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Home My WebLink AboutMiscellaneous - 279 WINTER STREET 4/30/2018 (2)SI N J O N C Z m � w O o -i M o Om m o --I o a . QII State abatement Professionals, inc. 4 Wilder Drive, Suite 12 Plaistow, NH 03865 October 24, 2014 Town of North Andover Health Department 1600 Osgood Street Bldg 20; Unit 2035 North Andover, MA 01845 Phone #: (978) 688-9540 Fax #: (978) 688-8476 Re: Asbestos Abatement @ Residence, 279 Winter Street To whom it may concern: 866 -565 -ASAP Fax: 603-378-0610 OCT 2 3 2014 TObvN ut- Nvrci n HNuOVER HEALTH DEPARTMENT All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the above referenced project on the following dates: Start Date: 11/07/14 End Date: 11/07/14 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information, please do not hesitate to contact me. Sincerely, J. Scott Curley President JSC:jab Enclosures Asbestos • Masonry Cleaning • Selective Demolition • Shot/Sand Blasting • Mold Remediation IT"' Commonwealth of Massachusetts 100210140 Asbestos Notification Form ANF -001 Project # Asbestos Project # I I Project Revision r- Project Cancellation A. Asbestos Abatement Description 1. Facility Location: RESIDENCE 279 WINTER STREET Instructions 1. All sections of this form must becompleted in order to comply with MassDEP notification requirements of 310 CMR 7.15 and Department of Labor Standards (DLS) notification requirements of 453 CMR 6.12 Name of Facility NORTH ANDOVER City/Town STEPHANIE MOORE Facility Contact Person Name Worksite Location: MA State 2. Is the facility occupied? IF Yes 17. No Street Address 01845 0000000000 Zip Code Telephone PROJECT MANAGER Facility Contact Person Title RESIDENCE,1 ST & 2ND FLOORS Building Name, Wing, Floor, Room, etc. 3. Is this a fee exempt notification (city, town, district, municipal housing authority, state facility, or owner -occupied residential property of four units or less)? r Yes ri No MassDEP Use Only 4. Blanket Permit Project Approval, if applicable: Date Received Approval ID # 5. Non -Traditional Asbestos Abatement Work Practice Approval, if applicable: Approval ID # 2. Submit Original Form To: Commonwealth of 6. Asbestos Contractor: Massachusetts ALL STATE ABATEMENT PROFESSIONALS 4 WILDER DRIVE SUITE 12 Asbestos Program P.O. Box 120087 Name Address Boston, MA 02112- PLAISTOW Ni 03865 6033780600 0087 Cityrrown State Zip Code Telephone AC000331 Contract Type: l.....:' Written 17 Verbal DLS License # 7, JEFFREYC JR CURLEY AS901553 Name of Contractor's On -Site Supervisor/Foreman . DLS Certification # 8. AIR TESTING SERVICES INC AA000124 Name of Project Monitor DLS Certification # 9. AIR TESTING SERVICES INC AA000124 Name of Asbestos Analytical Lab DLS Certification # 10. 11(7/2014 11/7/2014 Project Start Date (MM/DD/YYYY) End Date (MM/DD/YYYY) 7-3:30 NOW Work Hours - Monday Through Friday Work Hours - Saturday & Sunday 11. What type of project is this? r` Demolition F Renovation 1-', Repair r Other- Please Specify: Revised: 11/13/2013 Page 1 of 4 Commonwealth of Massachusetts 100210140 Asbestos Notification Form ANF -001 Asbestos Project # 1 � Project Revision f,,,. Cancellation A. Asbestos Abatement Description: (cont.) 12. Abatement procedures (check all that apply): Glove Bag 17 Encapsulation r Enclosure l` Disposal Only l - Cleanup r' Full Containment r Other - Please Specify: 13. Job is being conducted: r7 Indoors r Outdoors 14. Total amount of each type of asbestos Containing materials (ACM) to be removed, enclosed, or encapsulated: 0 500 Linear Feet (Lin. Ft.) Square Feet (Sq. Ft.) Boiler, Breaching, Duct, Transite Pipe Tank Surface Coatings Lin. Ft Sq. Ft Lin. Ft Sq. Ft Pipe Insulation Transite Shingles Lin. Ft Sq. Ft Spray -On Fireproofing Lin. Ft Sq. Ft Cloths, Woven Fabrics Lin. Ft Sq. Ft Insulating Cement Lin. Ft Sq. Ft 15. Describe the decontamination system(s) to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM. Transite Panels Other - Please Specify: VERMICULITE Lin. Ft Sq. Ft Lin. Ft Sq. Ft 500 Lin. Ft Sq. Ft 16. Describe the containerization/tltsposal metttoos to comply wan S to taunt /.t:) ana 433 FMK DOUBLE 6 MIL POLY 17. For Emergency Asbestos Operations, the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Date of Authorization (MM/DD/YYYY) Name of DLS Official Title of MassDEP Official Waiver # Title of DLS Official Date of Authorization (MM/DD/YYYY) Waiver # 18. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this l- yes r No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 b B. Facility Description 1. Current or prior use of facility: RESIDENCE 2. Is the facility owner -occupied residential with 4 units or less? 3 _ DIANE HUSTER 279 VINTER STREET Facility Owner Name NORTH ANDOVER City/Town 4. STEPHANIE MOORE Name of Facility Owner's On -Site Manager ANDOVER City/Town S ALL STATF ARATFMFNT PROFFSSIONA1 Name of General Contractor PLAISTOW Address MA 01845 0000000000 State Zip Code Telephone 8 CEDAR ROAD 100210140 Asbestos Project # [' Project Revision r Project Cancellation Yes r— No Address MA 01810 9784700492 State Zip Code Telephone 4 VILDER DRIVE, STE 12 Address NH 03865 6033780600 City/Town State Zip Code Telephone Note: Temporary FEDERAL INSURANCE COMPANY storage of Asbestos containing waste Contractor's Worker's Compensation Insurer material is only 44727722 4/15/2015 allowed at the place Policy # Expiration Date (MM/DD/YYYY) of business of a DLS licensed Asbestos 6 What is the size of this facility? 2000 2 contractor or a transfer station that is permitted by Square Feet # of Floors MassDEP and C. Asbestos Transportation & Disposal operated in compliance with Solid Waste Regulations 1. Transporter of asbestos -containing waste material from site of generation: 310 CMR 19.000 r! Directly to Landfill or i✓ To Temporary Storage Location/Transfer Station ALL STATE ABATEMENT PROFESSIONALS, INC. 4 WILDER DRIVE, STE 12 Name of Transporter Address PLAISTOW Ni 03865 6033780600 City/Town State Zip Code Telephone 2. If a temporary storage location/transfer station is used, list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: JOB/ROLLOFF, INC. Name of Transporter CHELSEA City/Town Revised: 11/13/2013 PO BOX 6037 Address MA 02150 State Zip Code 6173871495 Telephone Page 3 of 4 1 Commonwealth of Massachusetts (100210140 -, Asbestos Notification Form ANF -001 Asbestos Project # r Project Revision r Project Cancellation note: contractor must C. Asbestos Transportation & Disposal: (cont.) sign this form for DLS notification purposes 3. Name and address of temporary storage location/transfer station for the asbestos containing waste material: ALL STATE ABATEMENT PROFESSIONAL 4 WILDER DRIVE Temporary Storage Location Name PLAISTOW City/Town Address Ni 03865 State Zip Code 6033780600 Telephone 4. Name and location of final disposal site (asbestos landfill): TURNKEY LANDFILL WASTE MANAGEMENT OF NH Final Disposal Site Name 97 ROCHESTER NECK ROAD Address ROCHESTER City/Town D. Certification I certify that I have personally examined the foregoing and am familiar with the information contained in this document and all attachments and that, based on my inquiry of those individuals immediately responsible for obtaining the information, I believe that the information is true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including possible fines and imprisonment. The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid' unless payment of the applicable fee is made." Final Disposal Site Owner Name N1 03839 State Zip Code IfIRi111:11 �:7 �l�y;� / Name OFFICE MANAGER Position/Title 6033780600 6033302166 Telephone JUDITH BEREZANSKY Authorized Signature 10/24/2014 Date (MM/DD/YYYY) ASAP, INC. Telephone Representing 4 WILDER DR, STE 12 PLAISTOW Address City/Town Ni 03865 State Zip Code Revised: 11/13/2013 Page 4 of 4 ' � • � � Ir The Commonwealth o Massachusetts O(ilce Uee f usetts I'er�lt b. Department of Public Scfery Occupancy • fee ChockedBOARD OF FIRE PREVENTION REGULATIONS 521 CMR 1200 3/90 (leave etank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to ba periormed In accordance with the Mawchuseru Electrical Code, 527 MR 1 :00 (PLEASE PRINT IN INR OR TYPE INFOP.,,= ON) Date () City or Town of To the Inspector of Wires; The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) Z75 a)/ n (37 - Owner or Tenant 0l st_. -,— R �_k s 4+_ Owner's 1s this permit in conjunction with a building permit: Yes ❑ No Lam' (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service __Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service❑ Undgrd C3 No. of ?eters Amps / Volts Overhead Number of Feeders and Amoacity Location and Nature of Proposed Electrical Work a4 C No. of Lighting OutletsNo. of Hoc Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above In- rnd. ❑ rnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Be tery Units No. of Switch Outlets No, of Cas Burners FIRE ALARMS No. of Zones No. of Detection and Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Local ❑ Municipal Connection ❑ Other No. of Ranges No: of Air Cord. Total cons No. of DisposalsNo, of Heat Total Total Pu:.os Tons KW No. of Dishwashers Space/Area Heating KW No. of Dryers Heating Devices KW No, of Water Heaters Six,Ballasts Voltage LowWi ng No. Hydro Massage Tubs No. of Motors Total HP w1nLR; INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liabillt Insurance Policy including Completed Operations Coverage or s substantial equivalent. YES 9 NO jH I have submitted valid proof of same to this office. YES NO (] If you have checked YES, please indicate the type of co age by chking the appropriate box. INSURANCE t BOND ❑ OTHER (](Please Specify) A �. T,a Estimated Value of Elec rical Work $ kLxpiration ace Work to Start ii Inspection Date Requestedt Rough Final Signed under the enalties of perjury: FIRM NAME /!�� /� �G� C 7 k�(j � �l/ " LIC. NO. Sy 3 Licensee S, \_7/L Signature LIC. NO. Address0�111_ us. Tel. No. Alt. Tel. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or rts su stantial equivalent as required by Massachusetts GeneralwsTa ,, and that my signature on this pe it application waives this requirement. Owner Agent (Please check one S J Signature of Owner or Agent)'t Telephone No.. PERMIT FEE FIA Date ... ........... NORTH 1 TOWN OF NORTH ANDOVER 0 6 0 0 PERMIT FOR WIRING IL CMUS This certifies that .... ..... ............... . . .. ................... .. .... cc has permission to perform . ... ... wiring in the building of'2"-77.q ..... ? . . ... . . ............................. ....................... at ............................................................................... . North Andover, Mass. kv Fee.. ................... Lic. N 'i�i;�,'C'A"L' *1' NS**' P**E'C—T' 0** R** WHITE: Applicant CANARY: Buildi4 Dept. PINK: Treasurer Office Use Only The Commonwealth of Massachusetts • Permit 110. Department of Public Safety Occupancy b Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code. 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORHA_TION) Date /o— 96 City or Town of lVeem A1,olpdEie To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street 5 Number) _279 AV,mrre .S12EET' Owner or Tenant 1141,5 7-E4 Owner's Address .sgm6 (S08) (087-48D(, Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Buildin Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity. Location and Nature of Proposed Electrical Work Utility Authorization NO Overhead ❑ Undgrd ❑ Overhead ❑ Undgrd C No. of Meters No. of Meters No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total FNA No. of Lighting Fixtures Swimmin Pool Above In- g grnd. ❑ grnd. ❑ Generators FNA No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS . No. of Zones No. of Detection and Total No. of Ranges No. of Air Cond. tons Initiating Devices No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Municipal Other Local❑ Connection No. of Disposals Po No. of Heat Total Total Pumps Tons KW No. of Dishwashers Space/Area Heating KW of Dryers Heating Devices KW No. of Water Heaters Not of No. o Signs Ballasts Low o tage //JJ// Wiring ,a lAje F/ �` 114RI, No. Hydro Massage Tubs No. of Motors Total HP OTHER: C0 SMokE _DET'eCT-60F. :nr r} n inrar_ INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES ❑ NO ❑ I have submitted valid proof of same to this office. YES ❑ NO [] If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE ❑ BOND ❑ OTHER ❑ (Please Specify) Estimated Value of Electrical Work $ 27,f Ga Work to Start 10-28-96 Inspection Date Requested: Signed under the penalties of perjury: FIRM NAME ADT Security SystE Rough_ Expiration Date Final LIC. NO: 1 2 3 1 C Licensee Signature a.I LIC. NO. Address 60 William Street, Wellesley, MA 92181 Bus. Tel. No. 617 431-580( Alt. Tel. No. (617) 431-5831 OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. Signature of Owner or Agent PERMIT FEE $ .35 co Date ..... A/��/..�. .3 555 • �� TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... kDT has permission to perform ...... i2 bt l S `� ,�.� .......................... '........................ wiring in the building of .........s ... i •► r at ..... ��........1. ....t..! ► t. ?........: J ................. . North Andover, Mass. Fee.�Sf 7 .:............ Lic. No...j.��............................................................... / ELECTRICAL INSPECTOR E� o�ai1i 114: 35. Patn WHITE: Applicant CANARY: Building Dept. PINK: Treasurer BOARD OF HEALTH 146 MAIN STREET TELEPHONE# (508) 688-9540 APPLICA TION FOR ABANDO,NVENT OF SUBSURFACE DISPOSAL SYSTEM (SEPTIC SYSTEM) Pursuant to Section 310 CMR 13.334 of the State Environmental Code, Title V Name '2 1 &N d C 14 o 0Phone Address ---27_q -V iQTE-:2 Contractor hired for work: 3 0 Name � 60 067 C X501 6 0 5O N Phone (9976 --:2 0 4C Address yro C WQ N PL,r-Z Date for scheduled abandonment do C) Z , �1;91 The septic system at the above address has been abandoned according to Title V specifications. .. gnature of Contractor Method of septic tank abandonment (check one). () removal () sandfill ( ) crush () other Name of Offal Hauler A � U� 6 This form must be returned to the North Andover Board of Health. PLEASE DO NOT WRITE IN THE SPACE BELOW FOR HEALTH REPRESENTATIVE'S USE ONLY. --*"tIf ,4 Uel--I-T'to �5 qS Inspecting Agent Date