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31C-013 (6) DIG SAFE SYSTEM, INC. - Renew Existing Ticket Pagc I o i' i Request Number: 20144106485 Date 10/08/2014 Time 07:28 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address/Intersection: 69 PARADISE RD Nearest Cross Street 1: DRYADS GREEN ST Nearest Cross Street 2: Additional Information: Nature Of Work: DEMOLITION OF BUILDING Area Of Work: STREET TO BUILDING Area Is Premarked: Y Start Date: 10/14/2014 Start Time: 09:00 Caller: MICHAEL Title: Return Call: Phone#: 413-732-3179 Fax#: Alt.Phone#: Email Address: Contractor:ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY STREET City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviation Name AJ COMCAS COMCAST-SOUTH BURLINGTON MC NGRDEL NATIONAL GRID ELECTRIC-MASS ELEC ON ONTARG ON TARGET LOCATING RJ IDM INNOVATIVE DATA MANAGEMENT SP VERIZN VERIZON WG CMAGAS COLUMBIA GAS OF MASSACHUSETTS • There may be non-member utilities in the area that you need to notify. • Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. • The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. Renew Another Ticket Print Ticket Return To Menu Return To Home lttp://digsafefonn.digsafe.com/cgi-bin/dwcgi.exe 10/08/2014 DIG SAFE SYSTEM, INC. - Renew Existing Ticket Page I ol' I Request Number: 20144510056 Date 11/07/2014 Time 07:02 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address/Intersection: 69 PARADISE RD Nearest Cross Street 1: DRYADS GREEN ST Nearest Cross Street 2: Additional Information: Nature Of Work: DEMOLITION OF BUILDING Area Of Work: STREET TO BUILDING Area Is Premarked: Y Start Date: 11/14/2014 Start Time: 09:00 Caller: MICHAEL Title: Return Call: Phone#:413-732-3179 Fax#: Alt.Phone#: Email Address: Contractor: ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY STREET City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviation Name AJ COMCAS COMCAST-SOUTH BURLINGTON MC NGRDEL NATIONAL GRID ELECTRIC-MASS ELEC FoN ONTARG ON TARGET LOCATING RJ IDM INNOVATIVE DATA MANAGEMENT SP VERIZN VERIZON WG CMAGAS COLUMBIA GAS OF MASSACHUSETTS • There may be non-member utilities in the area that you need to notify. • Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. • The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. Renew Another Ticket Print Ticket Return To Menu Return To Home http://digsafeform.digsafe.com/cgi-bin/dwcgi.exe 11/07 1/2 0 14 Massachusetts Department of Environmental Protection . Bureau of Waste Prevention • Air Quality ,TM BWP AQ 06 'k Notification Prior to Construction or Demolition • This is a revision to an existing form. Project ID for existing form to be revised: • This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: • This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: � R None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: DEMOCOORD Transaction ID: 682804 Document: AQ 06-Construction/Demolition Notification Size of File: 218.61K Status of Transaction: In Process Date and Time Created: 9/512014:6:59:45 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 ,._•--,.' Bureau of Waste Prevention•Air Quality BWP AQ 06 1oo206807 _ -- Notification Prior to Construction or Demolition Asbestos Project Number it C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this UNAVAILABLE address is: This project r- Construction F Demolition is: 9/19/2014 12/31/2014 Project Start Date(MM/DD/YYYY) Project End Date(MM/DD/YYYY) 8. For demolition and construction projects, indicate dust suppression techniques to be used r` Seeding ry Wetting f— Covering r— Paving Shrouding r Other-Specify: 9.For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? N/A Name of MassDEP Official N/A Title 9/5/2014 N/A Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally ANDREWMIRKIN examined the foregoing and am Print Name familiar with the information ANDREWMIRKIN contained in this document and Authorized Signature all attachments and that,based PRESIDENT on my inquiry of those individuals immediately ASSOCIATED BUILDING WRECKERS responsible for obtaining the A information, I believe that the Representing information is true,accurate,and 9/5/2014 complete. I am aware that there Date(MM/DD/YYYY) are significant penalties for UNKNOWN submitting false information, including possible fines and P.E.# imprisonment.The undersigned hereby states, under the penalties of perjury,that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised:03/17/2014 Page 3 ot'3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 110020 Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3.General Contractor: ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET Name Address SPRINGFIELD MA 011050000 4137323179 City/Town State Zip Code Telephone ANDREWMIRKIN 4137323179 General Contractor's On-site Manager/Foreman Telephone C. General Construction or Demolition Description General 1.Construction or demolition contractor: Statement:If asbestos is found ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET during a Construction Contractor Name Address or Demolition operation,all SPRINGFIELD MA 011050000 4137323179 responsible parties City/Town State Zip Code Telephone must comply with 310 ANDREWMIRKIN 4137323179 CMR 7.00,7.09,7.15, and Chapter 21 E of Construction and Demolition On-site Manager Telephone the General Laws of the Commonwealth. 2. Licensed Contractor Supervisor: This would include, but would not bw ANDREWMIRKIN CS-062382 limited to,filing an asbestos removal Supervisor Name License Number notification with the Department and/or a 3.Is the entire facility to be demolished? r Yes F No notice of release/threat of 4. Describe the area(s)to be demolished: release of a hazardous DEMOLI11ON OF EN11RE STRUCTURE. substance to the Department,if applicable. 5.If this a construction project,describe the building(s)or addition(s)to be constructed: MassDEP Use Only Date Received 6. If this is a demolition or renovation project,were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? I✓ Yes F No 7. Was asbestos containing material(ACM)found? l✓ Yes No If yes,who conducted the survey? UNKNOWN ABATEMENT BY OTHERS Name Department of Labor Standards Certification Number Revised:03/17/2014 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality b BWP AQ 06 100206807 Notification Prior to Construction or Demolition Asbestos Project Number# A.Applicability A Construction or Demolition operation of an industrial,commercial, or institutional building,or residential building with 20 or more units is regulated by the Department of Environmental Protection(MassDEP), Bureau of Waste Prevention,Air Quality Division,under Regulations 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. Is this a fee exempt notification(city, town,district,municipal housing authority,state facility,owneroccupied residential property of four units or less)? Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? F Yes r No Type of Notification: (— Revision of an Existing Form (" Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# t All sections of this 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: form must be completed in order to Approval ID# comply with the B. General Project Description Department of p Environmental 1.Facility Information: Protection notification FORMER MEDICAL FACILITY 69 PARADISE ROAD requirements of 310 CMR 7.09. Name of facility Street Address NORTHAMPTON MA 010630000 4135852424 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of RICHARDKORZENIOWSKI FACILITIES Massachusetts Facility Contact Person Contact Person Title Asbestos Program 4135852424 DEMO @BUILDINGWRECKERS.COM P.O.Box 120087 Boston,MA Facility Contact Person Telephone Facility Contact Person Email 02112-0087 Facility Size: 20,000 4 Square Feet Number of Floors Was the facility built prior to 1980? F Yes F No Describe the current or prior use of the facility: VACANT MEDICAL FACILITY Is the facility a residential facility? F Yes F No If yes,how many units? 2.Facility Owner: SMITH COLLEGE 126 WEST STREET Facility Owner Name Address NORTHAMPTON MA 010630000 4135852424 City/Town State Zip Code Telephone RICHARD KORZENIOWSKI 126 WEST STREET On-Site Manager/Owner Representative Address Northampton MA 01063 4135852424 City/Town State Zip Code Telephone Revised:03/17/2014 Page 1 of 3 az raPnu arc Shaping the Future- CERTIFICATION OF VISUAL INSPECTION Client: Project Number: O KI o -to General Location: A rGn Abatement Contractor: Method of Abatement: Type and Quantity of Material Abated: 1/61 S S1�t�2Q �►P� X00 tr/ ,;�f /woe F Suspect Material Remaining in Work Area: el- k n -_er Specific Area Inspected:, l�L CERTIFICATION OF VISUAL INSPECTION in accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes, beams, ledges,walls, ceiling and floor,decontamination unit,sheet plastic,etc.) and has found no visible dust,debris or residue. By, (signature) Date: Print Name: ��� dr!�� / l�rig �i l' Print Title: Accreditation Number: State: ✓I/L_� I OWNERS REPRESENTATIVE CERTIFICATION i The Owner's Representative hereby certifies that he has accompanied to Contractor on his visual inspection and verifies that this inspection has been through and to the best of his knowledge and believes the Contractor certification abovq is a true and honest one. By:(signature) LL� Date: lCSf03 ! Print Name: Print Title: rj Accreditation Number: Iz State: Cardno ATC-73 William Franks Dr.-West Springfield,MA 01089 Phone +1413 7810070 m"v.cardno.com Fax +1 413 781 3734 www.cardnoatc.com ATC Shaping the Future CERTIFICATION OF VISUAL INSPECTION Client: Project Number: ©g/. l U�/��/fd 412 General Location: Abatement Contractor: I�t Method of Abatement: t. %,i,�Iy�t2vt Type and Quantity of Material Abated: SCl 46� eS-Ila/ Suspect Material Remaining in Work Area: n r7"-Z Specific Area Inspected: VVVWIA( CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area (all surfaces including pipes, beams, ledges,walls, ceiling and floor,decontamination unit heet plastic, etc.) and has found no visible dust,debris or residue. By:(signature) Date: ! i3 Print Name: L-e s Print Title: Accreditation Number:_ Soo State: OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied to Contractor on his visual inspection and verifies that this inspection has been through and to the best of his knowledge and believes the Contractor certification above is a true and honest one. By: (signature) J �Y Date: /d 3 Print Name: t� Print Title: Accreditation Number: ✓ �yL�/ State: �4&,) Cardno ATC-73 William Franks Dr:West Springfield,NIA 01089 Phone +1413 781 OD70 Nvmy.cardno.com Fax +1413 7813734 www.cardnoate.com 73 William Franks Drive West Springfield,MA,01089 ��� Tel: 493-781-0070 Fax: 413-781-3714 CF,W]E 'ICATION Or VISUAL INSPECTION 4 e CLIENT:_ 1 PROJECT NUMBER:.0 S — 1 C/�i 3 - I D q GENERAL LOCATION: l'iyr(�,2,'�?