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141 BOSTON ST - BPA-14-1456 COMPLETE DEMO S The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 Building Permit Application To Construct,Repair,Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: DateAppliet: 4 3 /�• Building Official(Print Name) Sigliature Date SECTION 1:SITE INFORMATION 1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers ! l 3�s�, . //6 ! 3 y L l a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(it) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L e.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public EY Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: ! v� Name(Print) City,State,ZIP , 3S o-54 5 F 7 k 3 / 7465 6 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief 1 Descripto ed Work': 0 NC(✓ Xl n/GI jJN CIG ,c, C, —Ir S SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Costs(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ 6.Total Project Co!t: $ C.f gU� Check No. Check Amount: Cash Amount: l` ❑Paid in Full ❑Outstanding Balance Due: S�TJa' CL 1 $ SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) d S 0 2. 3 pg_3 2, 2cd /; Q,q-T-R t G I<-- V'7 oG�� License Number Expiration Date Name of CSL Holder t7 A-l-J- y� � 5 �- List CSL Type(see below) No.and Street / Type Description L.. �/ pJ nJ (ivI /� � ' ct C[� Unrestricted Buildin s u to 3.....cu.ft. J R Restricted 1&2 FamilyDwelling City/Town,State,ZIP M Maso RC Roofm Coverin WS Window and Sidin �� ��^/63 J SF Solid Fuel Burning Appliances `T J I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Registration Number Expiration Date HIC Registrant Name HIC Company Name or No.and Street Email address City/Town, State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(0) 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........... ❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Awns t GK-- (M to act on my behalf,in all matters relative to work authorized by this building permit application. 3 /4 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information co tried in tl' npp' lion is true and accurate to the best of my knowledge and understanding. / V/ tr 9 . Print Owner's or A nzed Agent 3 's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at Nvww.mass.govioca Information on the Construction Supervisor License can be found at www.mass.<rov/dns 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" CITY OF SAL.EM) NaSSACHUSETTS BUILDING DEPARTMENT Q 130 W.+sHnvGTON STREE JP VEO l- SERVICES al TEL (978) 745-95 VAX(978) 740.98114 SEP -4 P 11: 11 KI\IBERLEY DR]SCOLL MAYOR THobL1s ST.PmRRE DIRECTOR OF PUBLIC PROPERTY/BUILDING CONMUSSIONER Demolition Permit Sign-Off y� (Supplement to permit application) 1, M (�s f r`5 C�S hereby supply the following releases as part of the application for a permit to dernolish the structure located at 14/ Q !�Y, . and shown on the Assessor's Maps of as being on Map # Block # Lot# 13 O The sixth edition of the.Massachusetts State Building Code, 780 CMR, states in part: ''A permit to demolish or remove a building or structure shall not be issued until a release is obtained from the utilities, stating that their respective service connections and appurtenant equipment, such as meters and regulators,have been removed or sealed and plugged in a safe manner." Utility to be Notified Notice Received by Date Received Gas <eff Telephone. - Electric 4 eTfe Public_Utilities (Municipal) jHealth Department_lf F-t Z_ 'I-Fire Department jp„Pp1��LFun Other - 5' a+g-d _4 CI Other- Demolition debris hauler: rA ti I /� Location of licensed demolition debris landfill: (7 78 I/y(ti 50� I�X yvl ! ( -4��� N, Signature of Applicant Date: 9 fi 14 Signature of Owner _ Date: 3 Ay This sheet must be returned to the Inspections Department along with a completed application for a permit, a site plan, and any other applicable information and fees. l�enuipwm.do,: am C["I'Y OF SiuEENi, bIi1SSACHUSETTS BUILDING DEPARTMEINT 3 120 WASHIINGTON STREET, 3'°FLOOR TEL (978) 745-9595 FxX(978) 740-9846 lcl S IB ERLEY D RISCO LL THO,%W ST.PIEe a R r q-%YOR DIRECTOR OF PUBLIC PROPERTY/BUILDING CO.\L\IISSIONEA Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrlcians/Plumbers •lrspllcant Information Please Print Legibly Vatnd Mr� rwK� uFe p rr5e5 (nusinessOrgmizatioro'Individual):Addrt:ss: oti� d A-Ile—01 t6p, cs-16— City/StatelZip: L V'AJ A-1 I11 f3 6"9rJr Phone #: Are yn can employer?Check the appropriate box: Type of project(required): I. I am a employer with -f' 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ lama sole proprietor or partner- listed on the attached sheet. S 7. El odeling .hip and have no employees These sub-contractors have It. emolition working for me in any capacity. workers'camp.insurance. 9. El Building addition [No workers'camp. insurance 5. ❑ We are a corporation and its .] officers have exercised their 10.❑ Electrical repairs or additions required 7.❑ I am a homeowner doing all well right of exemption per MGL I If] Plumbing repairs or additions myself.(\'o workers'comp. c. 152, §1(4),and we have no I2.❑ Roof repairs insurance required.] t employees. (No workers' cutup. insurance required.) I1.❑Other •Any applicant awl chucks bur al mwr also rill our the sectiun below showing)heir worker'compeosadun policy mruenailun. '1 hsmunw're"who submit)hie sffl(bvii indicating nhey im doing all work and then him outride aomncror most aahrril a new aftldavit indicating such. $annmunur phut chak this box most anachd as asWitiwsui xhat showing flu mmne and their worker'comp.pulley inlemtation. I am can eurptuyer duet is prupldhig workers'rantpeasatlon insurance for my employees, tfeluw is the policy cord job slid information. Insurance Company Name: - I -Ar�--a a `ems v S a policy it or Self-im, Lie. N: 6 5G v 13v5-4 IV Expiration Date: 6 i Job Site Address: L`7 f�`y� "J s �`�(E'�"'t City/State/Zip: ,k ttach a copy of the workers' cam m pcnsatioo policy declaration page(showing the policy no and ex plration data). Failure to secure cuvenge as required under Section 2JA of,%IGL c. 152 can lead to the imposition of criminal penalties of a line up to S1,500.00 undhor one-year imprisonment,as well as civil penahies in the form of it STOP WORK ORDER and a line mill)to S250.00 a day against the violator. Ile advised that a copy of this statement may be furwardcd to the Office of Invcstigotiuns nl'Ihe DIA ror insurance coverago vcrilicalion. Ida hereby rrrrily under die sins sad pen steles of perjury that the infurination provide)ubuv i.v it /and c•drreet Si••n I c' G/1 �J'¢j-�j ' Date: 9,! �. Phone d� Of icial use unly. Dun✓t ivrite in ibis area, ro be curupleted by eiry ut tanvn njjlviut City nr'fuwn: _ _ Pcrmit/LlccnseN Issuing Anihurity (circle one): - 1. hoard cal'lleahh 1. Ruildinq Departnteia .I.Cily(rimo Clerk J. Electrical btspectur 5. Plumbing Inspector 6. Other I CUIIIaet l'l'fflltl: CITY OF SALEM, MASSAQHUSETTS K , # ,, `•� BUILDING DEPARTMENT 120 WASMNGTON STREET,311D FLOOR \mv TEL. (978) 745-9595 FAX(978) 740-9846 KIMBERLEY DRISCOLL MAYOR THomAs STTIERRE DIRECTOR OF PUBLIC PROPERTY/BUILDING COMMISSIONER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL c40, S 54; Building Permit # is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111, S 150A. The debris will be transported by: (name of hauler) The debris will be disposed of in: 54 2 (name of facility) 78 wl 4-S U (address of facility) Signatur of applicant Date nationaignid August 12th, 2014 Attn: Peter Copelas This letter is to notify you that the gas service located at 141 Boston St, Salem, MA was cut off at the main on 81212014. h you have any questions, please feel frog to contact me @ 781-907-2915 Thank you, Andrew McCabe Gas Customer Fulfillment National Grid 40 Sylvan Road Waltham, MA 02451 Tel#:781,907.2915 Fax#:781»522-1057 And rew.mccabe@nationalgrid.com 1.1/07/2014 02 :46 (UTC/GMT) National Grid t�asc L nationalgrid 40 Sylvan Rd Waltham MA 02451 July 11, 2014 Peter Copelas,Trustee 135 Boston Street Salem MA 01970 RL: Service Removal for Building Demolition. Dear MhCapelas, This'letter is to confirm that,per your request,National Grid has removed the electrical. service and meter 57519508 from 141 Boston Street, Salem MA on 7/10/14. if you have any questions or need further assistance,please feel free to contact me at(508)357-4522. Sincerely, Deborah Correa Customer Fulfillment ph 508-357-4522 Fax# 1-888-266-8094 deborih.correa(a,nationalgrid.com I i I JF:48p Dennis Mastrolia 781 592 9513 p.1 Dennis the 1Mlennis "The King of Pes1 Con[ro!•' 7'erntile and Pesf control .Speeicrlisls MAIN OFFK F: "N'D L,AHS ?9LucvvrSo•ee� Lynn, ;1Ic. 01904 Un.von Lprn Lowell !i'obun' A'eaoron peaboc(r Lai-)encu DeriActin 565-r038 S93-0023 d59-11i0 935-DF,AD 3J=-5853 532-3-1-13 689-0697 25i-0000 August 29, 2014 Mr. Pat McGrath % 141 Boston Street Salem , MA. Rodent elimination for the demolition. Completed today.�a All inclusive $175.00. Follow up in seven (7) days to re bait all areas included. Thank you. Dennis Mastrolia781-592-0023. 978-459-2950. 800-649-3028 781-935-3323(Dead) We greatly appreciate your business and trust. Thirty three years serving clients with great success at fair and reasonable pricing policies. 09/02/20.14 14:33 FAX Benevento Insurance Z 0001./0001 �� CERTIFICATE OF LIABILITY INSURANCE DATE'�"�9�)14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS), AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If tIe certificate holder is an ADDITIONAL INSURED,the policypes)must be endorsed. If SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights t0 the certificate holder in lieu of such endorsement's). PRODUCER "T In rid Benevento Insurance Agency Inc PHONE 761 599-3411 MX 497 Humphrey Street N (Te1) 581-7200 E-MAIL Swampscott, MA 01907 Tl ADMESsm abenevento@bcmaventoinsurance.com _ INSURERS)AFFORDING COVERAGE NAIC4 ------ -- INSURERA:Arbella Protection usuRED INSURER B:Commerce Insurance Com n _ McGrath Enterprises INSURER C:Hartford I_n_surance Patrick Mcgrath INSURER D: 270 South Common St Lynn, MA 01905 INSURERE: .._ _......_ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSI ONS AND CONDITIONS OF SUCH POLICIES.L MITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS" ._ .. ._ ""..... LTR WPEOFINSURANCE L UBR POLICY EFF PoUDT Jum Will POUCY NUMBER (MMIWNYYn afflUDDYYYY) LINTS A GENETALLIABLITY 3600047427 5/24/14 5/24/15 EACH OCCURRENCE $ 1 OOO iQOO X COMERCIALGEWRALLIABIUTY DAMAGE TO RENTED ,000 CIAIMSMADE � MED OCCUR DIP Anyonea $ 100 DwPaem) $ 5,000 PERSO ML B ADV INJURY $ 1 00O 000 --- -- GENERAL AGGREGATE $ 2,000,000 GEN LAGGREGATELmTAPPLIESPER PRODUCTS-C Wh PAGG $ 2,000,000 X POLICY PRO- ---- $ CT OG B AUTOMOBILE DABIUT' BBBHJZ 8/4/14 6/4/15 COMBINIEDISINGLE LIMIT $ 1,000,OOO ANYAUTO BODILY INJURY(Per person) S AU OS SCHEDULED BODILY INJURY ami4en0 $ AUTOS X AUTOS ' HIREDALFTOS ONOSVYNED PROPERTY DAMAGE $ AUTr: wacaaeN - $ UNIRELLALUIB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C VARKERS COMPENSATION 6S60UB0542N54-6-10 5/26/14 5/26/15 g WC STATU- OTH- ANDEMPLOYERS'LIAMUTY' YIN 's _. - ANYPROPRIETDRIPAITTNERIE%ECUTNE E.L.EACH ACC $ 1OO OOO OFFICERMEMBER EXCLUDED? NIA _.. (Mar ,dla ,n NH)er E.L.DISEASE-EA EMPLOYE $ 100,000 ❑yes RIPMe OI4CI DESCRIPTION Ci OPEPATION$hebw E.L.DISEASE-POLICY LIMB S SOO OOO DESCRIPTION OF OPERAnDN$/LOO1nONS IVENOLES (AVach ACORD101,ARMiEaeal Relmrlm Sche4Vle,ifmorespaw LaregUmd) Excavation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE WITH THE POLICY PROVISIONS. Salem, MA 01970 AUTHORIZED REPRESENTATIVE Bryan Benevento ©19Bfi-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ( r �S�'14' Mo/rr Al Spectrum ervlces 43 Eight 1-ale•Road,Sutum,NI. 01 SJO m f1 ' ✓' Wi O 69 Wennvurth P.nad,Rerpre,MA 02151-3li5 C y" ,?; Phone:508-865--152i.Fez: 50 .265-5.K5 A� Hmaih ti lsreeCNcauirtecnet Soo:7:R11t�c'� i June 16, 2014 Report For: Po er A Copelas 13 .Boston Rd Sal m, MA 01970 4 Project: Re ldenoe 14 Boston Rd Sal im, MA 01979 Scope: Al $pectrUm Secvit a was,cpntracted to'perform-aia a bestos inspection on the ab va en(Itled pro.pefty. Th9 pyrpgga' Rf the Ins p Ion Was to identify all as Woe oontalning matenaWwhicll>exist within the. fracture so they can be re oved prior to demolition/ranovetions.ofaeratians, Date of Inspection: Ju a 6, 2014 Methodology: Ind strict hygiene services wer conducted by Robert F ravallese, a Pro esslonal Industrial hlygienigt and Massachusetts tic used ashestoe Inspector. Th se materials suspected tob�asbestos containing W re sampled, co ainerized, labeled and tranIferred to a Massachuse s licensed laboratory for an lysis by Polarized Light Microscopy Analysis: An ysis of the bulk samples we a performed by EPA M thod 5001R-93!'I16, July 1993 (Polarized Light Micro copy), All amples were analyzed by Ajsbestos 10 Lab; Wob,prn MA. A Mass. Results: DL o'licensed and NULAP acefredited laboratory, (Ma s#AA 000021(,I), ASBESTOS BULK S�MPLING DATA I Vocation •latcrial Com ositio yo Basement 2 x 4 ACT Fiberglass 10 Cellulose 30 Non l"ibrou; by Basement V✓allboard Cellulose 4p NonFibrot '. GO Basement Non Non F'ibrou 100 Basement Stucco on Fibrou 100 Basement 1 xl Floor'Tilel Non Fibroit. 100 Bath 1 x 1 Floor Tilt Non Fibrou lOD i I 1 I Ucation Material - Kitchen Com osit' ofR,r ' Linoleum Cellulose qp Kitchen Non Fibro s 6p 1 x 1 ACT Cellulose 20 Livin>Room on Fibro s 80 Brown Floor 'ile on Fibro s too Livin Roorn Plaster Nou Fibro t s hxterior Roof Fiberglass 150 Non Fibro s 85 2nd FI Hall Flaster Hair 2 ! Bath Non Fibro s _ 98 Linolotan Cellulose 35 Bath Non Fibrous 65 Thin Set Nan FibrQu too Livin Roan stucco Non Fibro Hall 1 x 1 Ploor Tole Non Fibrou 100 Lost 100 Stucco INon Fibrou 100 -Exterior Vapor Barrier Cell 70 Noq Fibrou 30 ' Chrysetile is a form of a.bestos, '-Anthrophyllte is a form f asbestos j T- Trace Findin s: 9 All, uspect materials ware neultive for the presence of shestos. I i i ' Robert F. Gray Ilese c: file AI# I � I I � I I I � I i i Asbe tos Identification Laboratory BOW 1W 165 New Boston St.,Ste 271 what - Woburn,MA 01801 nn (''�, ' Wub:WWW.aboObroclduntlllcaticnlaO. an LJ tl L �� ID Enl,ll;ntlkert,unning®gabaetcaldenilficutlnleb.Corn Lab:C. 0; 204:01''e-O June 101 2014 Bob Gravallese I protect Number: A•1 Spectrum Services ProJectNamac14.18_ on 43 Eight Lots Road Sutton,MA O1590 111tesampl'edr 2014.0 -04 W rkReceivod: 1�0114-6 -Oe Analyala Method: BULK P -M ANALYSIS PPA1600JR-93/�16, j i I Dear Bob Gravallese, I Asbestos Identification Laboratory ho a completed the analysys pf the samples from your office for theabove referenced project I The Information and analysis cone Ined In this report have bepti Qenerated using the ER k/600/R-93/116 Method for the Determination of Asbestos In Sul Building Matpaffile, Malarial Or products that oontpl more than 1% of any kind or combination of asbestos are consid red an Ilsbastos vgtttalninguildlhg material as determined by the EPA.This Polarized light Microscope(PLM)technique ey be perto medronner by vl ual ast6nat on or pgh1R cv Wring. Point taunting provides e determination of the area peroanta a of asbestos ln•,a sample; II the asbestos is•e IMAt@,• to be lees than 10% by visual estimation of friable material,the d ormin4tiort mqy be.:rsppatsd sing the potht'counJlhg to hnique;The results of the point counting supersede visual PLM fast ts. Resalts in this.r"I onlygelat0 ip 1haAtams tssted, This report-may not be used by the customer to claim product andoi toniont by Nv1,AP cr any plh r U.S.Government Agphc . i Laboratory results represent the zniWyslPcf samples as submilter�by the vustornpr. Inform lion regarding sample location, description,'area,volume,otc.,was r rpvided by the customer.Asbestos Idenlih'caon Laborer ry Is not responslbla for sample collection activities or analytical r11 thod IlmIlaill ,Rs. Unless notitlied in Writing to,return S mples, AsbaaWa Identlfioatlon Laboratory discards customer same,eS,aftar 30 days, This report all not be raprodur;od,a cept In full,without the written consent of Asbestos Identifloation boratory. • NVLAP Lab Code:20091&0 • Massuchuselta Cedifloatton Umnso: .,Agp0205 • stale of oennecticut,DOpadmOnt Of ubll6 Health Approved Envlronrn n1el Laboratory Registration N j flIborr PH-0142 • State Of Main$,Department Of Envirp antal Protection Asbestos Anatl leal Laboratory License Nurr ar:LB•0078(Sulk)LA-00157(Alr) • State of Rhode island and Providonc Plantations Oapartment Of Haalffl Certification:AAL-121 Thank you Bob Gravallese for your bu iirfess. I Michael Manning Owner/Director I I I I , i i June 1 U,2014 Bob Gravallese project Number; A•1 Spectrum Services Project Name:141 B ton43 Eight Lots Road Sutton,MA D159D Data Sampled: 201MD •DD Work Received: 2014.0 '00 Analysis Method: BULK A M ANALYSIS EPA/6D0/R-93/ 16 1 � I Fjgldi � olal ., Leeativii Color N:04-Ob'esftl/a AspegfQa 9/q ! ' E, SS 1 ACT gray Fiher.laea 10 Nona netec C�e3 W' cellu oae 30 1763 Non-Fl hroua 60 ss z WB multi Qellul.ose 40 None Detested j risa Nola-F brous 60 SS 3 STUCCO —r-------�.� I White N00-Fibrous 100 Nona Detected 1751 SS4 STUCCO F' - -_ White Nan-Fibrous 100 None Detected 176q SS5 FT tan Non-Fibrous 100 Nnno 0 o ted i 1765 SS B Ft tan NOa-�'i,brous 100 Ncnca ueteeted 1766 SS LINO multi Cellul ae 40 None net ;ted _L76'1 Non-F.i rous 60 $68 ACT gray Cellul ae 90 Nonene l]et�:ed 1768 Nonce}'i rous S89 FT tan Non-Fi 04a 300 Nuau Detc tei i 1769 SS 10 PL Way Non-b?ti rous 100Non - e betocted rno 6511 ROOF blank 1'ihe+rg0 aes 1S Nona petected � 3'I'11 Nan-Fi sous a3 SS 12 PL _ gray Synthe lc z NonepeLeceed 1772 i Non-F1 rous 9S S613 LINO multi Cellul0 ae 35 None DeCOct'ed 1773 Non-FibrQ46 65 SS 14 TMIN 5@T. ! tan Non-l=ib rous 1oo.None Detected 1774 i 8e'1:.of 2 • I 9 M kerlal yveaSlon Color Non; 'ebe96511a 94 5516 STUCCO White Non ibrouo 100 Norio Da�ct I 1776 6518 FT multi Non-. ibrous 100 None Detected 1776 i $S 17 STUCCO Whit® Non- ibrous 7.00 None detected 1777 I � SS 16 V8 black Cell lose 70 None Detected Non-Mbrous 30 ;77b Tue�d 79 J� . �- � End of Repots P&17e 2 of 2 Anelyz y patch; . 156 I i I I I i I i i I I � I LlMassachusetts 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: DEMOMAN Transaction ID: 677197 Document: AQ O6-Construction/Demolition Notification Size of File: 218.66K Status of Transaction: In Process Date and Time Created: 8/14/2014:11:34:50 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. BureElMassachusetts Department of Environmental Protection au 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: _ f i This job is being conducted under a Blanket Pemrit MassDEP assigned Blanket Authorization ID: r This job is being conducted under a Non Traditional Abatement Work Practice Permit. � MassDEP assigned Non Traditional Work Practice Authorization ID: I J G None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 L ElMassachusetts Department of Environmental Protection Bureau of Waste Prevention•Air Quality BWP AQ 06 100205539 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)? 17 Yes r 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 RESIDENCE 141 BOSTON RD. requirements of 310 CMR 7.09. Name of facility Street Address SALEM MA 0197900D0 9783174656 2.Submit Original Form To: City?own State Zip Code Telephone Commonwealth of PETER A.COPELAS OVvNER Massachusetts Facility Contact Person Contact Person Title Asbestos Program 9783174656 mcgmthenterprises@mmcast.net P.O.Box 120087 Boston,MA Facility Contact Person Telephone Facility Contact Person Email 02112.0087 Facility Size: 1800 2 Square Feet Number of Floors Was the facility built prior to 1980? r Yes ❑No Describe the current or prior use of the facility: VACANT HOUSE Is the facility a residential facility? r Yes ❑No If yes,how many units?2 2.Facility Owner: PETER A.COPELAS 135 BOSTON RD. Facility Owner Name Address SALEM MA 019790000 9783174656 City?own Slate Zip Code Telephone MCGRATH ENTERPRISES 28 OAKVILLE ST. On-Site Manager/Owner Representative Address Lynn MA 01905 7815982727 City/rown State Zip Code Telephone Revised:03/17/2014 Page I of �i Massachusetts Department of Environmental Protection El Bureau of Waste Prevention•Air QualityBWP AQ 06 1oo2oss3s Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3.General Contractor: MCGRATH ENTERPRISES 28 OAKVILLE ST. Name Address LYNN MA 019050000 7818445630 City/Town State Zip"Code Telephone PATRICK J.MCGRATH 7818445630 General Contractors On-site Manager/Foreman Telephone C. General Construction or Demolition Description General 1.Construction or demolition contractor: Statement:If asbestos is found MCGRATH ENTERPRISES 28 OAKVILLE ST. during a Construction Contractor Name Address or Demolition operation,all LYNN MA 019050000 7815982727 responsible parties City/rown State Zip Code Telephone must comply with 310 PATRICK J.MCGRATH 7818445630 CMR 7.00,7.09,7.15, and Chapter 21E 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 PACK MCGRATH NA 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 ❑No notes of release/threat of 4.Describe the area(s)to be demolished: release of a hazardous FULLCONTAINMENT substance to the Department,if applicable. € C'� 5.If this a construction project,describe the building(s)or addition(s)to be constructed: MassDEP Use Only ALL METHODS WILL COMPLY. ! Date Received 6.If this is a demolition or renovation project,were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? r Yes [--,'No 7.Was asbestos containing material(ACM)found? Yes r No If yes,who conducted the survey? AI SPECTRUM SERVICES Name Department of Labor Standards Certification Number Revised:03/172014 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention•Air Quality El BWP AQ 06 100205539 Notification Prior to Construction or Demolition Asbestos Project Number# C.General Consauclion or Demolition Description(continued) The Asbestos Abatement Notification Number for this 200919-0 address is:This project r Construction r Demolition is: 9/2/2014 9/5/2014 Project Start Date(MM/DD/YYYY) Project End Date(MM/DDNYYY) 8.For demolition and construction projects,indicate dust suppression techniques to be used r1 Seeding r Wetting �j Covering ❑ Paving C1 Shrouding Other-Specify: 9.For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? NA Name of MassDEP Official NA Title 8/12/2014 NA Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally PATRICK J.MCGRAiH examined the foregoing and am Print Name familiar with the information PAiWCKJ.MCGRATH contained in this document and Authorized Signature all attachments and that,based OVWOy on my inquiry of those individuals immediately Posroon(ntle responsible for obtaining the MCGR4TH UPRISES information,I believe that the Representing information is true,accurate,and 8/14/2014 complete.1 am aware that there Date(MMDDNYYY) are significant penalties for 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 of l4, �N4er � r c5e� �- UI � d,S e 1, 'R la. N h y<$(:f -61tff (� /U 41CL ( A) Gj /V �cl $ l rr� r'1 cx L