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18D-001 (8) s,COZ e ? ?d5Ct t Sd'l c .` lS� 599-09,> 11t 9 ''r5)3L"IAC9 •04-l77711(6)A1 ((‘)Ava EPT&M ER LAN e LAI&S 83 S EPTEM1 SR LANs BEACON FALLS, CT 00403 203-002-2533 CERTIFICATE OF VISUAL INSPECTION- DEMOLITION Project Name: Project Location: /36 i✓ Nf Si ✓t14'i7j 2 '7"" Work Area: P 4 T Contractor's Certification of Visual Inspection Supervisor hereby certifies that he has completed a visual inspection and verifies that this inspection has been thorough. All surfaces within the work area have been inspected. All identified ACM have been abated, removed from site, and there is no ACM visible. Signature: _ Date: ) Z Z / . Print Name: e.41 Print title: J -160" iC Contractor Name: ‘ SLL Technician Certification An SLL field technician hereby certifies that he has completed a visual inspection and verifies that this inspection has been thorough. All areas within the work area have been inspected. All identified ACM have 4- A' :ba > + removed from site, and there is no ACM visible. , Signature: ; �� Date: 7 2 / Z- Print Name: Mg (ti e, �i4 License Number /0(7 y 1 Exp. Date / VrZ septewu.ber L2vue gabs MUM 111111111•1111 23 .septewtbev Lam 1&e2covn. FRLk. CT 00403 203 - 662 -2533 08/22/2012 Baystate Contracting Svcs. 352 Albany Street Springfield, MA 01105 Attn: James Beaudry Project No. 136- NKS -NM Re: Former Bickford's 136 North King Street Northampton, MA The asbestos abatement project of Exterior Window and Door Caulk and Roof Duct Insulation Adhesive is considered completed because the post - abatement criteria for the asbestos abatement have been satisfied. A Mass Licensed Project Monitor conducted a visual inspection. No visible debris was found. Marco , �.. '19 .1 eDEP - MassDEP's OnlineFiling System https: / /edep.dep. mass .gov /Pages /PrintReceipt.asp: MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Username:BAYSTATE1 Nickname: BAYSTATE CONTRACTING My eDEP: Formstto! My Profiles* Help Receipt j Forms Signature Receipt Summary /Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 494043 Date and Time Submitted: 8/3/2012 5:01:31 PM Other Email : Form Name: AQ 04 - Asbestos Removal Notification Form ANF -001 Payment Information DEP code: 70384 Date: 8/3/2012 5:01:02 PM Amount ($): 85 Billing Info: BEAUDRY JAMES -- AccountType -- AccountNumber ** **1200 Confirmation Number: Contractor Contractor Number: AC000021 Name: BAYSTATE CONTRACTING SERVICES INC Address: 352 ALBANY STREET, SPRINGFIELD, MA 01005 413- 781 -0821 Supervisor JAMES BEAUDRY Project Monitor Lab Location EXTERIOR Project Start Date 8/16/2012 My eDEP MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.6.4.0© 2011 MassDEP r �� 8/1/2012 5:01 Ph ' , Commonwealth of Massachusetts • , . 100155104 . ' Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) - 1 r 1BAYSTATE CONTRACTING SERVICES INC 1 [3 52 ALBANY STREET 5. L a. Name of General Contractor b. Address [SPRINGFIELD 1 101105 / r J L413-781-0821 c City/Town d. Zip Code e. TeleRnone Number (area code and extension) , • iGREAT DIVIDE INSURANCE COMPANY ' 1 [WCA154464110 12/1/2013 • f. Contractor's Worker's Comp. Insurer 9,_Policy Number h. Exp. Date (mm/dd/yyyy) [4000 .1 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): [352 ALBANY STREET 1BAYSTATE CONTRACTING SERVICES INC 1 ,. a. Name of Transporter , .b. Address Note: Transfer Stations must 'SPRINGFIELD -- 1 [01105 1 [4137810821 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 !RED TECHNOLOGIES INC. ■ 110 NORTHWOOD DRIVE aName of Transporter b. Address r , -- BLOOMFIELD 1 i06002 1 r8602182428 t t__ c. City/Town d. Zip Code_ e. Telephone Number 3. 1CHARLES M. GORDON & SONS INC. i L2_93 PICKERING STREET _ . a. Refuse Transfer Station and Owner b. Address , r PORTAND 1 (16480 j 1 6 -- 11 . 117 ---1 ,___ Code eelephone Number 4. [MINERVA ENTERPRISES INC 1 [ ENTERPRISES INC a. Final Disposal Site Loc n atio Name b. Final Dispdsal Site Location Owner's Name ___ 19000 MINERVA _ ROAD [WAYNESBURG _______,____..._ c. Final Disposal Site Address d. City/Town .,,„ !OH 1 1 44688 - 1 3 e. State f. Zip Code g. Telephone Number co ....... ......... ° D. Certification 1■1111.1■1 N The undersigned hereby states, under the 'JAMES BEAUDRY 1 ;JAMES BEAUDRY _. . ........................° penalties of perjury, that he/she has read the a Name b. Authorized Signature o Commonwealth of Massachusetts regulations LPROJECT MANAGER ; 18/3/2012 .............. for the Removal, Containment or c. Position/Title _ _ 0,_Datekrnm/dd/yyyy) ,_ r - Encapsulation of Asbestos, 453 CMR 6.00 and [4137810821 1 1BAYSTATE CONTRACTI 1 310 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 1 o g. Address [SPRINGFIELD 1 [01105 h. City/Town i. Zip Code Z ,..........—,,,< U anf001ap.doc • 10/02 Asbestos Notification Form • Page 3 of 3 U fr' ' Commonwealth of Massachusetts • 100155104 1[1111 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encaDsulated:- (325 � . / \ or i , c. Boiler, breaching, duct, tank L [ —/ d Insulating cement surface coatings Lin. ft. n Lin. ft. sq. ft. i e. conuga�uo,�y*�u paper ' ^ ' r rmwe|xsp�rormuuouv pipe insulation Lm. ft Sq. it. | ! ' u opm�unn^,pmon:s h Transite woxuou� | � � � ' Lin. ft. Sq. ft. 325 � 4OO i Cloths, woven / Other, p�mnoxn*oxv ' ' � Lin. ft. Sq. ft. k. Thermal, solid core pipe 1 I 3 CAl|LK|NG/COAT insulation Lin o. Sv. I. Specify 14. Describe the decontamination system(s) to be used: i | ---'-------------------------'---------'-- ---' - REK8OTE DECON 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): |.- -______---������ -_......______-___-------_ - - - - -- ` T0 BE THC�ROU(3HLYVVETFED DOUBLE BAGGED ,LABELED AND PROPERLY DISPOSAL OF. |c/ 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: [�---'-------'--- ` ------' ! __- �___ ! [__ �������f DE0fi�aF --- b� Title ---- -----' - ' | � c. Date (mm/dd/yyyy) of Authorization_ , g�DEPvv�vor� I -�� � - | – | e. Name m DOS umc� f. Title | � ---- ----- ------- '- ----- -- — - l ______� , g. Date (mm/dd/yyyy) of Authorization h. DOS Waiver # o 17. Do prevailing wage rates as per M.6Lo.14S apply bx this project? | ) Yes � ,(\No o B. Facility Description C -1 -o 1. Current or prior use of facility: - - ' 0 2. Is � with / so/|ess? Fl � Yes �Nu - - --------'' - - ' - - - | [DWIGHT KHERR|KXAN{ BIG `f DRIVE ------ 3 ^ ___ -- �___-___ '- _ ___ -___-_ _ .a Name b. 'Address ____ � 413-781'OD31 ___ __ 0 (area code and nmen�oo) GO MEMORIAL DRIVE Li. 4 " a. Name of Facility Owner's On-Site Manager b. On-Site Manager ~~�~��~�~~�z -'------\ ------�---- � ���� [SPRINGFIELD ___ __--^ e. Telephone Number code and extension) III an001apdoo^ 10N2 Asbestos Notification Form ^ Page 2 of 3 II Commonwealth of Massachusetts ■ 100155104 Asbestos Notification Form ANF -001 Decal Number Important: A. Asbestos Abatement Description When filling out 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? E Yes Q No to move your cursor - do not b. Provide blanket decal number if applicable: -- - use the return Blanket Decal Number key. 2. Facility Location: j l FORMER BICKFORDS RESTAURANT g X NORTH KING STREET a. Name of Facility __ b Stre Address NORTHAMPTON IMA I 01060 4135044792 "� c. City /Town d State e. Zip Code f. Telephone Number INSTRUCTIONS 3 Worksite Location: 1. All sections of this " EXTERIOR ' j 136 I I d . 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? <..._i Yes W No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division �_ of Occupational IBAYSTATE CONTRACTING SERVICES INC i !352 ALBANY STREET Safety (DOS) a. Name b. Address notification r SPRINGFIELD I 01005 I E4137810821 requirements of 453 . t CMR 6.12 c City /Town d Zip Code e. Telephone Number AC000021 t .._ _..__ _ -_- J g. Contract Type: ✓ Written Verbal f DOS License Number 1DWIGHT MERRIMAN , ' PROJECT MANAGER h.'Facility Contact Person i. Contact Person's Title :JAMES BEAUDRY I AS074322 6. i _ I a Name of On Site Supervisor /Foreman b. Supervisor /Foreman DOS Certification Number ° UNKNOWN AT THIS TIME N /A 7. 1 --- i L._ a Name of Project Monitor b. Project Monitor DOS Certification Number [UNKNOWN AT THIS TIME jN /A a. Name of Analytical Lab b. Asbestos Analytical Lab DOS Certification Number 8/16/2012 1 18/31/2012 �� a Project Start Date (mm /ddlyyyy)_ b End Date (mm /ddlyyyy)_ o I7 00 5.00 I .N /A N c. Work hours Mon -Fri. d. Work hours Sat -Sun. ■O 10. a. What type of project is this? ▪ — o a ✓ Demolition i, i Renovation _ Repair ":,. Other, please specify: b. Describe 11. a. Check abatement procedures: o `. i Glove bag , Encapsulation o L Enclosure Disposal only - - � ; Cleanup ✓_, Other, specify: CAULKING /ROOFING COATING L . Full containment b. Describe z .< 12. Is the job being conducted: I _ ; Indoors? ;•"/i Outdoors? II anf001ap.doc • 10/02 Asbestos Notification Form • Page 1 of 3 II Associated Building Wreckers Inc. 352 Albany St., Springfield. MA 01105 Tel: (413) 732 - 3179/ (800) 448 -2822 Fax: (413) 734 734 -6224 July 26, 2012 To: John Hail Fax: 413 587 -1576 Of: Northampton DPW Sewer Dept. Phone: 413 587 -1574 Please be advised that the Former Bickford Restaurant located at: 162 North King Street Northampton, MA (rear of BigY plaza, backs to Cooke Avenue) it is being scheduled for demolition. When demolition is complete, the sewer will be properly capped and we will call to request an inspection. Thank you, Associated Building Wreckers, Inc. ausemmor .„ eDEP - MassDEP's Online Filing System https: / /edep.dep.mass.gov /Pages /PrintReceipt.asp; MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Username:BAYSTATE1 Nickname: BAYSTATE CONTRACTING 4.O0 orr My eDEP Forms My Profiles* Help Receipt Forms Signature Receipt Summary /Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 497519 Date and Time Submitted: 8/20/2012 6:15:06 AM Other Email : Form Name: Project Date Revision Notification DECAL # and Facility information Form Name: ANF001 DECAL # : 100155104 Facility Name: FORMER BICKFORDS RESTAURANT Address: 136 NORTH KING STREET, NORTHAMPTON, MA 4135044792 Original Project Dates Start Date: 8/16/2012 - End Date: 8/31/2012 Revised Project Dates Start Date - End Date My eDEP MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.6.4.0© 2011 MassDEP s IOni)n1� r,"t Ary ., 4' 1 p:: Massachusetts Department of Environmental Protection '100155104 L Bureau of Waste Prevention — Air Quality -----/ Project Revision Notification Decal Number For Asbestos Notification ANF-001 and AQ 06 G. Certification The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. r --- —1 , 'JAMES BEAUDRY j !JAMES BEAUDRY 1 Name ,, Authorized Signature [PROJECT MANAGER 1 [8/20/2012 2. Position/Title 3. Date (mm/dd/vVYv) !BAYS T CONTRACTIN — INC: 1 '4137810821 . L 4. Representing 5. Telephone 1352 ALBANY STREET 6. Address 'SPRINGFIELD r _, [01105 . 7. City/Town 8. Zip Code anfO6pdrn.doc • rev. 2/5/04 , ___ • Massachusetts Department of Environmental Protection :100155104 Bureau of Waste Prevention — Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 Important: A. Facility Location When filling out forms on uterthe use ' FIE BICKFORDS RESTAURANT comp, only the tab key 1. Name of Facility to move your k 36 NORTH KING STREET cursor - do not 2. Street Address use the return _ _ key. NORTHAMPTON 3. City 14135044792 4, State 5. Zip Code 6. Telephone Number INSTRUCTIONS B. Project Cancelled 1. This form is only available for j Check here if this project is/was cancelled. online filing of project date revisions. 2. Enter project decal number. C. Project Dates 3. Validate that [ _I1 III the project location is correct 1. Original Stall Date .. (rriMidd/Ryi5 - 2. Original End Date (mm/dd/vVVv) for the entered decal. '371:ala' ii;inTd`dTyjiy 4. Latest Revised End Date (mm/dd/yyyy) 4. Enter your new project dates. 5. Certify your notification. D. Revised Project Dates Submit date changes. {i/20/2012 '1 [8/31/2012 1. Revised Start Date (mm/dd/yyyy) 2. Revised End Date Date (mm/dd/yyyy) E. Other Project Revisions F. Revision History „ . ...... _ anfO6pdrn.doc • rev. 2/5/04 eDEP - MassDEP's OnlineFiling System https: / /edep.dep. mass .gov /Pages /PrintReceipt.asp_ MassDEP Home I Conlact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Username:BAYSTATE1 Nickname BAYSTATE CONTRACTING WO OP My eDEP, Formsiss My Profile's'''. Help [ Receipt Forms Signature Receipt A Summary /Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 498176 Date and Time Submitted: 8/21/2012 4:11:15 PM Other Email : Form Name: Project Date Revision Notification DECAL # and Facility information Form Name: ANFOO1 DECAL # : 100155104 Facility Name: FORMER BICKFORDS RESTAURANT Address: 136 NORTH KING STREET, NORTHAMPTON, MA 4135044792 Original Project Dates Start Date: 8/16/2012 - End Date: 8/31/2012 Revised Project Dates Start Date: 8/20/2012 - End Date: 8/31/2012 My eDEP MassDEP Home I Conlact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.6.4.0© 2011 MassDEP R/7 1 /7(1l 7 4• I l Pk k Massachusetts Department of Environmental Protection 100155104 Bureau of Waste Prevention — Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF -001 and AQ 06 G. Certification The undersigned hereby states, under the penalties of perjury, that he /she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this notification is true and correct to the best of his /her knowledge and belief. JAMES BEAUDRY _.._._._ iJAMES BEAUDRY 1. Name Authorized Signature PROJECT MANAGER 1 2 Position /Title 3. Date (mm /dd /yyyy) 1BAYSTATE CONTRACTING SERVICES,INC j 14137810821 4 Representing 5 Telephone 1352 ALBANY STREET 6. Address SPRINGFIELD 1 101105 7. City /Town 8. Zip Code anf06pdrn.doc • rev. 2/5/04 Massachusetts Department of Environmental Protection 100155104 Bureau of Waste Prevention — Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF -001 and AQ 06 Important: A. Facility ocation When filling out Y forms on the computer, use FORMER BICKFORDS RESTAURANT only the tab key 1. Name of Facility to move your i . 1 cursor - do not X136 NORTH KING STREET use the return 2. Street Address key. (NORTHAMPTON MA 3 City — 4. State 5 Zip Code 4135044792 _.. ,.._..__.A.. ._.. ...__ i 6. Telephone Number INSTRUCTIONS B. Project Cancelled 1. This form is _ only available for 4.m1 Check here if this project is /was cancelled. online filing of project date revisions. 