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31B-064 (2)
52 ROUND HILL RD BP-2017-0402 GIS if: COMMONWEALTH OF MASSACHUSETTS Map:Block:31B-064 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 Permitil BP-2017-0402 Project a JS-2017-000663 Est.Cost:$169000.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TRUCK CRANE SERV INC 074442 Lot Size(sq.ft.): 116740.80 Owner: CLARKE SCHOOL FOR THE DEAF BELL HALL Zoning:URC(IOo)/ Applicant: TRUCK CRANE SERV INC AT: 52 ROUND HILL RD Applicant Address: Phone: Insurance: 20 FAIRFIELD AVE (413) 562-9465 WC WESTFIELDMA01085 ISSUED ON:9/23/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMO GYMNASIUM 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 N 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 Occu anc si nat_ FeeType: Date Paid: Amount: Building 9/23/2016 0:00:00 $300.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit Fig Building Department Curb Cut/Driveway Permit - i$ 212 Main Street Sewer/Septic Availability c"J 0 Room 100 WaterIWell Availability N Northampton, MA 01060 Two Sets of Structural Plans 16-E phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans 1 11 2 Other Specify APPLIC• ION TO CONSTRUCT, REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office 52 Round Hill Rd Map Lot Unit Northampton, MA 01060 Galbriath Hall Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record,: Historic RH Summit 46 Round Hill Rd Name(Print) Current Mailing Address. Signature Telephone 2.2 Authorized Agent: Truck Crane Service / 20 Fairfield Ave Name Current Mailing Address: iTO Signature -1iAtA[ a. , Telephone er SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant �"! \ � 1. Building $169,000.00 (a)Building Permit Fee $300.00 2. Electrical (b) Estimated Total Cost of Construction from(6) 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection /I 6. Total=(1 +2+3+4+5) Check Number'1C 44 46302 This Section For Official Use Only Building Permit Number Date Issued (Signature: Building Commissioner/Inspector of Buildings Date Version!.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations 0 Existing Wall Signs 0 Demolition Repairs 0 Additions 0 Accessory Building Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing Change of Use Other 0 Brief Description Enter a brief description here. Of Proposed Work:() &'/m t&t la Al uAl SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 ❑ IA 0 A-4 O A-5 0 18 0 B Business 0 2A p E Educational 0 28 ❑ F Factory ❑ F-1 0 F-2 0 2C 0 H High Hazard ❑ 3A ❑ I Institutional 0 1-1 ❑ 1-2 ❑ 1-3 0 3B 0 M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 0 R-3 ❑ 5A 0 S Storage 0 S-i 0 S-2 ❑ 58 0 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1:, 2do 2nd 3d 3,d 4,h 4m Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal 0 On site disposal system Versionl.7 Commercial Building Permit May 15,2000 kNORTH,NMPTON ZONING KW Existing Proposed i Requred by Zoning This column to arbetilled in by Building Department 01117a „ =In Setbacks Front Side L: R: Rear Building Height aMil= Val Bldg. Square FootageEn MIIII Open Space Footage _alIn (Lot arca minus bldg&paved larkine) #of Parking Stages MIliMMVA� _--_- Fill: \ / (volume&Location) A. Has a Special Permit/Variance/Finding eve .--n issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the '-gistry of De:ds? NO O DONT KNOW • ES O IF YES: enter Book / Page \ and/or Document it B. Does the site contain a brook, b.dy of water or wetlands? NO DONT KNOW O YES O IF YES, has a permit been .r need to be obtained from the Cons ation Commission? Needs to be obtained O Obtained O , D e Issued: C. Do any signs exist o the property? YES O NO O IF YES, describe size, type and location: \\ D. Are there an proposed changes to or additions of signs intended for the property R YES O NO O IF YES, :escribe size, type and location: \\ E. MI e construction activity disturb(clearing,grading,excavation, or filling)over 1 acre or is it part of a ommon plan th. will disturb over 1 acre? YES © NO O IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May I5,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable 0 Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Rob Levesque Demolition Name Area of Responsibility RLA Associates Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Paul Liptak Not Applicable 0 Company Name: Truck Crane Service Responsible In Charge of Construction it sem Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Jim Hebert. as Owner of the subject property hereby authorize Paul Liptak, Truck Crane Service to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date Paul Liptak as%ref/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. ••A. under the pains and penalties of perjury. j Print Name ., I Wit/ 'r — /-2 –. Signature of Owner/Ag-nt Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable p Name of License Holder Paul Liptak License Number Truck Crane Service Address Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C.152,§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes O No 0 99/23/2016 09:49 4135696708 ROGER BUTLERINS PAGE 02/02 cr la ittE9N n CERTIFICATE OF LIABILITY INSURANCE OATCIMMAIMVV VI 9/23/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cal-Meats holder Man ADDITIONAL INSURED,the pollcy(Ms)must be endorisd. If SUBROGATION IS WAIVED,subject to the terms and contiiform of the policy,certain polkles may require an endorsement, A statement on this certificate does not confer tights to the certificate holder In Ileuu of such endorsamerd(s). �p� PRaWCeR N4MB CT Producer ROUSE _._ Hagar sutler TnsvzeawELAN: (4197562-2304 jffijc..,l.(Pl3)S6S-stns 5 Court Street / P 0 Baa 016 moara1 6_ _. IN3NR£Rt97PEFOedNO COVERAGE _. I HNC II __ testi bald MA 01086 ,NsuntsAR9SPEC - Scottsdale Ins Co � ai39] WINKED INSURERS LFLr'bella protection 6.1360__ Truck Crane Service Inc INsuRERCAIN - A I M MUTON. i _ 20 Fairfield Ave ASIBER0: INNER E; FRNttield MA 01085 MSURFq F' COVERAGES CERTIFICATE NUMBER:CL1692300891 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NCTWTHSTANDINQ ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT N1TH RESPECT TO V.MICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS_ yNy �yql TYPE OF INSURANCE LI u y .,R LIMITS A I OOMH£AMILL GENERAL LY 4tOY EACH OCCUPPENCE 8 1,060,000 __. A I CLM4SMADE X l OCCUR p� �1 E 100,000 __ _ 1CPea361001 1/T/2016 1/7/MI AND CEP pe S 5,Op0 �._�_ .._ _ 1 Y__ ` I ! : I PER$ONAt a AwmtwRY I9 1,000,000 GPMA00REWTE LIMIT APPLES PER: • .GENERAL ASCRESATE IS 2,000,000 P 2,000,000 I A{POLICY INC [PROWGTs COMPIOP AW I E X FRAPPE/NaNIETAMFe IPPR S ANY AUTO A r lllxo01,3095 2110/2038 3/30f201T SOUSTI RY1iLELRAR I..E 1,000.0110 B OTHER BopRY iNJURY1PMpenull S AViOXOSRE L41BRIlY • (INN 11 SCHEDULED BODLY INJURY 1Y NerustI[S EI��AUTOS NOTLOI NEG PROPTRTflAMIAGE • 16II _....— V HBIED AUTOS ALTS putecc'm'REI__. . I t I ORNRIDNARINEENBIsou 4 20,000 • UMBRELLA LMBj00CUR EACH OCCVTYRFNCG 3 EXCESS LIAR L. OLAMSMADE EACH `.;ZED ,RRfiNTRON3 p S WORKERS CdaPENsATNIN X I;UNITE I ERH ANOEMPL0YERt 4bNNY YIN' I NYCRORPICTOMPARmEWORECVTVFEL EACH ACCIDENT . . $00,000 C CC�P6p eICAEE PM ErCLU0 O" I N NIA[ FEL-400-,025134-203SA 11/18/201S I13/i6/201ST FL m6EESE EA EMPLOYCS 1 500 000 tlyvYd'°Yrt1M E.L.DEBASE�POLI(IV LIMIT l9 9Q0_ 000 pESORIPTON 0E OPERATIONS Nam I I1ii i I PEBCRM1 Ok Of OSRRATtONat LOCATORS I V@M0.ke 4ACDRD IM,AWR'gvl Ramos St.mq AA Mesas as wawa vat 4R¢Xen Confirmation of demolition liability, general liability. automobile liability and workers compensation coverage CERTIFICATE HOLDER CANCELLATION (413)587-1272 SHOULD ANY OP THE ABOVE DESCRIBED POLICIES EN CANCELLED BEFORE City OE NorthamptonTHE EXPIRATION DATE THEREOF, NOTICE WILL SE DELNERNI IN Attention: Lewis HasbrouckACCORDANCE WITH THE POIIDY PROVISIONS, 85 Bampton Avenue Northampton, MA 01060 AUTIDRBEP at,RE ENTAnYE - M Benjamtar CTSR, CC t t2AA 14. e• ;a'_ —'-- ®1988.2014ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD INS02612114011 09/23/2016 09:49 4135686708 ROGER BUTLERINS PAGE 01/02 y suruT Roger Butler Insurance Agency Inc. FAX COVER SHEET To: � r ),,,,,,,,,,,,.., J 3 .. .44'r:' '� 4 y rr /11 v I C — that ? gas [including cover sheet), -' i siiTxTl $ - Y 1 4a: A" - ..4 � .-x-,. . � G � . .44 Il as r t .ai w $ t w "t a J.e ane S1" =. � ' A v-Sfn r 4.4.;4", 9t' "fr'X b F 3h � I3.vfi ir),... e ins'i-icc._u� r�./�/eVn� f ?` ---/ZZ,L,Carrezt r Visit us on the web at www.rogerbutterinsurance.com 00 S Court Street • PO.Box 816 • Westfield, MA 01086 PAonc (413) 516;P-2031;4)1o: 622304 • Fax (413) 568-6708 that - zoo' Toll Ree In Wcatcrn Mace. 1-$00.660-9485 ma tax aro any attachments hereto are finendod only for the toss of the eadm.eoofa)named herein and maybe 4onldenaai,r ,-pubac.prnPrIetat, protected by the enemy/orient m other pnvilegg.Unaude&ad reeding,metnpulll�9,copying.raving or ether use of this communication IS proIbilod and may be unlawful.omen(by anyone other Than the named addressees)shall not be deemed a waiver of any privilege Or protection.If you ale nth a named addressee or it you believe that you have received Itis fax In error.please nobly the sender immedialoy and destroy all copies. nationalgrid 40 Sylvan Rd Waltham MA 02451 September 20, 2016 RE: Service Removal for Building Demolition Work Request number 22719046 Good Day, This letter is to confirm that,per your request,National Grid has removed the meters 41019182 53883793 05068660 05144508 43078683 44485950 60461660 42160165 44485582 59985373 10236861 57828154 42676362 25065506 60223646 and electrical service at 47 ROUND HILL RD NORTHAMPTON MA 01060.If you have any questions or need further assistance,please feel free to contact me at(508)357-4628. Sincerely, Shannon Ran Order Processing Rep Customer Order Fulfillment nationalgrid 40 Sylvan Road Waltham,MA 02451 Office (508-357-4514 Email Shannon.Kain@nalionalgrid.com 9232016 City of Northampton Mal-Re:52 Round Hill Rd Gabath Gym demo aJ fif Louis Hasbrouck <Ihasbrouck@northamptonma.gov> Northampton Re: 52 Round Hill Rd Galbraith Gym demo 1 message Louis Hasbrouck<Ihasbrouck@northamptonma.gov> Tue, Sep 20, 2016 at 10:29 AM To: Andrew Dunn <adunn@northamptonma.gov> Thanks. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax On Tue, Sep 20, 2016 at 10:26 AM, Andrew Dunn <adunn@northamptonma.gov> wrote: Okay great, we will turn off the water service and remove the meter today. The contractor will have to physically cut the service so it is not connected to the system. On Tuesday, September 20, 2016, Max Hebert <mhebert@historicroundhillsummit.com> wrote: Andrew, The gymnasium building is definitely ready to have the water disconnected, as soon as possible. The demolition contractor planned on using the hydrant located at the back of the building, if possible. Thank you, Max (413) 896-3019 From: Andrew Dunn <adunn@northamptonma.gov> Date: Monday, September 19, 2016 at 5:44 PM To: Louis Hasbrouck<Ihasbrouck@northamptonma.gov> Cc: Max Hebert <mhebert@historicroundhillsummit.com>, "Jim Hebert (jhebert@checkwriters.net)" <jhebert@checkwriters.net>, Michael Siddall <msiddall@siddalllaw.corn> Subject: Re: 52 Round Hill Rd Galbraith Gym demo Great, thank you On Monday, September 19, 2016, Louis Hasbrouck<Ihasbrouck@northamptonma.gov>wrote: Andrew, The building is empty and the asbestos abatement is done. I'm almost certain they're ready. I've copied Max Hebert; hell let you know for sure. Louis Hasbrouck Building Commissioner httpsl/mel.google.can/mal/caWOnui=28ik=ec5f19a57e&view=pArjhebert%40checkwriters.net&ye=true&search=query&th=157480052ee328818sim1=1574... 1/3 9'23'2018 City of Northampton Mal-Re:52 Round Hill Rd Galbraith Gym demo City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax On Mon, Sep 19, 2016 at 1:52 PM, Andrew Dunn <adunn@northamptonma.gov> wrote: Hi Louis, Do you know if the building is ready to have the water disconnected? On Fri, Sep 16, 2016 at 1:29 PM, Louis Hasbrouck <lhasbrouck@northamptonma.gov> wrote: Dave, Andrew, Brendan The demo permit for the gymnasium building at Clarke School will be here soon. If you don't already have them, here's the existing and demo site plans from the April 2016 special permit application along with the PB permit and your comments. I'll make sure I have water and sewer letters before I issue the permit. Louis Hasbrouck Building Commissioner City of Northampton Town of Williamsburg (413) 587-1240 office (413) 587-1272 fax Andrew Dunn, Water Superintendent Water Division, Public Works 237 Prospect St. Northampton MA adunn@northamptonma.gov 413-587-1098 Andrew Dunn, Water Superintendent Water Division, Public Works 237 Prospect St. Northampton MA adunn@northamptonma.gov 413-587-1098 Andrew Dunn, Water Superintendent Water Division, Public Works htgsl/mal.gaotje.can/mal/WWk'tu=28ik=ec5f19a57e8view=ptteq=jhebert%40checkwriters.rat8qs=true85aarch=q ary&th=1574B005PeA3288186im1=1574... 2/3 9/23/2016 City of Northampton Mail-Re:52 Round Hill Rb GS broth Gym demo 237 Prospect St. Northampton MA adunn@northamptonma.gov 413-587-1098 httpsl/malgoo0le.cam/mailkatu/OY?ui=28ik=ec5f19a57e8view=pt8¢Ihebert%40checkwriters.ne[Sgs=true&search=query81 1574A11V0ee3288185im1=1574... 33 Li. Massachasetts Dcpaitruer+t of Environmental Protection touznvnz SWP AQ Q6 Noti#icazron Prior to Consfna lion or Demolition, :RsbesTOe Project a Project Roy won Pm)eot cancollabOn A. Applicability A Constriction or Oemolitlon opetMUot oI an Induyb al commercial,or mstitolanal building,or roSldenbel to oloiny with 20 or Moro dolls is regulated by Ria Department OI Envlronmennl Protection(Ma$9OEP),Moreau of trusts rt vellllon,Air evalgy Olvaion under Retplaions 310 CMR t 09. Nntit va km Of COm ruction or Dertmltor eparatkrns+s roanrtee under 310 CMR 7 Ott(i ten (W;worteing days Pew to any Mott bong performed Tee folovnn<;intrnnafior.,s requtad pursuant to 310 CMR 7 vs. 131bIS a tee exflnpt dollr,cation(c:!1'.Iowp,dl,bKL mon rc pal ho.I idE sot hone.Stets(9t Ill ry optic, oo:upird residential propery of four units orlo%II' Ym I do I)n;pm Permit PrOject.Apphmal. if appl icablt. A PP+ovS ID s 2.Noxi Traditional Arhe.stos Ablarneiil 'IYorh Rap for ,Approt al.1 applicable I»attncttooe. App,orat It e — 1,All.ech nt of this H. General Project Description tour must up completed m wrier'c I Patthq'Information. comply with Ne O%,9RWKH GYMNASIUM S2RCt)ht'HILL RNAC WrMof ,.r___—...___... __.____--- -._. Environments/ RI;Ere laility Stmet?SCteae Protection NoRTHAMPTON etA 01060(rpO 41353IN705 reCWements 0111r; CkyRuwn State^ L6P Cody ' resale CMR r.AI r A.T.t ate PRES.TC 5..NJC. AGENTFCMt Z Sct'rul1)nylr* f"aC.9Ry CAI nlecI PeRen � - �_ attoeN Coated Psion 1lifr.— .. . rain To 41;is:m C5 TRu:atetA SSERO E(araltOC STNET GOMMOXMeatth 0.2 yIP CiPnd Pe w TIW0Iw tie ~� FMyly 1.M'h Mafan:nuwGe Fv Sect Pesch Emit P0-Box a01i2 bonen,Me 02211 i•acdih'Size WOO 1 — Saou�n?e.: . -- NtmuerNFluon—_..__..__ _.— ,,. Wet the IncAry Will prior to 14HGn I Ya No C•:scribe the mutes',or pew:use of the lomat.: C rMNK5alm rs tots Nary a residnmiAP lar.IluyP yrs ✓ NoW n yes M.v many un:n' - __.._....._-_.. 2 its itv aorta, +924ete 933 EMSTItEEr ..., —•. FacAty Choler Name _... .__.�-_.__._... Address .. -- VEST SPReirRELU MA Cl 0e90CG0 4!39011992 Oierfown Slats £q^Ma Telephoto. cAULT.LIPTAYPRES.Tr:$retC 20F.AIRFIE ILDAVE on n-SI9e Menagaf'Ownet ReneswRatirc AddreS4 LL T meaKeltl MA 01085 41353!0905 Caterte n ,_ — State ZN Code rn iNehxw --._— . 88:29/2E12E _5:9'2 9684519 TRUCKCRANEEERVICE1NC. PAGE 03 ILL .111 1a5sachusetts Department of Environmental Protection BWP AQ 06 100249912 Asbestos Project # Notification Prior to Construction or Demolition Pmicd Revision Project Cancellation B. General Project Description (continued) 3 General Contractor TRUCK CRANE SERwt€,INC, 70 FAIRFIELD AVE Name _— Adores ✓vEs7FIELLD MA 01086000C 4135315705 Cis/Mown - Sute 2h Code T ePptione PAUL T LIPTAK PRES.TCS INC. 4135316705 General Cameral Coniractoes 0n-sea Mane9erfFwpnan Telephone ' Statement'II C'. General Construction or Demolition Description esbenos;s tcund dating a ConstNL on r,.Demolition I.Construction.n demolition contractor xrorm:on at TRUERDRAM SERVICE.INC. reapongtp panic$ m FAWFIELOAVE. must comply MK 3'0 Contractor Name A.dress "-- CMR)00.409 7. 5 INESTVELD MA 010850000 4135316705 and Chanter 21T of UNrtown — — the Genafm Lacer m Stale Zip Code reteMvi» me Cmnmglweafm PAUL T.LIVIAK ETES,TGS. INC 4/35316705 This would:nuttily Constnesion and Detre/Mom 0osite Managen but Keith no Se —^` Tom✓`iptK' imttad to Piing all asbestos removal 2 Licensed Contractor Supervisor. rotlacawm wah the Oepanrntn arm,a PAX T.LIPTAJKPRES CS-076642 mar*tit SUM./Km Meme License Number -- 'eltgof1hteatof ele&Se vl a . lathe entire facility io be delpolinhcd' tubba m thYc No substance a me Department d 4 Descnbe the drea(s)to be d¢1ColiahW- appI:a is' ENTIRE STRUCTURE,WAI SANDFOOTERSREMOVED. MassDEP Use Once ' Date R.'wF* — ¶ If this a construction project,do cihe the huilding(s or addition(si to he constructed MON CONSTRUCTIVE.PARKING AREA ONLY fi. Were the structurc(s)surveyed for the presence of Aahcstua-Contalniag v yet vo .Material(ACM)'' Who co ucte0 the survey' 0 O.ASSOCIATES ROBERT KIRCHER AS107443 Name Department of labor Standards Certification Numbw Was asbestos containing material(A('41)found' a \c,, No Ref INt•j 03'17.2016 —__� Pepe?of L "el Massachusetts Department of Environmental Protection $W P AQ 06100249912 Notification Prior to Construction or Demolition Asbestos Project # Project Fcasiop Prmaa Canccilalwn y C. General Construction or Demolition Description (continued) Thr Asbestos Abatement Notification Number for this loo4ezea Address is _ — This project Construction y Dernoltbvn 4'14/2016 11f30/2016 P.olect Start Dab(MMND/YYYY! Proryp End Dale tMM/DDNYYY) e For demolition and construction growers. indicate dust suppression techniques Iv be used Seeding y Wetting Covering Paring Shrouding Other-Specify 4 Is this an Emergency Demolition Operators? Ye. y No Name or MaSSDEP Official who evaluated the emergersy file ,_ —'" Date of Autl:Ortaai,oIY n(MMIDOYYY) MaseDEP Wane Number ^— D. Certification Y nrdily that I have personally PAUL T LIPTNK examined the foregoing and am Print Name familiar with the information Pock r DPTAK contained in this document and AulhonzW Signature —" all attachments and that,based FESCFJtr On my inquiry of those Individuals immediately Poe9oNIMe -- responsible for obtaining the TRUCK CRANE SERMCENG information, I believe that the Representing information is true,accurate,ants 8'29n016 complete.I am aware that(here Date(MMIDONVYV') '---� are significant penalties for submitting false Information, including possible fines anti Pep imprisonment. The undersigned nereby states. under the penalties of perjury that I am aware that this permit application or notification shalt not be deemed valid unless payment or the applicable fee is made." 864286 28116 1`.::C2 5684510 TRUCM]RANESERV1�CEI41 PAGE 01 . ._ Massachusetts Department of Environmental Protection eDEP Transaction Copy '-sere ,s the fide you requested for your records. To retain a copy of this file you must save and!or print. Username: TCSINC Transaction tD: 850079 Document: AQ O6•Construction/Demolition Notification Size of Re! 226.27K Status of Transaction: in Process Date and Tune Created: 8124i201e:2:38:s3 PM Note. This file only includes forms that were part of your :ransactton 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. C0/29!2018. 15: 0I 5884510 TPUCKCPANESEPVICEINC PA:E 02 LMassachusetts Department of Environmental Protection BWP AQ 06 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 lob is being conducted under a Blanket Permit. MassDEP assigned Blanket Authonrtion ID: This job is being conducted under a Non Traditional Abatement Work Practice Pemut_ MasaDEP assigned Non Traditional Work Practice Authonciapon ID: a None of the above conditions apply.generate a new form_ Revised. I i.1.32U 13 Pape I of 1 88/29/2@1c 1°-:n'2 568451ft TRUOKCRt;NESERV10E11C PAGE L"a a V 6 &DEP-MassOEPs Orlinet lli 9 System M ssDEFin OMtc Filling System Us rn, ,e TLSINO Nickname LJPPY Transaction Overview Paym•m Print E. DEP TRANS u86Gi10 Payincnt Type Credit Card Payn'enl amour( 100 DEP Payreem Conirm,t on ID 29429 Payment Circle from bark 1080,8 Payment Dale &2&'2016237:18 PM mance.plea nIOe F&mp Svslem ver 1.,25,3 D®2e1F Me99DEP to imps'/areanco mast sistiPacratiPaymont sten 201E. Ivr:0'_ 56a1519 flei_P P/tEEerri1:ESM1C PAGE 05 529:2016 etlEP-MassDEP'e Orme v Svsa,n. Maeseees()nbeFleg System Vee:na,re.TCSINC M,}nank:,IPPV [ Transaction Overview J Paymes print Exit Payrer.CorAlrmation `hank yru. Your payment has been received Now Payrnert received after 330pm will not bo posted untli Mea neerbusir ass day, MessDEP's Online Ft.:rg System ver 1Z 2E 3 2016 MesSOEP hot::odepd w masa.gorievicts/PiiymeNRiymeniCerermoponwpK 1/I Oe'zi/_a 15: 5EFJ`113 TRUIIIPArEEERvicEIPK3 r'A3E EF 3/2912018 ihEP-M®sDEF'£DNlry iI'n System Mms4DEP'9 Dorm Fina Systeir lsen,ame'?3SIwi NcK,ame.LIPPY Receipt SurnmarylReceiFi -. print recap! Exn Your submission is complete. Thank you for using DEP's online reporting system. You can selecl "My eDEP" to see a list of your transactions. DEF Transaceioo ID. 860079 Date and Tirne Submitted: 8129/20162'38:04 PM Other Email DEP Transaction ID. 860079 Oats and Time Submitted' 829/2016 2:38:04 PM Other Email Form Nante. AU 06- Construction/Demolition Notification Form Name:AQ 06- Constructicn/Darnolition Notification Payment information DEP code: 129429 Dale: 8129/2016 2:31:18 PM Ainount (Si: 100 Payment Detail' LIPTAK PAUL --Acc untType _A.ccountNumber "°"3007 Conti mationNumber; Mass DEP OOre rimy 3rsra.m .-f..2 25 3.p:,a.20f!: ena”DEP IftIk wisp:ipner.;nri,1wesPintR2cmia msp. 11. Columbia Gas of Massachusetts A NiSource Company 995 Belmont Street Brockton,MA 02301 Date: September 16, 2016 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 52 Round Hill Rd TOWN : Northampton STATE : Massachusetts Sincerely, Heather Meunier Integration Center Columbia Gas Of Massachusetts 508-580-0100 ext 1342