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31B-053 (3) 26 LANGWORTHY RD BP-2016-0869 GIs #: COMMO] WEALTH OF MASSACHUSETTS Map:Block: 31 B-053 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2016-0869 Project# JS-2016-001469 Est. Cost: $106000.00 Fee: $689.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KENNETH LEBLANC 55471 Lot Size(sq ft.): 23086.80 Owner: GULLERUD$TEVE tonin J: URA(100)/ Applicant: KENNETH LEBLANC AT. 26 LANGWORTHY RD Applicant Address: Phone: Insurance: P O BOX 307 (413) 250-8234 () WC SOUTH HADLEYMA01075 ISSUED ON:3/71201,6 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMODEL KITCHEN & CREATE MSTR BEDROOM/BATH POST THIS CARD SO IT IS VISIBLE FROM THF: 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 $ignature: FeeType: Date Paid: Amount; Building 3/7/2016 0:00:00 $689.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �k T", J-- 'r--Cf(t File# BP-2016-08690 <!Ntft5 r✓ APPLICANT/CONTACT PERSON KENNETH LEBLANC — ADDRESS/PHONE P O BOX 307 SOUTH HADLEY01075 (413)250-8234() PROPERTY LOCATION 26 LANGWORTHY RD MAP 31 B PARCEL 053 001 ZONE URA(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid ,o Building Permit Filled out Fee Paid Typeof Construction: REMODEL KITCHEN&CREATE MSIR BEDROOM/BATH New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 55471 3 sets of Plans/Plot Plan THE FOL ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 oli ' Signature of Building Offi ial Date Note: Issuance of a Zoning permit does not relieve a applicatlt'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. l Department use only City of Northampton Status of Permit: JAN - b 2'011 5 Building Department Curb Cut/Driveway Permit { 212 Main Street Sewer/Septic Availability. 4 r i Room 100 Water/Well Availability, ' Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office C-24 L q�9 til,�sr`�di � Map Lot Unit I Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: ' every D &Ile tld f l /t/r �961 Name( in Current Mailing Add ss: ,) F Telephone Signature 2.2 Authorized A ent: ? /� LC se'�e . i R4 zy, i Name(Print) a Current Mailing Address: Signatu Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical -01. 61 Q (b)Estimated Total Cost of Construction from 6 3. Plumbing ®�r� , d' Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection ) 6. Total=0 +2+3 Check Number IS 67 W This Section Forfficial Use Only Building Permit Number: Date Islsued: Signature: Building Commissioner/Inspector of Buildings Date SECTION 5-DESCRIPTION OF PROPOSED WORK check all appli able) i New House ❑ Addition ❑ Replacement!Windows Alterations) Roofing ❑ Or Doors ED Accessory Bldg. ❑ Demolition ❑ New Signs [p] Decks [M Siding[0] Other[O] Brief Description of Proposed / / / Work: /YC/r L/ �.f°�f,�1 //1�/1'l/ "�! A11�� � A44 0 It � '�.fv,'`k Alteration of existing bedroom__ZYes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a. If New house and or addition to existing housing, complete the following: a. Use of building:One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? 71 es d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, L,e r as Owner of the subject property hereby authorize to act op ray behalf, in all,.fnatigre relativet , ork authorized by this building permit application. Signature of Owner' Date 1, BIV f-( �/ �"� �`tf�l A � J r�e/ �r,��%�� �� as Owner/Authorized Agent hereby declare that the statements and information on the foregoing 6pplication are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury. A/(-I�- Print Name Signature ofOwner/Agent Date Section 4. ZONING All Information Must Be Completed Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (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 ® DON'T KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW © YES 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 O Obtained O , 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 O NO O 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �C/Ul�� � � '� 0 S—S-y71 License Number A4 clize- Address Expiration Date Si ature Telephone 9.Reaistered Home Improvement Contractor: Not Applicable ❑ 179 Company Name Registration Number Address Expiration Date 14,` ee"7j— Telephone SECTION 10-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 buildigg permit. Signed Affidavit Attached Yes....... No...... ❑ 11. - Home Owner Exemption The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,oil a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature The Commonwealt of Massachusetts Department of In ustrial Accidents Office of In estigations I Congress Street, Suite 100 Boston,MA 02114-2017 M www mass.gov/dia Workers'Compensation Insurance Affidavit:'Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_�' /y/i � 61?I{}4"e Address: City/State/Zip: SO , jciljZE 'hone#: Are you an employer? Check the appropriate boy.- Type of project(required): 1.❑ I am a employer with 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. modeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.E] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [filo workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t 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: Policy#or Self-ins. Lic. #: Expiration Date: 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 insurance coverage verification. is Ido hereby certify u der the pains andpenalties of perjury that the information provided above is true and correct. Sianature: � 'l L, C 4qf_� Date: Phone#: 1-1/1' - d f-67 - g 9 5'V Oficial 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/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 01/05/2016 03:43 4135328522 METRAS INSURANCE PAGE 01/01 ,a► �R CERTIFICATE OF LIABILITY INSURANCE DA►> (M5iMIDI )16 THIS CERTIFICATE IS IM5UED AS A MATTER OF INFORMATION ONI,1( AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED I3Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITU'T'E A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERtIMCA,TE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the Ipoliey(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an efhdorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemeng( ),. PRODUCER CONTACT NAME: Denise M Blais Metras Insurance Agency PHONE " 2030 Memorial Drive L 413 536-1491 A N0: (413) 532-8522 ADDRESS: dblais@metrasinsurance.com Chicopee, MA. 01020 —INSURRI14:S AFFORDIN000VE13AGE NAICU INSURER A:Travelers INSURED msURERB:Weatern World HOMES BY I.EBIANC, INC INSURERC:AIM MYttual Insurance P.O. BOX 3107 INSURER D: �a INSURER E: ,..... ..,.,.