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HomeMy WebLinkAboutMiscellaneous - 54 MILTON STREET 4/30/2018 MILTON STREET � 210/93�37_0000.0 . I Air (duality Experts, Inc. (603) 894-6465 Asbestos Removal (800) 621-1189 40 Lowell Road, Unit 1 Residential-Commercial-Industrial (603) 894-7044 FAX Salem, NH 03079 AirQualityExperts@AQENH.com August 29, 2003 ` 203 � North Andover Health Department t 146 Main Street North Andover, MA 01845 ✓ I Dear Sir: Enclosed please find a copy of notification sent to the state for an Asbestos Abatement Project. The job will take place on September 16, 2003. Project: 54 Milton Street Any questions concerning this matter should be directed to my attention. Sincerely, Com- Christopher Thompson President Commonwealth of Massachusetts L 100000867 I ` Asbestos Notification Form ANF-001 -Decal Number Affix Asbestos Notification Decal Here Important: When filling out A. Asbestos Abatement Description forms on the computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less? ❑✓ Yes ❑No to move your cursor-do not b. Provide blanket decal number if applicable: use the return Blanket Decal Number key. 2. Facility Location: DAVID HOWARD 154 MILTON STREET a.Name of Fa b.Street Address _ NORTH ANDOVER MA 01845 c.Cityrrown d.State e.Zip Code f.Teiephone Number INSTRUCTIONS 3. Worksite Location: (� 1.All sections of this BASEMENT � I � I F777-1 form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? Z Yes ❑No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of Occupational AIR QUALITY EXPERTS, INC. 40 LOWELL ROAD, UNIT 1 Safety(DOS) a.Name b.Address notification SALEM 03079 6038946465 requirements of 453 CMR 6.12 C.City/Town d.Zip Code e.Telephone Number AC000167 f.DOS License Number g. Contract Type: ❑✓ Written ❑Verbal h.Facility Contact Person i.Contact Person's Title ti GERMAN POSADA ZINIGA AS032579 a.Name of On-Site Su ervisor/Foreman b.Supervisor/Foreman DOS Certification Number 7. INA a.Name of Project Monitor b.Project Monitor DOS Certification Number NA $' a.Name of Asbestos Analytical Lab b.Asbestos Anal ical Lab DOS Certification Number 09/1612003 091i 612003 � 9' a.Project Start Date mm/dd/ yy) b.End Date mm/dd/ yy_y �0 7AM-3PM (' N c.Work hours Mon-Fri. d.Work hours Sat-Sun. o 10. a.What type of project is this? o ❑ Demolition ❑✓ Renovation ❑ Repair ❑ Other, please specify: b.Describe 11. a. Check abatement procedures: ❑✓ Glove bag ❑ Encapsulation o ❑ Enclosure ❑ Disposal only _u- ❑Cleanup ❑ Other, specify: -- ❑ Full containment b.Describe ---z Q 12. Is the job being conducted: ❑✓ Indoors? ❑Outdoors? anf001ap.doc•10/02 Asbestos Notification Form-Page 1 of 3 Commonwealth of Massachusetts _ 100000867 Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed,or enca sulated: _ a.Total pipes or ducts(linear ft) o�u aces square c.Boiler,breaching,duct,tank . d.Insulating cement ----� surface coatings Lin.ft. Sq.ft. Lin.ft. (Sq.ft. e.Corrugated or layered paper 20 � f.Trowel/Sprayer coatings L i pipe insulation Lin.ft. Sq.ft. Lin.ft. Sq.ft. g.Spray-on fireproofing �inSq.ft. h.Transite board,wall board Li�� � i.Cloths,woven fabrics Ein j.Other,please specify: LiL_ ft_ Sq. L ft�! k.Thermal,solid core pipe I._.._ft Sq. n I insulation Lin. ift. I.Specify 14. Describe the decontamination system(s)to be used: 3 CHAMBER DECON 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): WET 2 PLY POLY BAGS 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title c.Date(mm/dd/yyyy)of Authorization d.DEP Waiver# e.Name of DOS Official f.DOS Official Title N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# 0 17. Do prevailing wage rates as per M.G.L. c. 149,§26, 27 or 27A—F apply to this project? R Yes No B. Facility Description 9-N „ _o 1. Current or prior use of facility: RESIDENTIAL �o 2. Is the facility owner-occupied residential with 4 units or less? ❑✓ Yes ❑ No DEVID HOWARD 54 MILTON STREET 3' a.Facili Owner Name ���� b.Address �O RT NOH ANDOVER, MA.........._ C) C.Cit /Town _ d.Zip Code e.Telephone Number area code and extension u_ 4. a.Name of Facili Owner's On-Site Manager b.00n--SiteManager Address �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) anf001ap.doc•10/02 Asbestos Notification Form•Page 2 of 3 ,__ Commonwealth of Massachusetts , 100000867 �.�� Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) 5' a.Name of General Contractor ( b.Address c.Cit /Town ._ d.Zip Code eTone Number area code and extension).,.— f. n..._f.Contractor's Worker's Comp.Insurer Policy Number h.Ex Date(mm/dd/yy 6. What is the size of this facility? 2400 1 a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): SAME AS CONTRACTOR Note:Transfer a.Name of Transporter �� b.Address Stations must comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT GROUP,INC. PO BOX 2132 a.Name of Transporter b.Address BRISTOL, PA 119007 1 1(877)999-9559 c.Ci /Town d.7in Code e.Telephone Number 3. (a_.Refuse Transfer Station and Owner b.Address c.Cit /Town d.Zip Code e.Telephone Number 4. BFI IMPERIAL LANDFILL BFI IMPERIAL LANDFILL a.Final Disposal Site Location Name _ b.Final Disposal Site Location Owner's Name PO BOX 47-11 BOGGS ROAD I IMPERIAL c.Final Disposal Site Address d.Cit /Town PA 15126 (724)695-0900 e.State f.Zip Code g.Telephone Number c, �O D. Certification Q__04 —� The undersigned hereby states,under the ICHRISTOPHER THOMPS C �- 0 penalties of perjury,that he/she has read the a.Name b.Authorized Signature �O Commonwealth of Massachusetts regulations IPRESIDENT 08/29/2003 for the Removal,Containment or c.Position/Title d.Date(mm/dd/yyyy) Encapsulation of Asbestos,453 CMR 6.00 and 603 894-6465 AIR QUALITY EXPERTS 310 CMR 7.15,and that the information ( ) , contained in this notification is true and correct e.Telephone Number f.Representing to the best of his/her knowledge and belief. 140 LOWELL ROAD, UNIT ONE O q.Address 9�_U_ ISALEM, NH �Z h.City/rown i.Zip Code �Q anf001ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 IArJA)Location A No. Date J NORT►, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ��s• °''���' Foundation Permit Fee $ 3 CMusE Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $'IM 14 � — ✓ 7 Building Inspector Div. Public Works PERMIT NO. �c�a APPLICATION FOR PERMIT TO BUILD********NORTH ANDOVER, NIA MAP NO. b LOTNO. bb ? 2. RECORDOFOWNERSHIP DATE BOOK PAGE ZONE SUB DIV. LOT NO. c� LOCATIONPURPOSE OF BUILDING L..' b OWNER'SNADIE bAIEP NO.OF STORIES 4 SIZE OWNER'S ADDRESS BASEMENT OR SLAB ARCIIFFECT'S NAME SIZE OF FLOOR TIMBERS" 1 2 ND 31t Bllll-DEB'S NAME SPAN DISTANCE TO NEARES•F BUILDING DIMENSIONS OF SILLS DISTANCE FROM STREET DIMENSIONS OF POSTS DISTANCE FROMLOTI,INES-SIDES REAR DIMENSIONS701`GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS ; IS BUILDING NEW SIZE OF FOOTING X IS BUILDING ADDITION NIATERIALOF CHIMNEY i' IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODEC IS BUILDING CONNECTEp TO TOWN WATER `J BOARD OF APPEALS ACTION, IF ANY ' IS BUILDING CONNECTED TO TOWN SEWER i IS BUILDING CONNECTED TO NATURAL GAS LINE INSTI)CI-IONS 3. PROPERTY INFORMATION LAND COST ii �J EST.BLDG.COST PAGE 1 FILLOUTSECTIONS 1-3 .{C 1 1 ' EST.BLDG.COST PER SQ. FT. C c EST.BLDG.COST PER ROOM ELECTRIC DIETERS MUST BE ON OUTSIDE OF BUILDING C SEPTIC PERMIT NO. ATTACHED GARAGES MUST,CONFORM-FO STATE FIRE REGULATIONS 4. APPROVED BY: n„ f PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DATE FILED OWNERS TELA CONTR.TEL# C � • SIGNATURE Of-04VNER OR AUTHORIZED AGENT CONTR.LICu z FEE s -;:�? ^' ILLC.H (/ PERNIFF GRANTED %) q� 8 19 r Revised 5/5/99 JAI MMMD AC 269- CERTIFICATE OF LIABILITY INSURANCE DATE 0 12-1999 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ZNTERNST INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 522 CHICP�RING ROAD HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, KA 01845 INSURERS AFFORDING COVERAGE INSURED INSURER A. TRUST ASSURANCE DIAVID CASTRICONE INSURER 9: ICASTERN CASUALTY ROOFING AND SIDING INC INSURER 0. M 7 HILLSIDE ROAD INSURER D: y BOXFORD eel► 01921- INSURER E: COVERAGES 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,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR1 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXFIRATI N LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A COMMERCIAL GENERAL LIABILITY TCP 1012811 08/06/1999 08/06/2000 FIREEll DA"OAn1onaflra s 50,000 CLAIMS MADE 10 OCCUR MED EXP(Any one neon s 5 000 PERSONAL&ADV INJURY b 1,000,000 OENERALAGOREOATE E 1,000,000. GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG b M 1,000,000 ❑ 0 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑�ANY AUTO (EeeoCidenl) ALL OWNED AUTOS BODILY INJVRY $ SCHEDULED AUTOS (Par parson) HIRED AUTOS BODILY INJURY b NON-OWNED AOTOS (Per acc70ora) PROPERTY DAMAGE $ (Per eecAdern) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT b ANY AUTO ' '� -•• OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS LIABILITY EACH OCCURRENCE b ❑ OCCVA 11J CLAIMS MADE AGGREGATE s DEDUCTIBLE s s RETENTION $ b WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMITS BWC99 A24009E.L.EACH ACCIDENT $ 100 000 09/23/1999 09/23/2000 ,a-.._.�_ E.L.DISEASE-EA EMPLOYE $ 500,OOO E.L.DISEASE-POLICY LIMIT s 100,000 OTHER i DESCRIPTION OF OPERATIONMOCATIONSIVEHICLESfEXCLUSIONS ADDED BY ENDORSE M ENTIS PECIAL PROVISIONS ROOFING AND SIDING CERTIFICATE HOLDER ADDITIONAL INSURED•INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,OUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIASIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR .REPRESENT AVTHORIZE B E ACORD 215-S(7!107) ete cofkpoRATION 1988 F , s . T T. ' jt .. .. I .. M.r .++s.-vim •..-. `- ^ da.� —4•.r t :. F ,F .. 1 1 " •..�,'»µ'•M-.Y a'/� O�f.CIILQIUL•O�✓(�LAdd�IlQCUO. .t. .'--NONE::INPROVENENT:CONTRACTOR Registration 104564 44 - Type tPRIVATE-CORPORATDW,:.t _ °Expiration /14-%00 �01 . �� ri ""kri 1 •k -- •" �r7 �* fr. x DAVID•.ASIRICONE kOOFINfi� SID r "` -� s = �: -�D.av�d 'T..Castriconet 4 � - 111sideRoaAd 1 �ADNISTRATOR Boxford MA#01721 h S t } 2 -r- ` BUILDING DEPARTMENT DEBRIS DISPOSAL FORNI In accordance with the provisions of MGL c 40 S 54,a condition of Building Permit Number Is that the debris resulting form this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150A The debris will be disposed of in: - V Location of Facility Signature of Permit Applicant Date. NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector I , NORTH _ Town of- - , over TO No. � Z h QA COCHI EE `y 0 - ' L dower, Mass. DRATED PP��,�Gj S 5� BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System I BUILDING INSPECTOR THIS CERTIFIES THAT 40.V. k do W r ......... ..................................... Foundation has permission to erect. r.�....P........, buildings on ....4.................. `..�, •••„••,S�••••..•.•... Rough to be occupied as Chimney . . . . . . . . . . ................................................................................................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VI01ATION of the Zoning or Building Regulations Voids this Permit. Rough S PERMIT EXPIRES IN 6 MONTHS Final / 37 UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR Rough ......................... AA.............................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. No G Date....!.. ./.rJ`.5./....�� f NORTH i °!,"`°:•""° TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUS� This certifies that .... h��..v ....... ...:.... ........R...c..(...........e...,.. ................. has permission to perform /( F !.!�?�lf... . ... . ............. .............. .......... ... ................... vtnnno in the building of.....U...Ck:Y,.A..........\A.n,—....................................... at;.t...` ......�!f.r..�. f!�?...5................................. .North Andover,Mass. � � Fee.... .. ....:....... Lic.No..,,,?.... ..7.., ............................................................... � ELECTRICAL INSPECTOR 11/30/98 09:38 25.40 PAID WHITE: Applicant CANARY: Building Dept. PINK:Treasurer The Commonwealth of Massachuse o:iicc Use Only �-' _= Percir No:_ Department of Public Safety _ Occupancy & 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 INFORMATION) Date ! [F �S City or Town of AIn , AAJO'Je.( To the Inspector of Wires: The undersigned applies for a permit to rform the electrical work described below. Location (Street & limber) ,rq /(�/�t Msf Owner or Tenant kpk1 1 1� HOt),1my Owner's Address sa-1^e . Is this permit in conjunction with a building permit: Yes ❑ No ® (Check Appropriate Box) Purpose of Building 5:��1�e, 7-uY^1�� e 11 l'nv, Utility Authorization NO. Existing Service ( Amps Pd / X°b Volts Overhead M Undgrd❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd❑ No. of Meters Number of Feeders and Ampacity //�� ( Location and Nature of Proposed Electrical Work A44 iwo Qofit L -- a is 1 J ev1l Y r � N1 / r min nG kv'� A DU+ sf-6�t In e dC i,� O.CG. No. of Lighting Out ets No. of Hot Tubs No. of Transformers K al KVA No. of Lighting FixturesSwimming Pool Above In- grnd. ❑ grnd. ❑ Generators KVA No. of Receptacle Outlets No. of Oil Burners Batter EmerUnigency Lighting No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices No. of Disposals No. of Heat Total Total No, of Sounding Devices Pum s Tons KW g No. of Dishwashers Space/Area Heating KW No. of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other Connection I No. of Water Heaters KW No, of No, of Low Voltage Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: 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) Expiration Date Estimated Value of t)Electrical Work $ Work to Start //-/.o -7 Inspection Date Requested: Rough Final Signed under /the penalties fof perjury: ( �` FIRM NAME52 t C''\ C C\C. LIC. N0. 3 773.- Licensee M-t-- Signature�T/ �'-�' LIC. NO. &I.-" tr. Address1(j j `JYf t/efY�`PI SF Z..., . /'�o�• U15C''I'?� Bus. Tel. No. 6F{a-9o'5_O Alt. Tel. No. 996-7937 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. PERMIT FEE S 45—• 0© Signature of Owner or Agent M Do Not Write In Here 3 D N For Electrical Inspector Only ca M r m C1 Street and No. n DName ........................................................... Z Electrician .................................................... PermitNo. .................................................... Comments ....................................................