32C-349 (6) BP-2022-0456
71 PLEASANT ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
32C-349-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2022-0456 PERMISSIONIS HEREBY GRANTED TO:
Project# REPAIRS Contractor: License:
LIBERTY GENERAL CONTRACTING
Est. Cost: 28000 INC 055839
Const.Class: Exp.Date:08/08/2022
Use Group: Owner: TRUSTEE CHAMPAGNE GARY R
Lot Size (sq.ft.)
Zoning: CB Applicant: LIBERTY GENERAL CONTRACTING INC
Applicant Address Phone: Insurance:
9B WEMELCO WAY 4132035924 WMZ8005710012022
EASTHAMPTON, MA 01027
ISSUED ON:04/28/2022
TO PERFORM THE FOLLOWING WORK:
REMOVE DEBRIS AND PARTITION WALL
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fees Paid: $196.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
--1'' 1:
The Commonwealth of Massachusetts APR 2 8 2022
t Office of Public Safety and Inspections
f.j
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Two-Family Dwelgng:;; ;,
(This Section For Official Use Only)
Building Permit Number: 2.- ys'6j Date Applied: Building Official:
SECTION 1:LOCATION
11 PItAiSQr i St-- 00bOVIIIIMA 01Moo rno3SiW oa
No.and Street City 3�9 Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 1rNe Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No UK'
Is an Independent Structural Engineering Peer Review required? Yes 0 No le
Brief Description of Proposed Work m( ��k1114 P AiS__Q ON __I
(d • C . , 1. , • ► . . / . 1 , - YAnM 1 •
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) r '
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable) /
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business CAI' E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1❑ I-2❑ I-3❑ I-4❑ _ M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4❑
S: Storage S-1❑ S-2❑ U: Utility 0 Special Use 0 and please describe below: _
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB ❑ j IIIA ❑ IIIB ❑ IV 0 VA 0 VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information Sewage Disposal: Trench Permit Debris Removal:
Public CICheck if outside Flood Zone 0 Indicate municipal 0 A trench will not be Licensed Disposal Site 0
Private 0 or indentify Zone: or on site system Elrequired 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Po eoi, 251 S 14ol l o 04(
Name P 'nt) No.and Streety/To)n Zip
Property Owner Contact Information:
t NA12__ -___g-I f% q 3 b57 u to 74 a sill , v►ctuQusbi o_
Title Telephone No.(business) Telephone No. (cell) e- ail address f C C
If applicable,the property owner hereby authorizes:
S1 0 o►C) 1
a Street Address Ci /Town State Zip
to apply for a act on the prop owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
•
Inc Company Nam
—tom ociaa.. 136 VW s CS—055931
Name of Person Responsible for Construction License No. and Type if Applicable
1% 1 IC.(10I1% S. i-lticil rth - D1D7S"
Street Address City/To wt) State Zip
413 7o3 5424 Li 13-9fo(-q 1 Loo -eoeilvve -zyclerA l -i-t e i ..cowl
Telephone No.(business) Telephone No.(cell) e-m re
.1�
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents 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.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor �`
and Materials) Total Construction Cost(from Item 6)=$ lA)
1.Building $ 20)us — Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)=$ .
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical (Other) $ Enclose check payable to IRIP.db
6.Total Cost $ )6 o I (contact municipality)and write check number here / 770
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
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.
) — Alt 1 _e -614 (iis _013_ 51 Vi_____VW
Ple a rint an sign name + Title Telephone No. at
El tA4444 t iiiktli., .i't J'Y1t --Gt.
Street Address City/Town State Zip Email Address 9G
i
Municipal Inspector to fill out this section upon application approval: q ZS 24ZZ
Name Date
Commonwealth of Massachusetts
41''''‘''-.) Division of Profess onal Licensure
Board of BuildingR at oos and Standards
ions sr
YoV
� 6',„ •
THEODORE
tom .
x
11 THE KNO4,S .� .
SOUTH HADL Y g * gig
5V a"
Comm' or # `
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1
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The Commonwealth of Massachusetts
} = — 1, Department of Industrial Accidents
= 1 1 Congress Street, Suite 100
c��;�{,� 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 Please Print I.eeibly
Name (Business/Organization/Individual):Liberty General Contracting, Inc.