/�w`, ABATEMENT CONTRACTOR:W1/T{l METHOD OF ABATEMENT: -- TYPE AND QUANTITY OF MATERIAL ABATED: SUSPECT MATERIAL REMAINING IN WORK AREA:NGlly t SPECIFIC AREA INSPECTED:- A ILU, 9- R UCI F 5,-,�i `�� G !1.�J1=✓L CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes,beams,ledges, walls, ceiling and floor,decontamination unit,sheet plastic, equipment, etc.)and has found no (' visible dust, debris or residue. Supervisor(Signature): Date: /a (Print Name) Accreditation Number: /45-C, 0 Z/q,7) State:_ OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he as accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification above is and-honest one. Project Monitor(Signature): j L -r Date: 61- 1 (Print Name): G %,N Accreditation.Number: el--1 State: . t C77) ATC, Shaping the Future CERTIFICATION OF VISUAL INSPECTION Client: C8 Project Number: 4! Z X D General Location: /!'IfJSD.y S,�/.'hAm Y Abatement Contractor: ��+tA �RWj � Method of Abatement: �'vl Z Ce.J �A/Ni+�1�rt! RAE n�oVA L Type and Quantity of Material Abated: QL '3,*% j!r�' 6f l� a);Z&W5-2d4k C+E.mA)t Suspect Material Remaining in Work Area: NA Specific Area Inspected: W10Rt��r9� oo �'n��A7•�/�'1,6�1 CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area (all surfaces including pipes, beams, ledges, walls, ceiling and floor,decontamination unit,sheet plastic,etc.)and has found no visible dust, debris or residue. By: (signature) .a 0 Date: /O i Print Name: Print Title: Accreditation Number: WJ-49021(t.s State:�kt1 Z OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification above is a true and honest one. By: (signature) !2yu"� Date: Print Name: Print Title: P130114C+ AVN408 Accreditation Number: //"D70"��lO _ State: Cardno ATC-73 William Franks Dr.-West Springfield,MA 01089 Phone +1413 7810070 www.cardno.com Fax +1413 7813734 www.cardnoatc.com ATC Shaping the Future CERTIFICATION OF VISUAL INSPECTION Client: Project Number: bgl- /03$;/093 _ General Location: Abaterent Contractor: V Method of Abatement: t-s . Type and Quantity of Material Abated: J Suspect Material Remaining in Work Area: pWvl ,.,pp n Specific Area Inspected: � A�"� 14- rt.X. CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area (all surfaces including pipes,beams, ledges,walls, ceiling and floor,decontamination unit,sheet plastic,etc.)and has found no visible dust, debris or residue. By: (signature) — d Date: !o _/_14(v i Print Name:� �/ r��sto _ Print Title: S✓,gip rvN.,S 6r Accreditation Number: Apo l�f�� State: GL4�44 OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification above is a true and honest one. By: (signature)_� 1 Date: Print Name: Slzoe �l lA5' i ` Print Title: PRO' lo+ 'v `p,N1+0R Accreditation Number: AM6,)C)JAJ() State: Cardno ATC-73 William Franks Dr.-West Springfield,MA 01089 Phone +1 413 7810070 wvrw.cardno.corn Fax +1413 7813734 www.cardnoatc.com Caartina 73 William Franks Drive West Springfield,MA,01089 Tel: 413-781-0070 /ETC Fax: 413-781-3714 f ( .CERTM( ATION Ol+VISUAL)NSP+CTION -— CLIENT:. - ----- PROJECT NUMBER: Ob 1 0 3 GENERAL LOCATION:_M A(/n/ A ABATEIv1ENTCONTRACTOR: UNP(C'0 _ METHOD OF ABATEMENT: G m GV& Ls/a ,C z r-&LL CGn/J,m' ''I_L-0) TYPE AND QUANTITY OF MATERIAL ABATED: ti 0 5 P O-{,�J't Ld C C- /'n r�- SUSPECT MATERIAL REMAINING IN WORD AREA: G iL SPECIFIC AREA INSPECTED: r'pGi R(,o-t �;v✓IJ`�ANG� I S1C/ f /�Sl �r"I QF�vCC' CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes,beams,ledges, walls, ceiling and floor,decontamination unit, sheet plastic, equipment, etc.)and has found no (' visible dust, debris or residue. f " Supezvisor(Signature): Date: _ (Print Name): Accreditation Number:h, ('a z(N' State: OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he as accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification above is.true an honest one. Project Monitor(Signature,):.Y�'J Date: (Print Name):V mv&7 m pni m0. Accreditation Number:A M 0 f'y7�� Stater l_ 73 William Franks Drive West Springfield,MA,01059 Tel: 413-761-0070 A C - Fax: 413-761-37 4 CERTIFICATION OF VISUAL INSPECTION _. CLIENT: r1 — T - -- PROJECT NUMBER: � � � R / GENERAL LOCATION:1✓I/�SC/'N Xly F E2 �P��7 ABATEMENT CONTRACTOR: 11,VX fL- / {� METHOD OR ABATEMENT:•.C(-u-y/9G W r-,V l- - TYPE AND QUANTITY OF MATERIAL ABATED: f -� ��Ci G U C SUSPECT MATERIAL REMAINING IN WORK AREA: N'PM C� nn SPEClFIC AREA INSPECTED:51 Rc&2 Qwm to 4- AA14SG S CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes,beams,ledges, walls, ceiling and floor,decontamination unit, sheq plastic,equipment, etc.)and has found no (' visible dust, debris or residue. Supervisor(Signature): Date: V' (Print Name): 1p&'5 IUV�°O Accreditation Number:�5 (JV y State: !q OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he as accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification above i e d nest one. Project Monitor(Signature): J Date: to! ( � (Print Name):0 'mok F/v"/�_ Accreditation Number:•0117-6�f State:A iq k 73 William Franks Drive West Springfield, MA,01089 �T� Tel: 413-781-0070 Fax: 413-781-3714 1 CERTM(` ATJON OF VISUAL NSPECTION CLIENT: - r p PROJECT NUMBER:O I— 1 tV "! GENERAL LOCATION:/41 45P't/ ABATEMENT CONTRACTOR: V ffP TC METHOD OF ABATEMENT: n G M GU�L 4✓C I rF� (=y LL C G�1//�/�CN/'►G't'r TYPE AND QUANTITY OF MATERIAL ABATED: C C ��v�j5 � � T V FI q-M5M SUSPECT MATERIAL REMAINING IN WOP�x AREA:61,6, - SPECIFIC AREA