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10D-019 167 Main Street Page 1 of 1 167 Main Street as Inc t. 'a a lu ' nsro a h6& %j f f, 1 f 20 m r i .. http://maps.massgis.state.ma.us/temp/OL_MORI S—Print/143 5 5 76966.1169254762.html 06/29/2015 Northampton, MA : Residential Property Record Card Page 2 of 2 Pool-Prefab Plastic Liner 1 1995 16 36 Building Sketch Descriptor/Area 12 A:1.5Fr/B 12 750 sgft Wood Deck B:EFP 12 EFP 12 14 14 144 sgft 144 168 C:Wood Deck 168 sgft 12 12 D:Wood Deck 30 56 sgft 25 1.5Fr/B 25 750 30 1A 4 1 D 4 4 Notice 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: CLT, Big Room Studios, and Northampton, MA assume no liability for any error or omission in the information provided here. Currently All Values Are Finalized For Fiscal Yr 2015. Comments regarding this service should be directed to: isarafin@northamotonassessor.us http://www.northampton.univers-clt.com/view_property_R.php?account no=10D-019-00... 06/29/2015 Northampton, MA : Residential Property Record Card Page 1 of 2 Northampton, MA : Residential Property Record Card [ Back to Search Results] [ Start a New Search ][ Helo with Printing ] Search For Properties Parcel ID Name Street Name MAIN ST Search Reset Parcel ID Card Map-Block-Lot Location Zoning State Class Acres IOD-019-001 1 167 MAIN ST 101 - n/a 0.800 Owner Information Property Picture Miller Moses D [ No Picture Available] 167 Main St Leeds MA 01053 Deed Information Book/Page: 9943/8 Sale Date: 2009/08/24 Dwelling Information Living Units: 1 Style: Conventional Story Height: 1.5 Exterior Wall: Alum/Vinyl Attic Living: None Basement: Full Year Built: 1860 Ground Floor Area: 750 Unfinished BSMT Area: 750 Fin BSMT Living: n/a Tot Living Area: 1312 Rec Room: 1 x 400 Tot Rooms: 6 Bedrooms: 3 Full Baths: 2 Half Baths: 0 Mas Fire Place n/a Frame Fire Place n/a Heating Type: Basic Valuation Land: $93,700 Building: $125,800 Total: $219,500 Sales History Document No Date Price Type Validity n/a 2009/08/24 $268,000 Land + Bldg 0 n/a 1995/02/01 $75,000 Land + Bldg Permit History Date Purpose Price 2004/10/22 12 X 12 SUNROOM $19,000 Out Building Information Type Qty Year Sizel Size2 Garage-Wd/Cb 1 1964 1 380 http://www.northampton.univers-elt.com/view_property_R.php?account no=10D-019-00... 06/29/2015 DIG SAFE SYSTEM, INC. - Renew Existing Ticket Page 1 of 2 Request Number:20152600525 Date 06/22/2015 Time 07:25 Latitude: Longitude: State: MASSACHUSETTS Municipality: NORTHAMPTON Address/Intersection: 167 MAIN STREET Nearest Cross Street 1: ARCH ST Nearest Cross Street 2: Additional Information: Nature Of Work: DEMOLITION Area Of Work: STREET TO BUILDING Area Is Premarked: Y Start Date: 06/26/2015 Start Time: 09:00 Caller: MICHAEL Title: Return Call: Phone#: 413-732-3179 Fax#: Alt.Phone#: Email Address: Contractor: ASSOCIATED BUILDING WRECKERS,INC Address: 352 ALBANY STREET City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work: Member Utility List Code Abbreviatio n Name AJ COMCAS COMCAST-SOUTH BURLINGTON J FFBRTEC IBERTECH NETWORKS-MA M114 MATECH MASSACHUSETTS TECHNOLOGY PARK CORP MC NGRDEL NATIONAL GRID ELECTRIC-MASS ELEC Fm--L-1 MCI MCI ON ONTARG ON TARGET LOCATING RJ VERIZN VERIZON SP VERIZN VERIZON WB BRKGAS BERKSHIRE GAS WG CMAGAS COLUMBIA GAS OF MASSACHUSETTS • There may be non-member utilities in the area that you need to notify. http://digsafeform.digsafe.com/cgi-bin/dwcgi.exe 06/22/2015 `7 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 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: I • This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: �— F7 None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 Massachusetts Department of Environmental Protection L11. 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: 739225 Document: AQ 06-Construction/Demolition Notification Size of File: 217.52K Status of Transaction: in Process Date and Time Created: 5/4/2015:11:51:11 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. eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System Username:DEM000ORD Nickname:DEM01 ;s-,.., .. LReceipt J Forms Signature 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: 739225 Date and Time Submitted: 5/4/2015 11:50:03 AM Other Email : DEP Transaction ID: 739225 Date and Time Submitted: 5/4/2015 11:50:03 AM Other Email : Form Name: AQ 06 - Construction/Demolition Notification Form Name: AQ 06 - Construction/Demolition Notification Payment Information DEP code Date Amount ($) Payment Detail My eDEP MassDEP Home Contact Privacy Policy MassDEP's Online Filing System ver.12.14.3.0© 2015 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 05/04/2015 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100219680 BWP AQ 06 Ll - - Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this TBD address is: This project (— Construction j✓ Demolition is: 5/18/2015 8/31/2015 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 f— Seeding [­v Wetting F— Covering f Paving )— Shrouding j— Other-Specify: 9. For Emergency Demolition Operations,who is the NlassDEP official who evaluated the emergency? Name of MassDEP Official Tide Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification I certify that I have personally ANDREW MIRKIN examined the foregoing and am Print Name familiar with the information ANDREW MIRKIN contained in this document and Authorized Signature all attachments and that,based PRESIDENT on my inquiry of those individuals immediately ASSOCIATED responsible for obtaining the ASSOCIATED BUILDING WRECKERS information,I believe that the Representing information is true,accurate,and 5/4/2015 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 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality 100219680 Ll I BWP AQ 06 ;y 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 ANDREW MIRKIN 4137323179 General Contractor's On-site Manager/Foreman Telephone General C. General Construction or Demolition Description Statement:If asbestos is found I.Construction or demolition contractor: during a Construction or Demolition ASSOCIATED BUILDING WRECKERS 352 ALBANY STREET operation,all Contractor Name Address responsible parties must comply with 310 SPRINGFIELD MA 011050000 4137323179 CMR 7.00,7.09,7.15, City/Town State Zip Code Telephone and Chapter 21 E of ANDREW MIRKIN 4137323179 the General Laws of the Commonwealth. Construction and Demolition On-site Manager Telephone This would include, but would not bw 2. Licensed Contractor Supervisor: limited to,filing an asbestos removal ANDREW MIRKIN CS-062382 notification with the Department and/or a Supervisor Name License Number notice of release/threat of 3. Is the entire facility to be demolished? P Yes F No release of a hazardous 4. Describe the area(s)to be demolished: substance to the Department,if ENTIRE STRUCTURE applicable. MassDEP Use Only 5. If this a construction project,describe the building(s)or addition(s)to be constructed: Date Received N/A 6. If this is a demolition or renovation project,were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? [✓Yes F No 7.Was asbestos containing material(ACM)found? R Yes I No If a survey was conducted,who conducted the survey? ASSUMED(FIRE DAMAGED N/A 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 100219680 BWP AQ 06 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 F No Type of Notification: (— Revision of an Existing Form (— Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.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 Department of B. General Project Description Environmental 1.Facility Information: Protection notification FIRE DAMAGED SINGLE FAMILY RESIDENCE 167 MAIN STREET requirements of 310 CMR 7.09. Name of facility Street Address NORTHAMPTON MA 010530000 4136950094 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of MOSES MILLER OWNER Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 4136950094 demo @buildingwreckers.com Boston,MA 02211 Facility Contact Person Telephone Facility Contact Person Email Facility Size: 2000 2 Square Feet Number of Floors Was the facility built prior to 1980? P Yes r No Describe the current or prior use of the facility: FIRE DAMAGED RESIDENTIAL STRUCTURE Is the facility a residential facility? F"' Yes r No If yes,how many units?1 2. Facility Owner: MOSES MILLER 167 MAIN STREET Facility Owner Name Address LEEDS(NORTHAMPTON) MA 010530000 4136950094 City/Town State Zip Code Telephone MOSES MILLER 167 MAIN STREET On-Site Manager/Owner Representative Address Leeds(Northampton) MA 01053 4136950094 City/Town State Zip Code Telephone Revised:03/17/2014 Pagel of 3 ASSOCIATED BUILDING WRECKERS, INC. PEOPLE'$.UNITED BANK Springfield,Massachusetts 352 ALBANY ST, 5171M/2211 SPRINGFIELD,MA 01105 PATE CHECK NO. AMOUNT 413-732-3179 05/05/2015 316980 $600.00 SIX HUNDRED AND XX/1.00 DOLLARS PAY - ...,. Commonwealth of Mass TO THE .MA DEP: ORDER P.O.Box 4062 OF Boston MA 02211 -- MP AUTNDRI2EDSMATURE 11" 311198011' 1: 2 2 1 0 2 113 61: 2 100 1160 7 3 311■ Massachusetts Department of Environmental Protection Bureau of Waste Prevention BWP AQ 36 Application for Non-Traditional Asbestos Abatement Work Practice Approval C. Certification "I certify that I have personally examined the foregoing and _ am familiar with the information contained in this document Signature and all attachments and that,based on my inquiry of those Stephen W. NieC individuals immediately responsible for obtaining the Printed Name information, I believe that the information is true,accurate, Project Designer and complete. I am aware that there are significant penalties for submitting false information,including Title possible fines and imprisonment. I am aware that this 05/28/2015 _ permit application or notification shall not be deemed valid Date(MM/DDNYYY) unless payment of the applicable fee is made." D. Submission of Application Note: MassDEP STEP 1•Submit Fee Payment STEP 2:Submit Application review will begin Send the materials below to the P.O.box address Send the following materials to the appropriate only after your submissions below to: MassDEP Regional Office*,Attention:Asbestos have been Section: received at both MassDEP locations. P.O. Box 4062 Boston, MA 02211 ®This original completed and signed form. ®A copy of this completed and signed form. ®A copy of the check or money order from Step 1. (D Fee payment of$600(check or money order ®Your proposed work plan,describing work payable to"Commonwealth of Massachusetts"). practices,duration and schedule.The proposal must: The following entities are exempt from this fee: • Include signature of the Asbestos Project • Cities,towns,counties or districts of the Designer who prepared it. Commonwealth • Demonstrate that the deviations from 310 CMR • Federally recognized Indian tribe housing 7.15 and alternatives proposed will not cause any authorities visible emissions to the outside air or pose • Municipal housing authorities significant risk to public health,safety or the • The Massachusetts Bay Transportation environment. Authority(MBTA) ®All supporting documentation. Entities that are exempt from the fee must still submit a copy of this completed and signed *Find the MassDEP Regional Office for the form,without payment,to the P.O.box above. community where this work will be done: http://www.mass.gov/eea/agencies/massdeD/about/ contacts/ 7/14 BWP AQ 36-Application for Approval of Non-Traditional Asbestos Abatement Work Practice Approval-Page 3 of 3 Massachusetts Department of Environmental Protection _ Bureau of Waste Prevention BWP AQ 36 Application for Non-Traditional Asbestos Abatement Work Practice Approval B. Project Information (continued) Demolition Contractor(If Applicable) Associated Building Wreckers, Inc_._ Contractor Name 352 Albany Street_ Address Springfield MA 01105 City/Town State ZIP Code 413-781-0820 Demo @buildingwreckers.com _ Telephone Number Email Address Circumstances--Check the appropriate box(es)to indicate why a Non-Traditional Asbestos Abatement Work Practice Approval is needed. ❑ Facility is being demolished under a state or local government order because it is structurally unsound and in danger of imminent collapse.(Please attach a copy of the order to your work plan proposal.) ❑ Asbestos Containing Material(ACM)or Asbestos Containing Waste Material(ACWM)was not accessible for testing,therefore not discovered until after demolition began and,as a result,cannot be safely removed. • Abatement activity is being conducted as part of an emergency renovation operation. • Asbestos abatement activity is being conducted to clean up and decontaminate a facility or portion of a facility where: ❑ Previous asbestos abatement activities were not conducted in compliance with 310 CMR 7.15. ❑ ACM deterioration, if not immediately attended to,would present a safety or public health hazard. ❑ Wetting during a facility renovation would unavoidably damage equipment or present a safety hazard. ® The project requires bulk loading of ACM and/or ACWM. List the requirements of 310 CMR 7.15 that you are unable to comply with and explain why: 310CMR 7.15(4);310 CMR 7.15(5);310 CMR 7.15(7)(c)1.-6; 310 CMR 7.15(7)(e);310 CMR 7.15(7)(f)3.a.-c.; 310 CMR 7.15(15)(b);310 CMR 7.15(16)(b). Building is fire-damaged, has been deemed as unsafe for human occupancy or use by the local building authority,and is unsafe for inspection or conventional asbestos removal. Other Project Details Types&Amounts of ACM Requiring Non-Traditional Work Practice(s): ®Friable 650 CY ®Non-Friable same _ Quantity in Cubic Meters(Cubic Yards) Quantity in Cubic Meters(Cubic Yards) Location(s)of ACM in the Facility: Entire building assumed to contain asbestos.—40'x.30' rectangular area building footprint, 1-1/2 story. 7/14 BWP AQ 36-Application for Approval of Non-Traditional Asbestos Abatement Work Practice Approval-Page 2 of 3 Massachusetts Department of Environmental Protection LlBureau of Waste Prevention BWP AQ 36 Application for Non-Traditional Asbestos Abatement Work Practice Approval A.Work Site Information Facility Important: Fire-damaged House When Facility Name or Site Description completing forms on a 167 Main Street computer,use Facility Address only the tab key Leeds _ MA 01053 to move your Cityfrown - - State ZIP Code cursor-do not use the return Owner key. Moses Miller Owner Name 167 Main Street Owner Address Leeds MA 01053 City/Town State ZIP Code 413 695-0094 _ unknown Telephone Number Email Address Applicant-❑ Check here if same as Owner and skip to next section.Otherwise,complete fields below. Moses Miller Applicant Name 167 Main Street Applicant Address Leeds _ MA 01053 Cityrrown State ZIP Code 413 695-0094 _ Telephone Number Email Address B. Project Information Asbestos Abatement Project Designer Stephen W. Niec_ AD071139 _ Name Department of labor Standards(DLS)Contractor License Number 650 Dwight Street,#1337 _ Address Holyoke MA 01041 City/Town State ZIP Code 413-221-8233 _ sniec forbeswheeier.c_om Telephone Number Email Address Asbestos Abatement Contractor _Pa ate Contracting Services_, Inc. AC000021 Contractor Name Department of labor Standards(DLS)Contractor 352 Albany Street Address S rp ingfield _ _ MA 01105 _ City/Town State ZIP Code 413-781-0820 _ Demo buildingwreckers.com _ Telephone Number _ Email Address 7114 BWP AQ 36-Application for Approval of Non-Traditional Asbestos Abatement Work Practice Approval-Page 1 of 3 Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 9 35. The NTWP is intended solely as guidance for the property owners in the conduct of the subject asbestos removal activities. 36. This NTWP is valid for ninety (90) days after it is approved by MassDEP and shall be deemed expired at the start of the ninety-first (91") day. If activities are to continue past the 90 day expiration date then the MassDEP shall be notified in writing at least ten (10) days in advance, specifically, on or before the eightieth(80`") day. Continuance of the work under the provisions of the NTWP shall be the sole determination and approval of MassDEP. Sincerely, A / !X Stephen W.Ni� Asbestos Project Designer MA License No. AD071139 413-221-8233 Forbes&Wheeler Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 8 remaining waste, small debris and detritus accumulated around the Site or on the slab or in the cellar hole (if any). This material shall be collected with wet methods utilizing either HEPA vacuums or squeegees and shovels or picked up by hand. Dry sweeping shall not be employed. The remaining asbestos or asbestos-contaminated materials shall then be sealed into leak-tight and properly labeled containers for disposal as ACWM. 27. Following the bulk loading operation and cleanup of all remnant or suspected ACWM, but prior to any continued Site work,excavation or backfilling,a final visual inspection shall be performed by the APM and AAC Site Supervisor and DC Site Supervisor to ensure that no remnant asbestos, co-mingled asbestos demolition debris, asbestos-contaminated water or any other suspected ACWM remains on any slab or in any cellar hole, on the ground around the work site, at the loading site, as well as any other area at the Site. The results of this inspection shall be recorded in the individual's respective Site logs. 28. All documentation regarding air monitoring collection and analysis results, as well as visual inspection reports,waste disposal records,contractor and consultant site logs,visitor sign in logs, notices of violation, cease and desist orders and MassDEP notifications shall be kept on Site for inspection by MassDEP and all other Federal, State and local governmental agency personnel during the asbestos demolition and bulk loading operation. Copies of all of the Site records and documentation are to be supplied to the MassDEP by the property owner, and each and every consultant, asbestos contractor and subcontractor upon request or within thirty (30) days of completion of the work if not requested earlier. Each submittal shall be accompanied by an original signed copy of the last page of the MassDEP approval letter. 29. This work plan does not negate the responsibility of the property owner, the contractors, subcontractors and consultants from complying with all other applicable Federal, State and local regulations. 30. This work plan applies specifically to the asbestos bulk loading of the structure and debris located at 167 Main Street, Leeds, MA 01053. This work plan does not apply to any past or future demolition or asbestos handling operations at the Site. All other MassDEP regulations are in effect for the duration of this asbestos demolition and bulk loading operation. 31. The property owner or the APM shall distribute copies of this work plan to each entity involved with the project. A copy of this work plan shall be kept at the Site for the duration of the project. 32. Should unforeseen Site conditions require changes to any of the procedures in this work plan,the undersigned Asbestos Project Designer may request an amendment or addendum to the NTWP. Any request for changes shall be made by the undersigned Asbestos Project Designer to MassDEP in writing. None of the added or amended conditions shall be utilized at the Site until the request has been reviewed and accepted by MassDEP and a written approval issued. 33. Should asbestos become released, property owners,their contractors, and subcontractors may be subject to enforcement action by the MassDEP, and may be held responsible for any subsequent abatement of the release. 34. The MassDEP may,at their sole discretion,revoke this NTWP. Forbes&Wheeler Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 7 http•//www mass gov/ee,daaencies/massdel2/recycle/r educe/using;-or-processing-asphalt- pavement-brick-and-concrete-.html 21. All heating system components or other building components for which there are no asbestos abatement records or inspection results shall be treated as "suspected" to have been covered or coated with asbestos shall be segregated to a remote area of the Site, wetted with amended water and covered with at least one layer of six-mil (0.006 inch)thick poly sheeting that is secured to the ground. These components shall be tested for asbestos materials prior to abatement within a full containment structure with HEPA filtered work area ventilation. Alternatively such components may be considered covered or coated with asbestos materials and abated without testing in accordance with the provisions of 310 CMR 7.15.The AMF is responsible for ensuring that the APM performs thorough visual inspections of each such containment as described in 310 CMR 7.15(8). No beating system components or insulated structural building, components are subject to the bulls loading or alternative handling procedures of this NTWP unless tested, and shall be segregated to a remote isolated work area on the Site or isolated and contained in-place for subsequent stripping and removal of the friable ACMs. Clearance Air monitoring pursuant to 453 CMR 6.14(5)(b)shall be conducted inside of these isolated work areas. 22. If it is necessary to leave a partially filled asbestos waste roll-off or track at the Site overnight, then it shall be wetted,covered and secured. 23. The asbestos contractor shall establish a loading area beneath and around the waste loading areas and the excavator swing zone and/or crane machine swing zone, which is to be kept free of visible debris and cleaned between loads to prevent trucks form accumulating ACWM in or in the tires. Installation one layer of six mil poly on top of one layer of reinforced six-mil poly sheeting may speed cleanup as the top layer of poly could be removed and replaced between loads to maintain the clean loading area. Alternatively, one layer of a '/4' thick waterproof asphalt sheeting or a '/4" thick Ethylene Propylene Diene Monomer (EPDM) liner may be used, and be cleaned at the end of each working day. Poly sheeting shall be disposed of as ACWM at the end of each working day. 24. ACWM shall not be stockpiled and shall not be crushed or compacted. If by unforeseen occurrence all ACWM generated during a particular work day is not loaded prior to the end of the shift, due to a delay in waste transport vehicle or roll-off availability, then the asbestos waste shall be wetted and covered with at least one-layer of six-mil poly sheeting that has been secured to the ground. This ACWM shall then be loaded the following day or the first day of project recommencement, prior to the commencement of any further demolition operations. The poly covers shall likewise be disposed of as ACWM and not stored or reused. 25. The contractors shall ensure that no water leaks from the trailer truck containers or roll-off dumpsters or any other permitted waste receptacles during transport to the landfill, and that the ACWM is covered at all times during transport. The trucks or roll-off dumpsters shall be in good condition with no holes or rusted out areas and with tailgates, which close tightly and are lockable. USDOT Class 9 placards shall be affixed to the exterior of each dumpster or truck prior to transport. 26. Following the completion of the removal of all of the bulk ACWM but prior to any further excavation or backfilling operations, the asbestos contractor shall collect, for disposal, all Forbes&Wheeler Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 6 f/cc)of air, then work shall not commence and MassDEP shall be notified of the exceedance by telephone within two(2)hours for evaluation of the work practices. Results for each sample shall be reported separately, time weighted average (TWA) calculations of the employee air samples are not acceptable for the purposes of this NTWP. 16. Analysis of both perimeter and employee air samples shall be performed by personnel who are properly trained in accordance with the NIOSH 582 or 582 equivalent method, are successful participants in the American Industrial Hygiene Association's Asbestos Analytical Registry (AIHA's AAR), are considered proficient with the most recent 'PAT" rounds, or alternatively, who are employees of a laboratory, which is licensed by the Commonwealth to perform such analysis and which is accredited with either the AIHA or National Voluntary Laboratory Accreditation Program(NVLAP)as appropriate. 17. No asbestos-related activities or asbestos removal work pursuant to this NTWP shall commence unless the APM is at the Site and all air monitoring stations, both perimeter and employee air monitoring, are in full operation. Acknowledgement that the air monitoring is in operation shall be recorded in the site logs or field sampling data sheets of the APM each day the air monitoring is being performed. 18. All of the co-mingled asbestos demolition debris shall be disposed of as ACWM. This material shall be thoroughly wetted with amended water prior to the start of work each day and kept wet during demolition and loading operations until bulk loaded. All asbestos waste shall be "live loaded" into roll-offs or dump trucks that have been lined with a minimum of two (2) ten-mil (0.010 inch thick) pre-foimed polyethylene ("'poly") liners. These liners shall be of sufficient size and installed in such a manner so that the top flaps will overlap and so that they can be sealed across the top of the load. During loading operations proper placards shall be displayed pursuant to 40 CFR Part 61. After sealing the exterior liner,it shall be properly labeled in accordance with 310 CMR 7.15. None of the asbestos waste shall remain on the ground or in a dumpster or truck in an uncovered state overnight. For the purposes of the NTWP "live-loaded" means placed into the lined roll-off or dump truck as it is produced and not accumulated or stockpiled. 19. The asbestos-contaminated building rubble shall be maintained in large sections during demolition and not crushed or compacted in any way. The loading operator may "heel-down" once on each bucket of ACWM deposited into the roll-off or dump truck to level the load in order to prevent uncontrolled shifting during transport. Sharp building components that are to be bulk loaded may tear the poly liners. If it is determined that tearing of the liners cannot be prevented, then the contractors shall place 3/8 inch thick(nominal thickness)plywood sheets inside the roll- off or dump truck, between the liners and the waste, to prevent tears to the poly. This plywood shall then be disposed of as ACWM with the load. 20. The ACWM shall not be otherwise crushed or compacted by hydraulic or other means. Large metal components such as un-insulated steel I-beams and large sections of uncoated concrete walls or floors, that are to be recycled, shall be washed and thoroughly decontaminated. Following decontamination each such large component shall be visually inspected by the APM. A list of these components and the results of each visual inspection thereof shall be recorded in the APM's Site log book. All clean masonry material that is to be removed for recycling shall be handled in accordance with all applicable local and state regulations including those at the following MassDEP Solid Waste Division's website link describing the proper handling of asphalt,brick and concrete resulting from demolition activities. Forbes&Wheeler Non-Traditional Work Plan 167 Main Street, Leeds,MA 01053 Page 5 necessary to prevent particulate overloading. Each air filter cassette shall have the start and stop time and associated start and stop flow rates recorded in the consultant's Site log or air sampling data sheet. Air monitoring series which repeatedly reveal samples that are overloaded with particulate and cannot be analyzed may be considered to be in noncompliance with the terms of NTWP Approval and MassDEP Air Quality regulations. Any noncompliance may result in the revocation of this NTWP and subsequent enforcement action by MassDEP. The AAC shall provide four (4) sources of one hundred ten volt alternating current (1IOv AC) such that MassDEP 1ersonnel may set up monitoring Mumps at any area around the perimeter of the site. These power sources shall be protected by ground-fault circuit interrupters (GFCI's). The AAC shall also provide sufficient Power cords meeting OSHA requirements for use by MassDEP personnel. 13. Analyses of the perimeter air samples shall be performed within one hour of collection and a copy of these results shall be provided to the APM and each contractor working at the Site, so that real time corrections in the work practices can be made. If the air monitoring results exceed one - one hundredth fiber per cubic centimeter(0.010 Vcc) of air, then all work shall stop. The work methods shall be evaluated by the Asbestos Project Monitor in consultation with the AMF, Asbestos Project Designer, Asbestos Site Supervisor and the demolition site supervisor prior to continuing any further work. MassDEP shall be notified by telephone by close of business (5:00 p.m.) on that same day of the air monitoring exceedance and the updated emission control procedures. If the airborne fiber concentrations reach or exceed fifteen thousandths fibers per cubic centimeter (0.015 f/cc) of air, then work shall stop and MassDEP shall be notified of the exceedance by telephone within two(2)hours. 14. Each and every contractor and subcontractor performing asbestos handling related work at the Site pursuant to this NTWP shall perform employee air monitoring, this is not to be confused with OSHA personal air monitoring requirements. The pump shall be operated at a minimum of 2.0 liters of air per minute and each sample shall collect a minimum of 275 liters of air. The employee air samples shall be located in the worker's breathing zone,which for the purposes of this NTWP is twelve inches(12") from the nose and mouth. Flow rates are to be measured by a device(rotometer) that has been calibrated to a primary standard within six(6) months of use at the site. A copy of the calibration records for each such measurement device(rotometer)shall be provided to MassDEP at least one (1)working day prior to the start of any work. The start and stop times and associated flow rates are to be recorded in each contractor's site log book. At least one in four workers, or one for each assigned job duty, shall wear a personal air monitoring pump. This includes supervisors,ground crew in the asbestos work area,ground crew outside the asbestos work area, asbestos removers, and equipment operators as appropriate. The employee air monitoring shall be performed on a continuous basis during all asbestos handling operations. If work stoppages are expected to exceed 30 minutes, such as lunch breaks or wait times for dumpster delivery or equipment repair, then each monitor shall be shut off and the flow rate and time recorded. When work recommences and the unit is re-started,the re-start time and flow rate shall be recorded. Employee air monitoring shall be performed until such time as the visual inspection pursuant to 310 CMR 7.15(8) is conducted. The AAC and DC are also required to ensure that employee monitoring is performed on their own employees and on the employees of all subcontractors,and that it is performed in compliance with the terms of the NTWP. 15. Analyses results of the employee air samples shall be provided to the APM by each contractor and subcontractor each morning prior to beginning any work on every day except the first day of work. If the air monitoring results exceed one- one hundredth fiber per cubic centimeter(0.010 Forbes&Wheeler Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 4 ensure adequate wetting of ACWM. A venturi or similar mixing system shall be affixed to the hose such that a surfactant is applied to the ACWM prior to handling. Alternatively, the surfactant may be applied by a separate system. Surfactant must be applied to the ACWM at the beginning of each day's work, after which water that is not amended may be used for wetting purposes. Hookups to a municipal fire hydrant and/or water tankers are required to meet this standard. The water tank trailer or truck, if used, shall be a minimum of 3,000 gallons. Garden hoses are not acceptable. If a water tank is used, it shall be equipped with a gas-powered centrifugal pump capable of discharging water at a minimum of 140 gpm, with enough pressure capable to reach all areas and heights of the building and the work. 9. Water runoff control shall be used to capture any water runoff from the site. If the water is collected into a lined collection pit then following all demolition and cleanup operations the liner shall be removed and disposed of as asbestos waste and three(3) inches of soil shall be excavated from the pit and disposed of as ACWM. Asbestos-contaminated water must pass through filters capable of capturing and containing particles greater than or equal to five (5) microns in size, before disposal to a sanitary sewer is permitted. Hay bales, silt fences, fiber rolls, fiber logs, and straw wattles are not acceptable for water runoff control. 10. The DC shall use equipment of sufficient size to ensure a controlled demolition operation and prevent an uncontrolled collapse. All equipment and personnel associated with the asbestos demolition and ACWM bulls loading operation shall be fully decontaminated on a daily basis and before being released to other service. At a minimum,the equipment operators shall be trained in accordance with the standards for Asbestos-Associated Project Workers described in 453 CMR 6.00, or trained and certified pursuant to any other necessary training described in 453 CMR 6.00 as determined by inspectors of the Springfield, MADLS office. Copies of said training and licenses shall be kept at the Site at all times for review by MassDEP personnel and shall be submitted with the requisite documentation listed in Condition 28 below. IL An APM holding a current and valid license issued by the MADLS shall perform perimeter air monitoring of the ambient air around the circumference of the work area. This perimeter air monitoring shall be performed on a continuous basis during the asbestos demolition and ACWM bulk loading operations until the start of the visual inspection required pursuant to 310 CMR 7.15(8). Attention shall be paid to the downwind sector as well as to all adjacent properties, streets and walkways to ensure that the circumferential monitoring points coincide with these sensitive receptors. The consultant shall have a minimum of four (4) air monitoring stations to accomplish adequate monitoring between the Site and all of the sensitive receptors. The AMF is responsible to ensure that the APM performs the sample collection in compliance with all parts of the NTWP. 12. All perimeter air samples shall be collected at a minimum flow rate of eight to sixteen liters per minute (8.0 to 16.0 1pm). Each sample shall collect a minimum volume of 1100 liters of air, except under special circumstances (such as low volume due to sudden end of working day) acceptable to MassDEP and which shall be noted by the APM either on the air sample data sheet or site log. Perimeter air samples shall be collected in the general breathing zone, which for the purposes of this NTWP is between 48 and 72 inches above ground level. Each air sample's start and stop flow rate shall be measured by a device(rotometer)that has been calibrated to a primary standard within six(6)months of use at the Site. A copy of the calibration records for each such measurement device(rotometer)shall be provided to MassDEP at least one(1)working day prior to the start of any activity pursuant to this NTWP. All air filter cassettes shall be changed as Forbes&Wheeler Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 3 the APM pursuant to this NTWP. Prior to the start of any work subject to this NTWP, the APM shall review each and every asbestos notification(and applicable revisions)prior to commencing any work. 4. Prior to the start of any work subject to this NTWP, the APM shall review all aspects of this NTWP with each contractor, subcontractor and consultant. A written record of each entity attending the review shall be kept by the APM conducting the review and submitted to MassDEP at least one(1)working day and in accordance with Condition number 28 below. 5. All contractors and subcontractors shall comply with all safety requirements, directives and instructions issued by City, State and Federal health, safety and building inspectors.. Failure to comply with such directives may immediately result in the revocation of this NTWP by the MassDEP. 6. A regulated work area shall be established using asbestos warning signs and asbestos barrier tape and physical barriers to prohibit unauthorized access into the work area during the asbestos demolition and bulk loading operation. 7. The AAC and every asbestos contractor and subcontractor working at the Site shall hold a current and valid license issued by the MADLS. The AAC shall be on site at all times during the asbestos demolition and bulls loading operation. The employees of each and every asbestos contractor shall also hold current and valid licenses issued by the MADLS as either asbestos workers and or asbestos supervisors. At least one(1)asbestos supervisor shall be on site for each four(4)workers. The AAC shall ensure all of the following: a) that the co-mingled asbestos and demolition waste material will be treated as Asbestos- Containing Waste Material("ACWM") and thoroughly wetted with amended water prior to handling and kept wet at all times during handling, b) that all of the roll-off dumpsters, truck waste containers, are properly lined as described in this NTWP, C) that all of the ACWM is properly containerized as described in this NTWP,by sealing the liners over the top of each load, labeling the outermost liner and ensuring that the loads are covered prior to transport from the Site, d) that no water leaks fi-om the vehicles during transport to the landfill, e) that the ACWM is properly tracked with MassDEP and USEPA required Waste Shipment records("WSR's"),effective 1-1-15. f) that all ACWM is disposed of properly in accordance with all local, State and Federal regulations regarding the transport and disposal of asbestos wastes, g) that the exterior of all vehicles leaving the Site are properly cleaned and free of any debris generated at the Site. 8. Large capacity fire hoses(minimum nominal inside diameter of 1-1/2 inches)shall be used during all phases of the demolition and ACWM loading operations to eliminate dust generation and Forbes&Wheeler Non-Traditional Work Plan 167 Main Street,Leeds,MA 01053 Page 2 The specific sections of the MassDEP asbestos regulation, 310 CMR 7.15, to which these Non-Traditional Work Practices will apply are: 310 CMR 7.15(4)-Survey Reports 310 CMR 7.15(5). - Requires the removal and disposal of any ACM in accordance with 310 CMR 7.15, prior to conducting any demolition and/or any renovation thereof; and removal or encapsulation any friable ACM that has been or will be exposed or created as a result of any demolition or renovation. 310 CMR 7.15(7)(c)L-6.—Work Area Preparation Requirements. 310 CMR 7.15(7)(e)—Work Area Ventilation System requirements. 310 CMR 7.15(7)(f)3.a. - c. —Requires prompt cleanup of all asbestos waste and removal from the worksite on a daily basis,and that said asbestos-containing waste materials be sealed into leak-tight containers such as bags,drums or wrapped in poly sheeting following removal. 310 CMR 7.15(15)(b)-Packaging Requirements for ACWM into leak tight containers. 310 CMR 7.15(16)(b) Transport of ACWM in Totally Enclosed Vehicles. The following conditions and work practices shall be strictly followed during the course of the asbestos demolition and bulk loading operation: 1. The asbestos abatement contractor ("AAC") shall submit a completed notification ("ANF-001") form to the MassDEP database at least ten (10) working days prior to the start of any work pursuant to this NTWP. All applicable notification fees shall be paid. The notification shall comply with all parts of MassDEP regulation 310 CMR 7.15(6), including acceptance by MassDEP. Failure to submit a properly completed notification form may result in the notification being rejected by MassDEP. Rejected notifications may be resubmitted within 30 days,however, the 10 working day notification period must be observed each time a rejected notification form is resubmitted. Each and every asbestos contractor and subcontractor who performs work at the Site shall submit an individual ANF-001 in the manner described above. 2. The demolition contractor("DC") shall submit a separate ANF-001 to the MassDEP database at least ten (10) working days prior to the start of any work pursuant to this NTWP. All applicable notification fees shall be paid. The notification shall comply with all parts of MassDEP regulation 310 CMR 7.15(6), including acceptance by MassDEP. Failure to submit a properly completed notification form may result in the notification being rejected by MassDEP. Rejected notifications may be resubmitted within 30 days,however,the 10 working day notification period must be observed each time a rejected notification form is resubmitted. Each and every demolition contractor and subcontractor who performs asbestos handling at the Site shall submit an individual ANF-001 in the manner described above. 3. The Asbestos Monitoring Firm("AMli")performing work subject to this NTWP shall designate an employee, who holds a current and valid license issued by the Massachusetts Division of Labor Standards ("MADLS") as an Asbestos Project Monitor ("APM") to perform all duties of Forbes&Wheeler 4 ��,-•„ 650 Dwight Street, #1337 (Holyoke, MA 0104I ``� TEL: 413-221-8233(FAX: 866-423-6355 www.forbeswheeler.com Members: AIHA/ASTM Asbestos ♦ Lead Paint ♦ Mold/Fungi ♦ EH&S Training ♦ Indoor Air Quality ♦ Industrial Hygiene ♦Hazardous Materials May 28,2015 z M, Mr. Robert Shultz Massachusetts Department of Environmental Protection(DEP) u. 1,1 Bureau of Waste Prevention Western Region 436 Dwight Street Springfield,MA 01103 RE: Asbestos Removal Work Plan Application for Non-Traditional Asbestos Abatement Work Practice Approval Demolition of Entire Building/Fire-Damaged Building Debris,as Special Waste 167 Main Street,Leeds,MA 01053 Dear Mr. Shultz: On behalf of the demolition contractor for the building owner(Moses Miller, 167 Main Street,Leeds,MA 01053),Forbes&Wheeler is requesting review and approval of the following Non-Traditional Work Plan ("NTWP"), in association with the attached BUT AQ 36 (Application for Non-Traditional Asbestos Abatement Work Practice Approval), requesting that the facility owner's contractor be allowed to demolish the entire building located at 167 Main Street, Leeds, MA 01053, without first removing the asbestos. The building has been damaged by fire, and is declared as unsafe for human occupancy or use by the local building authority. Therefore, an asbestos survey cannot be conducted. Both friable and non- friable asbestos-containing materials (ACM) are assumed to exist within the building materials. To the best of my knowledge, no asbestos survey was conducted prior to the fire. Therefore,the owner requests that the assumed asbestos materials be allowed to remain in place during demolition and be bulk loaded for disposal as asbestos waste. I have developed specific alternative work practices which shall be implemented by all contractors, sub-contractors and consultants,to ensure that"no release of asbestos to the ambient air space during the demolition and bulk loading operation" occurs. These alternate work practices include maintaining adequate wetness as required, by water runoff control, full time third party oversight, representative perimeter, and ambient air monitoring, full time asbestos contractors and other requirements listed below during the remaining asbestos demolition and bulk loading operation. By performing work pursuant to this NTWP,the owners and their contractors, subcontractors and consultants acknowledge and agree that failure to strictly comply with all of the work plan provisions and conditions stated herein may result in immediate revocation of this NTWP by the MassDEP and subsequent enforcement action by MassDEP. Forbes&Wheeler Non-Traditional Asbestos Abatement Work Plan Approval Number: WNT15022 167 Main Street Leeds,MA Page 4 NON--TRADITIONAL ASBESTOS ABATEMENT WORK PLAN SUBMITTAL CERTIFICATION All documentation submitted pursuant to the terms of this work plan shall comply with 310 CMR 7.01(2)(a)Accurate Submittal to the Department which states: "No person shall make any false, inaccurate, incomplete, or misleading statements in any application,record,report,plan,design, statement or document which that person submits to the Department pursuant to M.G.L. c. 111, §§ 142A through 142M,M.G.L. c. 111, § 150A,c. 21H, or 310 CMR 7.00 et seq." Finally, I certify that I am authorized by the property owner or the firm I represent to sign this form. All information must be printed legibly or typed. Name: Signed: Date: Entity Name,Address and Telephone Number: MassDEP Notification Number(s): MassDEP NTWP Approval Number: List of Attachments: Non-Traditional Asbestos Abatement Work Plan Approval Number: WNT15022 167 Main Street Leeds,MA Page 3 Approval. A copy of the application,work plan and Approval shall be kept at the Site for the . duration of the project. 13. Should unforeseen Site conditions require changes to any of the procedures in this work plan, the applicant may request an amendment or addendum to the NTWP. Any request for changes shall be made to MassDEP in writing. None of the added or amended conditions shall be utilized at the Site until the request has been reviewed and Approved by MassDEP. 14. Should asbestos become released,the owner,his contractors, subcontractors and consultants shall be held responsible for any subsequent abatement of the release and may be subject to enforcement action by the MassDEP. 15. MassDEP may, at its sole discretion,revoke this NTWP if violations of the regulations or any noncompliance with the submitted work plan,occur. 16. This Approval and NTWP are not intended and should not be relied upon to create rights or defenses,implied or otherwise,in any third parties,enforceable at law or in equity,by any person in any future litigation. MassDEP does not assume any liability in association with the performance of any activity in accordance with this NTWP. 17. This NTWP is valid for ninety (90) days after the date it is signed by MassDEP ("the effective date"). This NTWP shall expire at the start of the ninety-first (91St) day. If activities are to continue past the 90 day expiration date then the MassDEP shall be notified in writing at least ten (10) days in advance, specifically,on or before the eightieth (80th) day. Continuance of the work under the provisions of the NTWP shall be the sole determination and approval of MassDEP. 4" Date: (t f S 'lr�ul' Marc Simpson Permitting Section Chief Bureau of Air and Waste Western Regional Office attachment Non-Traditional Asbestos Abatement Work Plan Approval Number: VVNT15022 167 Main Street Leeds,MA Page 2 4. All contractors performing asbestos handling shall have current and valid notifications for the duration of the work. In the event MassDEP is notified by any financial institution that any applicable notification fee is not valid,then all work at the Site shall stop. The contractor who failed to pay the notification fee shall be subject to enforcement action by MassDEP for failing to notify prior to performing asbestos abatement activities. Work shall not resume until all notifications and notification fees are determined to be valid. 5. Contractors and consultants shall not use any work or monitoring practices which are not specifically listed in the work plan,this Approval or the MassDEP asbestos regulations, 310 CMR 7.15. 6. All contractors and subcontractors shall comply with all safety requirements,directives and instructions issued by city, state and federal health, safety and building inspectors. Failure to comply with such directives shall immediately result in immediate halt to all work at the Site and potential revocation of this NTWP. 7. No work pursuant to this NTWP shall commence unless the asbestos project monitor("APM") is at the Site and all air monitoring stations,both perimeter and employee monitoring, are in full operation. 8. All documentation regarding air monitoring methodologies,collection procedures, calibration records and analysis results,as well as visual inspections reports,waste disposal records,site log books,visitor sign in logs,notices of violation, cease and desist orders and MassDEP notifications shall be kept on Site for inspection by MassDEP and all other federal,state and local governmental agency personnel during the asbestos demolition and bulk loading operation. 9. Copies of all of the Site records and documentation are to be supplied to the MassDEP by the owner,and each and every contractor,subcontractor and consultant upon request or within thirty(3 0)days of completion of the work if not requested earlier. All submittals to MassDEP shall be accompanied by a completed Certification Statement, attached as the last page of this document. 10. This work plan does not negate the responsibility of the owners,the contractors,subcontractors and consultants from complying with all other applicable federal, state and local laws or regulations. 11. This work plan applies specifically to the asbestos demolition,clean-up and bulls loading at 167 Main Street in Leeds, MA. This work plan does not apply to any past or future demolition or asbestos handling operations at the Site. All other MassDEP regulations are in effect for the duration of this asbestos demolition and bulk loading operation. 12. The property owner shall ensure that a representative of each contractor, subcontractor and consultant,involved in this project,receive a copy of all parts of the NTWP including this i Commonwealth of Massachusetts Executive Office of Energy &Environmental Affairs LlDepartment of Environmental Protection Western Regional Office-436 Dwight Street, Springfield MA o11 03.413-784-1100 Charles D.Baker Matthew A.Beaton Governor Secretary Karyn E.Polito Martin Suuberg Lieutenant Governor Commissioner Moses Miller 167 Main Street Leeds,MA 01053 Re: Non-Traditional Asbestos Abatement Work Practice Fire Damaged Building Demolition 167 Main Street, Leeds Approval Number: WNT15022 Dear Mr. Miller: MassDEP Western Regional Office is in receipt of your application and attached work plan for the use of Non-Traditional Asbestos Abatement Work Practices ("NTWP" or"work plan"). The work plan, submitted by your consultant,requests that your contractors be allowed to demolish the building without removing the asbestos materials prior to demolition. This request is based on the building having been significantly damaged by fire rendering it unsafe to enter for any traditional asbestos inspections or removal operations. The remaining structure and debris pile shall be removed by hydraulic excavators and all materials shall be disposed of as Asbestos- Containing Waste Material("ACWM"). Your application to use NTWP's at the referenced site is APPROVED with the following conditions: 1. By performing work pursuant to this NTWP,the owner and his contractors, subcontractors and consultants acknowledge and agree that failure to strictly comply with all of the submitted work plan provisions and conditions contained in this Approval may result in immediate revocation of this NTWP and that all parties may be subject to enforcement action by MassDEP. 2. If the instrument of payment,used to pay the applicable fee for this NTWP,fails to be honored by the issuing financial institution,the NTWP shall be considered incomplete as of the date it was submitted and void. All parties involved in the operations shall be subject to enforcement action for failing to obtain an NTWP prior to performing such activity at the Site. 3. The owner has designated certain contractors to perform work at the Site pursuant to this work plan. These designees cannot be changed and this Approval is not transferrable. This information is available in alternate format.Call Michelle Waters-Ekanem,Diversity Director,at 617-292-5751.TTY#MassRelay Service 1-600-439.2370 MassDEP Website:www.mass.gov/dep Printed on Recycled Paper Ol\ ()| 7�U|<U|/\��PTO� \|/\SS/\O|US[l-[S DEPARTMENT OF PUBLIC WORKS |2)5LOCC5TSlKI O KoK[||/\M|'|l)N. \1J,\ 01060 113-587'1570 [�X4|3-07'|576 February 4` 20l5 Louis Hasbrouck, Building Inspector Municipal Office Annex 2l2 Main Street Nor(hacnptou, MoUlU60 Dear Mr. Hasbrouck: The water service u1A)67MainStreet Leeds has been disconnected from the city water supply and the water meter has been removed from the premises uoof February 4, 20l5. P|moxo contact me i[you have any questions. 3ioccre| gory R. Nuttelman Superintendent of Water Cc: Ned BunUny, Director of Public Works Jim LaUrila, City Engineer Page 1 of 1 Michael Orr From: Romito, Jeff[Jeff Romito@cable.comcast.com] Sent: Saturday, April 18, 2015 7:27 AM To: demo coordinator Subject: RE: Request for Disconnection of Service - 167 Main Street From: demo coordinator [mailto:demo @buildingwreckers.com] Sent: Friday,April 17, 2015 10:26 AM To: Romito,Jeff Subject: Request for Disconnection of Service- 167 Main Street Good Morning Jeff, Attached you will find a request for the disconnection of cable service at 167 Main Street in Northampton. Please let me know if you have any questions, or need any additional information. 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 04/20/2015 FRONT: Verizon Lngmeering 1116 Leland St. — Fli-.2 Framingham, Ma. 01702 IZE: 16—/ Ila i n :;t, NorLf-ianipton, 1 4ti This letter is to inform you that the Verizon services involving 167 Main St, Northampton, MA have been disconnected. V[,RILO\ Engineer "I'hank yon, Lisa Donovan Central Engineering 508-820-3533 A NiSource Company 995 Belmont Street Brockton, MA 02301 Date: April 30, 2015 To Whom It May Concern: The address listed below has had the gas service(s) disconnected and is now ready for demolition. ADDRESS : 167 Main St TOWN : Leeds STATE : Massachusetts Sincerely, Lisa Buckley Integration Center Columbia Gas Of Massachusetts 508-580-0100 Ext 1293 RECEIVED 06/05/2013 09:05 05/05/2015 03:02pm OVERLOOK EAST 14135851069 #950 Page 03/03 nationafgrid 40 Sylvan Rd Waltham MA 02451 May 4,2015 Mr.Moses Miller 57 Main St. Haydenville, MAO]039 EMAIL:mosesmill(u@gmail.com RE: Service Removal for Building Demolition Dear Mr.Miller: This letter is to confirm,per your request,that there is no service and/or meter(s)located at 167 Main St.,.Leeds,MA 01053 as of 5/4/15. If you have any questions or need further assistance,please feel free to contact me at f SO81 357-4605. Sincerely, AnnMarie Estrella Customer Fulfillment Fax: 1-888-266-8094 Phone: 1-ti 8-357-4605 annmarie.estrel la @nationalgrid.com nationalgrid Ref: WR#19330219 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(c%7 Mae.^SelrcetAr (Leeds) The debris will be transported by: As5ocia ed lwket�• xv% The debris will be received by: y jw t4*.6,rtabi j & c4c56*%g (w.Sj&td) Building permit number: Name of a mit plicantSSoG,o► e�,Fx�;tday�c,,t�J recerS.;wc_ Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of IndustrialAccidents 44 Office of Investigations " d 1 Congress Street, Suite 100 w Boston,MA 02114-2017 www mass.gov/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 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 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, 0 Demolition working or me in an capacity. employees and have workers' g y p �'• $ 9. E] Building addition [No workers' comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.0 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#I 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 anew 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:GREAT DIVIDE INSURANCE COMPANY Policy#or Self-ins. Lie. #:WCA154516513 Expiration Date:02/01/2016 Job Site Address: 167 Maid Street City/State/Zip:Leeds, MA 01053 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 one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day agairipf the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of re PIA fcf insurance coverage verification. I do hereby certi der tl pains and penalties of perjury that the information provided above is true and correct. Si nature: Date:b 1Lq1 1 Phone#: (413)732.3119 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: RECEIVED 00/04/2013 09:52 To: Mike Page 2 of 4 2015-07-04 20:29:50(GMT) 14136042000 From Moses D.Miller SECTION$-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor. Not Applicable d Name of Licen a Holder An ft%g .�tl Ly4 to LS-M?- License Number Ssl IM(.3%1?_oi Address Expirat o Date �7 Signature Telephone 9.Resist®ied llsme ImorovemeWt Contractor - Not Applicable ❑ Com an a e Registration Number HA etc :� t3 25 1 Addres Expiration Date. Telephone s�3 9 Z3Z-3 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.162,§26C(6)) ' Workers Compensation Insurance affidavit most 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....... el No...... Ci 11.-Home Ownelr Exemutio The current exemption for"homeowners"was extended to include Owner-occupled Dweliin-s of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.CMR 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,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home In a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that helshe shall be responsible for all such work performed under the buildine permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,-you maybe liable forperson(s) you hire to perform work for you under this permit The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances,`State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature --— RECEIVED 08/04/2013 09:52 To: Mike Page 3 of 4 2015-07-04 20:29:50(GMT) 14136042000 From:Moses D.Miller SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House Addition [] Replacement Windows Atteration(s) Roofing Or Doors 0 Accessory Bldg. ❑ Demolition ❑✓ Now Signs [01 Decks [p Siding[01 Other[O1 Brief Description of Proposed Work:Complpc demolidoneffirc Shmagt4 stwure.0twturt isloogoriaabiubiadac to damage(mm 6m) Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa.If New house and or addition to existing housina.complete the following 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 g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction Demolition I. Is construction within 100 ft.of wetlands?, Yes No. Is construction within 100 yr. floodpiain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. 1. Septic Tank_ City Sewer_j< Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize _A -CMt bu(%&VA9%1 2 e+i T.wG to act on my behalf,in all matters relative to work Mhorized by this building permit application, Z. Signature a Ow er Date as Owner/Authorized Agent hereby declare that the statements and Information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signe*penalties of perjury. Print N Signature of Ovmer/Agent Date RECEIVED 08/0412013 09:52 To: Mike Page 1 of 4 2015-07-04 20:29:50(GMT) 14136042000 From: Moses D. Miller Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by zoning This column to be filled in by Building Dcpartmcnt Lot Size 10.8 Acres Frontage Setbacks Front Side L: R'C�I L•= R= [� Rear C� Building Height B1dg..Square Footage % Open Space Footage (Lot arep minus bldg d:paved parking) #of Parking Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued forlon the site? NO 0 DONT KNOW °) YES IF YES, date issued:^� IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book F Page and/or Document#1 B. Does the site contain a brook,body of water or wetlands? NO 0 DONT KNOW YES Q 1F.YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES Q NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO Q 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 t acre? YES 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. RECEIVED 08/0412013 09:52 To:Mike Page 4 of 4 _ 2015-07-04 2029:50(GMT) 14136042000 From Moses D.Miller ,,� , pepartr�e11�1 r -us my �1"T h"p i4 City of Northampton x t� s 6 �a�5 Building Department CdrbCut1D;ivew'a Pe II � rl r ' �t ,N . ��� 't�� r'+ J ti'k 212 Main Street Aabilit�x-1 aka A va Room 100 watemNe►I AY81Iabpi l 3;y ;p, r r 5F i rthy Elect ic,Plumbing&Gas Inspedons l Northampton,MA 01060 orthampton,MA 01060 p one 41�1-587-1240 Fax 413-567-1272 Plot/Si le,Pl�ns i tpa r nii�j RAi'fi" APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION I-SITE INFORMATION 1.1 Property Address:c This section to be completed by office If. Maa v% `.�" cv-CLkf' ( Map Lot Unit L-� t.VAA atolaa ! Zone Ovaday Olstriet i Elm SL Dlatrict CB Distdct � SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT' 2.1 Owner of Record: Moses Miller 167 Main Street,Leeds,MA 01053 Name(P�int) GE_'S..,.� Current Mailing Address: (413)695-0094 Telephone Signature 2.2 Autho z d Acienth (413)712- 79 (413)732-3179 Name(Pri 1) Current Mailing Address; (413)732-3179 Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only cam leted by rmit applicant 1. Building (a)Building Permit Fes 2 Electrical (b)Estimated Total Cost of Construction from 6 3, Plumbing Building Permit Fee 4. Mechanical("VAC) 5.Fire Protection S. Total 10+2+3+4+5j Check Number sip This Section For Official Use Only puilding Permit Number. pate Issued: Signature: Building Commissioner/Inspector of Buildfngs Date File#BP-2016-0014 APPLICANT/CONTACT PERSON ASSOCIATED BUILDING WRECKERS INC ADDRESS/PHONE 352 ALBANY ST SPRINGFIELD01105 (413)732-3179 PROPERTY LOCATION 167 MAIN ST MAP IOD PARCEL 019 001 ZONE URB000)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: DEMOLISH HOUSE 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: __VApproved 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 ��"- f{IS�OX{C�!-C, t" v� �_3 oz" 7�6 1 i 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. 167 MAIN ST BP-2016-0014 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: lOD-019 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Catego!y: demolition BUILDING PERMIT Permit# BP-2016-0014 Proiect# JS-2016-000023 Est. Cost: $28500.00 Fee: $75.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: ASSOCIATED BUILDING WRECKERS INC 063282 Lot Size(sq. ft.): 9757.44 Owner: MILLER MOSES D Zoning. URB(100)/ Applicant. ASSOCIATED BUILDING WRECKERS INC AT. 167 MAIN ST Applicant Address: Phone: Insurance: 352 ALBANY ST (413) 732-3179 Workers Compensation SPRINGFIELDMA01105 ISSUED ON.711712015 0:00:00 TO PERFORM THE FOLLOWING WORK.DEMOLISH HOUSE 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 7/17/2015 0:00:00 $75.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner