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25-007 (2) 142 RIVERBANK RD BP-2019-0082 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:25 -007 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Cateeorv: demolition BUILDING PERMIT Permit# BP-2019-0082 Proiectft JS-2019-000125 Est.Cost: Fee $300.00 PERMISSIONIS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: WESTERN MASS DEMOLITION CORP 106022 Lot Siu(sa.ft.): 24001.56 Owner: HAYWARD HELEN A zonine: Applicant: WESTERN MASS DEMOLITION CORP AT: 142 RIVERBANK RD Applicant Address: Phone: Insurance: 30 SUNSET DR (413) 574-5254 WC WESTFIELDMA01085 ISSUED ON.•7/24/2018 0:00:00 TO PERFORM THE FOLLOWING WORK demo and removal of dwelling 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 Si¢nature: FeeType: Date Paid: Amount: Building 7/24/2018 0:00:00 $300.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2019-0082 APPLICANT/CONTACT PERSON WESTERN MASS DEiNOLI'I ION CORP ADDRESS/PHONE 30 SUNSET DR WESTFIE J (413)574-5254 PROPERTY LOCATION 142 RIVERBANK RD MAP 25 PARCEL 007 001 ZONE THIS SECTION FOR OFFICIAL U`�E ONLY: PERMIT APPLICATION CHECKNST ENC!,OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ` Fee Paid Tvv of Construction demo and removal of dwelling New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included' Owner/Statement or License 106022 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: _Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance• Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay Signature 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. Department use only -- City of Northampton Stems of Permit: Building Department Oulp Odttpriveviay permit �, >4 212 Main Street Sewer/Septic Avabbility Room 100 WsterlWeO AvaitabAgy, Northampton, MA 01060 Two Sets ofStructueAPlars- phone 413-587-1240 Fax 413-587 127 P C C i V E APPLICATION TO CONSTRUCT,ALTER,REPAIR, RE OE OLISH A ON OR O FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: . PT DFOUaDill6lgytiptli be ompleted by office NORTHAMPTON.MAm00 lIak I VCIbi Map Lot Un itw "I?,AQ.M� O/yC� Zone Overlay District / Elm St.DistrictCe District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 14-den " _}y ,441 1 it �ful2�»r Md (97 9j Name Print) CLMy ry�Mlm9�aAddressss kT -U�/ fi�"grption .l Signalu e 2.2 Auhoorized Adam: KI& a/ , 2 Name(PCurrent Mating Address: ltlavi Sig a Ts7-phbTred 5 CTION 3'-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection 6. Total=(1 +2+3+4+5) Check Number This Section For Oficial Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Insp /Iector of Buildings Date J eul ne- x h eT (iat/ cam C&..54 EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Depanmeot LotSize Fronto e Setbacks Timor Side U R -.. _. L: R Rear Building Height Bldg. Square Footage % Open Space Footage _ % (Lot area minus bldg&pavcd arkin ) k of Parking Spaces Fill: f�'olumc&LornOovJ A. Has a Special Permit/Va ri ance/Firi ever been issued for/on the site? NO O DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at theR gi try of Deeds? NO O DON'T KNOW YES Q IF YES: enter Book Page and/or Document M B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW O YESAV IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained "IV , Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property 7 YES O NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading, xcavatlon,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO fW IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition Replacement WindowsAlleration(s) Q Roofing \�rA Or Doors 0 Accessory Bldg. ❑ DNew Signs [0] Decks [0 Siding [p] Other[0] Brief Description of Proposed ji Work JL I�emFi(r,,.Q �hIII�LI Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet ea.If New house and or addition to existing housing,complete the following: a. Use of building: One Farl Two Family Other �- b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? J. Proposed Square footage of new construction. ensions e. Number of stories? f. Method of heating? Fireplaces or Woodsloves Number of each g. Energy Conservation Compliance. Wisecrack Energy Compliance farm attached? h. Type of constructio>00ft. I. Is construction withwe ds? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basemenor below fnished grade k. Will building confoilding and Zoning regulations? Yes No. L Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 44eI-en . 2n as Owner of the subject property // '/ ✓�-, r� herebyauthorize ♦°-I S I'�61�ZA-lA7nC7�/� to act on m e� ' in all matters relative to work authorized by this building permit application. Signature of Owner Date �.1�' n[(cZ/�� as Owner/Authorizetl Agent hereby declare that the statements antl information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains an9 penalties of perjury. Ko c L PdnLName u Signature of Own Agent Date SECTION 8-CONSTRUCTION SERVICES _ 8.1 Licensed Construction SuperviiNot/Alpplicabl)e ❑ Name of License Holder:_OT le �� �>�rt� "r\ License Number Address h Ex t�e Signature Telephone9.Registered Registered Nome Improvement Contractor: Not Applicable ❑ ////111L I I 7 3S Company Name RegistratioNumber ��1 T 1� GK A hONe L en Address E;frat,.m Carl l7 i1 on Telephone Wks,tz SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(8)) Workers Compensation Insurance affidavit must be corn plated 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...... No...... ❑ City of Northampton Massachusetts Rv�s`s DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Rorthavg,ton, MA 01060 5J I�'acn AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application The Office of Consumer Affairs and Business Regulation("OCABR")regulates the mgistration of contractors and subcontractors performing improvements or renovations on detached one to fouyfamily homes. Prior to performing work on such homes,a contractor must be registered as a Home Improvement Contractor("HIC"). M.G.L. Chapter 142A requires that the"reconstruction, alteration, renovates, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any prefisting owner-occupied building containing at least one but not more than four dwelling units....or to structures which raZadjacent to such residence or building"be done by registered contractors. / Note:Lf the homeowner has contracted with a corporation or�LC that entity must be registered Type of Work: / Est. Cost: Address of Work: Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law(exppm): _Job under$1,000.00 Owner obtaining own p it(explain): Building not owner-o copied _Other(specify): OWNERS OBTAINING THEIR OWN PERMIT OR ENTERING INTO CONTRACTS WITH UNREGISTERED CONTRACTORS OR SUBCONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK ARE NOT ELIGIBLE FOR AND DO'NOT HAVE ACCESS TO THE ARBITRATION PROGRADI OR GUARANTY FUND UNDER M.G.L.Chapter/142A.SUCH OWNERS ALSO ASSUME THE RESPONSIBILITES FOR ALL WORK PERFORMED UNDER THE BUILDING PERMIT.SEE NEXT PAGE FOR MORE INFORMATION. f Signed under the penalties of perjury: I hereby apply for a building permit as the agent of the owner: Date Contractor Name HIC Registration No. OR: Notwithstanding the above notice, I hereby apply for a building permit as the owner of the above property: Date Owner Name and Signature City of Northampton Massachusetts 2�s DEPARTMENT OF BUILDING INSPECTIONS 212 Main street a Municipal Building Northampton, MA 01060 Massachusetts Residential Building Code Section I IO.R5.1.2 Homeowner: Person (s) who own a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Section I IO.R5.1.3.1 Any homeowner performing work for which a building permit is required shall be exempt from the licensing provisions of 780 CMR 110.R5, provided that if a homeowner engages a person(s) for hire to do such work, then such homeowner shall act as supervisor. Such homeowner shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. Q'�- City of Northampton Massachusetts (i) DEPARTMENT OF BUILDING INSPECTIONS212 Nain Street 6N=icipal Builtl ng BcrNampton, M 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: (Please print house number and street name) Is to be disposed of at: (Please print nafnLf and location of rity) �/ Or will be disposed of in a dumpster onsite rented or leased from: m5el( _- VAhe (Company Name and Addr ) � r atur rmi A plicant or caner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. The Commonwealth of Massachusetts Department oflndustrial Accidents 1 Congress Street,Suite 100 Boston, MA 02114-20177 www.mass.gov/dia 14 orken'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly ]Name(Business/Organizafionilndividual):bfia4ieN Address: zQ Sume-t Die yf' City/State/Zip: LAJYVA4J ! Phone#: tj/,� .Are you an employer?Check the appropriate ox: Type of project(required): 11fj!f,Lapa a employer with-�cmpl.yces(full and/or pat-time) 7. ❑New construction 2.M1 am a sole ptnpriurrorprourship and have no employees xorking garment $, ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3 n am a homeowner doing all work notch [Noworken comp.insursncerancmd.l' 9' alttlan 4 I am a homeowner and will he lido tractors to conduct all work on 10[]Buildingidditinn gwn my auto ry. Iwill ensure that all contractors oma have worker;compensation insuranw or are sole 11.❑Electrical repairs or additions propriemrs with ao cmployecs. 12.❑Plumbing repairs or additions 5_r7 I am a general contractor and l have hired the sub-contactors listed of the attached sheet 13 �ROOCrepai[s These sub-creasers have employees and have worker;comp.insurance. 6-❑weareaw tionandits officers have exercised their right ofoxemtion 14.❑Other :pore b P pa MGI.c. 152,ill(4).vnd we have no employers.[No workers comp_insurance rcquimdd `Any phood Cataracts box#1 must also fill out the section below show ing their workers'compensation policy information. t Homeowners who submit tris affidavit indicating trey are doing of I work and then hire outside contactors must submit a new affidavit indicating such. :Conran...that check this box most attached an additional sheet showing the name of the cob-cottactors and state whether or not those entities have mrpl.yees_ If the sub-contraecom have employees,they must provide their workers'ron,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � `J1 / [ ,,, M p ,h �,f rye Insurance Company Name�D(A,k-/a6 �0 —✓1� ///(Jq&d �� (y/LA ne i1e)� �I Policy#or Self-ins. //Laic..#:QSq(�rj�j=6f/ Expiration Date: ',/ ✓Job Site Address: % H V'[�O�/)/Z- C.1/- City/StaticlZip: �f CJ11 - Attach a copy of the workers' compensation policy declaration page(showing the policy number and Apication date). Failure to secure coverage as required under MGL c. 152, sh25A is a criminal violation punishable by a fine up to$1,500.00 and/or unc-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepainss a /nddischaaJtiess ofperjury that the information provided above is/true and correct Signature' , 0> QDate7 Phone#: Oficial use only. Do not write in this area,to be completed by city or town ofciast City or Town: Peredit/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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"._every person in the service of another under any contract ofhire, express or implied,oral or written." An employer is defined as`an individual,parmership,association,corporation or other legal entity,or any two or more ofthc foregoing engaged in ajoint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house ofanother who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the pet entrance ofpublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cer ificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. Ifan LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be rammed to the airy or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure in fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permiblicense applications in any given year,need only submit one affidavit indicating current policy infoanation(if necessary)and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required in complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 02-23-75 www.mass.gov/dia Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership.association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives ofa deceased employer,or the receiver or trustee ofan individual,partnership,association or other legal entity,employing employees. However,the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply your insurance company's name, address and phone number along with a certificate of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. if an LLC or LLP does have employees,a policy is required.Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or tryout are required to obtain a workers'compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate Iine. City or Town Officials Pleas.be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bonom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number.In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture(i.e.a dog license or permit to bum leaves eta)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 www.mass.gov/dia Form Revised 02-23-15 waae - CSSL-106022 4537-20154Pleas SMAN51 a05;�Aa�D20 W UNBDERFFA 30 SU - NSEL DR _ g "� W SUd. ESiFIELD MA 01085. v n ESI ERFER ..�. a maMSEremve Isri3e."" -.G.., w - - xesiamn.a5 maeslm _ _.. 05N 112076 - - .•e A53J: ae F.: T Cer": HE-776280 Asbestos Supervlaor 9 _ DALE UNSDERFER 1 — E8. DALE W DNSDERFER Gale 0NO3ftd 30 SIMSET M E!p,Date O40019 WESTFIELD MA 01096 AS00 M %,sseMCAHES. SIR SpRltBEW IIUIIIIIIIIIIIIIIfNIIIIIIIRII /'F ' exPiraton Commissioner OPIUM'S OSHA �* us.xoanfm d la oaaarc.,a:sarary ago 4aam.nem�m�nro� Dale Unsderfer aGAuov rerwle'PCatYM''Cl:c'.patwne5.9ery a'C!!ee:^ ..ai a_Co:rse. �4me9 C. Bagnall, �Q/l??2/{'1'L4-'NLEUECU�� 4�C�� i�E^✓ri' - Office of ConsumeAffairs and Business Regulation 4Y 10 Pa ': Plaza - Suite 5170 Home Improvement CvlruGtor Registration Registration: 178435 Type: Corporatio Expiration: 4/16/2018 TN 419211 WESTERN MASS DEMOLITION Q DALE UNSDERFER `: �� 30 SUNSET DR. WESTFIELD, MA 01085 'i'�•---_,; � -:=�,�` — Update Address and return card.Mark reason for change. Address ❑ Renewal Q Employment Lost Card Cn1 n zoRosm ••{{�� ftOcc of C «Affam 511s sa iievul fo :g n License rislrnhon Is lid for mdnido'use mdy r + 4Yt OMEIAIFP OVEMr NTf•ONTRACTOR before f:e expvalian dste. If found return to: /4 I gi.tratlon 178x35 Typn: Offiac of Consumer ANosinessaiisand Nosiness Rerulntion 'QxG hxpiratlon 4)idI2018 Corporation lOPark Plaza Sm1e5170 • _•., .,_... aos[on,MA 02116 WESTERN MASS DEMO�,ITIQN CORP. 'DALE UNSDERFER �� — 30 SUNSET DR. WFSTFIEI-D.MA 01085 Underserrelary .Not valid witto I. coR a CERTIFICATE OF LIABILITY INSURANCE on07/17 ' 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: N the dartlrlrats holster Is an ADDITIONAL INSURED,the policy(les)most be endorsed. N SUBROGATION IS WAIVED,subject to Ma terms arM conditions of the policy,chain policies may raguNa an endorsement. A atalam nt on this cert8eals does not coder rights to the cemff1cs a holder In Hour of such endorawns s. moouce xNaE: Lisa Hibbert THE DOWD AGENCIES LLC R1OXE 413 43]-1043 juui'rw• EJ YL AaoREss: Bpbbart .ran 14 Bobala Road w9aRENaIAFFORpINGcoYERAaF _ xuc• HOLYOKE MA 01041 xsUlaa A; LIBERTY MUTUAL FIRE INS CO 23035 -- _ stall® souRa e: WESTERN MASS DEMOLITION CORP WalaEs O: _ Neursao _ _ _ SO MEDEIROS WAY wVINER E: WESTFIELD MA 010115 INNIUMN,: COVERAGES CERTIFICATE NUMBER: 292494 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. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS S1JWECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLMMS. e� TYVE OFNBVIMICE IIXILYXU6FA Fm1LY PoIIaY EYI LYTa _— COWEIKMLOEXER.LLLMBNrtY E9CNOLCUg1a:NCE S cl.,ym OE 1:1OCCUR PRFANSES Ea��iwu S WD"pVN megrml f _ N/A rER3awL a0Dvlranwr f _ GENL AGGREWIE UWr APPLIES MR GENFIULAOGREGPTE f POLICY JECT LOC PRODUCTS-CON'r—AGG 3 OIXER'. f pmppBILEUAyN1Y CONSWE IN L'4/ f Y. aO("LYINIum`FY`pN—) S ALL ED SCHEDULED WA ND,R, uuw(Psm ) 5 AUTOR AUTOS _ XIREDMITOS NCN YNNED NmPFRrvpAMAGE f U O$ a i UIIBRELw LVa OCCUR FACHOCCUR WE f EROF93 Wa cwMs+YAOe N/A A,ounE.R, f LED REIENTICN X V f WO1110318 r'pNPB19ATpM STA ER AXOEYPLOYEA6'LIRBINIY YIN AVWRSENBE?AAINER,EIfECU1NE ELEACHACCIDENI T 1,DO0.DOO A OPRCERnNaNaaaLxalroeoT wA wA wA WC231S39145501] 08/21/201] M112018 ryskrbryln" ELDISEASE-EAEMP-0YE f 1.000,ODO Ip 4/p.. OESLRIP1RDNOFWERATIONS. ELDISEPSE-P0.ICYUNR f 1.000,DDO WA pHCR►fIdI OFOPFXATNHIaI LOLAIMINBIYENFIFB IAMO1m.AWtlmN PemwY�B[NYM.nryb Mthe4H�nureq�mY gaA�El Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant W Endorsement WC 20 03 06 B,no authddzation is given to pay claims for benefits to employees In steles drier Man Massachusetts If 0.insured hires,or has hiretl dose employees outside of Massecl useds. This oerfificats of Insurance shows Me PoliW in force on Me dale stat this certificate arts issued(unless the expiration data on Me above Pdi W precedes rte issue staled this certificate of insurance). The stews of this overage can W monifaetl daily by ahxxssirlg rid Proof d Coverage-Coverage Verification Search tool at www.mesa.gowlwdNrohkescwnWwfiorOnv figaboW. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPOMFIGN DATE THEREOF, NOTICE WILL BE DELNERED M Kristine Wanczyk & Helen Hayward AccoRDAHCEwrrHTNE IroucYPltovaloxs. 142 Riverbank Road Am11Ma[®RFPRESEMTATNE Northampton MA 01062 Daniel M.Crpdey.CPCU,Vice President-Residual Market-WCRIBMA ®1988-2014 ACORD CORPORATION. All rights re annied- ACORD 25(2014/01) The ACORD name and logo are registered marks ofACORD G Environmemal Sampling and Testing Asbestos Air J f 54 Water Street (PCM) Ashburnham,MA 01430 O 978.927-1169 Sample Analytical Data Ol envirosample@verixon.net (NIOSH 7400) T CHAIN OF CUSTODY Client: Top Notch Abatement, LLC PO Box 115 Thomdike,MA 01079 Date: lune 18,2018 Job Number: 7649 Site: 142 Riverbank Road Northampton MA Location of Work: Bedroom Type bf Material: Tile& Mastic Type of Containment: Full containment with 2000 CFM HEPA Filter/Negative Pressure EDCIOsnre(NPE) Visual Inspection Determination:Pass Sample Location Flow Duration Volume Concentration 001 Blank-Open Lab QC 002 Blank-Closed Cassette QC 003 Inside Containment after 16 75 1200 <0.005 Asbestos Removal &Visual LPM Min Liters F/CC Inspection 1:00-2:15 Comments:Area is suitable for occupancy based on visual inspection,Air Sample Analyzed by: Raymond Bresnahan—AM 00001760 Collected by: Ben Weiderman AM 900624 Massachusetts DLS#AA000225/PAT#102395 Reference Slide#01-11-29-16 Analytical Method: Phase Contrast-NIOSH 7400 Industry Standard for Clearance-<0.010 Columbia Gas of Massachusetts A AFSou.oe Canwww 995 Belmont Sheet Brockton,MA 02301 Date: June 29, 2018 ToWhom It May Concern: The address listed below has no record of gas service and no record of gas main on this street. ADDRESS : 142-146 Riverbank Rd TOWN : Northampton STATE : Massachusetts Sincerely, _ — - -- JusttnZ?Money - - Integration Center Columbia Gas Of Massachusetts 508-580-0100 Ext 1404 nationalgrid 40 Sylvan Rd Waltham MA 02451 June 26, 2018 RE: Service Removal for Building Demolition 142 RIVERBANK RD NORTHAMPTON,MA To Whom It May Concern, This letter is to confirm that,per your request, National Grid has confirmed electric meter and service line have been removed from 142 RIVERBANK RD NORTHAMPTON, MA. The work request number for this job is 26513395. If you have any questions or need further assistance, please feel free to contact me at (508) 357 4658. Sincerely, Ross C ghlan Customer Order Fulfillment nationalgrid verizonv/ MA/RI OSP Center 385 Miles Standish Blvd Taunton, MA 02780 1-866-686-1195 ma-ri.osp.center@one.verizon.com To: Chris Date:6/28/2018 Re: Facility Removal for Demolition This letter confirms that Verizon's facilities have been disconnected and removed from the address below. 1426 Riverbank Rd, Northampton, MA Thank you, Stickney, Lynn A OSP Engineer 10YY�1R�VNi1iN aYdam�Ynr YYrI r la0lAlNYOI ?WW OYYYY jam••' rp°''' awrr YY 1.111YW1r � P 'w1. � rYtih _ _ lMI H 1. 0' � � Y • YN _�y4 1pYl {lM5�'YY� a /11 �lY t19 0. r IlrWppK'19NY 1` / / p ' (1Wlil � J lC7\1,9 YOVA z wYNTlY4 pr0y..IrwY Yai.M ra YyY ay11YOYtlY r YaYrwl Ywa Y1.r Y.L ru uw aaw r paYN wwYaaawl