2. Enter project decal number. C. Project Dates 3. Validate that ____ location is correct 0_..-.-- ...__t (.__. yy.YY�_ _._.._.. 8/31/2012 18/16/2012 the protect ,. _ – _ 1 O ma l St art Date m /dd/ 2. OngmalEndDate (mm /dd /yvvv) for the entered 1 8/20/2012 I 18/31/2012 decal. _._ .. __ .__Y_ 3. Latest Revised Start Date (mm /dd /yyyy) 4. Latest Revised End Date (mm /dd /yyyy) 4. Enter your new project dates. 5. Certify your notification. D. Revised Project Dates Submit date changes. E p 8!2112012 1. Revised Start Date (mm /dd /yyyy) 2. Revised End Date Date (mm /dd /yyyy) E. Other Project Revisions i F. Revision History m '_ EDEP: 08/20/2012 06:45:29 AM anf06pdrn.doc • rev. 2/5/04 Associated It ulldhig Wreckers, Inc. 352 Albany St., Springfield. MA 01105 Tel: (413) 732 -3179/ (800) 448 -2822 Fax: (413) 734 734 -6224 July's 2012 To: National Grid Fax: 888- 266 -8094 Phone: 800- 260 -0054 Please cut all services at the following location as it is being scheduled for demolition. 162 North King Street Northampton, Massachusetts (Former Bickford's Restaurant, rear of BigY plaza, backs to Cooke Avenue) Once disconnection has been completed, you may either sign below and fax it to me at 413- 734 -6224 or you may fax me notification on your company letterhead. Thank you very much for your assistance. Sincerely, Associated Building Wreckers, Inc. Service at: Have been disconnected as of Print name: _ Signature: Remarks, if any: F Massachusetts Department of Environmental Protection • Bureau of Waste Prevention • Air Quality 100156516 B W P 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)? [/j Yes }] No If yes, who conducted the survey? ERIC KUBIC b. Surveyor Name A1000327 c. Division of Occupational Safety Certification Number 7. Construction or Demolition: t 9/2/2012 111/30/2012 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 ✓I 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 1 .. c. Date (mm /dd /yyyy) of Authorization d. DEP Waiver Number D. Certification I certify that I have examined the :ANDREW MIRKIN 0 above and that to the best of my a. Print Name 0 knowledge it is true and complete. ;Andrew Mirkin The signature below subjects the b Authorized Signature signer to the general statutes PRESIDENT o regarding a false and misleading c_ Position /Title statement(s). ASSOCIATED BUILDING WRECKERS, INC. d Representing _ 18/21/2012 o e. Date (mm/dd/yyyy) 0 ® ag06.doc • 10/02 BWP AQ 06 • Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 10_0_1_56516_ 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 ASSOCIATED BUILDING WRECKERS INC. operation, all 4.. responsible parties a. Name must comply with [352 ALBANY STREET 310 CMR 7.00, b. Address 7.09, 7.15, and _ r Chapter 21E of the (SPRINGFIELD I MA 01105 General Laws of c. City /Town d State e Zip Code the Commonwealth. 4137323179 l l This would include, — —° but would not be f. Telephone Number (area code extension) „ q C mail Address (optional) Telephone to, filing an FRED VANDERHOOF 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 WRECKERS, INC. a. Name 352 ALBANY STREET b. Address SPRINGFIELD ,MA 01105 c. City/Town d State e Zip Code 4137323179 f. Telephone Number (area code and extension) g. E -mail Address (optional) 1 FRED VANDERHOOF h. On -site Manager Name 2. On -Site Supervisor: )WILLIAM BABCOCK On -Site Supervisor Name 3. Is the entire facility to be demolished? ,I] Yes 1 No N ° 4. Describe the area(s) to be demolished: o IENTIRE RESTAURANT N 0 ° 5. If this is a construction project, describe the building(s) or addition(s) to be constructed: N/A O d ® ag06.doc • 10/02 BWP AQ 06 • Page 2 of 3 ■ Massachusetts Department of Environmental Protection A . Bureau of Waste Prevention • Air Quality 1100156516 B ■' ` A ^ 06 Decal Number Notification Prior to Construction or Demolition Important: A. A licabilit When filling out ply 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 cursor - do not use the return (DEP), Bureau of Waste Prevention - Air Quality Control Regulations 310 CMR 7.09. Notification of 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. f., 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 less? L✓] Yes ( No 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 FORMER BICKFORD RESTAURANT Environmental Protection a. Name notification 162 NORTH KING STREET l requirements of b. Address 310 CMR 7.09 ;Northampton MA 01060 c City /Town d State e Zip Code 5 f. Telephone Nu mber (area code and extension) ._.. q Email Address (optional) 4210 ) j1 h. Size of Facility in Square Feet i. Number of Floors Wa the facility built prior to 1980? ✓6 Yes 1_. No J Y p t k. Describe the current or prior use of the facility: BICKFORD'S RESTAURANT I. Is the facility a residential facility? i 2 Yes ✓= No ° m. If yes, how many units? Number of Units ° 3. Facility Owner: N , Y FOODS, INC. o a. Name o 460 MEMORIAL DRIVE b. Address SPRINGFIELD t MA ; 01101 co c. City /Town d. State e. Zip Code 4135044792 I.... .__... o DWIGHT MERRIMA "' nd ,extension),, ,__, _, _q. E-mail s Address (optional) 0, t . , Telephone _ umber area co e a i Q h. Onsite Manager Name ® ag06.doc • 10/02 BWP AO 06 • Page 1 of 3 III 08/07/2012 15:09 4137327393 PAGE 01/01 Ca1umb a Gas of Massachusetts A NiSource Company 2025 Roosevelt Ave P 0. Box 2025 Springfield, MA 01102 -2025 Date: 1/ 0 / • To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now read for demolition. //e r 3/4 S � s �,q�7— ., ff Tyv F,),,,,,,3 ADDRESS : ' c / A/0 ' / - 4 !''1 G S I . TOWN : Akle / 7 4 I4dp7 /' STATE : Massachusetts • Sincerely, (! Maintenance Administrator Integration Center Columbia Gas Of Massachusetts 413-781-9200 Ext 2115 Page 1 of I Talia Totten From: Romito, Jeff [Jeff Romito@cable.comcast.com] Sent: Wednesday, August 01, 2012 2:48 PM To: Talia Totten Subject: RE: 162 North King Street Northampton, Massachusetts All set From: Talia Totten [ mailto :Talia @buildingwreckers.com] Sent: Thursday, July 26, 2012 2:09 PM To: Romito, Jeff Subject: 162 North King Street Northampton, Massachusetts Please see the attached disconnect request for the former Bickford's Restaurant. Thanks, Talia 08/01/12 .1 _ A,e__ Associated ' uilding Wreckers, Inc. 352 Albany St., Springfield. MA 01 105 Tel: (4.13) 732-3179/ (800) 448 -2822 Fax: (413) 734 -6224 :July 26, 2012 To: lleborah A. Pisciotta Email: deborah.pisciotta @verizon.com of: Verizon Phone: (413) 787 -0312 Please cut all services of all buildings at the following location as it is being scheduled for demolition: 162 North King Street .Northampton, Massachusetts (Former Bickford's Restaurant, rear of BigY plaza, backs to Cooke Avenue) Once disconnection has been completed, please either sign below and fax it to 413 -734- 6224 or send a n otification on your company letterhead, Thank you very much for your assistance in this matter. Sincerely, Associated Building Wreckers, Inc. SERVICE AT: IIAVE BEEN DISCONNEC'T'ED AS OF { 14) PRINT NAME: _ r�' - } } T ' SIGNATURE: -- ' REMARKS, IF ANY:(, f (( r DIG SAFE SYSTEM, INC. - Renew Existing Ticket Page 1 of 2 Request Number: 20123703807 Date 09/11/2012 Time 08:11 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address / Intersection: 162 N KING ST Nearest Cross Street 1: HATFIELD ST Nearest Cross Street 2: PINE BROOK CURV Additional Information: ALSO LISTED AT 136 NORTH KING STREET. BICKFORD'S IS IN REAR OF PLAZA, BACKS UP TO COOKE AVENUE Nature Of Work: DEMOLITION OF FORMER BICKFORD'S RESTAURANT Area Of Work: PRIVATE PROPERTY Area Is Premarked: Y Start Date: 09/14/2012 Start Time: 09:0C Caller: TALIA Title: Return Call: BEF 430PM Phone #: 413 - 732 -3179 Fax #: 413 - 734 -6224 Alt. Phone #: Email Address: TALIA@BUILDINGWRECKERS.COM Contractor: ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY ST City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviation Name Al27 G4STEC G4S TECHNOLOGY LLC AJ COMCAS COMCAST - SOUTH BURLINGTON MC NGRDEL NATIONAL GRID ELECTRIC -MASS ELEC ML MCI MCI ON ONTARG J ON TARGET LOCATING RJ IDM INNOVATIVE DATA MANAGEMENT SP VERIZN �l VERIZON WB BRKGAS BERKSHIRE GAS [COLUMBIA CMAGAS I COLUMBIA GAS OF MASSACHUSETTS S WI-I WMAELE WESTERN MASS ELECTRIC CO http:// digsafcform .digsalc.com /Cgi bin/dwegi.cxe 09/11 /12 DIG SAFE SYSTEM, INC. - Create New Quick Ticket Page 1 of 2 Request Number: 20123009642 Date 07/26/2012 Time 13:46 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address / Intersection: 162 N KING ST Nearest Cross Street 1: HATFIELD ST Nearest Cross Street 2: PINE BROOK CURV Additional Information: ALSO LISTED AT 136 NORTH KING STREET. BICKFORD'S IS IN REAR OF PLAZA, BACKS UP TO COOKE AVENUE Nature Of Work: DEMOLITION OF FORMER BICKFORD'S RESTAURANT Area Of Work: PRIVATE PROPERTY Area Is Prernarked: Y Start Date: 08/10/2012 Start Time 13:0C Caller: TALIA Title: Return Call: BEI= 430PM Phone #: 413 - 732 -3179 Fax #: 413 - 734 -6224 Alt, Phone #: Email Address: TALIA@BUILDINGWRECKERS.COM Contractor: ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY ST City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviation Name Al27 G4STEC G4S TECHNOLOGY LLC AJ r COMAS I COMCAST - SOUTH BURLINGTON MC NGRDEL NATIONAL GRID ELECTRIC -MASS ELEC ML MCI MCI SP VERIZN [ VVERIZON WB T BRKGAS I E3ERKSHIRE GAS WG CMAGAS I COLUMBIA GAS OF MASSACI- IUSETTS ON ONTARG I ON TARGET LOCATING RJ L IDM I iNNOVemVE DATA M,4r1AGEME:N I — • 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... http:// digsafeform .digsafe.com /cgi- bin/dlcgi.exe 07/26/12 at r o Reservoir Woods 90 Syivan Rd Waltham. MA 02151 September 12, 2012 Associated Building Wreckers Attn. Talia RE: Service Removal for Building Berne ition. Attn: This letter is to confirm that, per your request; National. Grid has removed the electrical service located at 162 North King Street in Northampton on September 12, 2012. If you have any questions or need further assistance, please feel free to contact me at (508) 357- 4661. Sincerely, • nationalgrid Custorner Order Fullilluocnt Central & \A/estc.rn MA MOffice 508 -357 -4661 g Fax 888 266 -8094 Sep 13 2012 13:05 City of Northampton DPW (413) 587 - 1389 p.1 AUG -21 -2012 14:40 From: To :DPW Central P.1/1 . Associated ■tuildin.g Wreckers, Inc. 352 Albany St., Springfield. '.MA 01105 Tel: (413) 732 3:1.79/ (Mull+) 448-2822 Fax: (41.3) 734 734 -6224 August 21, 2012 To: Dave Sparks Fax: 413 5ft7 -1576 Of: Northampton DPW Water Dept. Phone: 413 587 -1698 Please cut all services to any buildings at the location of: 162 North Ming Street Northampton, MA (Former Bickford's Restaurant, rear of l3igY plaza, backs to Cooke Avenue) as it is being scheduled for demolition. Once disconnection has been completed, you may either sign below and fax it to me at 41.3 - 734 -6224 or you may fax me notification on your company letterhead. Thank you very much for your assistance. i Sincerely, Associated Building Wrecicers, Inc. Service sit: C 81C IC `5 g n ia have been dis a as o f r �D' , do t f) .. hrinl Na •-�4 k � rratt !'' ' 2) 5 -- Mali ti t u rt: ru: Pi5/ � Remarks, if any: . .— . _ k ,a, •i74'f071L tsiV Y REAL ESTATE OFFICB IQ,IVV1 /VUL . e '. OF I. i' mIN . W R Rt tS, I NC . 352 Albtuiy S+rti`c1. Springfield, Massachusetts 91195 Vet: (413) 732 - 31791(800) 448.20 Fax: (413) 734- 0224 wrw,huhdingwreckera,com i July 25, 2012 Dwight Merriman llig Y Foods, Inc. 60 Memorial Drive Springfield, Massachusetts 01101 Thank you for the award of this contract. For the sum of !I 28,200.00 and salvage rights, we agree to abate and detnolish!thc if)rtner 13rickfot'd's Restaurant located behind the 13ig Y Supermarket in Northampton, Massachusetts, Associated Building Wreckers work includes: I) Asbestos abatement per survey by E.C.S. dated 7 -18 -2012. 2) Visual inspection by a third party industrial Hygienist once abate neatt is complete. 3) Demolition of the building and removal of all debris to an approved fcieility, including slab and foundations. 4) Removal and disposal of concrete walk in front of building to be demolished, 5) Notifying Dig Safe and arranging for the disconnection ofserviecs. . 0) 'faking out the demolition pennit. 7) burnishing a certificate for demolition vaunt liability and werkehr Compensation insurance, upon request. 8) Filling the voids from the foundation removals with recycled i ''A" minus heard pack 1111 to make the site safe. 9) Using water for dust control, as needed, via a water tanker. 10) Securing the site with 6' temporary chain link fencing, as required. 13ig ' hoods, Inc. will be responsible for: , I) Any service disconnection charges, if any. 2) Obtaining nay historical permits or special notifications, if requited. 3) Any repair to asphalt or patch to remaining masonry wall at sclruatioli point damaged during demolition in the work area. , 1) Any damage to underground services lbw Dig Safe and/or l3ig Y Foots, lac. Inns not made us aware of (including, but not limited to, Underground sprinklers, roof drains, septic systems andiundergrouad storage tanks). 5) Freon lcmovnl from mono') unit prior to demolition. ti) Cost associated with any hirzardous materials found at the silo, other tlian specified above. 7) Making job accessible to work. , if) Rodent control, if required. 9) Any final site restoration. 10) Making payment in full upon completion within thirty (30) days. Big 1' Foods, Rae, acknowledges that they are the owner of the property and are not in bankruptcy or petitioning fur bankruptcy. Any balance that becomes past due fm' any reason will be charged a service charge of l.5% per month, I R % annually. If it should become necessary to horn this account over for collection, the billed party agrees to pay till collection costs plus reasonable attorney's lees incurred. flig Y Foods, Inc. is unaware ofrury hazardous materiels or wastes on the property, ruin knows of no legal reason, regulation, or other eircurnshnteca, which might prevent or in any way interfere with the right or ability of Associated Building Wreckers. Inc. t to perfor'in the above work, if any hidden conditions do eXisi pll this rob, they arc the Owner's responsibility. Sincerely, A, • IATED BUILD' G WRECKERS, INC. Agreed and Accepted by: .- _ 1/ . - 341A Andrew Mirkin, president latvi>, ptriman, Date 111 I l3ig Y Foods, Inc. .\L'..1tm . so \13f,mo_cncrs_zo12 n cstnu' :un NortlGUltplclrI ,`lAat .: The Common vealth of Massachusetts Department of Industrial Accidents r _ Office of Investigations ,__. Err 600 Washington Street Boston, MA 02111 iwivw. mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name (t3usiness /Organi-r_ation /Individual): Associated Building Wreckers, Inc. Address: 352 Albany Street City /State /Zip: Springfield, Massachusetts 01105 Pho fit 413 732 -3179 Are you an employer'? Check the appropriate box: Type of project (required): I . U 1 am a employer with 26 4. I am a general contractor and I have hired the sub- contractors 6. U Ncw construction employees (full and /or part-time).* listed on the attached sheet. 7. I Remodeling 2. [J I am a sole proprietor or partner- ship and have no employees These sub contractors have 8. n Demolition for me in any ca�acit employees and have workers' working y I y. 9. (_I Building addition [No workers' comp_ insurance comp. insurance.+ 5. corporation and its 1 0.n Electrical repairs or additions required.] U We are a cor p 3. i am a homeowner doing all work officers have exercised their I I.[J Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] 1 c. 152,§§'1(4), and we have no employees. [No workers' 13. Other comp. insurance required.] *Any applicant that checks box tt I must also fill out the section below showing their workers' compensation policy information. I lomcowners 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. lithe sub - contractors have employees, they must provide their workers' comp. policy number. / (lna an ern /Moyer that is providin, workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name Great Divide Insurance Company Policy It or Self-ins. Lie. #: WCA 154510510 Expiration Date: 02/01 /201 Job Site Address: City /State /Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure. to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA For surance coverage verification. / do hereby cer,ify under the'na'ns and penalties of perjury that the information provided above is true and correct. Signature: • r \ s f ndrew Mirkin, President Date: ..)ef he 2 (� Phone #: 413 732 -3179 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit /License # Issuing Authority (circle one): 1. Board of health 2. Building Department 3. City /I'own Clerk 4. Electrical inspector 5. Plumbing inspector 6. Other Contact Person: Phone #: „, The Commonwealth of Massachusetts -, Department of Industrial Accidents � � ` Office of Investigations r,. _� t_ A 600 Washington Street ' .y Boston, MA 02111 k.� www.mass.gov /dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Plumbers Applicant Information Please Print Legibly Name (Business /Organization /Individual): Associated Building Wreckers, Inc. Address: 352 Albany Street City /State /Zip: Springfield, Massachusetts 01105 Phone 17: 413 732 -3179 Are you an employer? Check the appropriate box: Type of project (required): I. © I am a employer with 26 4. 1 1 1 am a general contractor and I employees (full and /or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. (—] Remodeling 2.1 1 am a sole proprietor or partner- These sub - contractors have ship and have no employees 8. ® Demolition for in any capacity. employees and have workers' working Y P” Y. 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3 . n I am a homeowner doing a l l work officers have exercised their 1 1 . 0 Plumbing repairs or additions 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. Ifomeowners who submit this affidavit indicating they arc 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: Great Divide Insurance Company Policy # or Self -ins. Lic. #: WCA 154516510 Expiration Date: 02/01/201/ Job Site Address: City /State /Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a line up to $1,500.00 and /or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for surance coverage verification. I do hereby 'r fy under the ia'ns and penalties of perjury that the information provided above is true and correct. Si nature: �.■1∎ ndrew Mirkin, President Date: .3 -'C.p!E= L=A-6ev' (3 _ 2C(.., Phone -it: 413 732 -3179 Official use only. Do not write in this area, to he completed by city or town official. City or Town: Permit /License # Issuing Authority (circle one): 1. Board of Ilealth 2. Building Department 3. City /'Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 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 I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, , 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 under the pains and penalties of perjury. Print Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Andrew Mirkin 62382 License Number 299 "1'anglewood Drive Longmeadow, Massachusetts 01 106 10/31/2013 Address Expiration Date (413) 732 -3179 Signature Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes CD No 0 VersionI.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 0 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 Associated Building Wreckers, Inc. Not Applicable 0 Company Name: Andrew Mirkin Responsible In Charge of Con- uction 352 illany Street Spr r,gfield, Massachusetts 01 105 Addre (413) 732 -3179 Signature Telephone Version) .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 4210 4210 Frontage Setbacks Front Side L: R: L: IZ: Rear Building Ileight Bldg. Square Footage Open Space Footage (Lot area minus bldg & paved parking) # of Parking Spaces 0 the Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO 0 DON'T KNOW C) YES C IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW 0 YES C IF YES: enter Book ' Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES 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 0 NO C) 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 C) IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 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 ID Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description Demolition of the former Bickford's Restaurant. Removing all debris to Western Recycling in Of Proposed Work: Wilbraham, MA. Area will be paved for a parking lot. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A -1 ❑ A -2 ❑ A -3 0 1A I ❑ A -4 ❑ A -5 ❑ 1B 0 B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1 -1 ❑ 1 -2 0 1 -3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ 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: Proposed Use Group: 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) 1 0 1 4,210 2 nd 2n 3 3rd d 4 th 4 th Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public p Private ❑ Zone Outside Flood Zone p Municipal p On site disposal system a • Version 1.7 Commercial Building Permit May 15, 2000 --�, Department use only City of Northampton Status of Permit: Building Department Curb Cut /Driveway Permit SEP 212 Main Street Sewer /Septic Availability ' I Room 100 Water /Well Availability OEPt Northampton, MA 01060 Two Sets of Structural Plans Noq au Northampton, on 413 -587 -1240 Fax 413 - 587 -1272 Plot/Site Plans 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 This section to be completed by office 1.1 Property Address: 162 North King Street Map Lot Unit (former I3ickford's Restuurant) Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Big Y Foods, Inc. 60 Memorial Drive Springfield, MA 01101 Name (Print) Current Mailing Address: (413) 504 -4792 Signature Telephone 2.2 Authorized Agent: h e 0 Jt7a Nam (Print) Current Mailing Address: .1 efifiZert I/ 61 \.) Signature Telephone 3 ) 7 SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $28,200.00 (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from (6) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection ?? 6. Total = (1 + 2 + 3 + 4 + 5) Check Number J // W d—C This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner /Inspector of Buildings Date Fa (74 File # BP- 2013 -0293 F l ?EP TES 1(1 APPLICANT /CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413) 732 -3179 yS16 ,A5 ( A&iz j-. PROPERTY LOCATION 162 NORTH KING ST 5 MAN N MAP 18D PARCEL 001 001 ZONE HB(100)/WP(16)/ THIS SECTION FOR OFFICIAL USE ONLY: Ckt' Q 1�3 PERMIT APPLICATION CHECKLISTst / I Z ENCLOSED REQUIRED DATE (-1 p ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ,5 Fee Paid ` =�, D--0-4, Typeof Construction: DEMOLITION OF FORMER BICKFORD'S RESTAURANT New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 062382 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON I ATION PRESENTED: A pproved Additional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND /OR Special Permit With Site Plan Major Project: Site Plan AND /OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission _ Permit DPW Storm Water Management Demolition Delay / / 1 Z— 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. 162 NORTH KING ST BP- 2013 -0293 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D - 001 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- 2013 -0293 Project # JS- 2013- 000479 Est. Cost: $28200.00 Fee: $200.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 062382 Lot Size(sq. ft.): 532738.80 Owner: D'AMOUR PAUL H ET AL C/O BIG Y TRUST Zoning: HB(100) /WP(16)/ Applicant: ASSOCIATED BUILDING WRECKERS INC AT: 162 NORTH KING ST Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732 -3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON:10/4/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: DEMOLITION OF FORMER BICKFORD'S RESTAURANT 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 10/4/2012 0:00:00 $200.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner