy) ..........o ■ O ..— • ag06.doc • 10/02 BWP AQ 06 • Page 3 of 3 II Massachusetts Department of Environmental Protection • )‘ Bureau of Waste Prevention • Air Quality 100101070 '� BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement: If B. General Project Description (cont.) asbestos is found during a 4. General Contractor: Construction or Demolition IMAROIS CONSTRUCTION COMPANY, INC operation, all responsible parties a. Name must comply with 1262 OLD LYMAN ROAD 310 CMR 7.00, b. Address 7.09, 7.15, and Chapter 2 21 E of the 'SOUTH HADLEY 1 MA 01075 C General Laws of c. City/Town d. State e. Zip Code the Commonwealth. 1(413) 533 -1320 carlm @maroiscc.com This would include, f. Telephone Number (area code and extension) q. E -mail Address (optional) but would not be limited to, filing an CARL MERCIERI 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. MAROIS CONSTRUCTION COMPANY, INC a. Name 262 OLD LYMAN ROAD b. Address 'SOUTH HADLEY MA • 01075 c. City/Town d. State e. Zip Code 1 (413) 533 -1320 Icarlm @maroiscc.com f. Telephone Number (area code and extension) g. E -mail Address (optional) 'CARL MERCIERI h. On -site Manager Name 2. On -Site Supervisor: CARL MERCIERI On -Site Supervisor Name 3. Is the entire facility to be demolished? Q Yes ❑ No - 4. Describe the area(s) to be demolished: �o EXISTING SLAB ON GRADE STRUCTURE & FUELING CANOPY 5. If this is a construction project, describe the building(s) or addition(s) to be constructed: � A NEW 2900 SF SLAB ON GRADE USE GROUP 'B' • agO6.doc • 10/02 BWP AQ 06 • Page 2 of 3 • Massachusetts Department of Environmental Protection • Bureau of Waste Prevention • Air Quality BWP AQ 06 100101070 Decal 1 Number s ,, 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 do not use e the return (DEP), Bureau of Waste Prevention - Air Quality Control Regulations 310 CMR 7.09. Notification of the key. Construction or Demolition operations is required under 310 CMR 7.09 (2) ten (10) days prior to any 16111 work being performed. The following information is required pursuant to 310 CMR 7.09. � IM B. General Project Description 1. a. Is this facility fee exempt - city, town, district, municipal housing authority, owner- occupied Instructions residence of four units or Tess? ❑ Yes 0 No 1. All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order 2 FaClllt Information: to comply with the y Department of 'PEOPLES BANK ' Environmental Protection a. Name notification 300 KING STREET requirements of b. Address 310 CMR 7.09 (Northampton MA 01060 c. City/Town d. State e. Zip Code f. Telephone Number (area code and extension) q. E -mail Address (optional) 2,944 1 h. Size of Facility in Square Feet i. Number of Floors j. Was the facility built prior to 1980? 0 Yes ❑ No k. Describe the current or prior use of the facility: 'PRIOR CONVENIENCE STORE / GAS STATION l I. Is the facility a residential facility? ❑ Yes P1 No � m. If yes, how many units? Number of Units m (:) 3. Facility Owner: N PEOPLES BANK ..........o a. Name •■••■•••1111110 1330 WHITNEY AVENUE b. Address HOLYOKE 1 (MA 01040 ..........o c. Citv/Town d. State e. Zip Code � o 1(413) 493 -7561 f. Telephone Number (area code and extension) q. E -mail Address (optional) C STACY SUTTON ......Q h. Onsite Manager Name ■ ag06.doc • 10/02 BWP AQ 06 • Page 1 of 3 ■ Page 3 of 3 Hello Albert, We met at 300 King Street in Northampton around 2 -3 weeks ago. We are trying to obtain a sign off from Verizon which would allow us to obtain a demolition permit for the existing structure. When we spoke, you stated that we should receive some paperwork and /or billing information from Verizon before a crew would be on site to remove your lines. We have yet to receive anything from your office. Can you check on the status of this — or provide me with a number of someone that I should contact to let us know what the next step is? Dan Steele Marois Construction Company, Inc. Phone: (413) 533 -1320 Fax: (413) 532 -1149 Cell: (413) 658 -4592 4/9/2010 • Page 2 of 3 Cell: (413) 658 -4592 From: Bessette JR, Albert E [ mailto: albert.e.bessette.jr ©verizon.com] Sent: Friday, March 12, 2010 9:35 AM To: Dan Steele Subject: RE: King Street Northampton Dan, This job has been released to schedule. Typically, reimbursable jobs receive priority, so it should be done in the next few weeks. Al From: Dan Steele [mailto:dans ©maroiscc.com] Sent: Thursday, March 11, 2010 9:45 AM To: Bessette JR, Albert E Subject: RE: King Street Northampton Hello Al, I am just checking in to verify that your department has received our check and that the work order is being processed. Can you confirm and give us a timeline as to when we could expect to see the sign off? Dan Steele Marois Construction Company, Inc. Phone: (413) 533 -1320 Fax: (413) 532 -1149 Cell: (413) 658 -4592 From: Bessette JR, Albert E [ mailto: albert.e.bessette.jr ©verizon.com] Sent: Wednesday, February 24, 2010 10:11 AM To: Dan Steele Subject: RE: King Street Northampton Dan, On February 22nd, I sent a Letter of Intent to Carl Mercieri of Marois Construction at 262 Old Lyman Road in South Hadley. The letter needs to be signed and sent back to me along with a check for the estimated cost. When I receive it, I'll send the job to the Construction Department to be scheduled. Thanks. Al Albert Bessette Right of Way Manager Verizon 365 State Street Springfield, MA 01105 (413) 787-0310 (413) 734 -9123 fax From: Dan Steele [mailto:dans ©maroiscc.com] Sent: Wednesday, February 24, 2010 9:57 AM To: Bessette JR, Albert E Subject: King Street Northampton 4/9/2010 Page 1 of 3 Dan Steele From: Bessette JR, Albert E [albert.e.bessette.jr @verizon.com] Sent: Friday, April 09, 2010 8:46 AM To: Dan Steele Subject: RE: King Street Northampton Dan, Allow this e -mail to verify that the work has been completed and our cable and facilities removed. Let me know if you need any additional notice. Al Albert Bessette Right of Way Manager Verizon 365 State Street Springfield, MA 01105 (413) 787 -0310 (413) 734 -9123 fax From: Dan Steele [mailto:dans ©maroiscc.com] Sent: Thursday, April 08, 2010 1:52 PM To: Bessette JR, Albert E Subject: RE: King Street Northampton Al, Does the sign off come from you? Is it something that is being mailed or could it be faxed /emailed? Dan Steele Marois Construction Company, Inc. Phone: (413) 533 -1320 Fax: (413) 532 -1149 Cell: (413) 658 -4592 From: Bessette JR, Albert E [ mailto: albert.e.bessette.jr ©verizon.com] Sent: Tuesday, March 30, 2010 8:46 AM To: Dan Steele Subject: RE: King Street Northampton They are working on it today. From: Dan Steele [mailto:dans ©maroiscc.com] Sent: Tuesday, March 30, 2010 7:15 AM To: Bessette JR, Albert E Subject: RE: King Street Northampton Hello Al, Has the work been completed? Dan Steele Marois Construction Company, Inc. Phone: (413) 533 -1320 Fax: (413) 532 -1149 4/9/2010 From:National Grid 17815221067 01/20/2010 14:11 #683 P.002/002 nationalgrid The power of action; January 20, 2010 Dan Steele Marois Construction Co Inc 262 Old Lyman Rd South Hadley, MA 01075 RE: Service Removal for Building Demolition. Dear Dan Steele: This letter is to confirm that, per ur' request, National Grid has removed the electrical service and meter from 300 ig St Northampton MA on 1/20/2010. If you have any questions or need furth assistance, please feel free to contact me at (781) 907 -3393. Since ely, ' - s Ramsdell ustomer Order Fulfillment Order Processing Representative Reservoir Woods 40 Sylvan Rd Waltham MA 02451 mi Office 781- 907 -3393 a Fax 315- 460 -9149 2Kristine.Ramsden@us.ngrid.com lHAMp 7 . CITY OF NORTHAMPTON, MASSACHUSETTS ?``' ~°" DEPARTMENT OF PUBLIC WORKS g ir! 125 LOCUST STREET �� >'� NO RTHAMPTON MA 01060 M 413 -587 -1 570 FAX 413 -587 -1576 Edward S Huntley, P.E. Director January 13, 2010 Anthony Patillo, Building Inspector Municipal Office Annex 212 Main Street Northampton, Ma 01060 Dear Mr. Patillo: The water service at #300 King Street (Mobile Station) has been shut at the property line and the water meter has been removed from the premises as of 1/13/2010. Please contact me if you have any questions. erely, t� 0 7 David Sparks Superintendent of Water Cc: Ned Huntley, Director of Public Works Jim Laurila, City Engineer t4/.3 yStateGas A NiSource Company 2025 Roosevelt Avenue P.O. Box 2025 Springfield, MA 01102 -2025 February 5, 2010 Marios Construction Co Inc 262 Old Lyman Rd South Hadley, Ma 01075 Dear Dan Steele, The address listed below has had the gas service(s) disconnected in the treebelt and is now ready for demolition. ADDRESS : 300 KING ST TOWN : NORTHAMPTON STATE : Massachusetts Sincerely, j),U) Terri Workforce Planning JAN, 7. 2!)10 1, 57PNi (vi4RTIN J CLAYTON IN NO. 129 P. 29 11DD /11 YY ACOrcv `;tl i wiCA) t Ut- LIAti1LI FY INSURANCE 01/07/2010 ooucER (413).536 -0804 FAX (413)534 -7874 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION arti n J, Clayton Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 649 Northampton Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . 0. Box 989 of yoke, MA 01041 -0989 INSURERS AFFORDING COVERAGE NAIC URED MAROIS CONSTRUCTION CO. , INC. IN3URERA: Hanover Insurance Company 262 OLD LYMAN ROAD INSURER B; AIM Mutual Insurance Company SOUTH HADLEY, MA 01075 IN$URES INSURER D: INSURER E: VERAQ $ HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IgqDD'L TYPE OF INSURANCE POLICY NU POLICY EFFECTIVE POUCYEXPIRATION UMiT$ InISRC DATF IMMIDD/YY) DATE OM WIDDIYY1 GENERAL LIABILITY ZDN62 51989 01/01/2010 01/01/2011 EACH OCCURR=_NCE s 1,000,001 X COMMERCIAL GENERAL uABILIW DAMAGE TO RENTED y 100,001 PFMFC (Fa ••rnran,a) CLAIMS MADE X OCCUR MED EXP (Any ona person) L 5,001 PERSONAL &ADVINJURY $ 1,000 GENERAL AGGREGATE 3 3,000,001 Gall AGGREGATE LIMIT APPLIESPER: PRODUCTS - COMP/OP AGG $ 2,000,001 7 POLICY PELT - LOC AUTOMOBILE LIABILITY AMN6632273 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea aczIdent) S 1,000,001 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY 2LI NON -OWNED AUTOS (Per sec/Cent) PROPERTY DAMAGE $ (Par Qccidon$ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT 3 ANY AUTO OTHER THAN EA ACC 3 AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY UHN6251990 01/01/2010 01/01/2011 EACH OCCIJRRENCE 1,000,001 OCCUR a CLAIMS MADE AGGREGATE 3 1,000,001 S DEDUCTIBLE 3 RETENTION 3 NORKERS COMPENSATION AND WM2800229301 01/01/2010 01/01/2011 x WC T MiUS CI R :MPLOYERS' U&BII!W E.L. EACH ACCIDENT S 500,001 iNY PROPRIETOR/PARTNER/EXECUTIVE )FFICER/MEMBER EXCLUDED? E.L. DISEASE• EA EMPLOYEES 500,001 y s, dscrjbe under IPECIAL PROVISIONS below E.L DISEASE - POLICY LIMIT S 500,000 3THER PTION OF OPERATIONS 1 LOCAT2DNS 1 VEHICLES 1 EXCLUSI ADDED BY ENDORSEMENT/ SPECIAL PROVIS(ONS IFICATE H • LD R _ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES EE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY • OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AuTHOR¢ED REPRESENTATIVE Daniel Sul 1 ivan/FMT D 25 (2001108) @ACORD CORPORATION 1988 The Commonwealth of Massachusetts • e Department of Industrial Accidents Office of Investigations off f iations a = w 600 Washington Street Boston, MA 02111 www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Applicant Information a9e5)(e-t/e/e.205," Please Print Legibly Name ( Business /Organization/Individual): W t''�t� S Address01 (.&2 OG Z y`l% —V City /S e /Zip: mi l, /T /� �� ,/ hone #: ` 373 20 Are u an employer? Check the appropriate box: Type of project (required): 1. I am a employer with 36 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub - contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub contractors have 8. ❑ Demolition capacity. employees and have workers' working for me in any P ty. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3. [11 I am a homeowner doing all work Plumbing P. myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13. ❑ Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ? Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. } Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. /� /� Insurance Company Name: /1, i�%�/ /!1U /7/- Policy # or Self -ins. Lic. #: t ijf77O0 2 / Expiration Date: f// /d // Job Site Address: aC/ M,v( 5 City /State /Zip: 4 / Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA f s +ranee • • age verification. I do hereby certify u er t ,gin . tie f perjury that the information provided above is tru an correct. Signature: C i( --4/j Date: 1/ Z C Phone #: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit Likense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City /Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: • 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 0 SECTION 11 - OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , as Owner of the subject property hereby authorize 0,,t pr - 7,0 ... to act on my behalf, in all matters relative to work authorized by this building permit application Signature of Owner Date ,f% , 45 .. .r` ....._ � „ ..._.. ...v_ , 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. Signed and the pains and nury 9 enalties of peP Print Name r er/Ag Signature t Date e g SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address / Expiration Date / Signature Telephone /04f/20 Q 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 buildn mit. Signed Affidavit Attached Yes No 0 Version 1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent StrUctu ai Engineering Structural Peer Review Required Yes 0 No 0 SECTION 11- OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT , as Owner of the subject property hereby authorize . / �/^ 2/ C ✓ : 7(4e . !C y to • my behalf, In aM matters relative to work authorized by this building permit application. Stgnat Date t, ` yY ' .. -.. , 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 belie( Signed und pasts and penalties of perjury. ', Print Name l %/ .fC Signature • < < Data SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Suvervtsot: Not Applicable 0 _.. gill__1 f f/ (dame of License Holder : _ - Ltcense Number Address ; Expiration Date Signature Telephone J `% /.I e SECTION 13 - WORKERS',COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(8)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial orthe liii3uance of the btiildirig, pefrimit. - — . Signed Affidavit Attached Yes ® ' 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: Not Applicable ❑ Name (Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor r / � _____, ✓' � ��, � �. _..m. _�_...._____ ...�__.._ Not Applicable ❑ ! Company Responsible In Charge of Construction i Address i a Signat 0 1/X4// Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size J Frontage I Setbacks Front Side R : ( L ....... R: . _.,._._. Rear t/ Building Height _ Bldg. Square Footage a Open Space Footage o (Lot area minus bldg & paved parking) # of Parking Spaces Fill: - • � _ __. _ ._ (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO Q DONT KNOW cc) YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES 0 IF YES: enter Book Page, and /or Document # Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 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 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excav i n, 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. Version 1.7 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 1 Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use 0 Other ❑ Brief Description Enter a brief description here. Of Proposed Work: — 7 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 I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B tiu M Mercantile ❑ 4 Q R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S-1 51 S-2 ❑ 5B I ❑ 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: posed Use Grou Existing Hazard Index 780 CMR 34): , „__., ___ Proposed Hazard Index 780 CMR 34): „___ SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1sl 9 l5— 1st 2nd 2nd 3rd_ ., __ .... ............. 3b 41n _ 4m Total Area (sf) c. 22 z <'-` Total Proposed New Construction s Total Height (ft) T,-+ I I- I•i ft 1 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system Versionl.7 Commercial Building Permit May , l , 5, 2000 Department use only City of Northampton Status of P t 4 Building Department Curb Cut(Dnueway • Permit A 212 Main Street SewerISepbcAvarl Room 100 Water/ Wrell Availability' . Northampton, MA 01060 Two Sets ofStructuraFPlans phone 413 - 587 -1240 Fax 413 - 587 -1272 Plot/Site (?lane Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office ' O V /� ,� Map Lot Unit Zone Overlay District �. ,__ .. ._.. a....., Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner o cord: c - ' /65 06/94/-, , , , , , )/,'( '7 j,-;. Name (Print) Current M cling Address: _/Vile— ...4/57 . //� ��7 0 Signature Telephone �0 //' 2.2 Authorized Agent: Name (Print) Current Mailing Addres ..0 --( ` Gt,)/ / /#1- / 'y �'‘ Signature Telephone L /i3 33 1 7 SECTION 3 ESTIMAT D CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1 1. Building hr /0 p n - 1 (a) Building Permit Fee 2. Electrical __,"._. -. - " : - (b) Estimated Total Cost of I _ Co from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) _._..�_., .. .. __ "., ... ..,. 5. Fire Protection \ 6. Total 1+2 +3 +4 +5 Check Number This Section For Official Use Only Duilding Permit Number Dote- Issued Sign Date Building Commissioner /Inspector of Buildings , Version 1.7 Commercial Building Permit May 15. 2000 Department use only City of Northampton status or Pam*: Building Department Curb Cut/oni,eway Perms , r∎11 212 Main Street sewer/SepticAvailability h . , . \1 Room 100 WaterMleN Availability .' )torthampton, MA 01060 Two Sets of Structural Plans phone 413-687 -1240 Fax 413 -587 -1272 Plot/Site Puns Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1- SITE INFORMATION 1 1 1 Pr„poertvAddress This section to be completed by office '3201) /{f/ //1/(1 fir' . Map Lot Unit it Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT ..• �`2 33D ( AUe, �t^�lVc9K e, mA D►O Name (Print) Cur C" Qom+ ii !L. t l_ f , rent Mailing Address: • .. 13-.5g- ��' ice' �.. rt�." - te ______. Telephone i` 2.2 Authortted eat Naga (Print) Currant Mating Address: Signature Telephone 1,/, ,!7. : -.' z , C1 4 4k .: - 1,,... 1:. * ...• Lt.- a l e , • ' t: J . Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Buildingi7d14 /5 s Building Permit Fee ' 2. Electric (b) Estimated Total Cost of • • • • Construction from (6) 3. Plumbing . Building Permit Fee 4. Mett+anical (HVAC) ' 5. Fire Pfotectlon . 6,-Total (1 + 2 + 3 + 4 + 3) Crock Numbe 0/11 D� $ p�t' This Section For Official Use Only Dullding reranit Number Dale Issued Signature Buileng Coni nissioner/Inspector of Buildings Dale File # BP- 2010 -0916 APPLICANT /CONTACT PERSON MAROIS CONSTRUCTION CO INC ADDRESS/PHONE 262 OLD LYMAN RD SOUTH HADLEY (413) 533 -1320 PROPERTY LOCATION 300 KING ST MAP 24B PARCEL 077 001 ZONE HB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 0IJ�6 `fa' Fee Paid t/� � a00-- ` 00 J Tvpeof Construction: DEMOLISH BUILDING New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 060872 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQRMATION PRESENTED: (/Approved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay Signature . 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. 3t ) man BP- 2010 -0916 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 -0916 Project # JS -2010- 001353 Est. Cost: $15000.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MAROIS CONSTRUCTION CO INC 060872 Lot Size(sq. ft.): 38681 .28 Owner: MOBIL OIL CORPORATION CIO PEOPLES BANK Zoning: HB(100)/ Applicant: MAROIS CONSTRUCTION CO INC AT: 300 KING ST Applicant Address: Phone: Insurance: 262 OLD LYMAN RD (413) 533 -1320 Workers Compensation SOUTH HADLEYMA01 075-2653 ISSUED ON:4/27/2010 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLISH BUILDING 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 4/27/2010 0:00:00 $200.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Building Commissioner - Anthony Patillo