Address:9B Wemelco Way
City/State/Zip:Easthampton, MA 01027 Phone#:413-203-5924
Are you an employer?Check the appropriate box:
Type of project(required):
1.p✓ I am a employer with 6 employees(full and/or part-time).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
9. Q✓ Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10 D Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.❑We arc a corporation and its officers have exercised their right of exemption per MGL c. 14. Other I4e..4.0-) .,
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.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:AIM Mutual Insurance Company
Policy#or Self-ins.Lic.#:WMZ8005710012022A Expiration Date:04/15/2022
Job Site Address:71 Pleasant St City/State/Zip:Northampton, MA 01060
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under 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.
I do hereby certify under the pains and penalties of'perjury that the information provided above is true and correct.
Signature. e thAALLQ1k Date: 4 I I a
Phone#:413-2 -59
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111 , S 150A.
Address of the work: 1 ( e( 50,1-- -
The debris will be transported by: 60 Lp tv\Q1Y\ S4 • '4Ok1lbc, 0AA '4
610
The debris will be received by: I) p1(1)4._ Cl
Building permit number:
Name of Permit ApplicantQCQPNJAQ11 -SCa
2-e3,\za % geomAii
Date Signature of Permit Applica
City of Northampton
K;NmaR1
(' � ;a Massachusetts *�
41
s DEPARTMENT OF BUILDING INSPECTIONS 3 '
212 Main Street • Municipal Building �it° -.��
hda' Northampton, MA 01060
•
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:
Location of Facility: Lp 'DU? i`n �t ) -k-A6,`\(- } 1( A °I Q� U
The debris will be transported by:
Name of Hauler: O 01/4L'4e- 6t'AeAAK,0
Signature of Applicant. () ).i\ Date: Li k2—
1
I
Reliable Results Plus, LLC u,
A.O.Box 163,Three Rivers,MA 01080
Phone: (413)324-6594 Fax: (413)283-8090
Email: ReliableResultsPluslt.CeGmaiLcom -_--
Thursday, March 31, 2022
Customer: Gary Champagne
Re: Pre Demolition Asbestos Survey
71 Pleasant Street
Northampton, MA
In response to your request, Reliable Results Plus, LLC obtained samples at the above mentioned address, for
asbestos analysis. The samples were collected on 03/22/2022 by Massachusetts Licensed Inspector, Marie
Teixeira (Lic. #A1900801).
In accordance with federal and state asbestos regulations, asbestos-containing materials (ACM'S) are required
to be identified and removed prior to demolition or renovation activities.
Building Description
This structure was used in the past as a restaurant and is located in the Central Business District of
Northampton. It is approximately 1,665 square feet. The structure is empty of most furnishings, with the
exception of heavy kitchen machinery (i.e. ovens, walk in refrigerators). Interior building materials include but
are not limited to: plaster, brick, tar paper, textured surface, adhesive, flooring, floor tile, and grout. (Exterior
was not sampled.)
Asbestos Sampling/Results
Twenty-five (25) samples of suspect asbestos-containing materials (ACM'S) were collected and submitted to an
accredited laboratory for analysis using Polarized Light Microscopy.
The following materials were found to be Asbestos Containing Materials (ACM's):
Field ID Material Location Color Non-Asbestos% Asbestos% Quantification
(Approximate)
2022-013-007 Floor Tile Entrance area 2nd layer under Multi Non-fibrous 60% Chrysotile 40% 665 square feet
black tile (browns)
2022-013-011 Flooring Kitchen floor 2nd layer Red Non-fibrous 70% Chrysotile 30% 450 square feet
2022-013-012 Floor tile Kitchen floor 3rd layer Gray Non-fibrous 98% Chrysotile 2% 450 square feet
(checkered)
2022-013-013 Floor tile Kitchen floor 3rd layer Multi Non-fibrous 98% Chrysotile 2% 450 square feet
(checkered)
2022-013-015 Floor tile Kitchen floor 4th layer Gray Non-fibrous 98% Chrysotile 2% 450 square feet
2022-013-016 Floor tile Kitchen floor 5th layer Brown Non-fibrous 98% Chrysotile 2% 450 square feet
2022-013-017 Floor tile Kitchen floor 6uh layer bottom Black Non-fibrous 97% Chrysotile 3% 450 square feet
2022-013-022 Floor tile Storage room Multi Non-fibrous 98% Chrysolite 2% 225 square feet
(white
with
flecks of
color)
The following materials were sampled and determined NOT to be asbestos-containing materials (less than 1%
asbestos):
Fieldw I Material r Location J Color I Non-Asbestos% J Asbestos%
2022-013-001 Plaster Ceilings walls throughout Gray Non-fibrous 1 0 0% N/D
2022-013-002 Ceiling tile Debris throughout Gray Mineral wool 30% N/D
Cellulose 30%
Non-fibrous 40%
2022-013-Q03 Adhesive Walk in cooler Yellow Non-fibrous 1 00% N/D
2022-013-004 Adhesive Walk in cooler yellow Non-fibrous 100% N/D
2022-013-005 Flooring Front entrance room Gray Non-fibrous 100% N/D
2022-013-006 Floor tile Front entrance room Black Non-fibrous 100% N/D
2022-013-008 Grout Associated with black Black Non-fibrous 100% N/D
floor tile
2022-013-009 Floor tile Kitchen layer I top Black Non-fibrous 100% N/D
2022-013-010 Adhesive Associated with Floor tile Yellow Non-fibrous 100% N/D
2922-013-014 Adhesive Associated with sample Black Non-fibrous 100% N/D
13
2022-013-018 Paper Kitchen floor: Under layer black Non-fibrous 100% N/D
6
2022-013-Q19 Brick Oven Gray Non-fibrous 100% N/D
^2022-013-020 Floor tile(checkered) Storage floor Gray Non-fibrous 100Yo N/D
2022-013-021 Floor tile(checkered) Storage floor White Non-fibrous 100% N/D
2022-013-023 Plaster Ceilings/walls Gray Non-fibrous 1o0% N/D
2022-013-024 Textured Surface Upper Storage white Non-fibrous 100% N/D
2022-013-025 Floor tile Bathroom white Non-fibrous 100% N/D
**Please refer to Attachment No.1 for asbestos laboratory results.
Limitations
This source is not intended to serve as a bidding document nor as a project specification and actual site
conditions and quantities should be field verified.
Conclusions/Recommendations
Asbestos containing materials (ACM's) were identified during Reliable Results Plus, LLC's inspection.
Identified ACM's should be removed, handled, and disposed, in accordance with applicable state and
federal regulations by a state licensed asbestos abatement company. If you have any questions regarding
the sampling and survey techniques used, please contact us.
Sincerely,
Marie Teixeira
Reliable Results Plus, LLC
Al IACHMENT NO.1
Laboratory Results/PLM Asbestos
s• Asbestos identification Laboratory.
0 165 New Boston St., Ste 227 MWL),#
cr Woburn,MA 01801
781-932-9600 Testing
Web:www.asbestosidentificationlab.cam Email: Lab Code: 2 0 0 919-0
` mikemanning@asbestosidentiftcationlab.com
�cx CAt� � Batch: 77394
Marie Teixeira Project Information Method:BULK PLM ANAL YSIS,
Reliable Results Plus,LLC #2022-013 EPA/600/R-93/116
PO Box 163
Three Rivers,MA 01080 71 Pleasant St.,
Northampton,
MA
Dear Marie Teixeira,
Asbestos Identification Laboratory has completed the analysis of the samples from your office for the above referenced project.
The Analysis Method is BULK PLM ANALYSIS, EPA/600/R-93/116The information and analysis contained in this report have
been generated using the EPA/600/R-93/116 Method for the Determination of Asbestos in Bulk Building Materials. Materials or
products that contain more than 1% of any kind or combination of asbestos are considered an asbestos containing building
material as determined by the EPA. This Polarized Light Microscope (PLM) technique may be performed either by visual
estimation or point counting. Point counting provides a determination of the area percentage of asbestos in a sample. If the
asbestos is estimated to be less than 10%by visual estimation of friable material,the determination may be repeated using the
point counting technique. The results of the point counting supersede visual PLM results. Results in this report only relate to
the items tested. This report may not be used by the customer to claim product endorsement by NVLAP or any other U.S.
Government Agency.
Laboratory results represent the analysis of samples as submitted by the customer. Information regarding sample location,
description, area, volume,etc., was provided by the customer.Asbestos Identification Laboratory is not responsible for sample
collection activities or analytical method limitations. Unless notified in writing to return samples, Asbestos Identification
Laboratory discards customer samples after 30 days. Samples containing subsamples or layers will be analyzed separately
when applicable. Reports are kept at Asbestos Identification Laboratory for three years. This report shall not be reproduced,
except in full, without the written consent of Asbestos Identification Laboratory.
• NVLAP Lab Code:200919-0
• Massachusetts Certification License:AA000208
• State of Connecticut,Department of Public Health Approved Environmental Laboratory Registration Number:PH-0142
• State of Maine,Department of Environmental Protection Asbestos Analytical Laboratory License Number:LB-0078(Bulk)LA-0087(Air)
• State of Rhode Island and Providence Plantations.Department of Health Certification:AAL-121
• State of Vermont,Department of Health Environmental Health License AL934461
Thank you Marie Teixeira for your business.
Michael Manning
Owner/Director
Marie Teixeira Project Information Method:BULK PLM ANALYSIS,
Reliable Results Plus,LLC #2022-013 EPA/B00/R-93/1 18
PO Box 163
Three Rivers,MA 01080 71 Pleasant St.,
Northampton,
MA
FieldID Material Location Color Non-Asbestos % Asbestos%
LabID
2022-013-001 Plaster Ceiling and Walls gray Non-Fibrous 100 None Detected
858018
2022-013-002 Ceiling Tile Debris Throughout gray Mineral Wool 30 None Detected
Cellulose 30
858019 Non-Fibrous 40
2022-013-003 Adhesive Walk-in Cooler yellow Non-Fibrous 100 None Detected
858020
2022-013-004 Adhesive Walk-in Cooler on Foam yellow Non-Fibrous 100 None Detected
858021.
2022-013-005 Flooring Front Entrance gray Non—Fibrous 100 None Detected
858022
2022-013-006 Floor Tile Front Entrance Room black Non—Fibrous 100 None Detected
858023
2022-013-007 Flooring Under Black Tile multi Non-Fibrous 60 Detected
Chrysotile 40
858024
2022-013-008 Grout Associated with Black Floor black Non-Fibrous 100 None Detected
Tile
856025
2022-013-009 Floor Tile Kitchen Layer 1 Top black Non—Fibrous 100 None Detected
858026
2022-013-010 Adhesive Associated with Floor Tile yellow Non-Fibrous 100 None Detected
858c27
2022-013-011 Flooring Layer 2 Under Floor Tile red Non-Fibrous 70 Detected
Chrysotile 30
858028
2022-013-012 Floor Tile Layer 3 Under Red Flooring gray Non-Fibrous 98 Detected
Checkered Chrysotile 2
858029
2022-013-013 Floor Tile Layer 3 Under Floor Tile multi Non-Fibrous 98 Detected
Checkered Chrysotile 2
858030
2022-013-014 Adhesive Associated with#14 Floor black Non-Fibrous 100 None Detected
Tile
858031
2022-013-015 Floor Tile Layer 4 Kitchen Floor gray Non-Fibrous 98 Detected
Chrysotile 2
958032
2022-013-016 Floor Tile Kitchen Floor Layer 5 brown Non-Fibrous 98 Detected
Chrysotile 2
858033
Sampled: March 22,2022 Received: March 30,2022 Analyzed: March 30,2022
Thursday 31 March
Made Teixeira Project Information Method:BULK PLM ANALYSIS.
Reliable Results Plus,LLC #2022-013 EPAI600/R-93/116
PO Box 163
Three Rivers,MA 01080 71 Pleasant St.,
Northampton,
MA
FieldiD Material Location Color Non-Asbestos % Asbestos%
LabID
2022-013-017 Floor Tile Layer 6 Kitchen Floor Bottom Layer black Non-Fibrous 97 Detected
Chrysotile 3
858034
2022-013-018 Paper Associated with Black black Non-Fibrous 100 None Detected
Layer 6
858035
2022-013-019 Brick Oven gray Non-Fibrous 100 None Detected
858036
2022-013-020 Floor Tile Checkered Storage Floor gray Non-Fibrous 100 None Detected
858037
2022-013-021 Floor Tile Checkered Storage Floor white Non-Fibrous 100 None Detected
858038
2022-013-022 Floor Tile Storage Room multi Non-Fibrous 98 Detected
Chzysotile 2
858039
2022-013-023 Plaster CeilingNValls gray Non-Fibrous 100 None Detected
858040
2022-013-024 Textured Surface Upper Storage Room white Non-Fibrous 100 None Detected
858041
2022-013-025 Floor Tile Bathroom Floor white Non-Fibrous 100 None Detected
858042
Sampled: ��iiMarch 22,2022 Received: March 30,2022 Analyzed: March 30,2022
Thursday 31 March 2372/...''
CHAIN OF CUSTODY Page 1 of 6,
Client Reliable Results Plus LLC EPA/600/R-93/116 Turnaround Time Sample Method
Address: P n Box 163 Three Rivers MA 01080 Asbestos Identification Lab JLess 3 Hrs Lipulk
Project Site a#:71 Pleasant St, Northampton, MA 165 New Boston St. , s =Same Day =Soa
2022-013 Suite 227 0
/email address: t� ° 111 Next Day =Wipe
413-324-6594/ReiiabieResultsPlusLLC _
mail.com Woburn, MA 01801 F t ti
(7$1 j332-9600 ,rl ' ,a Two Day =Point Count
Contact: Marie Teixeira '<^s``
www,asbestosidentificationlab.com Stop on 1st Positive? 'fe,/No
Relinquish by/date: Marie Teixeira 3/29/2022 Date Sampled: 3/22/2022 Notify Method: Msil/E-Mail/V I
Received by/date: ll)'! (2,c/2„ Anayzed By: j.)f 1 ' 0
BATCH#f � -T rev oer+e "' _7 Z �
#of Samples Received: Date:
Temp in Celsius= 7_--3 Stereo Scope Optical Properties RI Non-Asbestos Percentage(%)
c
o O Field ID/ °
xi CD
(Client a ar a,
L" 2 Reference) a rn a c E
,—
CO Material I Location a c o o e •w o, -o m y d u 2
u N iT c, w ill o w c_ Q .01
,
C `o s x Asbestos .� e• .e c t a a a) 2 11 ,- E' c
v , ii , Lt. Minerals a 2 , tat in ca 0.a II -1-- w 0, s Q 2°,
to 2022-013-001 Material Gray Chrysolte
--� Plaster Amosite
JCrocidoitte
Location t Tremoiite
ceiling and walls Anthophytlite _ e
00 Actlnolile
4
2022-013-002 Material Gray Chrysolite
(3.-` Ceiling the s--, Agnostic 7
12,
L% � Crocidoilte
Location Q ~! '-' Tremobte
Debris throughout Anthaphyllite - G j� t"t CI
Aclinolite
2022-013-003 Material Yeqow Chrysolte
CIS Adhesive Amosite
1410001 ki Crocidolite
Location C l ki Tremolite
walk in cooler Anthophyllite hi C)
Actinoilte
Page 2 of efl ,
Temp in Celcius= Stereo Scope _ Optical Properties RI Non-Asbestos Percentage(%)
`o
esQ O Field ID/ u, o 0
h (n .a"
°ca (Client c U No
U)
a Reference) Material I Location ma04 o a c w o,
- o a, o w u o
`II N o N e CL m
o E ° r o o, O
i o Asbestos l ° c d o a 00 c c IQ U z � ;` Minerals s _ 0 w 0 n a I _L 2 i U
L.
s rn O z°
2022-013-004 Material yellow Chrysolite
Adhesive r, Amosite
� J Crocktorite
Location �C !— Tremolite
walk in cooler on foam Anthophyhite /c)
Actlnolite
2022-013-005 Material gray Chrysotile
C ) Flooring Amosite ,
(-6 Crocidoitte
Location i r Y t : Tremolite
entrance ttl Anthophylliie IC)
Acttnolite
r 2022-013-008 Material black Chrysotile
C--" Floor tile Amosite
0 I, ,Crocidotite
Location t'-- ''Tremohte - _ - — '
front entrance room Anthophyllite /0 C
Actlnolite
-(_2022-013-007 Material Multi Chrysotite '-t,irY-1. ) V - - L,.. )J iff7 Oft
-1-" Flooring (-7 Amosite
� Crocktottte
/
Location U � J t Tremohte
under black tile --p— Anthophylhie 66
Actlnolite
2022-013-008 Material black Chrysolite
6 Grout Amosite _ -
'NIn .1 Crocidofite
Location 0 r Tremolite
Associate with black floor tile Anthophylfile i� 0
Actlnolite
Page 3 of W
Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%)
a o
O Field ID/ H .a m
h (Client y m to m o c E to ao m
- Reference) Material/Location 0 c o 0 o w `g 'o 0 o w 2
io n CA t 0 N O '� .- c
o = a) .c c) o •c V m w d = � ii
o g ., Asbestos c ..F. o� ` o a+ 5. b. m
c .c
G Ti 0 Gxi C ti) K m II ar To A +� O
o° . U x r w Minerals eZ n w - in m ; a 'u. g 0 x. co 4_ z
2022-013-009 Material Black Chrysotile ._ '-.-" 1._- (v4'l;? "�`
c Floor the C:7. Amosite ,
N (3 Crocidolite
Location y Tremotite _
Kitchen layer 1 top Anthophyltte t
Actinotite
2022-013-010 Material Yeaow Chrysolite
Adhesive � Amosite ,
/ 1 Crocidclite
Location O t /"` Tremotite
Associated with floor tile Anthophyllite /CA
Actinotite
2022-013 all Material 'Zet� Chrysotile c '�y�; t' --* { N.)i-7r'7 j.ff,-'
C t. Flooring layer 2 /9 Amosite
Croddotite
Location }C1 / I Tremolite
under Floor tile j= Ant ophytCte 70
Actinotite
2022-013-012 Material gray Chrysolite � t,,,U P -b-; (_ _ CU, rii7+14{_,
Floor tile layer 3 checkered Amosite
P ) Croadolite
Location Li ,NJ Tremotite
under red flooring Anthophyltite rig
Actinotite
_ 2022-013-013 Material Multi Chrysolite I...- t J 24 (7 ~f (�„_IQ 1.�'7),4-
Floor tile layer 3 checkered (ice 3 Amosite
N., Crocidotte
Location �� Tremotite - _ f"
under floor tile Anthophyltite '3
Actinotite
•
Page of___II___
Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%)
o
o ro
t3 Field ID! o Q, co
co (Client w ,4"'". to rn o c o =
A Material I Location 0 C O o C d N m o
Reference) c o Ti rn o
m to m ro a) Qc o C L (5 o a
d 0 • 3 f y u
0 0 E x @ Asbestos -Q °- ;c i o a c - c ,c c
v 43 s° t� it Minerals Q 2 to in m n. II -4- ti g U = N O Z
•2022-013-014 Material Blact4 Chrysotile
} Adhesive Amosife
U 'Ni (. Crocidolite ,
Location !! Tremolite
associated with#14 Floor tile Anthophyllite I6C
Actinolile
2022-013-015 Material Gray Chrysotile 7_,.
( I`-�f, S7 5 "(--
Floor tile layer layer 4 `f, Amostfe
N} )} Crocidolite
Location i Tremolite '.
kitchen floor
Anthophylltie
Actinolite
2022-013-016 Material brawn Chrysolite _ I,---LA} (l t- L._ NJ ),c7 g f'4--
Floor tile ( Amosife
('4 } wr } Crocidolite
Location +`-' hematite
kitchen floor layer 5 Anthophyllite
Actinolite
2022-013-017 Material B, Chrysolite f /? -Black `; 1'
Floor tile layer 6 p_Th Amosife
Crocidolite
Location J Ni �+ Tremolite
Kitchen floor bottom iaye' Anthophyllite 9'7
Actinolite
2022-013-018 Material Chrysotile
paper C. 1 '
Amosite
Location
�-'� �i !/v Tremolitee
associated with black layer 6 Anthophyllitep+z:
Aclinolite
Page 5 of 6
Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%)
a
0
ILO Field ID/ a o
(Client ° Y 7, c' Ui E o a
n Reference) Material I Location n c 0 to o o w rn o H _'S d u
to a m m to 0 = 4+- C R a i0 a
E..y o E x R Asbestos . a �n 5 m o ry c c , c
4 0 = r Minerals Q go it , FS m a (I -1- ii g c°', = N O z°
_� 2022-013-019 Material gray Chrysolite
t,r.) Brick P Amosite
(`. Crocidolite _
Location • �,� Tremotite
oven Anthophyllite P-C_)
Actinotite
--i,_ 2022-013-020 Material gray Chrysottle
4( 0 Floor tile checkered ( , \Amosite
Croctdoiite
Location !✓ �� Tremotite
storage floor Anthophyllite
Act indite
2022-013-021 Material wm;te Chrysolite Y
floor tile checkered (4'1 Amosite
tiCrocidolite
Location 02 '4,,1 J r---`Tremotite
storage floor Anthophyllite ``''
Aotinoiite
2022-013-022 Material Mutt Chrysotite 2
P "t ), N 1-5`57l1So
Floor tile Amosite
-'-, `Crocddolite
Location l) '' ( Ni t Tremotite
storage room Anthophytlite ';? i<
Actinolite q S?
2022-013-023 Material Gray Chrysotite
plaster Amosite ..
( c !`-,Croddolite .
Location C.) I. hJ Tremotite
ceiling MallsAnthophytlite
Actinolite
Page 6 of 6
Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%)
o
a Field ID!
ci
o ° o
° o,
i (Client P >` c v
E o -
0
a a c o o mf o
s Reference) Material!Location a o c •
E� o wrn 5 w a) u 2
r W
co n ` co co C
.0
� Q a. o u lL o O C 1i
0 oE �m Asbestos o t5 y m a, a z am11
0 0 i } n ca, •iQ >. _ c
p d x r- w Minerals Q 2 , a(' en if, a II -- L Q , z co4
z
2022-013-024 Material white Chrysolite
Textured surface (�
AmositeN t ` croddokte
Location ! Tremoite
upper storage room Anthophyiltte PC j
Actinotite
2022M13 025 Material white Chrysotite
Amosite
floor tile Q''7
` ` Crocidofite
Location G� k) Tremoite _ `
bathroom floor Anthophyllite /CX=
Actinotite
Material Chrysolite
Amosite
CrocidoUte
w
Location Tremoitte
Anthophytiite
Actinotite _
Material Chrysolite
Amosite
Croddoiite _
Location Tremoitte
Anthophytiite
Actinotite
Material Chrysolite r
Amosite
Crocidotite - -
Location Tremoitte
Anihophyitite
Actinotite _
Attachment No. 2
Floor Plan
•
f'
i
d
}
Storage room i
i
- heating
Bathroom4
i
I
f
{
{
#1 I.44 ,
i
.1111010 Waik-in 5
#440. '
i
• #1#1 I 0 I OS. '.
71 Pleasant St
A4***
41004144411411,111111
Northampton, MA i
4 '
, . ,‘,.. ,,,„..- <,;,,,,,, 1
Entrance area 1111
I
• !
1
STREET I