INSPECTED: ,&- CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project any applicable regulations the Contractor hereby certifies that ha has visually inspected the work area(all surfaces including pipes, beams,ledges, walls, ceiling and floor,decontamination unit, sheet plastic,equipment, etc.)and has found no ( visible dust, debris or residue. Supervisor(Signature): r Ly Date: 1 (Print Name): zIZ4 w� �,S e� Accreditation Number: S We-7qJ State: OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he as accompanied the Contractor on his visual I inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certification Vabbove .true and honest one. Project M ): j Date: �V 1 ✓ I (Print Name): i/ /�'1�/!V%.M�i✓� Accreditation Number: } & State:,� ATC Shaping the Future CC CERTIFICATION OF VISUAL INSPECTION Client: C)(7Y1 L�'�1 �c Project Number: �i O Ff 3 0 General Location: 14-4 5 0-11 Abatement Contractor: 1 00� ✓ff�1' Method of Abatement: [ f P�+vJ Type and Quantity of Material Abated: eQ �G Suspect Material Remainin in Work Area: 61,Q , Specific Area Inspected: CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area (all surfaces including pipes, beams, ledges, walls, ceiling and floor,decontamination u it, et plastic,etc.)and has found no visible dust, debris or residue. By:(signature) /. -.._._��_._ Date: /Z"'ZZ Print Print Title: e�!//Sale Accreditation Number: State: /r-Li OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied to Contractor on his visual inspection and verifies that this inspection has been through and to the best of his knowledge and believes the Contractor C ification above is a true and honest one. By:(signature) � �'( �Z-. Date: Print Name: Print Title: � f c — Accreditation Number: 'AhAnr Ica' State: Cardno ATC-73 William Franks Dr.-West Springfield,MA 01089 Phone +1413 7810070 mwi.cardno.com Fax +14137813734 www.cardnoatc.com Car�n�� ATC Shaping the Future /- CERTIFICATION OF VISUAL INSPECTION Client: 6D e q-C Project Number: 6 General Location: , e (K6el 1 G-tm 4 47_J)4 y»Qv/ Abatement Contractor: V61 Q.✓i r A J Method of Abatement: .cv- Put I ti eNM Q� ty Type and Quantity of Material Abated:___4� a� Qa� Suspect Material Remaining in Work Area:A/012 tit a J // Specific Area Inspected: O�n ass- off' S ( e CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes, beams ledges, walls, ceiling and floor,decontamination flit heet plastic,etc.) and has found no visible dust, debris or residue. I By: (signature) Date: Z c I Print Name: AKA'c,kq? 4, 62 Print Title: Accreditation Number: d_'bQ ',n12 State: 1"44 - i I I OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied to Contractor on his Visual inspection and verifies that this inspection has been through and to the best of his knowledge and believes the Contra cto r cqrtif ication above is a true and honest one. By: (signature) Date: ate: p1.� Print Name: Print Title: f c `041 J� c Accreditation Number: 0�-� � State: Cardno ATC-73 William Franks Dr.-West Springfield,MA 01089 Phone +1 413 781 0070 www.Gardno.com Fax +14137813734 www.card noatc.corn avdn West William Franks Drive f Springfield, MA,01085 Tel: 413-781-0070 ATC Fax: 413-781-3734 CERTIFICATION OF VISUAL INSPECTION CLIENT: C' / c, PROJECT NUMBER: D 38, l d 13 GENERAL LOCATION: r e� 'a-rA J�e 0 if ABATEMENT CONTRACTOR: V ,,{{` tS I METHOD OF ABATEMENT: C%Yi t v►t I,� j TYPE AND QUAN'T'ITY OF MATERIAL ABATED: SUSPECT MATERIAL REMAINING IN WORK AREA: D 1 _ SPECIFIC AREA INSPECTED: Cl 1 nrt o eJ' �J (+ r �y 1 G CERTIFICATION OF VISUAL INSPECTION I In accordance with Specification for this project any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes, beams,ledges, walls, ceiling and floor,decontamination unit, sheet plastic, equipment, etc.) and has found no { visible dust, debris or residue. Supervisor(Signature): c --_ Date: � I (Print Name): -- Accreditation Number:— S� L�3 State: M/� I OWNER'S S REPRESENTATNE CERTIFICATION The Owner's Representative hereby certifies that he as accompanied the Contractor on his visual inspection and verifies that this inspection has been thorough and to the best of his knowledge and believes the Contractor certific n above is,true and honest one. 0 Project Monitor(Signature): Get Date: I (Print Name): (�l Accreditation Number: f I t�YJ 0 7 �o`�- State: =iavcft a ATC Shaping the Future CERTIFICATION OF VISUAL INSPECTION Client: i Project Number: General Location: /1�GtS�. .i •r i�'rs� Abatement Contractor: w Method of Abatement: /Vo Y1 2 Type and Quantity of Material Abated: /1VOK t- Suspect Material Remaining in Work Area: ,e/or,--c Specific Area Inspected: /J7' e-a� cr— — A arc s +o dlar-t a'�nt r' CERTIFICATION OF VISUAL INSPECTION In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes,beams, ledges,walls, ceiling and floor,decontamination unit,sheet plastic, etc.) and has found no visible dust, debris or residue. By: (signature) Date: Z Print Name: cif l4litr� /�. sir u D Print Title: Accreditation Number: /dS 0G 7/ tL3 State: OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied to Contractor on his visual inspection and verifies that this inspection has been through and to the best of his knowledge and believes the Contractor certification above is a true and honest one. By: (signature) / dZJ �� Date: Print Name: 40� GJal�acC Print Title: Alvo/e-A i's fi Accreditation Number: 41' 11001-17)f State: /"r-If Cardno ATC-73 William Franks Dr,-West Springfield,MA 01089 Phone +1413 7810070 mwi.cardno.com Fax +1 413 781 3734 mvwxardnoatc,com !� I ATV Shaping the Future CERTIFICATION OF VISUAL INSPECTION Client: _5 ,, L5" Project Number:— (991 10L/3 General Location: /LLmeml Abatement Contractor: Lin"' St r o ___-- Method of Abatement: Ko(tn�, Type and Quantity of Material Abated: S" 4 7T4ekx,( -5 Suspect Material Remaining in Work Area: Zlny dOSBf' Q Specific Area Inspected:-Sc tl? 4J+ - 7�� a�F�°�r s CERTIFICATION OF VISUAL INSPECTION i In accordance with Specification for this project and any applicable regulations the Contractor hereby certifies that he has visually inspected the work area(all surfaces including pipes, beams, ledges,walls, ceiling and floor,decontamination unit,sheet plastic,etc.) and has found no visible dust,debris or residue. By:(signature) Date: �7 Print Name: Print Title: Accreditation Number: o o ?_t`L,-� State: /Nt4 OWNER'S REPRESENTATIVE CERTIFICATION The Owner's Representative hereby certifies that he has accompanied to Contractor on his visual inspection and verifies that this inspection has been through and to the best of his knowledge and believes the Contractor certification above is a true and honest one. By:(signature) "#a Date: Print Name: ;6 "ll'p-l`aVif i Print Title: � 4T1j /IY9iewlJf Accreditation Number: /�In��y7 _ State: Cardno ATC-73 William Franks Dr:West Springfield,MA 01089 Phone +1413 7810070 wwty.cardno.com Fax +1413 7813734 www,cardnoate.com 2 Cardno Arc Shaping the Future Background air samples were collected during preparation, and before demolition activities made collecting background air samples impractical due to dusty conditions. As the abatement project progressed, Cardno ATC monitored the Contractor's work practices, generating site logs, as well as conducting visual inspections of each completed area before running Phase Contrast Microscopy (PCM) air clearances. A final visual inspection was performed by Cardno ATC and the asbestos abatement supervisor prior to the collection of final air clearance samples in each containment area. Final Air Clearances were conducted by a licensed monitor using Phase Contrast Microscopy (PCM)following state guidelines. Analysis was on site using the NIOSH 7400 Method, by the project monitor holding a valid NIOSH 582 or Equivalent Training Certificate. The Cardno ATC drawings and specifications for the project show the general locations of asbestos containing materials removed from the Infirmary during the building abatement phase of this project. Some concealed materials were discovered during the abatement/demolition process. These materials were sampled and analyzed by Polarized Light Microscopy (PLM). No asbestos was detected in the Infirmary building materials that were outside the original scope of work. No asbestos containing materials remain in the accessible areas of the facility that we inspected during the building abatement. Project closeout submittals including disposal documentation should be obtained from the contractor and maintained in the abatement files. Cardno ATC will submit additional documentation including specifications, plans, data and logs in the final report. If you should have any questions regarding this report, please feel free to contact our office at 413.781.0070. Thank you for selecting Cardno ATC to provided continued consulting services to Smith College Sincerely, Cardno ATC Michael Matilainen CIH, CSP Brian Williams Senior EH&S Consultant Branch Manager For Cardno ATC For Cardno ATC m icimei.Rlctl Ian ienCd�cc7-rdno.com Cni 10 S'u,i i f�1:, a)1 www.cardnoatc.com Cardno ATC Shaping the Future October 30, 2014 Mr. Richard J. Korzeniowski Cardno ATC Smith College 126 West Street 73 William Franks Dr. West Springfield,MA 01089 Northampton, MA 01063 Phone +1413 7810070 Fax +1413 7813734 RE: Asbestos Abatement Project Monitoring Documentation www.cardno.com Smith College Infirmary Building Cardno ATC Project No. 081.10438.1093 www.cardnoatc.com Dear Mr. Korzeniowski: Enclosed please find the project documentation for the asbestos abatement project limited to the Smith College Infirmary Building. All final air samples collected during abatement activities were less than 0.010 fibers per cubic centimeter, which is below acceptable levels established by regulations. Based on the visual inspection and the air sample results, it is Cardno ATC's opinion that the asbestos abatement action is considered complete in each of the inspected abatement areas. The following Massachusetts Licensed Asbestos Project Monitors and Inspectors performed the monitoring of the project on August 27, 2014 to October 22, 2014: • Steve Dolinski AM070770, A1070449 • Douglas Montminy AM073146, A1073730 • Rob Wallace AM900474, A1900529 • David Heelon AM073572, A1000145 • Lee Musante AM900479 The asbestos abatement was performed by United Service of 18 Canal Street, Holyoke (a Massachusetts licensed asbestos abatement contractor, AC0007729) in general accordance with the Cardno ATC Asbestos Abatement Project Manual. Cardno ATC performed project management including: • Review of contractor worker certification • Interpretation of the abatement work, contractor oversight • Collection and analysis of ambient and clearance air samples • Identification and quantification of removed asbestos Australia • Belgium • Canada • Columbia • Ecuador • Germany • Indonesia • Italy Kenya • New Zealand • Papua New Guinea • Peru • Tanzania • United Arab Emirates United Kingdom - United States • Operations in 85 countries Service Slip / Invoice ORDER: 202027 DATE: 10/31/14 c Friday Work Location: [40007538] i3 732--3179 Assmiated Building Wreckers 352 Albany St Attn: Mlchae Off Springfield, MA 01105.1017 echnician Tech License# PICO ## iir« (Car-melo Flores} 32600 st Service Map Code rime Quantity 1 X TECHNICIA'i E'--NA"URE 0/0 UOM Amount Equip. Target 0 WiXl EA 240000 M Cel rR&jcnis 0 005�J EA 48 0000 Mice/Rodents I haeby%kncwftdge the sadsfa'(Ux and egret to pay the cost of sMvtts X PLEASE RAY FROM THIS INVOICE Page I of I Michael Orr From: John Hall Uhall @northamptonma.gov] Sent: Thursday, November 06, 2014 11:33 AM To: demo @buildingwreckers.com Subject: 65 Paradise Road Vlike, I sent an E-Mail to Louis Hasbrouck, Northampton Building Commissioner, around 11:15 i.m. this morning, telling him that I had inspected the Sewer Service cut off at this address, done )y Gccleher Enterprises. J.H. (City of Northampton E-mail is a public record except when it falls under one 11/06/2014 CITY OF NORTHAMPTON,MASSACHUSETTS :DEPARTMENT OF PUBLIC WORKS 125 LOCUST STREET NORTHAMPTON, MA 01060 413-587-1570 FAX 413-587-1576 Edward S Huntley, P.E. Director November 6, 2014 Louis Hasbrouck, Building Inspector Municipal Office Annex 212 Main Street Northampton, Ma 01060 Dear Mr. Hasbrouck: The water service at#69 Paradise Road has been disconnected from the city water supply and the water meter has been removed from the premises as of November 6, 2014. Please contact me if you have any questions. Sind gory R. Nuttelman uperintendent of Water Cc: Ned Huntley, Director of Public Works Jim Laurila, City Engineer Page 1 of 1 Michael Orr From: Richard Korzeniowski [rkorzeni @smith.edu] Sent: Saturday, November 01, 2014 8:02 AM To: demo coordinator Subject: Fwd: Decommissioned units at Mason "ike, Here is the email from Samuel T Hannigan, State Elevator Inspector, indicating that the elevators at Mason Infirmary have been decommissioned and we can proceed. f you have any questions please contact me. thanks Rich K. ---------- Forwarded message ---------- From: Hannigan, Samuel (DPS) <samuel.hanniganL&state.ma.us> Date: Fri, Oct 31, 2014 at 1:49 PM Subject: Decommissioned units at Mason To: "rkorzcniL&,smith.edu" <rkorzeni&smith.edu> :�c: Michelle Kelleher<Michelle.Kelliher(&us.schindler.com> [Zich, ireg Lawler has been in contact with me today about the paperwork for Mason. We will meet :arly next week to transfer the completed forms which will then be delivered to you. Until then, you may forward this email at your discretion in order to show that I have inspected unit Zumbers 214-P-146 and 214-D-147, and they have been decommissioned in accordance with 524 ZMR 11.02, which is the standard for removing elevator units from service in Massachusetts. f I can be of any further assistance to you, please do not hesitate to contact me through this -mail address, or by phone, at 617-938-4298. Samuel T Hannigan State Elevator Inspector "ass. Dept. of Public Safety Sent from my iPhone , .. FI i,�ti( uurdivalir I:r,n�ilnn, AI� Illiil�i , � rkurzcni(n-smith.edu 11/03/2014 DATE: 10/27/2014 FROM: Verizon Engineering 146 Leland St. —Flr.2 Framingham, Ma. 01702 RE: 65 and 69 Paradise Rd, Northampton, MA This letter is to inform you that the Verizon services involving 65 and 69 Paradise Rd, Northampton, MA have been disconnected. RIZON Engineer Thank you, Lisa Donovan Central Engineering 866-686-1195 XFINITY Connect Page 1 of 1 XFINITY Connect abw_inc @comcast.net +Font Size- RE: Disconnection of Service-69 Paradise Road From :Jeff Romito <Jeff Romito @cable.comcast.com> Thu,Oct 30,2014 11:13 AM Subject:RE: Disconnection of Service-69 Paradise Road To:ASSOCIATED BUILDING <abw_inc @comcast.net> All set From: ASSOCIATED BUILDING [mailto:abw_inc @comcast.net] Sent: Wednesday, October 29, 2014 3:16 PM To: Romito, Jeff Subject: Disconnection of Service - 69 Paradise Road Good Afternoon Jeff, Attached you will find a request for the disconnection of service at 69 Paradise Road in Northampton. Thank you, Michael Orr Associated Building Wreckers Demolition Coordinator 352 Albany Street Springfield, MA Telephone: (413) 732-3179 Fax: (413) 734-6224 Demo _buildingwreckers.com http://web.mail.comcast.net/zimbra/h/printmessage?id=449789&tz=America/New York... 10/30/2014 10/27/1014 Smith College Mail-Letter of Cable Abandoned at Elizabeth Mason Infirmary and Sunnyside Steve. From: Richard Korzeniowski [mailto ,:. ;rr� "( .�-�Jtl] Sent: Thursday, August 14, 2014 1:02 PM To: Steve Hill Subject: Fwd: Letter of Cable Abandoned at Elizabeth Mason Infirmary and Sunnyside i011ot'xd tent hi '!w1l https:Hm ail.google.com/mail/u/0/?ui=2&i k=25c37d6l95&view=pt&q=aperez°/a40sm ith.edu&qs=true&search=query&th=147d51 d9eacbb9d0&si m l=147d51 d9cac... 2/2 10/27/2J14 Smith College Mail-Letter of Cable Abandoned at Elizabeth Mason Infirmary and Sunnyside nN nk Richard Korzeniowski <rkorzeni @smith.edu> L� , Letter of Cable Abandoned at Elizabeth Mason Infirmary and Sunnyside 3 messages Al Evans-Perez <aperez @smith.edu> Thu, Aug 14, 2014 at 11:23 AM To: Richard Korzeniowski <rkorzeni @smith.edu> Cc: Frank Roach <froach @smith.edu>, Sharon Moore <samoore @smith.edu>, Eric Brewer<ebrewer @smith.edu> Dear Rich, This is to inform you that the cable plant (both copper and fiber)to both Elizabeth Mason Infirmary and Sunnyside are now considered abandoned and no longer connected to the Smith College Telecommunications or Smith College Fiber Networks. The intent of this letter is to allow for the demolition of said buildings. Yours Truly, Al Perez Telecommunications Manager Smith College Richard Korzeniowski <rkorzeni @smith.edu> Thu, Aug 14, 2014 at 1:02 PM To: Steve Hill <steve @buildingwreckers.com> Steve, Here is the telecommunications termination for 70 and 69 Paradise Road. 69 and 70 Paradise is serviced by Smith College system. Will this due? Rich K. i(2uotad text Puciden) r' f imt'd K�:r-t rtiowski Facilities EFI&S Coordinator Smith College 126 West Street Northampton, MA 01063 T F: Email: xo . ti .ed_i Steve Hill <steve @buildingwreckers.com> Fri, Aug 15, 2014 at 5:17 AM To: Democoord User<Demo @buildingwreckers.com> Cc: Richard Korzeniowski <rkorzeni @smith.edu> N1 i l<C: Could you please let Rich knoxV if LOUiS would be ok with this email as proof of termination 7'llank you, https:Hm ai I.googl e.com/m ai I/u/0/?ui=2&i k=25c37d6l95&vi ew=pt&q=aperez%40sm i th.edu&qs=true&search=query&th=147d51 d9cacbb9d0&si m 1=147d51 d9cac... 112 Collins Electric FOUNDED 1906 53 Second Avenue Opp.Mass.Tpke.Exit 6 Chicopee,MA.Mailing Address Post Office Box 3311.Springfield,MA 01102-3311 Telephone(413)592-9222. FAX(413)592-4157 Richard J. Korzemowski Oct. 27, 2014 SMITH COLLEGE Envifonmental Health and Safety Physical Plant 126 West Street Northampton, Ma. 01063 Dear Richard, Collins Electric has disconnected the power to the Mason Infirmary at the end of Paradise Road Northampton, Ma. It has been disconnected and made safe in the manhole. Please contact me with any questions. Very truly yours, The Collins Electric Co., Inc. Mark G. Lemelin Vice President Complete Office Also In Pittsfield,Massachusetts iY , 4 A NiSource Company 995 Belmont Street Brockton,MA 02301 Date: August 18, 2014 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 69 Paradise Road TOWN : Northampton STATE : Massachusetts Sincerely, Lisa Buckley Integration Center Columbia Gas Of Massachusetts 508-580-0100 Ext 1293 The Commonwealth of Massachusetts - - Department of Industrial Accidents Office of Investigations �= I Congress Street, Suite 100 Boston,MA 02114-2017 (� www•m a ss.Qov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ASSOCIATED BUILDING WRECKERS, INC. Address:352 ALBANY STREET City/State/Zip:SPRINGFIELD, MA 01105 Phone #: (413) 732-3179 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 32 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, FE-1 Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#l 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. TContractors 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:GREAT DIVIDE INSURANCE COMPANY Policy#or Self-ins. Lic. #:WCA154516512 Expiration Date:02/01/2015 Job Site Address: 69 PARADISE ROAD City/State/Zip:NORTHAMPTON,MA 01063 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or o -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 y again it the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations o the DIA fol insurance coverage verification. I do hereby cer der th ai s and penalties of perjury that the information provided above is true and correct. Signature: Date:OCTOBER 31, 2014 raw w •r , K Phone# Li%*51\132'-6 o 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): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: SECTION 8-CONSTRUCTION SERVICES 881 Licensed Construction Supervisor: Not Applicable ❑ Name of L •en•eHold : ,ArACeW CS, 0(107-36Z License Number 352-_ s � mod,. Q�j Oro 1-3► 12-0\5 ILA --- -- /address Expiration Date L�% T32 3-1-79 Sign,iU.ire awb,+feW Telephone 9. Registered Home Improvement Contractor; Not Applicable ❑ sso 5 yid wqj I Q ;f- b g�1(oq Coimpaim/NaVne Registration Number Address Expiration Cate Telephone��u3�"73Z-3t7� SECTION 10-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) r 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... .. ❑ 11. - Home Owner .Exempt on.. The current exemption for"homeowners" was extended to include Owner-occupied Dwellings of one(1) or two('_) families and to allow such homeowner to en-age an individual for hire who does not possess a license,t rovided (hat (lie owner acts as supervisor. C11'I111 780, Sixth Edition Section 108.3.5.1. Definition of(homeowner: Person (s)who own a parcel of land on which he/she resides or intends to reside,nn which thrre is,or is intended to be,a one or two family ciNvelling,attached or detached structtu•es accessory to such use and/or 1,a1m shuctures.A_persott who constructs more than one home in a two-year period shall not be considered :1 homeowner. Such"homeowner"shall submit.to the Building Official,on a form acceptable to the Building Official,Lhal he/shc shall be responsible for all such worl(performed under the buildin!*permit. As acting Construction Supervisor your presence on the job site will be required from time to tittle. tfurillu.,uul uprnt completion of the wort( for which this permit is issued. Also be advised that with reference to Chapter '152(Workers' Compensation) and Chapter 1 5, (Liability ofFmployers to Lntployees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may he liable fir persoll(s) You hire to perform wort: for you under this permit. -1 he undersigned"homeowner''certifies and assumes responsibility for compliance with the State Buildinc;COLIC,City oll Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. homeowner Sip-n,ilure Y SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) j New House ❑ Addition ❑ Replacement Windows Alterations) ❑ Roofing F�l Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs 10] Decks [0 Siding[O] Other[Cg] i Brief C Zescription of Proposed Work:\ nna\�l:on o �'orn►Qt'2v��' rrna,cz. 06. 'A adac,,c n� Q tact i�c_y sx�i5 C�'►02 tom.,,\eQ I Alteration of existing bedroom Yes x No Adding new bedroom Yes X No Attached Narrative Renovating unfinished basement -_—_--YesNo Plans Attached Roll -Sheet Ga. If New house and or addition to existing housing complete the following I a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms C. Is there a garage attached? d Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating?_ Fireplaces or Woodstoves _.________Number of each, q Energy Conservation Compliance. Masscheck Energy Compliance form attached? i h. Type of construction i Is construction within 100 ft, of wetlands? Yes No. is construction within 100 yr. floodplain_____Ycs No j. Depth of basement or cellar floor below finished grade k Will building conform to the Building and Zoning regulations? Yes No . I Septic Tank City Sewer Private well City water Supply I SECTION 7a -OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PER as Owner of the subject property hereby authorize ASSOCZak e4 TRIuMma WM4,akS�'tyNc,,to act on my behalf, in all matters relative to work a prized by this building permit application. L Signature of Owner Date I as Owner/Authorized l Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge { and belief. Signed Lind.r t e pains a penalties of perjury. I � Print Name signature of Owner/Agent Date Section 4. ZONING All Information Mtist Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by "Zoning I his Colunui In he filled in by Buildinc Dcpartnu nt Lot Si�.e Frontage Setbacl:c� Front Side L: R: L:'. R: Rear Building Height Bldg. Square. Footage �%o —��'----------- Open Space Footage `% II_ol arra minus hldr,@ paved xui,ina) 4 Ot Pal king Spaces Fill: (volume&'Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DON'T KNOW O YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW O YES O IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES O NO 0 IF YES, describe size, type and location: E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES.. then a Northampton Storm Water Management Permit from the DPW is required "1114C-11ftc+ 111•4M 117,19r-116.%noo1 Tus 101%9114 Department use only L ng I Northampton Status of Permit: ;Building of Department Curb Cut/Driveway Pert-nit j! 212 Main Street Sewer/Septic Availability NOV I Room 100 Water/Well Availability Efec L 777 ortharyipton, MA 01060 Two Sets of Structural eA13-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify-- APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address. This section to be completed by office �Oq �QfCAC11 se Road Map Lot----------------Unit.- Qof4 arAp4wl"M A Zone Overlay District­­­­­­ Elm St.District—­----.----- CB District„_--_____ SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: sm;kM ctoOkople 0-c-l1kc-e 04 -VMi;LSVMf- .1-Ax owl. Name(Print) urrent alng Addr ss 815-'7-164 S 9 Telephone Signature 2.2 AUth iZ d Acient: T be4m, —wc-, %.4 S-�r&Qk.4bQr%WqVAdd, HA qkw�fi Name(Pri t) Current Mailing Address: SIql)ahire ire%AJ 'e 4%cW!A Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS ltern Estimated Cost (Dollars)to be Official Use Only completed by permit applicant 1, Building "l),q69 oc-v (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from (6) 3 PILLIrribing Building Pert-nit Fee 4 Mechanical(HVAC) b Fire Protection 6 Total=(1 + 2 + 3 + Check Number Ji 6 This Section For Official Use Only ---- --- Date B uilding Permit Number. Issued. Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0530 APPLICANT/CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD (413)732-3179 PROPERTY LOCATION 69 PARADISE RD-MASON HALL INFIRMARY MAP 31 C PARCEL 013 001 ZONE EU(123)/RR(86)/WP(86)/URC(38)/FFR(1)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building,Permit Filled out , e Fee Paid Typeof Construction:_DEMOLITION OF FORMER INFIRMARY&(4)GARAGE STRUCTURES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 063282 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON 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. 69 PARADISE RD-MASON HALL INFIRMARY BP-2015-0530 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 C-013 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: demolition BUILDING PERMIT Permit# BP-2015-0530 Project# JS-2013-001892 Est.Cost: $200000.00 Fee: $280.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 063282 Lot Size(sq. 8.1 308056.32 Owner: SMITH COLLEGE c/o Sharon Moore Zoning: EU(123)/RR(86)/WP(86)/URC(38)/FFR(I)/ Applicant: ASSOCIATED BUILDING WRECKERS INC AT. 69 PARADISE RD - MASON HALL INFIRMARY Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732-3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON.111712014 0:00:00 TO PERFORM THE FOLLOWING WORK.DEMOLITION OF FORMER INFIRMARY & (4) GARAGE STRUCTURES POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 11/7/2014 0:00:00 $280.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner