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25C-121 (5) BP-2021-2273 15 ELIZABETH ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 25C-121-001 CITY OF NORTHAMPTON Permit: Demo PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2021-2273 PERMISSIONIS HEREBY GRANTED TO: Project# demo Contractor: License: Est. Cost: 4000 BAYSTATE CONTRACTING 062382 Const.Class: Exp.Date: 10/31/2023 Use Group: Owner: BIRDIE PROPERTIES, LLC Lot Size (sq.ft.) Zoning: URB Applicant: BAYSTATE CONTRACTING Applicant Address Phone: Insurance: 352 ALBANY ST (413)732-3179 WCA1544641 SPRINGFIELD, MA 01105 ISSUED ON:12/10/2021 TO PERFORM THE FOLLOWING WORK: DEMO FRONT PORCH& SIDE ENTRY 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. Signature: frrAL > 1 R Fees Paid: S65.00 212 Main Street,Phone(413) 587-1240,Fax:(413)587-1272 Office of the Building Commissioner whey, r if4 / DEC _ 1�he Commonwealth of Massachusetts 1 / 2O27Boaad of Building Regulations and Standards FOR a MUNICIPALITY Massachusetts State Building Code, 780 CMR rr . USE Bi f, ff4`P v J plication To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number:8 0.-) Date Applied: Building Official(Print Name) I Signature e SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 15 Elizabeth Street 25C-121-001 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: 3049 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided N/A N/A N/A 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage// Disposal System: Public 0 N/A Private 0 Zone: _ Outside Flood Zone? Municipal❑AOn site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Robert J. Billieux Sr. C/O Debra A. Hawkins Durham, NC 27704 Name(Print) City,State,ZIP 311 Greenwood Dr. (919) 277-0649 dhawkins4570@gmail.com No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building D Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2:Rough separation, demolition and removal of the covered front porch and side entry, including any footings or piers. Leave demo areas rough graded with onsite soils. SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 4, 000 . n 1. Building Permit Fee: $ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost' (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5. Mechanical (Fire Suppression) Total All Fees: Check No.1( Check Amount:406 Cash Amount: 6. Total Project Cost: $ 4, 000 .'° ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-062382 10/31/23 Andrew Mirkin License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 352 Albany Street No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) Springfield, MA 01105 R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances (413) 781-0820 ABWinc@comcast .net I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 150930 5/7/2 0 2 2 Baystate Contracting Services, Inc. HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 352 Albany Street james@baystatecontracting.com No.and Street Email address Springfield, MA 01105 (413) 781-0820 City/Town,State,ZIP Telephone SECTION 6: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 ® No .0 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Baystate Contracting Services, Inc. to act on my behalf,in all matters relative to work authorized by this building permit application. Debra Hawkins 12/3/2021 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATION By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Andrew Mirkin, President, Baystate Contracting Services, Inc. 12/3/2021 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq. ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton /4OPt HAMY,o.. ,.•.. s, . Massachusetts t w y f DEPARTMENT OF BUILDING INSPECTIONS T 212 Main Street • Municipal Building v,;•. CDC Northampton, MA 01060 -J'NW , `moo CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance of the provisions of MGL c 40, S54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility, as defined by MGL c 111, S 150A. The debris will be disposed of in: USA Hauling & Recycling Location of Facility: 120 Old Boston Road, Wilbraham, MA The debris will be transported by: Name of Hauler: Associated Building Wreckers, Inc. Signature of Applicant: Date: 12/3/2021 Andrew Mirkin, President The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 ?" Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Name(Business/Organizational/Individual): Baystate Contracting Services, Inc. Address: 352 Albany Street City: Springfield State: MA Zip: 01105 Phone#: (413) 781-0820 �AArre-�you an employer?Check the appropriate box: Type of project(required): rill. I am an employer with 1 0 employees(full and/or part time)* 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in any n 8. Remodeling capacity.[No workers'comp.insurance required.] ICI ✓19. Demolition 3. I am a homeowner doing all work myself.[No workers'comp.insurance required]t 10. Building addition I n 4. I am a homeowner and will be hiring contractors to conduct all work on my property. 11. Electrical repairs or additions I I will ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 712. Plumbing repairs or additions n5. I am a general contractor and I have hired the sub-contractors listed on the attached 713. Roof Repairs sheet. These sub-contractors have employees and have workers'comp.insurance.± n6. We are a corporation and its officers have exercised their right of exemption per MGL. n14. Other c.152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners 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 attach 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. l am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Great Divide Insurance Co. Policy#or Self-ins.Lic.#: WCA1544641-20 Expiration Date: 2�1�2022 Job Site Address: 15 Elizabeth Street, Northampton, MA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL.c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. nI do hereby certify under the pains and penalties of perjury that the information provided above is true and correct,and that clicking this checkbox and typing my name in the field below will act as my signature. Name: Andrew Mirkin Date: 12/2/2021 Phone#: (413) 732-3179 Email: abw_inc@comcast.net • Construction Supervisor Unrestricted •Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Commonwealth of Massachusetts Division of Occupational Licensure Board of Building Regulations and Standards Const{uton Srvisor �' .._ 1' CS-062382 4c 6Ipires: 10/31/2023 ANDREW H MIRKIN 299 TANGLEWOOD DR1101 LONGMEADOtWV MA 01106 oa Commissioner fe', it, K. D&nitta., J Kt - %0 .ygae),-.) �e, me4e/4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration =7 _ Type: Corporation 11,71 —t---�--1-[ 1 l� Registration:• 150930 BAYSTATE CONTRACTING SERVICES,INC� .. w 352 ALBANY ST. ii r Expiration: 05/07/2022 SPRINGFIELD, MA 01105 IA _ = e� 1:,k =:14—'—=-- '... 4. ‘IF .r Update Address and Return Card. SCA 1 Ca 20M 05,17 ./, 7,/,,/,('/,//7,//; /2. //,//i),/e:4,),//' Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 150930 05/07/2022 10 Washin ton Street -Suite 710 BAYSTATE CONTRACTING SERVICES,INC. Tst ,MA 2118 ANDREW MIRKIN 352 ALBANY ST. 1a/..a,,✓,:'. w-'��f>/ SPRINGFIELD,MA 01105 Undersecretary Not valid without signature (DIG SAFE SYSTEM, INC - MA) 12/02/2021 16:46:40 -BB -MC -WG *** INTERNET TICKET *** ***** REGULAR ***** TIME..16:46 DATE..12/02/2021 REQUEST NO...20214810036 STATE MASSACHUSETTS MUNICIPALITY NORTHAMPTON ADDRESS..15 STREET...ELIZABETH ST NEAREST CROSS STREET 1..BRIDGE ST DEMOLITION OF FRONT PORCH AND SIDE ENTRY INCLUDING FOOTINGS OR PIERS NATURE OF WORK..DEMOLITION EXTENT OF WORK STREET TO STRUCTURE AREA IS PREMARKED..YES START DATE 12/07/2021 START TIME..17:00 CALLER JOHN JEFFRESS TITLE RETURN CALL PHONE # 413-732-3179 FAX # ALT. PHONE # 800-448-2822 EMAIL ADDRESS DEMO@BUILDINGWRECKERS.COM CONTRACTOR ASSOCIATED BUILDING WRECKERS ADDRESS 352 ALBANY ST CITY SPRINGFIELD STATE MA ZIP 01105 EXCAVATOR DOING WORK..ASSOCIATED BUILDING WRECKERS Service Area ALLY TXp€(0 Contact Alternate Contact Emergesy Contact VERIZON TELEPHONE (800)624-9675 *Principal NATIONAL GRID ELECTRIC- ELECTRIC USIC LOC MASS ELEC (800)778-9140 *Principal EVERSOURCE GAS OF MA GAS (800)688-6160 WG HIT GAS LINE NUMBER *Principal (800)525-8222 This Dig Safe ticket expires on:01/01/2022 There may be non member utilities in the area that you need to notify. Electric and other utilities may not mark lines they don't own or maintain.You may need to hire a private company to locate these lines. The excavator is responsible to maintain marks placed by the member utilities. J. Sexton Construction& Design, LLC 49 Edward Dr. Holyoke,MA 01040 November 29, 2021 Steven Hill Associated Building Wreckers, Inc. 352 Albany Street Springfield, MA 01105 Steven, This letter is to confirm that no electrical terminations on the two exterior porches contain active live power. The light fixture on the side porch has been disconnected from the circuit and properly terminated inside. There are currently no existing electrical lights or devices connected to the front porch. All electrical work has been performed by Mathew Sheedy license No. 12571-B. Sincerely, Jason Sexton J. Sexton Construction&Design, LLC 49 Edward Dr. Holyoke,MA 01040 413-210-1778 office@jsextoncd.com Nall Massachusetts Department of Environmental Protection BWP AQ 04 (ANF-001) 100355531 Asbestos Project # Asbestos Notification Form j rr ProProjectect Cancellation A. Asbestos Abatement Description 1.Facility Location: RESIDENTIAL STRUCTURE 15 ELIZABETH STREET Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTHAMPTON must be completed in MA 01060 4132101778 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification JASON SEXTON OWNER requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: FRONT PORCH Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? P a.Yes r b.No 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)? P. a.Yes r b. No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, if applicable: Approval ID# 6. Asbestos Contractor: NON LICENSED REMOVAL NON LICENSED REMOVAL a.Name b.Address NON LICENSED REMOVAL MA 02108 6172925500 c.City/Town d.State e.Zip Code f.Telephone AC000000 h. Contract Type: 17 1. Written r 2.Verbal g.DLS License# NON LICENSED REMOVAL NON LICENSED REMOVAL AS000000 7. a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# 8 MARCO A.CARRALERO AM041931 a.Name of Project Monitor b.DLS Certification# 9 GREEN ENVIRONMENTAL CONSULTING INC AA000242 a.Name of Asbestos Analytical Lab b.DLS Certification# 10. 11/23/2021 11/23/2021 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 700-330 N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 11.What type of project is this? r a.Demolition P b. Renovation r c.Repair r d. Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection 100355531 BWP AQ04 ANF-001 � ) Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation A.Asbestos Abatement Description: (cont.) 12. Abatement procedures(check all that apply): r a.Glove Bag r b.Encapsulation r c.Enclosure r d. Disposal Only r e. Cleanup r f.Full Containment P g. Other-Please Specify: EXTERIOR NON-FRIABLE 13. Job is being conducted: r a. Indoors b. Outdoors 14 a. Total amount of each type of asbestos Containing materials(ACM)to be removed, enclosed, or encapsulated: 200 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c. Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. d.Pipe Insulation e.Transite Shingles 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. f. Spray-On Fireproofing g. Transite Panels 200 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. h. Cloths, Woven Fabrics i. Other-Please Specify: 1.Lin.Ft. 2.Sq.Ft. j. Insulating Cement 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. 15. Describe the decontamination system(s)to be used: REMOTE 3 STAGE DECON UNIT WITH TEMPERED WATER AND FILTRATION 16. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): PROPERLY WETTED,DOUBLE BAGGED,LABELED AND DISPOSED OF PROPERLY 17. For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a.Name of MassDEP Official b.Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver# e.Name of DLS Official f.Title of DLS Official g.Date of Authorization(MM/DD/YYYY) h.Waiver# 18. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this r a.Yes 17 b.No project? Revised: 11/13/2013 Page 2 of 4 Massachusetts Department of Environmental Protection 100355531 s--- BWP AQ 04 (ANF-001) --- - Asbestos Project # Asbestos Notification Form r Project Revision r Project Cancellation B. Facility Description RESIDENTIAL STRUCTURE 1. Current or prior use of facility: 2. Is the facility owner-occupied residential with 4 units or less? r0 a.Yes 1 b. No 3 JASON SEXTON 15 ELIZABETH STREET a.Facility Owner Name b.Address NORTHAMPTON MA 01060 4132101778 c.City/Town d.State e.Zip Code f.Telephone 4 JASON SEXTON 15 ELIZABET STREET a.Name of Facility Owner's On-Site Manager b.Address NORTHAMPTON MA 01060 4132101778 c.City/Town d.State e.Zip Code f.Telephone 5 J.SEXTON CONSTRUCTION&DESIGN 49 EDWARDS STREET a.Name of General Contractor b.Address HOLYOKE MA 01040 4132101778 c.City/Town d.State e.Zip Code f.Telephone GREAT DIVIDE INSURANCE g.Contractor's Worker's Compensation Insurer WCA1545165-18 2/2/2022 h.Policy# i.Expiration Date(MM/DD/YYYY) 2400 2 6. What is the size of this facility? a.Square Feet b.#of Floors Note:Temporary storage of Asbestos C. Asbestos Transportation & Disposal containing waste 1. Transporter of asbestos-containing waste material from site of generation: material is only allowed at the place r a. Directly to Landfill or P b.To Temporary Storage Location/Transfer Station of business of a DLS licensed Asbestos contractor or a transfer BAYSTATE CONTRACTING SERVICES 352 ALBANY STREET station that is c.Name of Transporter d.Address permitted by MassDEP and SPRINGFIELD MA 01105 4137810821 operated in e.City/Town f.State g.Zip Code h.Telephone compliance with Solid Waste Regulations 310 CMR 19.000 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: RED TECHNOLOGIES LLC 173 PICKERING STREET a.Name of Transporter b.Address PORTLAND Cr 06480 8603421022 c.City/Town d.State e.Zip Code f.Telephone Revised: 11/13/2013 Page 3 of 4 Massachusetts Department of Environmental Protection 100355531 BWP AQ (ANF-001) Asbestos Project# Asbestos Notification Form 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 TRANSFER&LOGISTICS 173 PICKERING STREET a.Temporary Storage Location Name b.Address PORTLAND GT 06480 8603421022 c.City/Town d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA ENTERPRISES MINERVA ENTERPRISES a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA RD. c.Address WAYNESBURG OH 44688 3308663435 d.City/Town e.State f.Zip Code g.Telephone Note:Contractor must sign this form for DLS notification purposes D. Certification JAMES BEAUDRY JAMES BEAUDRY "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PROJECT MANAGER 11/2/2021 familiar with the information contained in this document and 3.Position/Title 4.Date(MM/DD/YYYY) all attachments and that, based 4137810821 BAYSTATE CONTRACTING SERVICES on my inquiry of those 5.Telephone 6.Representing individuals immediately 352 ALBANY STREET SPRINGFIELD responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 01105 information is true, accurate, and complete. I am aware that there 9.State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment. The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 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 • 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: BAYSTATEI Transaction ID: 1321190 Document: AQ 04 -Asbestos Removal Notification Form ANF-001 SiZe of File: 231.26K Status of Transaction: In Process Date and Time Created: 11/2/2021:6:38:39 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. ' Massachusetts Department of Environmental Protection BWP AQ 04 (ANF-001) PreForm Asbestos Notification Form ✓ 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: 17 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): P 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)1.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. r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System Username:BAYSTATE 1 Nickname:BAYSTATE CONTRACTING LOO OFF My eDEP f Formss' My Profiles' Help I Notifications Receipt J Forms Sign ure 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: 1321190 Date and Time Submitted: 11/2/2021 6:37:04 AM Other Email : DEP Transaction ID: 1321190 Date and Time Submitted: 11/2/2021 6:37:04 AM Other Email : Form Name: AQ 04 -Asbestos Removal Notification Form ANF-001 Form Name: AQ 04 -Asbestos Removal Notification Form ANF-001 Payment Information DEP code Date Amount ($) Billing Info My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.15.21.0.0© 2019 MassDEP LMassachusetts Department of Environmental Protection 100355531 R1 BWP AQ 04 (ANF-001) Asbestos Project# Project Revision Notification Project Revision [T Project Cancellation A. Asbestos Abatement Description 1.Facility Location: RESIDENTIAL STRUCTURE 15 ELIZABETH STREET Instructions 1.All a.Name of Facility b.Street Address sections of this form NORTHAMPTON must be completed in MA 01060 4132101778 order to comply with c.City/Town d.State e.Zip Code f.Telephone MassDEP notification JASON SEXTON OWNER requirements of 310 CMR 7.15 and g.Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: FRONT PORCH Standards(DLS) notification i.Building Name,Wing,Floor,Room,etc. requirements of 453 2.Blanket Permit Project Approval,if applicable: CMR 6.12 Approval ID# 3.Non-Traditional Asbestos Abatement Work Practice Approval, MassDEP Use Only if applicable: Approval ID# Date Received 11 f yy , '^1,` i'", 11/24/2021 d elect Start Date(MM/DD/YYYY) b nd Date(MM/Da ) 700-330 N/A c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday B. Other Project Revisions: Note:Temporary storage of Asbestos containing waste material is only allowed at the place of business of a DLS licensed Asbestos contractor or a transfer station that is permitted by MassDEP and operated in compliance with Solid Waste Regulations 310 CMR 19.000 Note:Contractor must sign this form for DLS notification purposes Revised: 11/13/2013 Page 1 of 2 Massachusetts Department of Environmental Protection 10O355531R1 BWP AQ 04 (ANF-001) Asbestos Project# Project Revision Notification r Project Revision E Project Cancellation C. Certification JAMES BEAUDRY JAMES BEAUDRY "I certify that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PROJECT MANAGER 11/23/2021 familiar with the information 3.Position/Title 4.Date(MM/DD/YYYY) contained in this document and all attachments and that,based 4137810821 BAYSTATE CONTRACTING SERVICES on my inquiry of those 5.Telephone 6.Representing individuals immediately 352 ALBANY STREET SPRINGFIELD responsible for obtaining the 7.Address 8.City/Town information, I believe that the MA 01105 information is true,accurate,and complete.I am aware that there 9.State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 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 2 of 2 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: BAYSTATEI Transaction ID: 1326539 Document: AQ 04-Asbestos Removal Notification Form ANF-001 Size of File: 223.58K Status of Transaction: In Process Date and Time Created: 11/23/2021:8:34:41 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. Massachusetts Department of Environmental Protection BWP AQ 04 (ANF-001) PreForm [Lill Asbestos Notification Form <w This is a revision to an existing form. Project ID for existing form to be revised: 100355531 ✓ 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: ✓ 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): ✓ 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)1.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. r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 MassDEP Home I Contact i Privacy Policy MassDEP's Online Filing System Username:BAYSTATE1 Nickname:BAYSTATE CONTRACTING Loa OFF My eDu-- iiiy t totnieMIN elpI Notifications L Receipt Forms lignature Payment Receipt Summary/Receipt print receipt 1 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: 1326539 Date and Time Submitted: 11/23/2021 8:32:14 AM Other Email : DEP Transaction ID: 1326539 Date and Time Submitted: 11/23/2021 8:32:14 AM Other Email : Form Name: AQ 04 - Asbestos Removal Notification Form ANF-001 Form Name: AQ 04 - Asbestos Removal Notification Form ANF-001 Payment Information DEP code: 214274 Date: 11/23/2021 8:32:03 AM Amount ($): 35 Billing Info: JAMES BEAUDRY --- Payment Transaction Number: 299576f7- 0480-4def-ab43-5d2ca5de6127 --- Payment Invoice Number: EFA2737C- 9301-453D-BD38-82475B09CD38 My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.15.21.0.0© 2019 MassDEP September Lane Labs, INC P. O. Box 275 Beacon Falls, CT 06403 203-668-8533 11/26/2021 Associated Building Wreckers, INC. 352 Albany Street Springfield, MA 01105 Project Manager: Steven Hill Project No: 15-ES-NHM 15 Elizabeth Street Northampton, MA The asbestos abatement project is considered completed because the post- abatement criteria for the asbestos abatement have been satisfied. On November 24, 2021, a Licensed Project Monitor completed a final visual inspection. No visible debris was found. ABATED ACM: Exterior Porch Transite Siding Marco Carralero MA License # AM041931 ASSOBUI-01 DKELLEY ,d►C.oizo CERTIFICATE OF LIABILITY INSURANCE DAT2/1/2021 ) 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 certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Denise Kelley,CISR NAME: People's United Insurance Agency,Inc. PHONE (413) FAX No: 413 327-7517 One Monarch Place,10th Fir (A/C,No,Est): 327-7517 { )( ) Springfield,MA 01144 AADDRESS:Denise.Kelley@AssuredPartners.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Nautilus Insurance Company 17370 INSURED INSURER B:Colony Insurance Company 39993 Baystate Contracting Services,Inc. INSURER C:Great Divide Ins.Co. 25224 352 Albany Street INSURER D: Springfield,MA 01105 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD IMMIDDIYYYY) IMMIDD/YYYY) 1,000,000 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE X OCCUR ECP2031158-10 2/1/2021 2/1/2022 DAMAGE TO RENTED 100,000 X X PREMISES(Ea occurrence) $ 10,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1'000'000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILECOMBINED SINGLE LIMIT LIABILITY (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOSO ONLY AUTOS p BODILY INJURY(Per accident) $ AUTOS ONLY AUUTOS ONLY (Per PROPERTY B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS-MADE X x EX04257660 2/1/2021 2/1/2022 AGGREGATE $ 5,000,000 DED RETENTION$ $ C WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y WCA1545165-20 2/1/2021 2/1/2022 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N N/A X E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Pollution Liability x x ECP2031158-10 2/1/2021 2/1/2022 See Description Box DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Pollution Liability Limit:Limit Per Occurrence;$1,000,000:Limit Aggregate;$3,000,000 Please be advised the below listed certificate holder is listed as Additional Insured on a Primary and Non-Contributory basis in regards to the General Liability,Pollution Liability,Umbrella(Excess)Liability,and Workers Compensation policies listed above when being required by written contract.Waiver of Subrogation in favor of certificate holder for all above listed policies. Umbrella(Excess)Policy is written on a follow form basis over the above listed General Liability,Pollution Liability,Employers Liability(Workers Compensation),and the Auto Liability with Commerce Insurance,Policy#19MMZP4610. SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Northampton THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 210 Main Street Northampton,MA 01060 AUTHORIZED REPRESENTATIVE Peaftee '7?g ted Todanaete 119m,, 7t. ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID:ASSOBUI-01 DKELLEY LOC#: 1 ACORD ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED People's United Insurance Agency, Inc. Baystate Contracting Services,Inc. 352 Albany Street POLICY NUMBER Springfield,MA 01105 SEE PAGE 1 CARRIER NAIC CODE SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: RE:Any and all jobs.City of Northampton is listed as additional insured under general liability as required by written contract for work performed by insured subject to terms and conditions of the policy. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Northampton, MA : Assessor Database Property Search: Parcel ID: Owner Name: Street Number: Street Name: 15 ELIZABETH ST V Search Reset Property Detail: Parcel ID: Card: Street Name: Street Number: Zoning: State Class: Acres: Plot: 25C-121-001 1 ELIZABETH ST 15 Single Family Residence 0.07 Owner Information: Property Images: Owner Name: BILLIEUX ROBERT J SR Picture: Owner 2 Name: Owner 3 Name: C/O DEBRA A HAWKINS1 tot Street 1: 311 GREENWOOD DR City: DURHAM State: NC Zip: 27704 ��f Dwelling Information: ! ai Style: RANCH _ ' �� Year Built: 1900 Exterior Walls: ASBESTOS Story Height: 1.0 Attic: NONE Basement: FULL Bsmt Gar Spaces: 0 Total Living Area: 705 Total Living Area Minus FBLA: 705 Sketch: Finished Basement Area: 0 Rec Room: 0 Heating System: OIL/WARM AIR Central Air: No Fireplaces: 0 Rooms: 5 Bedrooms: 2 Full Baths: 1 Half Baths: 0 Valuation: Appraised Land: $106,000.00 Appraised Bldg: $54,100.00 Appraised Total: $160,100.00 Descriptor/Area 29 A:1Fr/B 705 sqft B:OFP 4 180 sqft 15 5 C C:OFP 20 sqft 30 1 Fr/B 8 6 5 6 99 16 15 15 BFP 6 Q Out-Buildings: Code: Description: Units: Year Built: Sizel: Size2: Area: Grade: Condition: RG1 1 1925 1 294 294 C AVERAGE(Res) The information delivered through this on-line database is provided in the spirit of open access to government information and is intended as an enhanced service and convenience for citizens of Northampton,MA. The providers of this database:Tyler CLT,Big Room Studios,and Northampton,MA assume no liability for any error or omission in the information provided here. Comments regarding this service should be directed to:jsarafin@northamptonassessor.us Thu. December 2,2021 :04:53 PM :0.05s: 10mbig00IR1 STUDIOS