HomeMy WebLinkAboutMiscellaneous - 57 DAVIS STREET 4/30/2018 (3) 57 DAVIS STREET D 1
J 210/056.0-0002-0000.0
.I
Address.7S - Title of File
Page 9 of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planniing Board — Conservation Commission— Building Departnler�t
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As�e� �fntltJcailon Form— ANF-001
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Asbestos Abatement DescriptionYJ
5 •7` ;!< l
1. facility location:
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DlsTaucnO/f
Add`n`
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N���:1�_._. �w�.�.............�.!............_......__....._......fig_".
I.AA$odiorsofINS _ ._........__.._.. _. ram, TWO"form must be compNed CW/1-
hrLis locomply with Semen-E- ........__.._..._.._......._..._............
.__..__..___._._.____.__
M Dep srtmerd of jr d is ro who#b2sos2 bua'Aoa arrM,/,Mg0.ilea,roars
Errilrodmanlal
Fidectlon nolircalion 2. Is the IACIIRy occupied? I Yas O No
tgAimrds of 710 CMR
1.15(hi aorkdai drys
b 3 Asbestos Contractor.
prbrnoGfntian
reavid o/erry abatsswr ; SU(�
prom:rd M __.. ......_...___-_._._—..............._...._.__.
Depedmnd at labor r� Q (�� R
end Waddle T(�V n�on o d-� V 0 ........'..f.•�o.- --
...................................................... ... 00 t
neraicalfonreQuienerrs _........................ .._......._....................................._.............._ .. IrlrpMne
o1453C1016.12 (ren C*/row �o
rays prim mdriaian is
f#g0dorAxr A C ().Q..Q..�.q ...................
................................................................................................
MabTWIae)adPro" arr+.nrer
r ai Wee Imar or
MM f*. 4. On-Sqe project Supervllssoor/Foreem(aan: / ` L
2.S,6miQlplrolForm . �Gl. l.._. e �1._7.! ! _................ �......l........f!_.........._......._..._......._.__._.........._.. —
Te: Nunt _ DLIC&Nbroal
cammeawealtb of
Yanaclwstts 5. .Project Monitor.
Wades hegraae
tai.t:ooe7 _._ C 1 l�........
...n.................................................................._................................................_..
.. .......... . .h.
sales,KA02112- Ileac LCICerlaribn/
:087
6. Asbestos Analytical lab:
y11�J1....
��r��'q Irv........ '
qal a0
USEmimWAil b...
..... ...................�.........C...P..O.......�...0...0
ro Cif
h*Wo"AgM� ecHlcwork hours(Mon.-Fd.) Qn....
..S..a._l.•._S_u._n...) -
_—
1 of aswas demolloN7.. Project
rencrrtlon oprallons
stele°to NESItAPS(40 tl Whit type of project Is this? (circle one): dw alm reprt aranron 0Wr fertvab)
CFR Subprl AQ.
raoraw .
9. Describe the asbestos abatement procedures to be used (circle): obi oro eocau+xe w aoe1 d-W
R?f'?���?����s a`'�' nc�orst�fba aspxwroNl orrr(e�l+b1
10. Is the bb being conducted �(ndoors ❑outdoors?
rte'
11. Total amount of each type of Asbestos Containing Materials(ACM)to be handled on pipes or ducts(linear h.)—110'- or oth7 r
surfaces(square fl.)LL 1' ) _.to be removed,enclosed or encapsulated:
flneadsquad feet
bolter,breaching,&ct tint sa(am Marino... KU rwmsl,sow cora pie ins darlon......_J
smnWW or h)w@d pAw pie ktwlsUon....ae hruWhp cdr ad.................. _l
spafonir4woobng....................._.J rowel/sP'ryarcoxings.............. . /
alerts,worm Wks....................._ aansde bard,wall boyo,............_1
orw(pkase dambe)....................
U. Describe the decontamination system(s)to be used:
...Mr ...... ..@Y1. ......�....................... ........................ ..w___:w...... ..�.T......_.__.....
13. Describe the contalnerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(8):
.........................................................................................................................................................._.......................
14. For Emergency Asbestos Abatement Operations,the DEP and DLI offlcWs who evaluated the emergency:
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xu,r aarrordar
_........... ...................N..{ L
...................................... ........._................................ ...............................................
_._...._.._......_............................................................................................................................................................................__.......
O+r aAu{weyron WiKr/
15: Do prevailing wage rates apply as per M.G.L.c.149,§26,27,or 27A-F to this project? O Yes No
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Facility Description
1. Current or prior use of facility: Res(,c 1)CC
2. Is the facility owner-occupied residential with 4 units or less? 0 Yes 0 No
3. Facility Ownero ICA
r
Adrw
__............................� .»
_......__. _...._..........._._.
ury/rowe aoa rrspaw
4. Facility's Owner's On-She`Manager.
..................................11J.. . ..................................... ..........................................................................................................._.__...
_
�._... ____ __._.._._..__._....»......_._._��.....___....._..._..._......__.fir .»_..____..
cw/r-
5. General Contractor.
_......._.........N.... . ............................_......................................................_..._..........................
_...»»....__.-..___—_
Nacos Adanss
--._.... -._............._........_"..._............................_............ ._....................................._..._................._..__...._.....__.....
py?own...__ Ito cad# f�Mpeoni
Conwof s WorbR Camp,InsUnr Pot Ex0•au
6. What is the sire of the facility?_%6 tl) (/of floors)
13 Asbestos Transportation and Disposal
t. Transporter of asbestos-containing waste material from she to temporary storage site(11 necessary)to final disposal site:
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Adm
t .n 1vn............................................ ..........�7.a- .. ....:..... ....5..r�..8...'��U...' ...
Clry/fown Ib ma frsgae
2.• Transporter of asbestos-containing waste material from removalltemporary storage site to final disposal site:
c�no_... �Jc.►�t ._...
Note:Transfer
.� x..01 an.0...... C .......... o.01 byo
............................ ... ..~ 3'�a"0667
Stations must 3. Refuse transfer station and owner(11 applicable):
comply With the
Solid Waste
tions 310 CMR
U0O .............__........»-.............................................................................................................._..............._._.__ .�-
044— Iw aaar frspnone
4. Final Disposal Site:
......_Rs.n.:.....�-G c ......I L. ....................._....._.............
____�..
layeoo sure 0MVIS KM
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Adtm
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Crty/lds ltocode frpeovw
Certlf C8110n
The undersigned hereby stales,under the penahies of perjury,that he/she hat read the Commonwealth of Massachusetts Regulations
for the Removal.Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the Information contained In
this notification Is true and correct to the best of his/her know4amnief.FW A4 9 f ANote:Contractor / R musfslgnfhise_1.__...__. S 50v'form for DLI _.........................._.._ ....._........_.._................__._..............._____
Auslnmp Rr/w-fing rrwnar
noUficafion -
purpvtet --110 pn__� :�'........._...._.............'IG.un..-t�✓� 0;1 60
A� Gry/rowm Ibmds
Fee exempt(City.Town,district,municipal housing authority,owner-occupied residential of four units or less)10 yes 0 no
Slicker/(from front of form):