- -- Ass 1lac SOUTH HADLEY, MA 01075 INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA' BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTIMTWSTANDING ANY REQUIREMENT,TERM OR CONDITION DF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDI D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, — EEN REDUCED BY PAID CLAIMS, N�XCLUSIONS AND CONDITIONS OF SUCH POLICIES, sIUSRUMITS SHOWN MAY HAVE Pyr EFF POIJQYEXP ------ ---- ---�------- -' LTR TYPE OFINSURANCE _17OUCYNUMBER Ml06/YYYY (MMJOIYYYY-yl LIMITS BSS GENERALLIABIL11Y 6/4/15 6/4/16 EACH OCCURRENCE $ 1,000,000 ,Iq GOMMFRCIALGFNERALLIABILITY DAMAGFTORENTEO 1 DAMAETOCIAIM -MADE IJ OCCUR MED EXP A one erson $ 5 000 _ PERSONAL&ADV INJURY $ 1,Q0)0 000 GENF.RAL AGGRFGATF GEN'L AGGREGATE LIMIT APPLIES PER PRODu=-COMPIOPAGG $ 1,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY BA4 ]4{6227 3/17/15 3/3.7/16-COMBINED tSINGLE LIMIT_ $ ANYAUTO BODILY INJURY(Per pamon) $ -500.000 _ ALI,OWNEP SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS 500,000 NON-OWNED PROPL„R1Y DAMAGE HIftEDAU705 AUTOS Peroecident $ 100,000 'h UMBRELLA LAAO OCCUR EACH OCCURRENCE $ EXCESSL1A5 CL%IMS,MADE AGGREGATE $ DEC) RETENTION;G WORKERS COMPENSATION Ajc400702'71582015A 8/19/15 B/19/16 X WC 9TATU- )TH- AND EMPLOYERS'LIABILITY YIN MLT ANY PROPRIEIORIPARTNERIEXECUTNE E.L.E AC H ACCI DE NT $ 100,000 OFFICERM)EMSER EXCLUDED9 y N I A (Mmcinlary In NH) EL DISEASE•EA EMPLOYEE ' 100,000 Ifyyee deecrfoeunoor OESLRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT z 500,000 DESCRIPTION OFOPERA,TIONS I LOCATIONS I VEHICLES (Attach ACORD 101,)kddIdonPI RnnArke Egchnduln,If mare Apacn IRmgArod) Proof of Covrarage. I C,EkTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE A61OVE 0E$CRI9ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN City of Northampton ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Northampton, MA 01060 AUTHORIZED REPRESENTVE Denise M Blais � Q 1988-2010 ACORD CORPORATION, All rights reserved. A'PORD 25(2010/015) The AC ORD nai ne and logo are registered marks of ACID RD Phone; Fax: (413) 587-1272 E-Mail: City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: �✓,r� .- �,s,, .� , � The debris will be transported by: wr"zd�'x The debris will be received by: Building permit number: Name of Permit Applicant _ C 'J ��' '� -zA-(- Date Signature of Permit Applicant cs strucnacl"2.14.50 i[B,i]d J1 LeblancKenCree entSt-Level 8 12-15-15 FanBeam Engme 4.13.1.1 ', >daterialsDambax 1>30 8:03aff7 I of 2 Member Data Description: CalcG1 Member Type:Girder Application:Floor Comments: Top Lateral Bracing:Continuous Bottom Lateral Bracing:Continuous Standard Load: Moisture Condition:Dry Building Code:IBC/IRC Live Load: 0 PLF Deflection Criteria: L/360 live,L/240 total Dead Load: 0 PLF Deck Connection:Nailed Member Weight: 9.4 PLF Filename:C:\KMWUOBS\ Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform(PLF) Top 0' 0.00" 11' 9.50" 20 7 Live Replacement Uniform PLF Top 0' 0.00" 11' 9.50" 193 64 Live O 1 9 2 Q/ 11 9 E Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF Plate(425psi) N/A 1.500" 1651# 2 11 9.500" Girder SPF Plate 425psi N/A N/A 1651# Maximum Load Case Reactions used for applying point loads tor line oads)to Carrying members Live Dead 1 1199# 453# 2 1199# 453# Design spans 11' 3.375' Product: 1-3/4x9-1/2 VERSA-LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS Design assumes continuous lateral bracing along the top chord. Design assumes continuous lateral bracing along the bottom chord'. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 4657.# 13958.# 33% 5.86' Total Load D+L Shear 1419.# 6317.# 22% 0.23' Total Load D+L TL Deflection 0.2133" 0.5641" U634 5.86' Total Load D+L LL Deflection 0.1548" 0.3760" U874 5.86' Total Load L Control: LL Deflection DOLS: Live=100°/ Snow=115°/ Roof=125% Wind=160% Manufacturer's installatior guide MUST be consulted for multi-ply connection details and alternatives Minimum bearing length requirements at hangared connections depend on the connection style and are not included in this design. All pmdl.rf names am trademarks of their respam-owners Doug Hodgins rk Miles Inc. Copyright(C)20'.5 by Simpson strong-Tie Company Inc ALL RIGHTS RESERVED. 21 West St. "Passing s defined as when the member,floor joist.beam or glider.shown on laisdmwmif meets applicable design aitena for Loads I narmo Conditions,and Spans tined on this sheet The desgo must be reviewed bya qualified designeror design professional asrequired'orapproval.Thisdesign assumespmduga installation according to the manufart—irs West Hatfield Ma. ea(I C2IIGnS 000, Popp ! City of Northampton Building Department Plan Review 212 Main Street 3046DH 30460H 30460H 30460H Northampton, MA 01060 2'-b" 1 V-10"- - x 0 m BEDROOM#4 ;o iwpj/ BEDROOM#3 ( BEDROOM#5 G [V 2666 2668 m m m n � m 2668 n ! D in BEDROOM#1 � 2668 268 2668 BEDROOM#b ' iv x 0 BEDROOM#2 n :o v L L in 3046DH 3046DH LIVING AREA //As1 EXISTING FLOOR PLAN 5GALE 1/4"=1'0" 26 LANGWORTHY 5T NORTHAMPTON MA i 4'-6„ --- 8,-3„�fF----8.-8..�. 10'-8" —_---�1 29'1” 5'-9" 4'-11" i -4._7„ 3046OH 30460H 3046H 3040- 3040H I i ! NEW MASTER BEDROOM! -r o ))� NEW PLUSU BEA..Sr/,�KING WER6.RAGE W4LL' /'�y n y �L -44 /Jn 11068 668 BATH BATH P WALK IN �- ---r 16-10" ------ !L v � 2865 6 ! m I 2668 I 26 5 I _ ~ S1t Q 2668 -.5 m m ry � i BEDROOM#1 2665 P-- BEDROOM#3 `^ x NOOK m i V C BEDROOM#2 I -12'4"-- FTi m I - 30400H I 304�QH I 2 6 2,_6 ,_EE , ! � L�VINREA ' 8. I ! �j1 Ale�� Ai I ry� 1 4' 5'-1 1" 16'--- I I 2641,11H 5046111 2 DH 30460H 30460H NEvtru. OW —E—E I I I I q I � I - m INEry SLIDING GLA55 DOOR - ✓'N.L.I MGV ER I' - ' INTO EXI5TIN(1- �, m n itl - DEN/5TUDY = ry W p J j DINING AREA obej v 2646D 2b46DH b4bDH '�`,I I I �PLUSN BEAM i 4(,46L5 4646L5 2040D _ _ _ /o I REMOVESPIRALST/.IRS r BF5 I j 1 12-b T0 9E1OME PANTRY N KI HN, LAYOUT r }i N o I EXISTING BUILT N5 I � 2468 -T—f N RE OVE DOOR m m 5UN ROOM �wI ER OPENINb / m to IV BUILT INS TO BE I I ' EGONEIGURED to Q N NE-0 FRENLH DDORS `. ry ry ry LIVING ROOM ry n4'-1"- m- I .4' 6 _ I 1 r-----__—.-1 F--_.__—.--- 2 STAIRS TURNED Q NO TO EAL O 1ROTDOOR im Di_ Hoo E b1 { I 1 UP R S. ZI) 834 __ -- --- N O _ v LL REHOVE DOOR J 1 _ a, —ER OPENINb � BOLO d070 I � �I I I I 4646L5 5068 304{VH 3040DH3068 304 DH 30460H NEW DOOR L-5-4" f rel -TO�J- A) 1141 60th b Ccs Strnchucnic1.1 S>:0:t3b'I`r41 km Beam Enuine I.1I.eblancKenCrecIentSt-bevel 8 12-15-15 LI Material,Datalase Iso 8:03 am I/.,J//l AA 2 o f 2 Member Data Description:CalcG2 Member Type:Girder Application:Floor Comments: Top Lateral Bracing:Continuous Bottom Lateral Bracing:Continuous Standard Load: Moisture Condition:Dry Building Code:IBC/IRC Live Load: 0 PLF Deflection Criteria: L1360 live,LI240 total Dead Load: 0 PLF Deck Connection:Nailed Member Weight: 18.7 PLF Filename:C:\KMW\JOBS\ Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform(PLF) Top 0' 0.00" 12'10.00" 20 7 Live Replacement Uniform(PLF) Top 0' 0.00" 12'10.00" 180 6C Live Replacement Uniform(PLF) Top 12'10.00" 17' 6.75" 173 58 Live Point(LBS) Top 12' 9.13" 222 182 Live Point LBS Top 12'10.00" 1107 449 Live 17 612 17 612 Bearings and Reactions Input Min Gravity Gravity Location Type Material Lenggth Required Reaction Uplift 1 0' 0.000" Wall SPF Plate(425psi) N/A 1.500" 2884# 2 17' 6.750" Wall SPF Plate 425 si N/A 1.500" 3709# Maximum Load Case Reactions Used for appipng point loads'rime loads)to oarryng members Live Dead 1 2009# 875# 2 2560# 1149# Design spans 16' 9.500" Product: 1-3/4x9-1/2 VERSA-LAM 2.0 3100 SP 4 ply PASSES DESIGN CHECKS Design assumes continuous lateral bracing along the top chord. Design assumes continuous lateral bracing along the bottom chord'. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 145741 29032.# 50% 10.46' Total Load D+L Shear 3512.# 12635.# 27% 16.95' Total Load D+L TL Deflection 0 7370" 0 8396" 0273 8.78' Total Load D+L LL Deflection 0.5106" 0.5597" U394 8.78' Total Load L Control: LL Deflection DOLS: Live=100% Snow--115% Roof=125% Wind=160% Design assumes a repetitive member use increase in bending stress: 4% Manufacturers installation guide MUST be consulted for multi-ply connection details and alternatives All pmd nrl names am trademarks of their respective owners Doug Hodgins Miles St. Copyright(C)2015 by Simpson Strong-Tic Company Inc ALL RIC-117S iles TS RESERVED. "Passing is tlefhad as when the member,noorjoist,beam or gindec shown on thisdrawing meets albolirable,design orteda for Loads,Loading Cnnd0mrs.and Spans Iided on this sheet 21 V V The tlesign mast be reviewed by a qualified designer rordesign professional as required for approval.This design assumes product installation a¢oming to the manufacturer s West Hatfield Ma. eaucauons 3tructurer -2.1460[eaaacj km LeblancKenCrocentSt Level 8 km B eamEngine 4.13.4.1 2-18-16 .Materials Database 1530 9:58am loft Member Data Description:CalcG1 Member Type: Girder Application: Floor Comments: Top Lateral Bracing: Continuous Bottom Lateral Bracing:Continuous Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 0 PLF Deflection Criteria: L/360 live, L/240 total Dead Load: 0 PLF Deck Connection: Nailed Member Weight: 9.4 PLF Filename: C:\KMW\JOBS\ Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PLF) Top 0' 0.00" 11' 9.50" 20 7 Live Replacement Uniform PLF Top 0' 0.00" 11' 9.50" 193 64 Live 11 9 8 11 9 8 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF Plate(425psi) N/A 1.500" 1651# 2 11' 9.500" Girder SPF Plate(425psi) N/A N/A 1651# Maximum Load Case Reactions Used for applying point loads(or line loads)to carrying members Live Dead 1 1199# 453# 2 1199# 453# Design spans 11' 3.375" Product: 1-3/4x9-1/2 VERSA-LAM 2.0 3100 SP ' 2 ply PASSES DESIGN CHECKS Design assumes continuous lateral bracing along the top chord. Design assumes continuous lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 4657.# 13958.# 33% 5.86' Total Load D+L Shear 1419.# 6317.# 22% 0.23' Total Load D+L TL Deflection 0.2133" 0.5641" U634 5.86' Total Load D+L LL Deflection 0.1548" 0.3760" U874 5.86' Total Load L Control: LL Deflection DOLS: Live=100% Snow=115% Roof=125% Wind=160% Manufacturer's installation guide MUST be consulted for multi-ply connection details and alternatives Minimum bearing length requirements at hangared connections depend on the connection style and are not included in this design. OF MqS S,gcy �o CHRISTOPHER G u, DUDEK , w CIVIL No.29566 All product names are trademarks of their respective owners r� Copyright(C)2015 by Simpson Strang-Te Company Inc.ALL RIGHTS RESERVED. , "Passing is defined as when the member,floorjoist,beam or girder,shown on this drawing meets applicable design criteria for Loads,Loading Conditions,and Spans listed on this sheet. t. design must be reviewed by a qualified designer or design professional as required for approval.Thisdesign assumes product installation according to the manufacturer's specifications. West Hatfield Ma. CS Beam 4.19.50.1 km BcamUginc 4.13.4.1 1-21-16 Materials Dar^base 1530 2:06pm IofI Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing: Continuous Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: L/3C0 live, L/240 total Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 17.7 PLF Filename: Beam Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform (PSF) Top 0' 0.00" 16'10.00" 15' 0.00" 31 15 Snow 7, „ i77 yl MX' O ,777 1610 0 Q 1610' 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF Plate(425psi) N/A 4.039" 6008# 2 16'10.000" Wall SPF Plate(425psi) N/A 4.039" 6008# Maximum Load Case Reactions Used for applying point loads(or line loads)to carrying members Snow Dead 1 3948# 2060# 2 3948# 2060# Design spans 16'11.750" Product: 1-3/4x18 VERSA-LAM 2.0 3100 SP 2'i ply PASSES DESIGN CHECKS Connect members with 3 rows of 16d common nails at 12.0"oc Minimum 4.04"bearing required at bearing#1 Minimum 4.04"bearing required at bearing#2 Design assumes continuous lateral bracing along the top chord. Design assumes continuous lateral bracing along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 25503.# 53675.# 47% 8.42' Total Load D+S Shear 49471 13765.# 35% -0.06' Total Load D+S TL Deflection 0.3890" 0.8490" U523 8.42' Total Load D+S LL Deflection 0.2556" 0.5660" U797 8.42' Total Load S Control: Positive Moment DOLS: Live=100% Snow=115% Roof=125% Wind=160% IH OF MgSs cti 9 �o CHRISTOPHER G N DUDEK CIVIL Q) No.29566 O 4 All product names are trademari of their respective owners Copyright(C)2015 by Simpson Strong-Te Company Inc.ALL RIGHTS RESERVED. ' "Passing Is defined as when the member,flow loig,beam or girder,shown on this drawing meets applicable design criteria for Loags,Loading Conditions.and Spans listed on this sheet.The design must be reviewed b a ualilietl deli ner or des n rofessional as re uired fora rovat.This desi n assumes roduct instal ation accordin to the manufacturers clficat!ons. CS Beam 4.19.50.1 kmBoamtvigine4.13.4.1 2-18-16 Matcnals Daf.3base 1530 10:42am loft Member Data Description: Member Type: Beam Application: Floor Top Lateral Bracing: Continuous Bottom Lateral Bracing:' 0.00 Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: L/360 live, L/240 total Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 17.7 PLF Filename: 16 ft 10 in Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform(PSF) Top 0' 0.00" 16'10.00" 1'5' 0.00" 31 15 Snow 1610 0 161010 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF Plate(425psi) N/A 4.039" 6008# 2 16'10.000" Wall SPF Plate(425si N/A 4.039" 6008# Maximum Load Case Reactions Used for applying point loads(or line loads)to carrying members Snow Dead 1 3948# 2060# 2 3948# 2060# Design spans 16'11.750" Product: 1-3/4x18 VERSA-LAM 2.0 3100 SP 2 ply PASSES DESIGN CHECKS Connect members with 3 rows of 16d common nails at 12.0"oc Minimum 4.04"bearing required at bearing#1 Minimum 4.04"bearing required at bearing#2 Design assumes continuous lateral bracing along the top chord. Design assumes maximum unbraced length of 0.00'along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 255031 536751 47% 8.42' Total Load D+S Shear 4947.# 13765.# 35% -0.06' Total Load D+S TL Deflection 0.3890" 0.8490" U523 8.42' Total Load D+S LL Deflection 0.2556" 0.5660" U797 8.42' Total Load S Control: Positive Moment DOLS: Live=100% Snow=115% Root=125% Wind=160% \H OF MgSS Off, 9 �o CHRISTOPHER G N DUDEK , o CIVIL No.29566 o � All product names are trademarks of their respective owners Copyright(C)2015 by Simpson Strong-Te Company Inc.ALL RIGHTS RESERVED. ' "Passing is defined as when the member floorjoist,beam or girdeS shown on this drawing meets applicable design criteria for Loads,Loading Conditions,and Spans listed on this sheet The design must be reviewed b a ualified des ner or des n rotessional as re wired for a roval.This des n assumes roduct'.nstalation accordin to the manufacturers cificahons. M Recommendations Steven Gullerud 26 Langworthy Rd Northampton,MA 01060-2122 Site ID:S00050107291 Project ID:P00050122198 10/19/2015 Your Energy Efficiency Recommendations Following are some recommendations for improving the energy efficiency of your home.When considering energy efficiency,it is important to think of your home as one large interactive system.Each part works individually but also in concert with the other parts of your home.This is known as the Whole House Approach.In order to maximize your benefits,your investment,as well as your energy savings,your home energy advisor has grouped recommendations into one or more packages. Recommendations are based on your Energy Specialist's evaluation: Packages F Estimated d Estimated Estimated Estimated Description • Payback Cost incentive Customer Savings Years Air Sealing Perform Air Sealing at Estimated 62.5 12 $1,011.84 $1,011.84 $0.00 $248.86 Immediate CFM50 Per Hour Exterior Door Weather Stripping 3 $82.77 $82.77 $0.00 N/A Immediate Door Sweep 3 $69.54 $69.54 $0.00 N/A Immediate Subtotal $1.,164.1S ` $1,164.15 $0.00 $248.86 Immediate Weatherization Hatch:Thermal Barrier Polyiso 2 inch 1 $41.71 -- $43.59 0.72 (Attic) Hatch:Thermal Barrier Polyiso 2 inch 1 $41.71 -- $44.42 0.71 (Attic) Attic Slope Enclosed Cellulose Dense 369 $948.33 - $271.85 2.64 Pack 6" Damming 64 $140.16 -- - N/A N/A Sheathing Access 2 $72.28 j -- N/A N/A Temporary Access 2 $171.92 - -- N/A N/A Hatch:Thermal Barrier Polyiso 2 inch 1 $41.71 -- $51.69 0.61 (Attic) Hatch:Thermal Barrier Polyiso 2 inch 1 $41.71 - -- $54.98 0.57 (Attic) Hatch:Thermal Barrier Polyiso 2 inch 1 $41.71 - -- $58.61 0.54 (Attic) Install 2"Thermal Barrier Polyiso On 169 $743.60 -- $82.59 6.81 Kneewall Kneewall Floor Open Blow Cellulose 81 $140.13 - - $58.69 1.81 10" Dense Pack 10"Cellulose In Garage 440 $1,324.40 - $256.88 3.90 Powered by Conservation Services Group Page 1 of 3 Recommendations Steven Gullerud 26 Langworthy Rd Northampton,MA 01060-2122 Site ID:500050107291 Project ID:P00050122198 10/19/2015 Ceiling Insulate Wood Shingle Sided Wall 953 $2,058.48 -- - $595.82 2.61 With 4"Dense Pack Cellulose Attic Floor Open Blow Cellulose 7" 1,563 $2,391.39 -- $270.14 6.69 Subtotal $4199.24 $�;il�0.00 $10;1".24,11 $1,7139.14 3.46 Totals $9,363.39 $3,164.15 $6,199.24 $2,038.11 3.04 Procedures used to make these estimates are consistent with criteria established by the United States Department of Energy for residential Home Energy Assessments.The costs and incentives detailed above for weatherization improvements have been estimated by your Energy Specialist under the program for which you may be eligible.Contractor costs for energy efficiency improvements such as new heating,water heating,and cooling equipment can vary widely depending on the Size and type of equipment chosen and site specific installation requirements. The intent of this table is to illustrate the measures which,based on your Home Energy Assessment,will yield the greatest results,and to show the impact that program incentives can have on the cost of improvements you choose to make. Payback years is the number of years estimated for a package of improvements to pay for itself in energy savings.Payback estimates do not account for future price fluctuations,nor do they incorporate bene'fits of possible tax credits.A cost effective measure will typically pay for itself within its expected lifetime.Payback estimates are only calculated for packages,because the Home Energy Assessment is based upon a Whole House Approach,and measures often work in conjunction with one another to maximize your savings.Remember that payback estimates are indeed estimates.The packages shown in this report reflect the expertise and experience of your Energy Specialist,and you are encouraged to consult with your contractor to select the recommendations that will best benefit your home.You are advised not to select recommendations or packages solely on the basis of estimated payback,but also to consider failing equipment,health and safety risks,and other non-energy factors, such as comfort. Additional information on the recommendations for your home follow on the next page(s). Powered by Conservation Services Group Page 2 of 3 Recommendations Steven Gullerud 26 Langworthy Rd Northampton,MA 01060-2122 Site ID:500050107291 Project ID:P00050122198 10i19n015 r Air Sealing Air infiltrating the home through small cracks and gaps can result in as much as 20% of the typical home's heating and cooling costs. In the winter, cold dry air leaks into the home while the heated air exits.In the summer,the hot outside air enters the home and brings unwanted humidity.Outside air can leak in around window and door frames, floor and ceiling joints, electrical and plumbing access points, wall joints,exhaust fans,etc.While any one of these small leaks may be minor,collectively they can have W the same effect as leaving'a window open all year long. Air infiltration can also cause water vapor to condense inside walls and ceilings,causing insulation to become wet and ineffective and resulting in the growth of mildew and structural damage.While it is possible to make a home too air tight without proper ventilation,the vast majority of homes are much too drafty.The Energy Specialist has determined your home probably has excessive air infiltration and could benefit from professional air sealing services. Blower door assisted air sealing is an effective and accurate method to measure air tightness and identify areas where air infiltration is occurring. Using the blower door when site conditions allow, a contractor measures overall leakage and identifies specific locations.Those locations are then treated using a variety of methods (caulk, foam, weather stripping, etc.). Safety testing of any combustion appliances in your home should be conducted before and after any air sealing is done. Attic Insulation Attic/ceiling insulation prevents conductive heat transfer between your home,the attic space, and the outside. Like all insulation, ceiling insulation helps keep the home warm in the winter and cool in the summer.Attic insulation is often the easiest and most cost-effective place to insulate because most attics provide easy access for the Installations.The ready access and lower installation cost often makes this a very cost-effective measure.',This is not to say ceiling insulation is necessarily more important than wall or floor insulation.Attic insulation is most effective when the ceiling plane between the home and the attic space is tightly sealed,so air sealing should be performed before attic insulation is installed. Adding insulation above your ceiling can be very cost effective.The energy savings gained will usually pay for the cost of installing the additional insulation in only a few years. It is recommended ceilings be insulated to R-38. If the thickness of your existing insulation is 6 inches or less, you should realize significant savings in your (heating and cooling costs after bringing the level to R-38. We strongly recommend air sealing the home before installing any insulation in the attic.Attic hatches in particular can be an area of unrestricted heat transfer. They should be insulated with rigid insulation board and air sealed with weather-stripping. Wall Insulation Wall insulation reduces heat transfer through your home's walls. Wall insulation is as important as attic insulation, but often more difficult to install. Most wall insulation is placed in the wall cavity between the framing'studs, although rigid board insulation is sometimes used for continuous insulation.The most practical method to insulate existing enclosed walls is by blowing in cellulose fiber. This not only provides a thermal barrier,it also air seals the walls of your home, preventing excessive air infiltration. If insulation already exists in the wall cavities, it can be very difficult to blow in additional insulation. If there is no existing insulation, cellulose can be blown into the walls through holes drilled t from inside or outside. Adding insulation in your walls can be very cost-effective. We recommend you fill the wall cavity, usually 3.5" thick, with cellulose fiber using the dense pack method to block air infiltration. Insulating in this manner will keep your home warmer in the winter,cooler in the summer,and lower your energy use year-round. Because wall insulation can make your home more air-tight,safety testing of any combustion appliances in your home should be conducted before and after the installation. , . , .. . . . . , . . 1 > . . . . . . . . Powered by Conservation Services Group Page 3 of 3 abim e environmental contracting ■ restoration ■ bio-recovery January 4, 2016 Mr. Steven Gullerud 26 Langworthy Road Northampton,MA 01060 i RE: Documentation Report for Abide,Inc.Project# 15573 Building Name: 26 Langworthy Road,!Northampton, MA Abatement Date(s): 10/26/2015-10/29/'2015 Amount of Waste Generated (in Cubic Yards): 5.50 CY Dear Mr. Gullerud: i Enclosed please find the abatement documentation report for the above referenced project. This report includes all necessarydocumentation umentation as required by applicable state and federal regulations. This documentation report includes the original waste manifest(s)for this project. Please store these records in a safe place. i - If you have any questions,or need any further information,please do not hesitate to contact our office. Thank you. Sincerely, Maria Tilli President MT/mk p.o. box 886 1 east Longmeadow, ma 01028 1 phone 413.525.0644 1 fax 413.525.0678 1 www.abideinc.com Abide, Inc. is SOMWBA certified by the Commonwealth of Massachusetts, Department of Business and Technology. Abide, Inc.'s standard TERMS AND CONDITIONS require payment for services upon presentation of invoice. Invoices unpaid after 30 DAYS are past due and subject to a FINANCE CHARGE computed at a monthly rate of 1 1/2%(ANNUAL PERCENTAGE RATE OF 18%)or the maxi- mum percentage allowed by the law. Client is responsible for legal.and collection costs if necessary to collect past due amounts. Commonwealth of Massachusetts _ 100229721 ���� Asbestos Notification form ANF-001 \ Asbestos Project# f'' Project Revision F, Project Cancellation A. Asbestos Abatement Description 0 ri Q l nal 19 q3b 1.Facility Location: LQMWoyt by STEVEN GULLERUD RESIDENCE 26 W ROAD i Name of Facility Street Address Instructions 1.All NORTHAMPTON MA 01060 4136763323 sections of this form Cityrrown State Zip Code Telephone must be completed in STEVEN GULLERUD OWNER order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: 1ST FLOOR AND BASEMENT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? t✓Yes F No notification requirements of 453 CMR 6.12 3. Is this a fee exempt notification(city,town,district, municipal housing authority,state facility,or owner-occupied residential property of four units or less)? r' Yes r No MassDEP Use Only 4 Blanket Permit Project Approval,if applicable: i Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of 6.Asbestos Contractor: Massachusetts ABS INC 483 SHAKER ROAD P.O.Box 4062 Boston,MA 02211 Name Address EAST LONGMEADOW MA 01028 4135250644 Cityrrown State Zip Code Telephone AC000254 Contract Type: i—v Written r verbal DLS License# 7. DAN BUTTS AS073674 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# 8. STEPHEN W NEC AM072377 Name of Project Monitor DLS Certification# 9, FORBES TESTING LABS AA000228 Name of Asbestos Analytical Lab DLS Certification# 10. 10/26/2015 10/29/2015 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 7AM-5PM NA Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11.What type of project is this? r Demolition ry—. Renovation r Repair r Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Commonwealth of Massachusetts `100229721 l Asbestos Notificatio>r>k Farm ANF-001 ---- ----____., ( ' Project Cancellation Asbestos Project# � r Project Revision� A.Asbestos Abatement Description: (cont.) I 12.Abatement procedures(check all that apply): ' C Glove Bag r Encapsulation r Enclosure r Disposal Only f ' Cleanup IY Full Containment f— Other-Please Specify: 13.Job is being conducted: r Indoors [` Outdoors 14.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: j�p 135 1 D Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, Transite Pipe Tank Surface Coatings Lin.Ft. Sq.R. Lin.Ft. Sq.Ft Pipe Insulation 135 Transite Shingles Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Spray-On Fireproofing Transite Panels I Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths,Woven Fabrics Other-Please Specify: Lin.Ft. Sq.Ft. Insulating Cement VAT/MASTIC/1%MLWm >RVr 19w¢ Lin.Ft. Sq.Ft. Lin.Ft Sq.Ft 15.Describe the decontamination system(s)to be used: 3 CHAMBER WITH SHOWER 16.Describe the containcrization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): ALL ACM TO ADEQUATELY WETTED,DOUBLE BAGGED,SEALED AND LABELED f 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Oficial Title of MassDEP Official Date of Authorization(MM/DD/YYYY) Waiver# Name of DLS Official Title of DLS Official Date of Authorization(MM/DD/YYYY) Waiver# 18.Do prevailing wage rates as per M.G.L.c. 149,§26,27 or 27A—F apply to this yes F No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachus 100229721 Asbestos Notificati<o Form ANF-001 `�,,,t � Asbestos Project# Li C` Project Revision ("" Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENTIAL i 2. Is the facility owner-occupied residential with 4 units or less? r Yes r No 3.STEVEN GULLERUD j 26 OAD Facility Owner Name Address MA 01060 4136763323 Cityfrown State Zip Code Telephone I 4.NA NA Name of Facility Owner's On-Site Manager Address j NA MA 01060 4136763323 4City/Town State Zip Code Telephone 5.NA NA Name of General Contractor Address NA MA 01028 4135250644 Note:Temporary storage of Asbestos City/Town State Zip Code Telephone containing waste NA material is only j allowed at the place Contractor's Worker's Compensation Insurer of business of a DLS NA 9/1/2016 licensed AsbestosPolicy# Expiration Date(MMtDDNYYY) contractorroror a transfer station that is 6.What is the size of this facility? 2890 2 permitted by tY MassDEP and operated in Square Feet #of Floors tSolid Waste Regulations C. Asbestos Transportation & Disposal com 310 CMR 19.000 1.Transporter of asbestos-containing waste material from site of generation: r Directly to Landfill or F. To Temporary Storage Location/Transfer Station ABIDE INC 483 SHAKER RD PO BOX 886 Name of Transporter Address EAST LONGMEADOW MA 01028 4135250644 CitytTown State Zip Code Telephone i 2.If a temporary storage location/transfer station is used,list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: I f TRANSWASTE INC 3 BARKER DRIVE Name of Transporter Address WAWNGFORD Cr 06492 2032698300 Cityfrown State Zip Code Telephone Note:Contractor must sign this form for DLS Revised: 11/13/2013 Page 3 of 4 Moo" . . _. .._....— 000229721 ,7 Asbestos Notificatio> Form ANF-001 Asbestos Project# j r Project Revision r Project Cancellation nuuucauuu ywpw.a . G Asbestos Transportation&Disposal:(cant.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: ABIDE INC 483 SHAKER RD PO BOX 886 I Temporary Storage Location Name Address EAST LONGMEADOW MA 01028 4135250644 Cfty/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES MINERVAENTERPRISES INC Final Disposal Site Name Final Disposal Site Owner Name 9000 MINERVA SE Address WAYNESBURG CH 44688 3308663435 City/Town State Zip Code Telephone D. Certification "I certify that I have personally examined the foregoing and am MIARIATILLi MARIA TILLI familiar with the information ane Authorized Signature contained in this document and PRESIDENT 9/2812015 all attachments and that,based on my inquiry of those Posmon le, Date(MM/DDNYYY) individuals immediately 4135250644 ABIDE QVC responsible for obtaining the Telephone Representing information,I believe that the 4803 SHAKER RD EAST LONGMEADOW information is true,accurate,and Address City/Town complete. I am aware that there MA 01028 are significant penalties for state Zip Cade submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement j (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid 11 unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 D�1 f nand: �� 6 1)515Commonwealth of Massachusetts 1002' 0� � Asbestos NotificatioO Form ANF- 001 Asbestos Project# Project Revision Notification 1✓ Project Revision i f7 Project Cancellation A. Asbestos Abatement Description 4N*V: 1,9q3` ? 1.Facility Location: &4*V- INy STEVEN GULLERUDRESIDENCE 26+f OAD Name of Facility Street Address Instructions 1.Ail NORTHAWTON MA 01060 4136763323 sections of this form CitytTown State Zip Code Telephone must be completed in STEVENGULLERUD OWNER order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: IST FLOOR AND BASEMENT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2.Blanket Permit Project Approval,if applicable: notification requirements of 453 Approval ID# CMR 6.12 3.Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: Approval ID# MassDEP Use Only j 10/26/2015 10/29/2015 Date Received Project Start Date(MM/DDNYYY) End Date(MM/DD/YYYY) 7AM-5PM NA Work Fours-Monday Through Friday Work Hours-Saturday&Sunday 2.Submit Original Form To: B. Other Project Revisions: Commonwealth of ,� Massachusetts P.O.Box 4062 ADDITIONAL 2$SF LINOLEUM IN IST FLOOR BATHROOM Boston,MA 02.211 Note:Temporary storage of Asbestos containing waste , material is only allowed at the place of business of a DLS licensed Asbestos contractor or a transfer station that is permitted by MassDEP and operated in compliance with Solid Waste Regulations 310 CMR 19.000 Revised: 11/13/2013 Page 1 of 2 Commonwealth of Massachusetts 10ozz97z1R1 � Asbestos Notification Form ANF-001 Asbestos Project# t Project Revision Notification! I✓i Project Revision r� Project Cancellation MUM;WUtIdUtUI IIIUJt sign this form for ALS C. Certification notification purposes "I certify that I have personally examined the foregoing and am MARIA TiLLI MARIATILLI familiar with the information Name Authorized Signature contained in this document and PRESCEW 10/23/2015 all attachments and that,based on my inquiry of those Postiontritle Date(MMtDD1YYYY) individuals immediately 4135250644 ABIDE INC, responsible for obtaining the telephone Representing information,I believe that the 483 SHAKER RD EAST LONGMEADOW information is true,accurate,and Address City/-rown complete.I am aware that there MA 41028 are significant penalties for State Zip Code submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 5.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 2 of 2 i i ATC Shaping the Future November 3,2015 Mrs.Maria Tilli Abide Environmental Cardno ATC PO Box 886 East Longmeadow,MA 01028 73 William Franks Dr. West Springfield,MA 01089 Phone +1413 7810070 RE: Asbestos Final Air Clearance Fax +1413 7813734 26 Langworthy Road, Northampton www.cardno.com Cardno ATC Project No. 183ABD1562 www.cardnoatc.com Dear Mrs.Tilli, Asbestos abatement Clearance Monitoring Procedures as described in the State of Massachusetts Department of Labor Standards(DLS)Regulations 453 CMR 6.14(5)were performed in the abatement area(s)referenced above. Cardno ATC's Massachusetts licensed asbestos project monitor,Tom Witkos;AM073950,performed the final clearancevisual inspection,air sampling and analysis on October 29,2015. Final air clearance sampling was performed after successful,completion of the visual inspection performed by the asbestos abatement supervisor and project monitor. Analysis of air samples was performed on-site using Phase Contrast Microscopy (PCM), NIOSH 7400 Method. Analysis of all air samples indicated levels equal to or below 0.010 fibers per cubic centimeter(f/cc),the minimum level required by the US Environmental Protection/agency and State of Massachusetts DLS following an Asbestos Response Action. Enclosed please find the PCM air sample analysis report,the Certificate of Visual Inspection and the Site Log. If you have any questions,please call our West Springfield,Massachusetts office at(413)781-0070. Sincerely, Cardno ATC 52 Edward Kolodziej Brian Williams Senior Project Manager Branch Manager Enclosures Australia • Belgium • Canada • Columbia • Ecuador a Germany • Indonesia • Italy Kenya • New Zealand • Papua New Guinea • Peru • Tanzania • United Arab Emirates United Kingdom • United States • Operations in 85 countries www.cardnoatc.com William Franks 8 �rc�►l'[�"`'!O'� West Springfield, 09fngfieid,MA.619 AATCs I 413.781.0070 1 V Fax 413.781.3734 Shaping the Future ASBESTOS PCM AIR SAMPLE ANALYSIS REPORT CUENT NAME JOB SITE SAMPLED BY DATE SAMPLED Cardno AT JOB# Abide 126 Langwotthy Road,Northampto ITorn Witkos 29-001-15 1183ABDI563 ANALYTICAL SERVICE LICENSE#: AA000005 AAR ANALYSIS:Turn Wdkos DATE OF ANALYSIS:29.Oct-15 Sample# Sample Location - SampleType volume Fiberftieid Fiberelcc 01 Field Blank Field Blank 0!100 02 Field Blank Field Bank x100 03 let Floor Bathroom Final Air Clearance 1246 1/100 70.002 04 Near NAFU Final Air Clearance 1230 2.5/100 <0.002 05 Basement Left Side Room Final Air Clearance 1260 2/100 <0.002 06 Basement Center of Room Final Arc Clearance 1245 3.51100 70.002 07 Basement Bathroom Oil TankArea Flnal Air Clearance 1230 5.5/100 70,002 f I I t I t } f f Cava"aPCM ATR SAMPLING CHAIN-OF-CUJ TODY .arc iFra'ect Name:�b Ls"L,0 %&+i4&. J Collection on Date: /Oj9 .," Project#. Ito Client: fi"o Date of Analysis: its- Project Monitor: Ir $-.& tJk�•Kc� �1� 73gs-e) --_ Location: 0r CW,-. 3s+r�llpgw.� I Work Area: VAT4-OU1,Wrc, 4aKalte�N, Project Manager: 1i Lit ML(JCSs#vs+! Analyst Ratometer#;_j�Ir t3'7 Signature:— -- Location Sample Actual Adjusted Anal'st Sample# or Type Time Flow Rate Total Volume J . Result ' Worker Name/SSN/Task/PPE 1-10 Start End Start End (L) �01) Count Caunt (fJcc)TimeID „14•C •of Field Blank . t/cc f/cc Initials -u 2, Field Blank © tea IJ . 1y J$j tca PY-5 t i�O6 � °`( Kix, ttov:u 7 OP4 o% 150 ISO 030 o.ont 2 slwe ,do cs os -te"Pr+ td� 128owt C�a(� (oho ls� t5� _ �`� (�q►o baoZ4 xlt�� rta+xaL -- "o� C6krfa,&P 10600- 7 6767. to a 1Sa is* V3 1^50 b.co�i " 4va2 Raft mw4,Oi( tR�(�, 7 D qag TaSi tS a ig o Z t Z.3a Ss/loo 400t r %5-� C Reference Slide c,} b3 Duplicate Slide ,�- tac Sample Tme: . 1)Area Background 3)During Prep Work 5)During Final Clean 7)Final Air Clearance 9)Associated Work 2)Pre-Abatement 4)During Removal 6)During Glovebag Removal 8)Personal Air Sample 34)Hazard Assessment Relinquished By: --Ior.1..�1a'&6 Date:_jo(u4s, -- Received By. Data: DA-MY'�M LOG P e o Project, iAa!? �� -�c4 � Date:_ a1 Pmiet#:_ 193,46a 1563 y.._, _ o; o ?b914S�r4ka?3ts3 Clime AQ(a6 -r,>C Dr� Time _ ORSER.VVA.TIONS/A. ONS Ciba Cert�«�A R,, 0.9 s y b 4 Vwsu.�'t yesAgaas t Asir .tl t,�► Ck+x t E tfwa d T' 4- cS (.A dt3V LJ ✓r p c� JAA V d9Ur(.I� j Z br,S R Liv 4,J le Fcoo& R+c' ij u m F 08 aC- Lt ka 6u _A%,( t, . 4 4 UA V. - -to utas ,�sLOU 04FO ' ,PA 0 04 W NA G! IF .4 14fle a ?.amu ra at !sr Fwo•c. 4 U Scar e 4 �1;s T". slRfG A ` 10A, D' f k U 1S £,t a !mss 3 x,ry t' t�t►� +Cc sl 46 � u �� -n- j .qua.t - VA 706 Av44rjlly lS v � nk- a dace. W(r Gluu.4is Jw 1n 6w Too" o" A A— ,i j Cardno ATC Repi-cse ntative SLmablr Tz i a Xk A07355b 73 William Franks Drive West Springfield,MA,01089 ATC Tel: 413-781-0070 Fax: 41.3-781-3734 CERTIFICATION OF VISUAL INSPECTION NT: PROJECT NUMBER-- /r 3 ,4f3D t S t 3 �0,3 : GENERAL LOCATION:_ at LAqWOA, . 5040 ABATEMENT CONTRACTOR: $tOi' Tote METHOD OF ABATEMENT: &KT 1qe,,rg0A3 TYPE AND QUANTITY OF MATERIAL ABATED: , Q�►o Ss �'�� 0,ra IW r1C it" Cum SUSPECT MATERIAL R.EMAINING IN WORK AREA: L to 1-SUA4_ ,«�yrr� vus�tt SPECIFIC AREA INSPECTED: rtootiFr�1 i i i CERTIFICATION OF VISUAL INSPECTION I In accordance with Specification for this project any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes,beams,ledges, walls, ceiling and floor,decontamination unit,sheet plastic,equipment, etc.)and has found no r. visible dust, debris or residue. I Supervisor(Signature): Date: /61-v??-/6 (Print Name): J-oh)) ,1Na&we e—u Accreditation Number: 19,57N !el, State: !`i'146uf OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he as accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification above is:true and honest one. I Project Monitor(Signature); Date: (Print Name):_ 1-14a^4's t2. WGT'iL'o'S Accreditation Number: State: � US EPA ASBESTOS WASTE SHIPMENT RECORD RQ,ASBESTOS,9,NA2212,PG I 11 # 2030 CT,MA,RI,VT,NH,ME NY GENERATORS GENERATORS EPA Region 2 EMERGENCY RESPONSE EPA New England 290 Broadway,26th Floor 3 Barker Drive-Wallingford,CT 06492 1 Congress Street New York,NY 10007-1866 TELEPHONE (203)269-8300-Fax:(203)269-8600 Boston,MA 02114-2023 (212)637-3000 #1-800-750-3460 MA DEP Compliant (617)918-1111 1001��qa) assDEP Asbtos TK# ASBESTOS DISPOSALM ,& DOCUMENTATION FORM Notification Nuesmber Job Number 1.5593 MA DLS Lic#AC000254 GENERATOR/BUILDING OWNER Contractor Abide Inc. Contact Person Maria Tilli Sbn= 6 u i le rQ Address P.O. Box 886,483 Shaker Road Address 4o Laryivy�q City East Longmeadow State MA Zip 01028 city -,j _1 state — N)o _0 A C)IO Telephone Number 413-525-0644 Phone Numberdbrl Date Container Del. .--Date of Pickup Type of Container 100 VAA GENERATING LOCATION VOLUME .5..976 CY Friable Non-Friable 11 mc = abm­e, MUST BE IN CUBIC YARDS r k Address Qty.in Cubic Yards 01y.in Cubic Yards city State Zip Bag 0(#-3Z Drum* 1111 Wrapped 0#_ Phone Number Other E1# Description MA DEP Asbestos Notification Number 100 Gzv:)qA I shippers Certification I certify the above named material does not contain free liquid as defined by 40 CFR pad 260.10 or any applicable state law,is not a hazardous waste as defined by 40 CFR part 261 or any applicable state law,has been property described,classified,marked,labeled and packaged,and is in proper condition for transportation according to NESHAP standards for asbestos waste disposal found in 40 CFR part 61.150,and 310 CMR 7.15. Shipper's Certification: I hereby declare that the contents of this consignment are fully and accurately described above by the proper shipping name,and are classified,packaged, marked and labeled/placarded,and are in all respects in pr -cording to applicable international and national government regulations. pr condition for transport ac Authorized Signature, P )5,ke S41 e jov.13 Signature Printed Name Titleiio.Zp-1505fe ,�' Transporter 1: Abide Inc.,483 Shaker Road, East Longmeadow, MA 01028 413-525-0644 Name Address Telephone If A D 10-20-15 IOC lS Driver: '04� cry4'e4�LReqistration#: . MA �TCJCJ 51; .2a4 Date: tO 10.2iS O'Signature Printed Name Title SZe,^'o State/# Certification Date 10 41hj'5 I(>.a*W I herby certify that the contents of this shipment are In all respects in the proper condition for transport according to applicable international,federal,state Transporter 2: TLa~, Inc. ceLDrKrib,Wallingford, CT 06492 (203) 269-8300 Driver: .. .................Registration#: -577 I`MA Date: 'L 16 001 i9nature Printed Name Title State/# Certification Date I he certify that the contents of this shipment are in all respects in the proper condition for transport according to applicable international,federal,state and local regulations. Transporter 3: TransWaste, Inc., 3 Barker Drive,Wallingford, CT 06492 (203)269-8300 Name Address Telephone# Driver: __-Registration Date:— Signature Printed Name Title State I# Certification Date I herby certify that the contents of this shipment are in all respects in the proper condition for transport according to applicable international,federal,state and local regulations. Site r-1: Modern Landfill Site Minerva Enterprises Site F]: Hakes Landfill _ Site El: Address: 4400 Mount Pisgah Rd. AdXSS: 9000 Minerva S.E. — Address: 4376 Manning Ridge Rd. Address: York,PA 17402 Waynesburg,OH 44688 Painted Post,NY 14870 Phone: 717-246-4615 Phone: 330-866-3435 — Phone: 607-937-6044 Phone: Indicate Any Discrepancies Certification of receipt of materials covered by this manifest. Disposal Facility Certification:I hereby certify that(1)the quantity of the ACWM li>"In this asbestos waste shipment record Is the same quantity accepted for disposal and(2) 1 facility holds the appy priate permits and/or authors tion ac, St for disposal the ACWM described. :A.AeIt 1�5 Name of Authorized Agent Signature Printed Name Title Receip Date GENERATOR