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39-041 (3) I ATWOOD DR-CLARION BP-2016-1339 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39-041 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-2016-1339 Project# JS-2016-001710 Est. Cost: $630500.00 Fee: $300.00 PERMISSION IS.HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 063282 Lot Size(sq.ft.): 217800.00 Owner: ATWOOD DRIVE LLC Zoning: GB Applicant• ASSOCIATED BUILDING WRECKERS INC AT. 1 ATWOOD DR - CLARION Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732-3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON.511812016 0:00:00 TO PERFORM THE FOLLOWING WORK.COMPLETE DEMOLITION OF THE CLARION HOTEL 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 5/18/2016 0:00:00 $300.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2016-1339 APPLICANT/CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD01105 (413)732-3179 PROPERTY LOCATION 1 ATWOOD DR-CLARION MAP 39 PARCEL 041 001 ZONE GB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: COMPLETE DEMOLITION OF THE CLARION HOTEL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 063282 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOR ATION PRESENTED: 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 OZ,­ /�� -5—//t? /1 (:�, 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. RECEIVED 06/13/2014 02:48 MAY-12-2016 08:14 From:RLS PROPERTIES 4132532:160 To:14137346224 P.1/4 —err ra �EQ.r E - Department use only 'i City of Northampton Status03fpermlr i V Building Department curb;Cut/OrivowAypemtit 212 Main Street Seweri$ ttc.AAyallablllty �.., ,! DING INBPE ROOfIl 1001.1 Wat rNVaN Availabthty .__._ HAMPTON Northampton, MA 01060 Cvtiq':Set9'of StruGtur91 Pians _ -, _• _ ,_, I phone 413-587-12.40 Fax 413-58"7-1272 PlovIlte Plans Clther apecily APPLICATION TO CONSTRUCT.ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY r)WELLING SECTION 1 -SITE INFORMATION �•_r-� _ — ^, ._ 1.1 Pronertv Addr�s This section to be completed by oce ffi Map I Zone _ _Overlay btstrict,_•_--­.­._ ! Elm at.District,,,,,,-, CB Dlstric[---_-.--_­ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner of Record: NTme(Printf} Qu rrent��a'linAddrew Telepl'Iofm 2.2 uthor d A nt: 'ySZr4` S4ritt�r S��'tt �.l.� .00S Name(Prin Current Malling Addres ' rT Slgnalura ___��-• Tcicphano x ___ ...,—. SECTION 3-I,STIMATEt)CONSTRUCTION CO§U Item Estimated Cost(Dollars)to be Official Use Only completed b permit 9 iicant 1, Building4 e>w 45oa as (a)Bullding Permit Fee 2. Electrical V`/ T (b)Estimated Total Cost of Construction from_(6) 3 Plumbing- _ Building Permit Fee ,••-...- 4. Machanical(FiVAC) D Fire Protection I 0 Total= 1 +2+3+4+6) Cneck Number �b This Section For Official Use Only �. TT 1301ding Permit Number: Date-.... -�_ ,., Issue J { Signature; I 8ulld;;c':l Cornmisaionedki!...peclor of Guildina% Date RECEIVED 06/13/2014 02:48 MAY-12-2016 08:14 From:RLS PROPERTIES 4132532160 To:14137346224 P.2/4 Section 4• 'ZONING Alt Information Must.8e Completed,hermit Can Be Denied We To Incomplete Infcm,mation Existing Proposed Required by Zoning 1 iU91101111,111 jr,he fill�(l in 1,v [illi lllln„l,rc.Pn�Int4'nl I,ot 4 i �'rontfl'�c Setbacks Front Silk L R: L. R:_.... Rear Buildin_,Ffei*hi Bldg. Squarc Footage % Open Spacc Footage % (Lot alta minus bldg fi p,lved , Of Parkine,ti arcs ' Fill; .. . . ., A. Has a Special Permit/Variance/Finding ever leen issued for/on the site? NO O DON'T KNOW a YES 0 IF YES, date issued:' IF YES: Was the permit recorded at the Registry of'Deeds? NO 0 DON'T KNOW 0 YES 0 IF YES: enter Book , Page. and/or' Document# S. Does the slte contain,a brook, body of water or wetlands? NO DON'T KNOW 0 YES IF YES, Has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained Date issued: C. Do any signs exist on the property? YES NO 0 iF YES, describe sizo, type and location: /A , im D. Are there any proposed changes to or additions of signs intended for the property? YES 0 1 NO 0 iF YES, de=scribe size, type and location: E, Will the construction activity disturb(clearing,grading,excavation,or filling)over i acre or is it part of a common plar1 that will disturb over-1 aci-0 YES 0 NO 0 IF YES,th.,in a Northampton Storm Wate,iMoflagemcnt Permit from the DPW is requiter/ RECEIVED 06/13/2014 02:48 MAY-12-2016 08:14 From:RLS PROPERTIES 4132532160 To:14137346224 P.3/4 SECTION 5-DESCRIPTION OF PROPOSED WORK!chock all applicable) t New House Addition Replacement Windows Alteration(p) I Reefing [' Or Door$ Accessory Bldg F—i i Demolition X New Signs Ir.3) Decks f(M 51ding(Oj Other jpj i i Bret D@,cription of Proposed I Work. r�iiAi�� 8 �v`4 �e+trtllc_+� et,,V.er4 � i i f I Alteration of existing bedroom _ YeS No Adding new bedroom Yes No Attached Narrative Renovating unfinished baserrlent Yes No Plans Attached Roll •Sheet "—"� yF sa.A_New house and or addition t4 alstlno h2 sing, comulete the following: i a. Use of building nn©Family Two Family_Other I b. Number of roams in each family unit: Number of Bathrooms c, Is there n garage attached? ii d Proposed Square footage of now construction. Dimensians f P. Number of stories? f f. Method of hydting?_. . - _ Fireplaces or'Woodstoves Number of each___�y g Energy Conservation Compliance Mssscheck Energy Compliance fonli attached? h. Type of construction 1 i Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain—Yes Nu ` f. Depth of basement of Cellar floor below finished grade I k Will building conform to the Building and Zoning regulations? Yes No. I iI Septic Tank City Sewer Private well W City water Supply SECTION 7a-OWNER AUTHORIZATION•TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. property -- as Owner of the subjar_t hereby authorize ` to act on my behalf-in 31! a w© a work autl med by this building ^' Pei application, w i Signature of Owner I' �-�'�� - ,as GerrlErl9Autnorizcd ! Agent hereby f!CClare that the staten;r.nts And infomnation on the foregoing application are true and accurate,to the best of my knowledge and belief. i i8igneinthe C s andpenu;ties of.perjury. Algrraiure of(7wcr/Agent Cale —� RECEIVED 06/13/2014 02:48 MAY-12-2016 08:14 From:RLS PROPERTIES 4132532160 To:14137346224 P.4/4 I .k SECTION 8-CONSTRUCTION SERVICES _t $.]l.fr onsad Cunstructlan Supervisor: Nc)t Applicobte C3 N eoI ng e Hal I Liaon9N Number Addres, M Expiration Dale r � � Slflnature Te~phone. `�31�tA __---- _--• ----- d M91- yemQnt Contractor: Not Applicable ❑ I C N e �— Registration Nunlber UAA 040f2 81Z ZOV"I Address __...._..- ... . Expirtltion Date Telephone SECTION 10-10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.O.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 hullding permit. Signed Affidavit Attached Yes. ... ❑ No...... D 11. - Home Owner Exemption The current esemptiort roi homeownom"wits extended to include• caner-4.ectl licd_.Dwcilirigs ofone(1) or two(2)titinilics and to allow such homeowner to engage all aldlvidllal far hire Who(toe,not possess a license,i)rUvic c 1 haN-Iho uw•lier acts ossa•tervisor.c'M R 780, Sixth Edition Section DcPnition.of hionleowner:Person(s)who Own a pared of 1;1110 of)wllioh he/she re5it1C5 VI.inlclids tV rcisidc,on which tlic e is,or is intended to bc,a one or two family 6ve11ing.attached or detached structitres accessory to such list anti/or farill structures.A pcisoli who constructs more thillt usle liome.in it two-yea►r period>listll uot be cousldered a hom1 urvner. Such`•homeowner'•shall submit to the 13uildinr Official,oil a form acceptable to the t3uiltling Official,thal Ile/she.-�hi11t be resi2misihfe fur all steric work nel•(nrmed under the huil(Iinut oeu•n)it. As acting,C;onslructiasu Sul)ervigr r your presence on the•job Site WIIIIbe re(htirrd li-0111 till)C t0 tulle,durinE sulci tlluln completion of the Work for Which this permit is issuad. Also be advised ihat with reference to Chapter 152(Workcrs'Compensation) find Chapter 153(Liability of En)ployers ti. F nlpioyeeS for io..juries 1101 resulting ill DeAll of the Massachusetts CvnOral Low-,Annutatet(. ol� i may he IIghl for perjon(h) You hire to perforin work for you under this permit, Tile Li licivr5iknl'd"homeowim •vurtif es and assumes responsibility for comphillice With the$tato,f3ail(tlil?L 17r1CIC,l Iry sif Northampton 01-dinances.State and Lucal Zoning Laws aticl Stott of IMassachuselts Get)era.l taws Aiu)olutc(I. Homeowner tiignaturr The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations a 1 Congress Street Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bus iness/Organization/lndividual): ASSOCIATED BUILDING WRECKERS, INC Address: 352 ALBANY STREET City/State/Zip: SPRINGFIELD, MA 01105 Phone #:413-732-3179 Are you an employer? Check the appropriate box: Type of project(required): I.❑■ I am a employer with 32 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.ElI am a homeowner doing all work officers have exercised their 11.0 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. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also till 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 policv and job site information. Insurance Company Name: GREAT DIVIDE INSURANCE COMPANY Policy# or Self-ins. Lie. #:WCA154516515 Expiration Date:02/01/2017 Job Site Address: 1 Attwood Drive City/State/Zip: Northampton, MA 01060 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 on -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.0 a ay against e violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations fth DIA for surance coverage verification. I do hereby ceder the ains and penalties of perjury that the information provided above is true and correct. S4znature: Date:May 9, 2016 Phone#:o& 17 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/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Construction Supervisor Restricted to: Unrestricted-lRuildings of any use group which contain less than 35,040 cubic teat(991 cubic meters)of enclosed space. Failure to possess a current edition at the Massachusetts State Building Cade is cause for revocation of this license_ DPS" Licensing inforrnatiori visvt. WWW,NiASS,GOVIDPS Massachusetts Department of Public Safety Beard of Building Regulations and Standards License CS-062382 t, ... ANDREW H MIRKIN 289 TANGLEWOOD J. LONGMEADOW MA M �r Expirafion. Commissioner 10139/2017 - ! r : Office of Consumer Affairs and Business Regulation. 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Hone Improvement Contractor Registration Registration: 169969 Type: Corporation Expiration: 8125/2017 Tri# 268310 ASSOCIATED BUILDING WRECKERS, INC. ANDREW MIRKIN 352 ALBANY STREET SPRINGFIELD, MA 01105 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card _-Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ;registration: 169969 Type: Office of Consumer Affairs and Business Regulation Expiration: 8/2512017 Corporation IQ Park I'Iaza-S 'te Si'r0 Boston, i12ll i ASSOCIATED BUILDING WRECKERS, INC. 3 l ANDREW MIRKIN 352 ALBANY STREET SPRINGFIELD MA 01105 Undersecretary Not valid without signature RECEIVED 06/03/2014 09:02 02/05/2016 08:28 (UTC/GMT) National Grid page 1 nationalgrid 40 Sylvan Rd Waltham MA 02451 May 2, 2016 RE: Service Removal for Building Demolition, 1 Atwood Dr. Northampton,MA To whom it may concern: This letter is to confirm that per your request, National Grid has confirmed electrical meter# 15850823 and service line have been removed from 1 Atwood Dr.Northampton, MA. The work was processed on work request 21529918. If you have any questions or need further assistance,please feel free to contact me at (508)357 4554. Sincerely, Amanda Rodriguez Customer Order Fulfillment nationalgrid G1UM6 a Gas of Massachusetts A NiSource Company 995 Belmont Street Brockton, MA 02301 Date: May 9, 2016 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 1 Atwood Dr TOWN : Northampton STATE : Massachusetts Sincerely, Heather Meunier Integration Center Columbia Gas Of Massachusetts 508-580-0100 x 1342 Associated Bufl4ing Wreckers, Itic. 352 Albany St.,Springfield.MA 01105 Tel: (413)732-31791(800)448-2822 Fax: (413)734-6224 February 23,2016 To: Pam Puchala Email: pamela.d.puchalaAverizon.com Alternate Email: ma-ri.osp.centerAverizon.com of. Verizon Phone: (866) 686-1195 (508)884-4908 Please cut all services of all buildings at the following location as it is being scheduled for demolition: I Atwood Drive,Northampton,MA Once disconnection has been completed,please either sign below and fax it to(413)734- 6224 or send a notification on your company letterhead. Thank you very much for your assistance in this matter. Sincerely, Associated Building Wreckers, Inc. SERVICE AT: I Atwood Drive,Northampton,MA HAVE BEEN DISCONNECTED AS OF 3122- PRINT NAME: SIGNATURE: REMARKS,IF ANY: demo coordinator From: Romito, Jeff <Jeff_Romito@cable.comcast.com> Sent: February 26, 2016 12:32 PM To: demo coordinator Subject: RE: Request for Disconnection of Service - 1 Atwood Drive All set From: demo coordinator [mailto:demo@buildingwreckers.com] Sent: Friday, February 26, 2016 9:42 AM To: Romito,Jeff<Jeff_Romito@cable.comcast.com> Subject: Request for Disconnection of Service - 1 Atwood Drive Good Morning Jeff, Attached you will find a request for the disconnection of cable service at the former Clarion Hotel located at 1 Atwood Drive in Northampton. Please let me know if you have any questions, or require any additional information. Thank you, Michael Orr Demolition Coordinator Associated Building Wreckers, Inc. 352 Albany Street Springfield, MA 01105 (413) 732-3179 (0) (413) 734-6224 (F) demo@ buildingwreckers.com ,s Commonwealth of Massachusetts 100237785 Asbestos Notification Form ANF-001 Asbestos Project# r Project Revision 1- Project Cancellation A. Asbestos Abatement Description 1. Facility Location: FORMER HOTEL 1 ATWOOD DRIVE Name of Facility Street Address Instructions 1.All NORTHAMPTON MA 01060 4132374471 sections of this form City/Town State Zip Code Telephone must be completed in CURT SHUMWAY MANAGER order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: THROUGH-OUT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? r 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)? F Yes F No MassDEP Use Only 4. Blanket Permit Project Approval,if applicable: 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 ASSOCIATED CONTRACTORS WRECKERS INC 352 ALBANY STREET P.O.Box 4062 Boston,MA 02211 Name Address SPRINGFIELD MA 01105 4137323179 City/Town State Zip Code Telephone AC000898 Contract Type: F_Written F Verbal DLS License# 7. JAMIE BRYSON AS074021 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# $, DAVID GERARD ABAD AM071610 Name of Project Monitor DLS Certification# 9, O'REILLY TALBOT&OKUN ASSOCIATES INC AA000089 Name of Asbestos Analytical Lab DLS Certification# 10, 3/7/2016 4/15/2016 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 7:00 A.M.-4:00 P.M. N/A Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11.What type of project is this? r Demolition r Renovation r Repair r Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 J r Commonwealth of Massachusetts 100237785 Asbestos Notification Form ANF-001 �. Asbestos Project# F- Project Revision F- Project Cancellation A. Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): F Glove Bag r Encapsulation r Enclosure r Disposal Only r Cleanup F Full Containment I— Other-Please Specify: 13.Job is being conducted: F Indoors F Outdoors 14.Total amount of each type of asbestos Containing materials (ACM)to be removed,enclosed,or encapsulated: 2000 126800 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Pipe Insulation 2000 Transite Shingles Lin.Ft. Sq Ft. Lin.Ft. Sq.Ft. Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths,Woven Fabrics Other-Please Specify: Lin.Ft. Sq.Ft. Insulating Cement FLOORING,ADHESIVE,CTLS 126800 Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. 15. Describe the decontamination system(s)to be used: THREE STAGE AND REMOTE DECONTAMINATION UNITS. 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): TO BE WETTED,WRAPPED IN POLY,DOUBLE BAGGED,LABELED AND PROPERLY TRANSPORTED FOR DISPOSAL. 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official 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 r yes r No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachusetts 100237785 Asbestos Notification Form ANF-001 .,. Asbestos Project# Project Revision r' Project Cancellation B. Facility Description 1.Current or prior use of facility: FORMER HOTEL 2. Is the facility owner-occupied residential with 4 units or less? r— Yes F No 3,ATWOOD DRIVE LLC 220 NORTH PLEASANT STREET Facility Owner Name Address AMHERST MA 01002 4132374471 City/Town State Zip Code Telephone 4,CURT SHUMWAY 220 NORTH PLEASANT STREET Name of Facility Owner's On-Site Manager Address AMHERST MA 01002 4132374471 City/Town State Zip Code Telephone 5.ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET Name of General Contractor Address SPRINGFIELD MA 01105 4137323179 Note:Temporary storage of Asbestos City/Town State Zip Code Telephone containing waste GREAT DIVIDE INSURANCE COMPANY material is only allowed at the place Contractor's Worker's Compensation Insurer of business of a DLS WCA154516515 2/1/2017 licensed Asbestos Policy# Expiration Date(MM/DD/YYYY) contractor or a transfer station that is 6. What is the size of this facility? 50000 2 permitted by MassDEP and operated in Square Feet #of Floors compliance with Solid Waste Regulations l• Y C. Asbestos Transportation & Disposal 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 ASSOCIATED BUILDING WRECKERS,INC 352 ALBANY STREET Name of Transporter Address SPRINGFIELD MA 01105 4137323179 City/Town State Zip Code Telephone 2. 1 f 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: RED TECHNOLOGIES INC 10 NORTHWOOD DRIVE Name of Transporter Address BLOOMFIELD CT 06002 8602182428 City/Town State Zip Code Telephone Note:Contractor must sign this form for DLS Revised: 11/13/2013 Page 3 of 4 Commonwealth of Massachusetts 100237785 1 Asbestos Notification Form ANF-001 '.....^ Asbestos Project# r Project Revision r— Project Cancellation C.Asbestos Transportation& Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: RED TECH TRANSFER&LOGISTICS 203 PICKERING STREET Temporary Storage Location Name Address PORTLAND CT 06480 8603421012 City/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES INC MINERVA ENTERPRISES INC Final Disposal Site Name Final Disposal Site Owner Name 9000 MINERVA ROAD Address WAYNESBURG CH 44688 3308663435 City/Town State Zip Code Telephone A Certification "I certify that I have personally examined the foregoing and am ANDREWMIRKIN ANDREWMIRKIN familiar with the information Name Authorized Signature contained in this document and PRESIDENT 2/23/2016 all attachments and that, based on my inquiry of those Position/Title Date(MM/DD/YYYY) individuals immediately 4137323179 ASSOCIATED BUILDING WRECKERS responsible for obtaining the Telephone Representing information, I believe that the 352 ALBANY STREET SPRINGFIELD information is true, accurate, and Address City/Town complete. I am aware that there MA 01105 are significant penalties for submitting false information, State Zip Code including possible fines and imprisonment. The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (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 unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 e,DEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System Usemame:DEMOCOORD Nickname:DEM01 My eDEP Forms - My Profileca Help Notifications Receipt . _E_.. sr Da^„�SJ Forms Signature Payment 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: 812165 Date and Time Submitted: 2/23/2016 10:14:54 AM Other Email : DEP Transaction ID: 812165 Date and Time Submitted: 2/23/2016 10:14:54 AM Other Email : Form Name: AQ04-Asbestos Removal Notification Form ANF-001 Form Name: AQ 04 -Asbestos Removal Notification Form ANF-001 Payment Information DEP code: 120308 Date: 2/23/2016 10:14:43 AM Amount($): 100 Billing Info: COORDINATOR DEMO --AccountType--AccountNumber ****2979 Confirmation Number: My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.12.20.7.00 2015 MassDEP https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx 02/23/2016 Massachusetts Department of Environmental Protection eDEP Transaction Copy .......... Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: DEMocooRD Transaction ID: 812165 Document: AQ04-Asbestos Removal Notification Form ANF-001 Size of File: 110.44K Status of Transaction: In Process Date and Time Created: 2/23/2016:10:17:33 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. # 71Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP ANF-001 Pre-Form Notification Prior to Construction or Demolition r This is a revision to an existing form. Project ID for existing form to be revised: f•This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: r This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: r This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards because(please check one box below): f•This job involves breaking,shearing or slicing of non-friable asbestos-containing material only(e.g.cement shingles/panels,cement pipe,asphalt roofing or siding,vinyl floor tiles,etc.)in a manner that does not generate asbestos dust or render the material friable,as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.13(2)(a)5.All work must be done in compliance with the applicable regulations at 310 CMR 7.15;or • This job involves work on asbestos containing material that is classified by the Department of Labor Standards (DLS)as a `Small-Scale Asbestos Project,' an `Asbestos-Associated Project', or an `Asbestos Response Action' by qualified`in-house' personnel as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.00,and will be performed in accordance with all the requirements of 453 CMR 6.13 (1)(a),453 CMR 6.13 (2)(a)l.and 3., and 453 CMR 6.14(1)(a),as applicable. All work must be done in compliance with the applicable regulations at 310 CMR 7.15. • None of the above conditions apply,generate a new form Revised: 11/13/2013 Page 1 of 1 e O'REILLY,TALBOT&OKUN ASSOCIATES 293 BRIDGE STREET SUITE 500 SPRINGFIELD, MA 01103 413-788-6222 Asbestos Abatement Visual Clearance Inspection Project Number: cS`� — U i — 0 .; Site Surveyed: Project Name: /4'� t, •-, Address p Location of Containment: Usc-\-e' T F Date Inspected: i 7"' Asbestos Abatement Contractor. r-2)el Asbestos Supervisor: y Visual Clearance Result(circle one): Ass Fail (71 Reason for Failure: Description of Asbestos Abatement L � Tr The above asbestos abatement regulated area has been visually inspected by the asbestos abatement supervisor and asbestos abatement project monitor. The regulated area was dry and all surfaces were free of visible debris. Asbestos Supervisor/DOS# Asbestos Project Monitor/DOS# Phase Contrast Microscopy (PCM) Fiber Count NIOSH 7400 Method, Revision 3, Issue 2, 8/15/94 CLIENT: The Hampshire Hospitality Group PROJECT: Clarion Hotel and Conference Center ADDRESS: One Atwood Drive One Atwood Drive, Northampton MA Northampton, MA Logged: 3/14/16 PHONE: Date/Time Due: FAX: Scope: Sample ID Location Sample Date # # Volum Fibers/m Fibers/cc= LOD (less than) Fibers Fields a(L) m2=E C APR-031416-01 CL Main Basement Kitchen Area 3/14/2016 21 100 1200 26.75 0.009 0.004 APR-031416-02CL Inside Berkshire Meeting Room 3/14/2016 19.5 100 1200 24.84 0.008 0.004 APR-031416-03CL Between Hall and Hampshire 3/14/2016 19 100 1200 24.20 0.008 0.004 Room APR-031416-04CL Rear Bathroom Hall(Downstairs 3/14/2016 16 100 1200 20.38 0.007 0.004 from Kitchen) APR-031416-05CL BLANK 3/14/2016 0 100 0.00 APR-031416-03CL 10%RECOUNT 3/14/2016 20.5 100 1200 26.11 0.008 0.004 QC Checks: "t Analyst Name: Andy Rolin er Analyst Signature: _C4�L l6 k�-f O'Reilly,Talbot&Okun Associates,Inc. - 293 Bridge Street,Suite 500 - Springfield,MA 01103 Phone:(413)788-6222 - Fax(413)788-8830 O'REILLY,TALBOT&OKUN ASSOCIATES 293 BRIDGE STREET SUITE 500 SPRINGFIELD,MA 01103 413-788-6222 Asbestos Abatement Visual Clearance Inspection Project Number: 7.5,E — I — 0 Site Surveyed: j Project Name: Address .✓�v �� , _ I w. IvA Location of Containment: Date Inspected: Asbestos Abatement Contractor: �4� sem`• ��= Asbestos Supervisor: Visual Clearance Result(circle one): ass, Fail Reason for Failure: Description of Asbestos Abatement ................................. ......... ........................ ...................... ........... .................... The above asbestos abatement regulated area has been visually inspected by the asbestos abatement supervisor and asbestos abatement project monitor. . he regulated area was dry and all surf Ices were free of visible debris. of Asbestos Supervisor/DOS# Asbestos Project Monitor I DOS# Phase Contrast Microscopy(PCM) Fiber Count NIOSH 7400 Method, Revision 3, Issue 2, 8/15/94 CLIENT: The Hampshire Hospitality Group PROJECT: Clarion Hotel and Conference Center ADDRESS: One Atwood Drive One Atwood Drive, Northampton MA Northampton, MA Logged: 3/16/16 PHONE: Date/Time Due: FAX: Scope: Sample ID Location Sample Date # # Volum Fibers/m Fibers/cc= LOD (less than) Fibers Fields a(L) m2=E C APR-031616-01 CL AB Corner of Containment,Near 3/16/2016 13.5 100 1200 17.20 0.006 0.004 Decon APR-031616-02CL CD Corner of Containment 3/16/2016 7 100 1200 8.92 0.003 0.004 APR-031616-03CL Center of Containment 3/16/2016 16 100 1200 20.38 0.007 0.004 APR-031616-04CL Back of Containment,Near 3/16/2016 12 100 1200 15.29 0.005 0.004 Negative Air Machines APR-031616-05CL BLANK 3/16/2016 0 100 0.00 APR-031616-04CL 10%RECOUNT 3/16/2016 11 100 1200 14.01 0.004 0.004 QC Checks: M Analyst Name: And olin er Analyst Signature: O'Reilly,Talbot&Okun Associates,Inc. - 293 Bridge Street,Suite 500 - Springfield,MA 01103 Phone:(413)788-6222 - Fax(413)788-8830 O'REILLY,TALBOT&OKUN ASSOCIATES 293 BRIDGE STREET SUITE 500 SPRINGFIELD,MA 01103 413-788-6222 - Asbestos Abatement Visual Clearance Inspection Project Number: 1�J " C% D Site Surveyed: h Project Name: Address A�AbJ Ve- 1,AA Location of Containment: f' V-�-b� Date Inspected: Ll Asbestos Abatement Contractor: Asbestos Supervisor: t R CL <—c-- Visual 'Visual Clearance Result(circle one): Pass Fail Reason for Failure: Description of Asbestos Abatement r S L� The above asbestos 4batement regulated area has been visually inspected by the asbestos abatement supervisor and asbestos abatement project monitor.The regulated area was dry and all surfaces were free of visible debris. t+14 00 Asbestos Supervisor/DOS # Asbestos Project Monitor/DOS# A,--, 1" -.- -t4/ Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs Department of Environmental Protection Western Regional Office•436 Dwight Street, Springfield MA 01103.413-784-1100 Charles D. Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner Robert Kirchherr OTO Associates 293 Bridge St Springfield, MA 01103 Re: Non-Traditional Work Practice Former Clarion Hotel 1 Atwood Dr Northampton, MA 01060 Approval Number: WNT16013 Dear Mr. Kirchherr: MassDEP Western Regional Office is in receipt of your application and attached work plan for the use of Non-Traditional Asbestos Abatement Work Practices ("NTWP" or "work plan") application. The work plan has been submitted on behalf of Hampshire Hospitality Group. This request is based upon a determination that work cannot be conducted in strict conformance with Regulation 310 CMR 7.15. They include one of more of the following citations; 310 CMR 7.15(7)(c), 310 CMR 7.15(7)(e), 310 CMR 7.15(7)(f)2, 310 CMR 7.15(7)(f)3, 310 CMR 7.15(7)(f)5, 310 CMR 7.15(15)(b), and 310 CMR 7.15(16). The Department's review of the application is solely on work that is proposed to be done under a Non- Traditional Abatement. If materials were submitted that included specifications on work done in accordance with the regulations under 310 CMR 7.15, The Department did not review those components as part of this plan. Your application to use NTWP's at the referenced site is APPROVED with the following conditions: 1. By performing work outlined in the plan pursuant to this NTWP, the property owners and their contractors, subcontractors and consultants acknowledge and agree that failure to strictly comply with all of the submitted work plan provisions and conditions contained in this Approval may result in revocation of this NTWP and that all parties may be subject to enforcement action by MassDEP. This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-800-439-2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper Non-Traditional Asbestos Abatement Work Plan Approval Number: WNT16013 1 Atwood Drive Northampton, MA Page 2 2. The applicant has designated certain licensed contractors to perform work at the Site pursuant to this work plan. MassDEP shall be notified if contractors change. 3. No work pursuant to this NTWP shall commence unless the asbestos project monitor("APM") is at the Site and all air monitoring stations are in full operation. 4. Perimeter air monitoring shall be performed at a statistically significant number of locations (including downwind) and if results exceed 0.010 f/cc of air then work must be halted and corrective actions taken before work can resume. 5. Should unforeseen Site conditions require changes to any of the procedures in this work plan, the applicant may request an amendment or addendum to the NTWP. Any request for changes shall be made to MassDEP in writing. 6. MassDEP may, at its sole discretion, revoke this NTWP if violations of the regulations or any noncompliance with the submitted work plan, occur. 7. MassDEP does not assume any liability in association with the performance of any activity in accordance with this NTWP. 8. MassDEP may inspect the site when work is occurring to ensure compliance with this approved plan. 9. This NTWP is valid for ninety (90) days after the date it is signed by MassDEP ("the effective date"). If activities are to continue past the 90 day expiration date then extension requests must be sent to the MassDEP in writing at least ten(10)days in advance of the expiration date. Tii�dranr��a�M�U wrdar It Ilt DeprlMe���trr.