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HomeMy WebLinkAboutMiscellaneous - 381 MASSACHUSETTS AVENUE 4/30/2018 (2)W °1 Insurance Adjustment Service, Inc. 936 Roosevelt Trail Unit 5 Windham, ME 04062 (207) 892-0522 Fax (207) 892-0526 UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 139 SECTION 3B TO: Board of Health/Building Inspector RE: Insured: Peter Lemieux Property Address: 387 Mass. Ave. N. Andover, MA Date of Loss: 2/3/2011 Policy Number: Type of Loss: File or Claim Number: 68278 Date: February 27, 2011 TOWN OF NORTH ANDOVER Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 38 is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, locations, policy number, date of loss and claim or file number. Thank you for your cooperation. Very Truly yours, George S Long Adjuster Ext. 128 ABATEMENT CONTROL SERVICES, INC. ASBESTOS REMOVAL & MAINTENANCE 84/� �, fiEALI APR � 2�j APRIL 5, 2001 t NORTH ANDOVER BOARD OF HEALTH 27 Charles Street North Andover, MA 01845 DEAR SIR/MADAM ENCLOSED PLEASE FIND A COPY OF NOTIFICATION SENT TO THE STATE FOR AN ASBESTOS ABATEMENT PROJECT. THE JOB WILL TAKE PLACE ON APRIL 21, 2001 LOCATION: 381 MASSACHUSETTS AVE. ANY QUESTIONS CONCERNIG THIS MATTER SHOULD BE DIRECTED TO MY ATTENTION. SINCERLY, -; /.,W FRANK BALOGH PRESIDENT 2 INDUSTRIAL WAY • SALEM, NH 03079 • NH (603) 898-9472 • MA (888) 870-9292 • FAX (603) 898-1846 smuonou L AY saaworls Of Ws f nanwto oomph with the pspartarnt of Protection of 310 O+R 7.35 (W NOWW as,WPW iFAVA*W0' ar awranrnrpWA* V4 the asps UNA of tabs aad Induces mwiudw aequiremwz of 453 01R 6.12 (ondbrV p is nobnf WAV & rytpyhrddwr aoaaaxw POW? 00AWdraoohms IiawwarS4"W l * Form Ta Commbaw"Ift of Massachuutu ASMAN program 3. This Form may be used for riodryirw Me Re;w 1 of asbestos derrw+awwrer"aum aixrsaons ta,blea to NE9MAP5 (40 CFR subpart 4 Narttioo�---m � aerate Gue l Dow" date I Rev. 6/92 2. is the facility ow, ? M Yes ❑ No 3. Asbestos Contractor ABATEMENT CONTROL SVCrINC- 2 INDUSTRIAL WAY mane aaaress 603-898-9472 SALEM, NH 03079 yp =do rel4:l-V cgyrar» AC000362 auuarur r 4. On -Site Project Sup 4W1Forenwn: Frank Balogh Argas 5. Project Monitor: t AAM 6... Asda" MalyWW tab: Written avWa t7yW (WNW Or W44) AS 30269 gflCeroofcapM t ndvne aueeroofcau iw t 7. Project start date 4 / 21etW date 4/21 specific work hours (Mon. -Fri.) 1 am 4 om (Sat -Sun.) 8. whattypeofprojedlsWs? abnomix r4awi Aw"aaw O&W(awaw) asbestos removal 9. Desafbe the asbestos abatement procedures to be used: g/Ove &V O 41 ffiff J poly around c>a7u4mwt da>Int{p axaaw/adan do sa/ash' structure 10. 15 the job being oorbtxtW ❑ Indoors ® outdoors? 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) Or other surfaces (square ft) _=0o be removed, enclosed or encapsulated: Mlle f I SQU—" reet lLlcaf $ uale ket A29W4&A21#* A4 aw/'dP/ILr mid'♦iv 7Jk�7nai JLidNliW'i7pdid?9 d'�'txN'ta Tiwtey�io7la'�'�' WM 4*& T/ylflll LOYQ NY/aWl� ayaYiitrrnA�aw A'ikY(pfli�Qd�'�t'%. Transite Shingles 12. Describe the decontamination system(s) to be used: Poly around Structure 13. Describe the containerizatlorVdisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): Wet removal into 6 mil Poly Asbestos Labeled Bags. 14. For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency: AWik'MQFrA91GW 71tk araArArrtlrn�aoFM WW&W0 n�,bacua>yaw nAe arced MIAW&ata, warae•r 15. Do prevaillrtp wage rats apply as per M.G.L G 149, 4 26, 27, or 27A•F to this project? ❑ Yes ® No cdusensCMPfi Com�oawea/1bolQfassa AsbeslosNotillcatloofoia��N�00> „' 3 13 asa�sros�a�emeolOes�/v�oo "_,�.•�.�=.�>:•�;��:�:;..t;.:_:.{�_a .:�:.. 1. Faality location: John Markuns 381 Massachusetts Ave. 71f01845 Addiesi 978-683-5104 N. Andover, MA � dads Taf�a�ars Ay/lown Outside of House Hrrattrohe, ,gjALV;' a((*rynam4 /. • 2. is the facility ow, ? M Yes ❑ No 3. Asbestos Contractor ABATEMENT CONTROL SVCrINC- 2 INDUSTRIAL WAY mane aaaress 603-898-9472 SALEM, NH 03079 yp =do rel4:l-V cgyrar» AC000362 auuarur r 4. On -Site Project Sup 4W1Forenwn: Frank Balogh Argas 5. Project Monitor: t AAM 6... Asda" MalyWW tab: Written avWa t7yW (WNW Or W44) AS 30269 gflCeroofcapM t ndvne aueeroofcau iw t 7. Project start date 4 / 21etW date 4/21 specific work hours (Mon. -Fri.) 1 am 4 om (Sat -Sun.) 8. whattypeofprojedlsWs? abnomix r4awi Aw"aaw O&W(awaw) asbestos removal 9. Desafbe the asbestos abatement procedures to be used: g/Ove &V O 41 ffiff J poly around c>a7u4mwt da>Int{p axaaw/adan do sa/ash' structure 10. 15 the job being oorbtxtW ❑ Indoors ® outdoors? 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear ft.) Or other surfaces (square ft) _=0o be removed, enclosed or encapsulated: Mlle f I SQU—" reet lLlcaf $ uale ket A29W4&A21#* A4 aw/'dP/ILr mid'♦iv 7Jk�7nai JLidNliW'i7pdid?9 d'�'txN'ta Tiwtey�io7la'�'�' WM 4*& T/ylflll LOYQ NY/aWl� ayaYiitrrnA�aw A'ikY(pfli�Qd�'�t'%. Transite Shingles 12. Describe the decontamination system(s) to be used: Poly around Structure 13. Describe the containerizatlorVdisposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): Wet removal into 6 mil Poly Asbestos Labeled Bags. 14. For Emergency Asbestos Abatement Operations, the DEP and DLI officials who evaluated the emergency: AWik'MQFrA91GW 71tk araArArrtlrn�aoFM WW&W0 n�,bacua>yaw nAe arced MIAW&ata, warae•r 15. Do prevaillrtp wage rats apply as per M.G.L G 149, 4 26, 27, or 27A•F to this project? ❑ Yes ® No do0 1. CAMMt er prior use of facWty: Rpsi f1P.nrP. 4 units or less? © Yes ❑ No 2. Is the facility owneroocuged residential with 3. FAWY Owner: ..John Markuns 381 Massa ,ralatrrr N" 01845 MA 978-683-5104 N. Andover, t rwaa�a,a 4. . Facilltys Ownefs 01 -Ste Manages: •• noevra ' Z{o a it TeYga�iwx S. GaKral Contractor: ,laarsr A" —"�—" ZO exons rewnfaxrx —4WOXWt Wat" EVA AW 6. What Is the sire of the facility?12 O.Qsq fU 2 (x floors) �sDosfosltaospoiladooaodolsvosa/ Nates Trans v Sad IYA& ,&YA l /tql A6- 40W3J00NR JAGS 1. Transporter of asbestos contaWng waste material from site to temporary storage site (if necessary) to final disposal site? ABATEMENT CONTROL SERVICES,INC - 2 INDUSTRIAL WP,Y /AVW 03079 693-898-9472 SALEM, NH zo too" 2. TrWuPwter of asbestos'oo^taWng waste materials from remmVtemporary storage site to final disposal site: NOW 3. Refuse trarlder station and owner (If apPlkable): ,lanae ur/r� 20 a* roo" zo erade rete a%W 4' Fowl Disposal Ste. WASTE MGMT OF NH- TURNKEY H.TURNKEY LANDFILL gs,v,nn jarjo s A" 90 ROCHESTER'NECK RD 'ms's` 03067 603-332-2386 ROCHESTER, --NH Te Ncas a The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts Re9aWedns for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained i^ this notification is true and correct to the best of his/her knowledge and belief. 4/5/01 FRANK BALOGHEMENT CONTROL SVC,IAyu PRESIDENT ABATNC. 603-898-9472 Rmsmmav r0 9 2 INDUSTRIAL WAY SrALEM, NH ,�aetas � ed residential of four units or less)? Yes No Fee exempt (City, Town, W4 municipal housing authority, awrleroawPl® &W4 Sticker a (from Uorrc of forrry: F J.\ D lecLiWAWFI "# 1. Current or pilar use or facility: C•ty/lown Rpstaanop 3. Refuse transfer station and owner (if applicable): Nota TiaufIr . with 4 units or less? © Yes ❑ No StaGip�smust 2. is the fad ity owner occupied residential ,y�,,110 3. Facility Owner: , p►�i»iaipr�la- . John Markuns 381 MassachusettG Aaldrsr Ave. l6CAD AWN 01845 N. Andover, MA 978-683-5104 4, aade Te>c W/T 4. • Facility's OwnWs Ort•Site Manager: �• Aoldirsr IM+�t 47 aw Tekia�iau r arm L General Cantracta: Aafavrsr � � crate T,x .a.— awn Gq/% Cavaurt Wafts CO* /asrrn poky.# 6. What Is the site Of the facility? 12 o Qsq ft) 2 (* floors) �saesloslrayspoiladOOaodOlspOsa/ 1. Transporter of as, ,e5tos.containing waste material from site to temporary storage site (if necessary) to final disposal site? ABATEMENT CONTROL SERVICES,INC . 2 INDUSTRIAL WF,Y zww— SALEM, NH 03079 693-898-9472 � zv avo iax�arr 2. Transporter of asbestos-contalni g waste materials from removaVtemporary storage site to final disposal site: L T*4V-x 2 A rh")OV 4. Final Disposal Site:' `TURNKEY LANDFILL WA:+TE MGMT OF NH p»rx,sKme 1arawn AhlAe 90 ROCHESTER'NECK RD ROCHESTER, --NH 03067 603-332-2386 ZO CA* rakiMare py/Town _-- Ole The undersigned hereby states, under the penalties of perjury, that he/she has read the 'Commonwealth of Massachusetts Regulations for the Removal, Containment or Encapsulatlon of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this nobficatlon is true and correct to the best of his/her knowledge and belief. 4/5/01 FRANK BALOGH ~tow ABATEMENT CONTROL SVC,INC. 603-898-9472 PRESIDENT 7" R anO T03079 2 INDUSTRIAL WAY SALEM, NH A&W i CA* Wed residential of four units or less)? yes No Fee exempt (Oty, Town, distr4 municipal housing authority, owneroea+®❑ 5tidcar rs (from front of (orm): q49 • AGvnr C•ty/lown 3. Refuse transfer station and owner (if applicable): Nota TiaufIr . StaGip�smust • parrpywidr 0�e ,y�,,110 sad WA0 p►�i»iaipr�la- . pats310Gr/R C TOW l6CAD L T*4V-x 2 A rh")OV 4. Final Disposal Site:' `TURNKEY LANDFILL WA:+TE MGMT OF NH p»rx,sKme 1arawn AhlAe 90 ROCHESTER'NECK RD ROCHESTER, --NH 03067 603-332-2386 ZO CA* rakiMare py/Town _-- Ole The undersigned hereby states, under the penalties of perjury, that he/she has read the 'Commonwealth of Massachusetts Regulations for the Removal, Containment or Encapsulatlon of Asbestos, 453 CMR 6.00 and 310 CMR 7.15, and that the information contained in this nobficatlon is true and correct to the best of his/her knowledge and belief. 4/5/01 FRANK BALOGH ~tow ABATEMENT CONTROL SVC,INC. 603-898-9472 PRESIDENT 7" R anO T03079 2 INDUSTRIAL WAY SALEM, NH A&W i CA* Wed residential of four units or less)? yes No Fee exempt (Oty, Town, distr4 municipal housing authority, owneroea+®❑ 5tidcar rs (from front of (orm): q49 urmuculd L AN sections Of flys rarm gas n order to _ with ft aspartn ea proaNdw equrrnem of 310 OYt 7.15 fAW atritlV '*)w0wfiMw1wAV &AvawamyAAAwn"A VAw and the Dopa ama oftsboraad 1udusw" mm11odon requfremrss of 453 OtR 6.12 (AwAP c A,ia nadXiaar At A%N4ed0t wr AWAMces'VOGAT OVAWAMAW Aaufrsaw+r lw.A 2. Sub" OrOW Form Ta Commoew"" of 1014""hussrss Asbestos ►MOM FAM220w-ow 3. TM Form may be tied for noofyirq a* "6Nwwgnw ProWCON A90XV Reown 1 of ssDe " derrwstloryrrlowuorl opwao" subject to NL91APS (40 CFR Subpart 4 NOW"= e Rawn Otte Dow" dale i Rev. 6/92 5 Cov�moowea/1bPI fassacdusens 01 EXEMPT 13 ,OsaesrosA�alemealOesc✓lp�oo .__. y��._._ _.._.::..__.__ ..._ _. . 1. Facility location: John Markuns 381 Massachusetts Ave. A Anti W 01845 978-683-5104 N. Andover, MA rix Outside of House W"104V na#tKelAW 4 A, *ft &W,, AVM 2. Is the fadlitY oaupicd? fn Yes ❑ No 3. Asbestos Contractor: ABATEMENT CONTROL SVC,INC. Acme SALEM, NH AC000362 ArlL1 ww r 4. On -Site Project supervisor/Foreman- Frank Balogh N" S. Projxt Monitor: - . ,.i NNW 6.. Asbestos Analytical lab: �.1 2 INDUSTRIAL WAY 03079 603-898-9472 regoaar Written Cmo'ect ryXr (gWiA W Or vMWJ AS 30269 AUCero7lW&M l N" AUCnO/kaOEn / 7. Project start date 4/21 end date 4/21 sped work hours (Mon. -Fri.) em om (sat -Sun.) 8 What type of Project Is Ws? aWWaV Mo.* rerrovadan odfftaWUN asbestos removal 9. Describe the asbestos abatement procedures to be used: Ow Lug 04122" dewnt(o axa�ladan/Qyy, oyrar(e�dainJ poly around avu#mwstructure 10. Is the job being conducted ❑ Indoors ® outdoors? 11. Total amount ofeaoh type of Asbestos Containing oar encapsulateto d: handled on pipes or ducts (linear R.) or other be surfaces (square IL) 12 0 leet aOw,6MarN�i atet antx awmrOrpr rwvw AWWrapreutuO- Q17yiHadp4jl.ldiair'i� � - �yw�d11A'ari'R' r/we1{�-0�sle.'aatoi'gr a&4 MOIeAA" n1RGreLGYra !IY/[elYO AYrr(FM•NY4rrvAdtA a�M (iPub= '�O�k% Transite Shingles 12. Describe the deco taminadw systems) to be used: Poly around Structure 13. Describe the eor"Inerization/dcsposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): Wet removal into 6 mil Poly Asbestos Labeled Bags 14. For Emergwcy Asbestos Abatement Operations, the DEP and DU officials who evaluated the emergency: Aw w9_F MA7ArHf . Ara wiawo 1&wVfxfanfdw aao+�waa�+aim 7xre W~.# ,Ada i1&W.# 15. Oo prevailing wage rates aA* as Per M.G.L c. 149, 4 26, 27, or 27A•F to this project? ❑ Yes 13 No