�zpCd���e1 e w�e�Ile DEt ice rntc0��e Date: May 2, 2016 John Moriarty, Environmental Analyst MassDEP Western Regional Office - Environmental S afetyHealthGeotechnical + I 293 Bridge Street O'Reilly, Talbot & Okun +__ � [ A S S O C I A T E S ] Suite 500 Springfield,MA 01103 Te 1 413 788 6222 Fax 413 788 8830 www.oto-env.com April 16, 2016 Mr. John Moriarty Commonwealth of Massachusetts Department of Environmental Protection Western Region 436 Dwight Street Springfield, MA 01103 Re: Asbestos Abatement Procedures at Former Clarion Hotel 1 Atwood Drive Northampton, Massachusetts Dear Mr. Moriarty: We are requesting to perform Non-Traditional Asbestos Abatement Practices (NTWP) at the former Clarion Hotel in Northampton, Massachusetts. As we briefly discussed, the former Clarion Hotel is scheduled for demolition. O'Reilly, Talbot & Okun Associates, Inc. (OTO) personnel have performed an asbestos assessment in accordance the Environmental Protection Agency (EPA) National Emission Standard for Hazardous Air Pollutants (NESHAP) regulation. The assessment identified asbestos containing ceiling tile, resilient flooring, and thermal system pipe fitting insulation. In addition, non-asbestos containing gypsum wallboard was identified as being attached to concrete block fire walls using asbestos containing adhesive compounds. Associated Building Wreckers has been awarded the contract for removing the asbestos and performing the demolition of the structure. Associated Building Wreckers / Baystate Asbestos have removed the ceiling tiles, floor tiles and thermal system pipe insulation in preparation for demolition. Based on the current condition and location of the asbestos containing adhesive used to secure the gypsum wallboard to the concrete block fire walls, we are requesting to demolish the fire walls and dispose of the concrete block, gypsum wallboard and asbestos adhesive compounds using bulk loading waste disposal techniques. Specifically, we are requesting to use a mechanical excavator and other heavy equipment to demolish the concrete block fire walls and dispose as asbestos containing waste material. The asbestos containing debris will be bulk loaded and disposed of as asbestos containing waste material (ACWM). We will isolate and segregate the concrete block fire walls from the wood roofing structure in order to minimize the quantity of waste materials. O'Reilly, Talbot $ Okun 4— 'm [ A S S O C I A T E S1 1 We are requesting to employ non-traditional work practices (NTWP) and engineering controls to demolish the concrete block fire walls without removing the asbestos containing adhesive during the bulk loading of the asbestos containing waste material to ensure compliance with the following MassDEP asbestos handling regulations: • 310 CMR 7.15 (7)(c) Requiring work area preparation requirements to prevent the emissions to the ambient air; • 310 CMR 7.15 (7)(e) Requirements for work area ventilation systems; • 310 CMR 7.15(7)(f)2. Requirements for stripping asbestos coated objects prior to disposal;, • 310 CMR 7.15 (7)(f)(3) Requiring that asbestos waste be sealed into leak tight containers prior to disposal; 310 CMR 7.15 (7) (f) (5) Requiring the removal of work area barriers and work area ventilation systems only after visual inspection. (only applicable to the table tops currently located outside the building); • 310 CMR 7.15 (15)(b) Requirements for sealing ACWM into leak tight containers; and, • 310 CMR 7.15 (16) Requirements for transportation of ACWM into fully enclosed vehicles. The plans are to use Associated Building Wreckers / Baystate Asbestos to perform demolition of the concrete block fire walls and bulk loading of waste materials. Associated Building Wreckers will perform the demolition and Baystate Asbestos personnel will perform the ground work and bulk loading operations. O'Reilly, Talbot & Okun Associates, Inc. (OTO) asbestos project monitors/inspectors will be onsite throughout operation to observe, perform ambient air monitoring and visual inspections. The following is a summary of our work plan and the engineering controls for the demolition and disposal of the concrete block fire walls and asbestos containing adhesive: Concrete Block Fire Walls Demolition and Disposal: 1. A regulated work area will be established using asbestos warning signs or asbestos barrier tape and physical barriers to prohibit unauthorized access into the exterior work area. Page 2 of 8 - t O'Reilly, Talbot & Okun [ A S S O C I A T E S I 2. The demolition contractor will perform operations to separate wood and other non-asbestos containing building materials. The goal is to perform the non-asbestos demolition and segregate the non-asbestos waste from the concrete block fire walls. Once the work area is segregated the contractor will demolish the concrete block fire walls with the gypsum wallboard that is attached using asbestos adhesive compounds. 3. The asbestos abatement contractor will be onsite throughout the fire wall demolition and removal. Personnel will utilize wet methods to maintain dust control and minimize fiber release and perform all manual site work. Asbestos ground personnel will ensure the concrete block walls are wet using fire hoses as the block walls are being demolished and containerized. 4. The asbestos containing waste will be placed in a poly lined waste container using mechanical equipment for disposal as ACWM. 5. The ACWM as described above shall be live loaded into trucks or roll-off dumpsters, that have been lined with a minimum of two (2) ten-mil (0.010 inch thick) pre-formed poly liners. These liners will be of sufficient size so that they can be sealed across the top of the load in an overlapping manner. After sealing the exterior liner, it will be properly labeled. 6. Water will be contained within the work areas. Excess water from the asbestos wetting operation shall be collected and filtered using a 5.0 micron filter prior to disposal into a sanitary sewer. 7. The mechanical equipment and personnel will be decontaminated at the completion of the asbestos containing soil excavation and before performing other non-asbestos related work. 8. Ambient air monitoring around the circumference of the exterior work area will be performed on a continuous basis during the excavation and bulk loading of the contaminated soil. Attention will be paid to the downwind sector, as well as all occupied structures to ensure that circumferential monitoring points coincide with these sensitive receptors. The industrial hygiene ambient air sampling will be performed according to the NIOSH 7400 methodology. Analyses of the air samples will be performed promptly so that corrections in the work practices can be made immediately. If the air monitoring results exceed the airborne fiber levels of one - one hundredth fiber per cubic centimeter (0.010 f/cc) of air, then all work shall stop. The work methods shall be evaluated prior to continuing any further work and MassDEP shall be notified by telephone by close of business (5:00 p.m.) on that same day. If airborne fiber level exceed fifteen thousandths (0.015f/cc) fibers per cubic centimeter of air then all work shall stop and MassDEP shall be notified within two (2) hours Page 3 of 8 O'Reilly, Talbot & Okun � "'—► [ A S S O C I A T E S for consultation on altering the work practices. All air monitoring will be performed by consultants who are properly trained and licensed in the Commonwealth of Massachusetts ("Commonwealth") as Asbestos Project Monitors. 9. All documentation regarding air monitoring results, visual inspections and waste disposal will be kept on Site for inspection by MassDEP personnel during the excavation operation. Copies of the documentation are to be supplied to the MassDEP by the owner, contractors and consultants upon request or within thirty (30) days of completion of the work if not requested earlier. All such submittals shall be accompanied by a completed certification form that is attached to the approval letter for this Non- Traditional Work Plan (NTWP). 10. OTO will distribute copies of this NTWP to each entity involved with the project and shall review the NTWP with a representative of each such entity. A copy of the sign in log containing the name of each such attendee and the firm they represent shall be provided to MassDEP prior to the start of any activity pursuant to this NTWP. A copy of this NTWP shall be kept at the Site for the duration of the project. We appreciate your assistance on this project. If you have any questions or need further information, please contact me at your convenience. Sincerely, O'Reilly, Talbot Okun Associates, Inc. Robert F. Kirchherr, CSP Principal Massachusetts Asbestos Designer AD71137 Page 4 of 8 Commonwealth of Massachusetts Asbestos Notification Form ANF-001 100242090 L r—Asbestos Project# Project Revision r— Project Cancellation A. Asbestos Abatement Description 1. Facility Location: FORMER CLARION HOTEL 1 ATWOOD DRIVE Name of Facility Street Address Instructions 1.All NORTHAMPTON MA 01060 4132374471 sections of this form City/Town State Zip Code Telephone must be completed in CURT SHUMWAY MANAGER order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: THROUGH-OUT CMR 7.15 and Department of Labor Building Name,Wing,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied? r Yes r 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)? F Yes F No MassDEP Use Only 4. Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval,WNT16013 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of 6.Asbestos Contractor: Massachusetts ASSOCIATED CONTRACTORS WRECKERS INC 352 ALBANY STREET P.O.Box 4062 Boston,MA 02211 Name Address SPRINGFIELD MA 01105 4137323179 City/Town State Zip Code Telephone A0000898 Contract Type: r Written r Verbal DLS License# 7. JAMES BEAUDRY AS074322 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# 8, DAVID GERARD ABAD AM071610 Name of Project Monitor DLS Certification# 9, O'REILLY TALBOT&OKUN ASSOCIATES INC AA000089 Name of Asbestos Analytical Lab DLS Certification# 10, 5/16/2016 5/27/2016 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 7:00 A.M.-4:00 P.M. N/A Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11. What type of project is this? F Demolition r— Renovation r Repair r Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 '71 7 Commonwealth of Massachusetts 100242090 Asbestos Notification Form ANF-001 '�,�.. Asbestos Project# r Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): r Glove Bag r Encapsulation r Enclosure r Disposal Only r Cleanup r Full Containment F Other-Please Specify: BULK LOADING INTO POLY LINED TRAILERS 13.Job is being conducted: r Indoors r Outdoors 14.Total amount of each type of asbestos Containing materials (ACM)to be removed,enclosed,or encapsulated: 0 0 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Pipe Insulation Transite Shingles Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths, Woven Fabrics Other-Please Specify: Lin.Ft. Sq.Ft. Insulating Cement 800 C.Y DEMO DEBRIS Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. 15.Describe the decontamination system(s)to be used: REMOTE DECONTAMINATION UNIT 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): TO BE WETTED,AND BULK LOADED INTO POLY LINED DUMP TRAILERS,AND PROPERLY TRANSPORTED FOR DISPOSAL. 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official 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 r Yes r No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachusetts 100242090 Asbestos Notification Form ANF-001 Asbestos Project# r Project Revision � (- Project Cancellation B. Facility Description 1.Current or prior use of facility: FORMER HOTEL 2. Is the facility owner-occupied residential with 4 units or less? r— Yes F No 3.ATWOOD DRIVE LLC 220 NORTH PLEASANT STREET Facility Owner Name Address AMHERST MA 01002 4132374471 City/Town State Zip Code Telephone 4,CURT SHUMWAY 220 NORTH PLEASANT STREET Name of Facility Owner's On-Site Manager Address AMHERST MA 01002 4132374471 City/Town State Zip Code Telephone 5.ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET Name of General Contractor Address SPRINGFIELD MA 01105 4137323179 Note:Temporary storage of Asbestos City/Town State Zip Code Telephone containing waste GREAT DIVIDE INSURANCE COMPANY material is only allowed at the place Contractor's Worker's Compensation Insurer of business of a DLS WCA154516515 2/1/2017 licensed Asbestos Policy# Expiration Date(MM/DD/YYYY) contractor or a transfer station that is 6. What is the size of this facility? 50000 2 permitted by y' MassDEP and operated in Square Feet #of Floors compliance with Solid ! Asbestos Transportation & Disposal Waste Regulations l.• P p 310 CMR 19.000 1. Transporter of asbestos-containing waste material from site of generation: F Directly to Landfill or r— To Temporary Storage Location/Transfer Station GOULETTRUCKING,INC. 20 INDUSTRIAL DRIVE WEST Name of Transporter Address SOUTH DEERFIELD MA 01373 4136651323 City/Town State Zip Code Telephone 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: Name of Transporter Address City/Town State Zip Code Telephone Note:Contractor must sign this form for DLS Revised: 11/13/2013 Page 3 of 4 `71 Commonwealth of Massachusetts 100242090 Asbestos Notification Form ANF-001 Asbestos Project# r Project Revision I— Project Cancellation C.Asbestos Transportation& Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: Temporary Storage Location Name Address City/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): CASELLA RESOURCE SOLUTIONS CASELLA RESOURCE SOLUTIONS Final Disposal Site Name Final Disposal Site Owner Name 1618 SEARS ROAD Address ELMIRA NY 14903 6072154451 City/Town State Zip Code Telephone D. Certification "I certify that I have personally examined the foregoing and am ANDREWMIRKIN ANDREWMIRKIN familiar with the information Name Authorized Signature contained in this document and PRESIDENT 5/2/2016 all attachments and that, based on my inquiry of those Position/Title Date(MM/DD/YYYY) individuals immediately 4137323179 ASSOCIATED BUILDING WRECKERS responsible for obtaining the Telephone Representing information, I believe that the 352 ALBANY STREET SPRINGFIELD information is true, accurate,and Address City/Town complete. I am aware that there MA 01105 are significant penalties for submitting false information, State Zip Code including possible fines and imprisonment. The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (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 unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact i Privacy Policy MassDEP's Online Filing System Usemame:DEM0000RD Nickname:DEM01 My eDEP Forms KA My Profile ZA Help Notifications Receipt J Forms Signature Payment Receipt Summary/Receipt tl 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: 828577 Date and Time Submitted: 5/2/2016 12:48:27 PM Other Email : DEP Transaction ID: 828577 Date and Time Submitted: 5/2/2016 12:48:27 PM Other Email : Form Name: AQ04-Asbestos Removal Notification Form ANF-001 Form Name: AQ 04 -Asbestos Removal Notification Form ANF-001 Payment Information DEP code: 123397 Date: 5/2/2016 12:48:14 PM Amount($): 100 Billing Info: COORDINATOR DEMO --AccountType --AccountNumber ***"2979 Confirmation Number: My eDEP MassDEP Home Contact I Privacy Policy MassDEP's Online Filing System ver.12.22.3.00 2016 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 05/02/2016 Massachusetts Department of Environmental Protection y eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: DEMocooRD Transaction ID: 828577 Document: AQ04-Asbestos Removal Notification Form ANF-001 Size of File: 111.86K Status of Transaction: In Process Date and Time Created: 5/2/2016:12:50:24 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. ,l Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality ` BWP ANF-001 Pre-Form Notification Prior to Construction or Demolition • This is a revision to an existing form. Project ID for existing form to be revised: • This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: • This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: WNT16013 • This job does not require the use of an asbestos contractor licensed by the MA Department of Labor Standards because(please check one box below): f•This job involves breaking,shearing or slicing of non-friable asbestos-containing material only(e.g.cement shingles/panels,cement pipe,asphalt roofing or siding,vinyl floor tiles,etc.)in a manner that does not generate asbestos dust or render the material friable,as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.13(2)(a)5.All work must be done in compliance with the applicable regulations at 310 CMR 7.15;or r This job involves work on asbestos containing material that is classified by the Department of Labor Standards (DLS)as a`Small-Scale Asbestos Project,' an `Asbestos-Associated Project', or an `Asbestos Response Action' by qualified`in-house' personnel as allowed by the Department of Labor Standards(DLS)at 453 CMR 6.00,and will be performed in accordance with all the requirements of 453 CMR 6.13(1)(a),453 CMR 6.13(2)(a)1. and 3., and 453 CMR 6.14(])(a),as applicable.All work.must be done in compliance with the applicable regulations at 310 CMR 7.15. f•None of the above conditions apply,generate a new form Revised: 11/13/2013 Page 1 of 1 Massachusetts Department of Environmental Protection tBureau of Waste Prevention • Air Quality BWP AQ 06- Revision Notification 10023779281 Ll Notification Prior to Construction or Demolition Asbestos Project Number# A. Applicability A Construction or Demolition operation of an industrial, commercial, or institutional building, or residential building with 20 or more units is regulated by the Department of Environmental Protection (MassDEP), Bureau of Waste Prevention,Air Quality Division, under Regulations 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. Is this a fee exempt notification(city, town,district,municipal housing authority,state facility,owneroccupied residential property of four units or less)? Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? F Yes F No Type of Notification: F Revision of an Existing Form r Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.All sections of th is 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: form must be completed in order to Approval ID# comply with the Department of B. General Project Description Environmental 1. Facility Information: Protection notification FORMER HOTEL 1 ATWOOD DRIVE requirements of 310 CMR 7.09. Name of facility Street Address NORTHAMPTON MA 106000000 4132374471 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of CURT SHUMWAY MANAGER Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 4132374471 DEMO BUILDINGWRECKERS.COM Boston,MA 02211 �° Facility Contact Person Telephone Facility Contact Person Email C.Project Dates and Other Revisions 3/7/2016 6/30/2016 Project Start Date(MM/DD/YYYY) Project End Date(MM/DD/YYYY) Other Project Revisions DEMOLITION WILL BE PERFORMED UNDER NTAAWP APPROVAL NUMBER WNT16013 � Revised:03/17/2014 Page I of 2 Massachusetts Department of Environmental Protection `7 Bureau of Waste Prevention • Air Quality �' BWP AQ 06- Revision Notification 1100237792R1 Notification Prior to Construction or Demolition Asbestos Project Number# General A Certification Statement:If asbestos is found "I certify that I have personally ANDREWMIRKIN during a Construction examined the foregoing and am Print Name or Demolition operation,all familiar with the information ANDREWMIRKIN responsible parties contained in this document and Authorized Signature must comply with 310 all attachments and that, based PRESIDENT CMR 7.00,7.09,7.15, on my inquiry of those and Chapter 21Eof individuals immediately Position[Title the General Laws of responsible for obtaining the D BUILDING WRECKERS the Commonwealth. information, I believe that the Representing This would include, information is true,accurate,and 5/2/2016 but would not bw complete. I am aware that there Date(MM/DD/YYYY) limited to,filing an are significant penalties for N/A asbestos removal submitting false information, notification with the including possible fines and P.E.# Department and/or a imprisonment.The undersigned notice of hereby states, under the release/threat of release of a penalties of perjury,that I am hazardous aware that this permit substance to the application or notification shall Department,if not be deemed valid unless applicable. payment of the applicable fee is made." MassDEP Use Only Date Received Revised:03/17/2014 Page 2 oft eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System Usemame:DEM000ORD Nickname:DEM01 My eDEP Forms rteMy Profile 9A Help Notifications Receipt J Forms Signature Payment Receipt Summary/Receipt IL 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: 828589 Date and Time Submitted: 5/2/2016 12:57:23 PM Other Email : DEP Transaction ID: 828589 Date and Time Submitted: 5/2/2016 12:57:23 PM Other Email : Form Name: AQ 06 -Construction/Demolition Notification Form Name: AQ 06 -Construction/Demolition Notification Payment Information DEP code: 123400 Date: 5/2/2016 12:57:17 PM Amount ($): 35 Payment Detail: COORDINATOR DEMO--AccountType--AccountNumber ****2979 Confirmation Number: My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.12.22.3.00 2016 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 05/02/2016 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: DEMocooRD Transaction ID: 828589 Document: AQ 06-Construction/Demolition Notification Size of File: 91.30K Status of Transaction: in Process Date and Time Created: 5/2/2016:12:59:41 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality - BWP AQ 06 Notification Prior to Construction or Demolition LI n * This is a revision to an existing form. Project ID for existing form to be revised: 1100237792 f This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: *This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 Massachusetts Department of Environmental Protection La Bureau of Waste Prevention • Air Quality BWP AQ 06 100237792 Notification Prior to Construction or Demolition Asbestos Project Number# A. Applicability A Construction or Demolition operation of an industrial, commercial, or institutional building, or residential building with 20 or more units is regulated by the Department of Environmental Protection(MassDEP), Bureau of Waste Prevention,Air Quality Division, under Regulations 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. Is this a fee exempt notification(city, town, district, municipal housing authority,state facility,owneroccupied residential property of four units or less)? Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? F Yes F No Type of Notification: r" Revision of an Existing Form Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.All sections of th is 2.Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: form must be completed in order to Approval ID# comply with the Department of B. General Project Description Environmental 1. Facility Information: Protection notification FORMER HOTEL 1 ATWOOD DRIVE requirements of 310 CMR 7.09. Name of facility Street Address NORTHAMPTON MA 010600000 4132374471 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of CURT SHUMWAY MANAGER Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 4132374471 DEMO@BUILDINGWRECKERS.COM Boston,MA 02211 Facility Contact Person Telephone Facility Contact Person Email Facility Size: 50000 2 Square Feet Number of Floors Was the facility built prior to 1980? F Yes F No Describe the current or prior use of the facility: FORMER HOTEL Is the facility a residential facility? r Yes FNo If yes,how many units? 2.Facility Owner: ATWOOD DRIVE LLC 220 NORTH PLEASANT STREET Facility Owner Name Address AMHERST MA 010020000 4132374471 City/Town State Zip Code Telephone CURT SHUMWAY 220 NORTH PLEASANT STREET On-Site Manager/Owner Representative Address Amherst MA 01002 4132374471 City/Town State Zip Code Telephone Revised:03/17/2014 Page 1 of 3 Massachusetts Department of Environmental Protection L."7 , � Bureau of Waste Prevention • Air Quality BWP AQ 06 100237792 ` Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3. General Contractor: ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET Name Address SPRINGFIELD MA 011050000 4137323179 City/Town State Zip Code Telephone ANDREW MIRKIN 4137323179 General Contractor's On-site Manager/Foreman Telephone General C. General Construction or Demolition Description Statement:If asbestos is found 1.Construction or demolition contractor: during a Construction or Demolition ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET operation,all Contractor Name Address responsible parties must comply with 310 SPRINGFIELD MA 011050000 4137323179 CMR 7.00,7.0 9,7.15, City/Town State Zip Code Telephone and Chapter 21E of the General Laws of ANDREW MIRKIN 4137323179 the Commonwealth. Construction and Demolition On-site Manager Telephone This would include, but would not low 2. Licensed Contractor Supervisor: limited to,fling an asbestos removal ANDREWMIRKIN CS-062382 notification with the Department and/or a Supervisor Name License Number notice of release/threat of 3. Is the entire facility to be demolished? F Yes FNo release of a hazardous 4.Describe the area(s)to be demolished: substance to the Department,if ENTIRE STRUCTURE applicable. MassDEP Use Only 5. If this a construction project,describe the buiIding(s)or addition(s)to be constructed: Date Received N/A .l 6.If this is a demolition or renovation project,were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? F Yes F No 7. Was asbestos containing material(ACM)found? Yes r No If a survey was conducted,who conducted the survey? O'REILLY,TALBOT&OKUN UNKNOWN Name Department of Labor Standards Certification Number Revised:03/17/2014 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality B WP AQ 06 100237792 Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this 100237785 address is: This project Construction r7o Demolition is: 3/7/2016 6/30/2016 Project Start Date(MM/DD/YYYY) Project End Date(MM/DD/YYYY) 8. For demolition and construction projects, indicate dust suppression techniques to be used r Seeding r Wetting r Covering r Paving r' Shrouding r Other-Specify: 9. For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? Name of MassDEP Official Title Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally ANDREWMIRKIN examined the foregoing and am Print Name familiar with the information ANDREWMIRKIN contained in this document and Authorized Signature all attachments and that, based PRESIDENT on my inquiry of those individuals immediately Positionrritle responsible for obtaining the ASSOCIATED BUILDING WRECKERS information, I believe that the Representing information is true,accurate,and 2/23/2016 complete. I am aware that there Date(MM/DDNYYY) are significant penalties for N/A submitting false information, including possible fines and P.E.# imprisonment.The undersigned hereby states, under the penalties of perjury,that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised:03/17/2014 Page 3 of eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home i Contact I Privacy Policy MassDEP's Online Filing System Usemame:DEMOCDDRD Nickname:DEM01 My eDEP Forms LA My Profile iza Help Notifications LReceipt Forms Signature Payment Receipt Summary/Receipt print re FExit 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: 812179 Date and Time Submitted: 2/23/2016 10:34:48 AM Other Email : DEP Transaction ID: 812179 Date and Time Submitted: 2/23/2016 10:34:48 AM Other Email : Form Name: AQ 06 -Construction/Demolition Notification Form Name: AQ 06 -Construction/Demolition Notification Payment Information DEP code: 120311 Date: 2/23/2016 10:34:05 AM Amount($): 100 Payment Detail: COORDINATOR DEMO--AccountType--AccountNumber ****2979 ConfirmationNumber: My eDEP MassDEP Home Contact i Privacy Policy MassDEP's Online Filing System ver.12.20.7.00 2015 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 02/23/2016 Massachusetts Department of Environmental Protection u eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: DEMOCOORD Transaction ID: 812179 Document: AQ 06 -Construction/Demolition Notification Size of File: 100.79K Status of Transaction: in Process Date and Time Created: 2/23/2016:10:36:17 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. LIMassachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality BWP AQ 06 Notification Prior to Construction or Demolition • This is a revision to an existing form. Project ID for existing form to be revised: f•This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: f•This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: • None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 DIG SAFE SYSTEM, INC. - Renew Existing Ticket Page 1 of 2 Request Number: 20161603637 Date 04/19/2016 Time 08:57 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address/Intersection: 1 ATWOOD DR Nearest Cross Street 1: PARSONS SWAMP RD Nearest Cross Street 2: Additional Information: Nature Of Work: DEMOLITION OF HOTEL Area Of Work: STREET TO HOTEL Area Is Premarked: Y Stan.Date: 04/25/2016 Start Time: 09:00 Caller: MICHAEL Title: Return Call: Phone#: 413-732-3179 Fax#: Alt.Phone#: Email Address: Contractor: ASSOCIATED BUILDING WRECKERS,INC. Address: 352 ALBANY STREET City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviation11 Name RJ VERIZN VERIZON SP VERIZN VERIZON WG CMAGAS COLUMBIA GAS OF MASSACHUSETTS • There may be non-member utilities in the area that you need to notify. • Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. • The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. http://digsafeform.digsafe.com/cgi-bin/dwcgi.exe 04/19/2016