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Home My WebLink AboutMiscellaneous - 71 ELM STREET 4/30/2018All State Abatement professionals, inc. 4 Wilder Drive, Suite 12 Plaistow, NH 03865 April 13, 2006 Town of North Andover Board of Health 120 Main Street North Andover, MA 01845 Phone #: (978) 688-9540 Fax #: (978) 688-9542 Re: Asbestos Abatement @ To whom it may concern: 866 -565 -ASAP Fax: 603-378-0610 RECEIVED APP 2 5 2006 TOWN OF NORTH ANDOVER HEALTH DEFARTf1 1ENT Residence, 71 Elm Street All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the above referenced project on the following dates: Start Date: 04/27/06 End Date: 04/28/06 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 3 V �A M rt (D O —n TI Eo n G v 0 A W 3 O ty �p O L1 rt �, o a D 3 � fD W O >y C1 O --n _ avv nOr -fi O C N O O 3 rt 3 3 CL Ifp 0 p m O rt i lD 1 i � 1 c a I I I 0 (A m 1i7l O v 0 n V �A M rt (D O —n TI Eo PATRICK J. DONOVAN ASSOCIATES, INC. claim and Foss .adjustments P. 0. BOX 110 WAKEFIELD, MA 01880 (617) 245-5540 — FAX (617) 245-7016 February 19, 1997 - Building Commissioner City or Town Hall North Andover, MA 01845,.` Insured Property Address Insurer Policy Number Type of Loss Date of Loss Our File # : 855 Realty Trust :69-71-73 Elm Street North Andover, MA 01845 : Preferred Mutual Insurance Company : BOP130507109 : Fire : February 15, 1997 : WAP26098 Claim has been made involving loss, damage or destruction of the above -captioned property, which may either exceed $1,000 or cause Mass. Gen. Laws, Chapter 143, Section 6, to be applicable. If any notice under Mass. Gen. Laws, Chapter 139, Section 313 is appropriate, please direct it to the attention of the writer and include a reference to the captioned Insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Steph n J. Da o, Seni Adjuster SJD/so ASSOCIAT10N OF INDEPENDENT INSURANCE ADJUSTERS ASSOUAT04 of Massachusetts I Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B TO: Building Commissioner or Inspector of Buildings Board of Health or Board of Selectmen Town Hall ) or ( Town Hall ( North Andover MA ) ( North Andover MA RE: Insured: George & Ellen Schruender Property address: 71 Elm Street North Andover MA Policy No. SBP1462584 Loss of October 29, 1992 File or Claim No. LW16408 Claim has been made involving or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Chapter 143, Section 153, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139 Sec. 3B. is appropriate please direct it to the . attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. deductible. Insurance Adjuster Title On this date, I caused copies of this notice to be sent to the persons named above at the address indicated above first class mail. Signature and date 65 MERRIMACK STREET, LAWRENCE, MASSACHUSETTS 01843 FAX N0: 508-687-7246. A Mern AQ"rdM fiwg-GroAr1.6 3 LE\DSEY ,� 0MORDEN /!„ CLUM SERVICES, INC `�� Form of Notice of Casualty Loss to Building Under Mass. Gen. Laws, Ch. 139, Sec. 3B T0: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen Town Hall ) or ( To n Mail-' North Andover MA ) ( -North 'Andover 'MA RE: Insured: George & Ellen Schruender Property address: 71 Elm Street - North Andover MA Policy No. SBP1462584 Loss of November 1, 1992 File or Claim No. LW16799 Claim has been made involving or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Chapter 143, Section 153, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139 Sec. 3B. is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim or file number. deductible. Insurance Adiuster Title On this date, I caused copies of this notice to be sent to the persons named above at the address indicated above first class mail. 4/13/93 Signature dnd date 65 MERRIMACK STREET, LAWRENCE, MASSACHUSETTS 01843 FAX N0: 508-687-7246. (508) 686 - 4163 A Member of the Morden and HeWg Group V Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. INSTRUCTIONS 1. All sections of this form must be completed in order to comply with DEP notification requirements of 310 CMR 7.15 and the Division of Occupational Safety (DOS) notfiication requirements of 453 CMR 6.12 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (100031351 Dec -l -lumber -- RECEIVED APR 2 5 2006 w-- 1 HEALTH DEPARTMEP a. Is this facility fee exempt - city, town, district, municipal housing authority, owner -occupied residence of four units or less? ✓LD Yes M No b. Provide blanket decal number if applicable: 2. Facility Location: (RESIDENCE a. Name of Facility North Andover c. City/Town d. State 3. Worksite Location: Blanket Decal Number F7i ELM STREET b. Street Address 01845 e. Zip Code f. Telephone Number RESIDENCE �� OUTSIDE a. Building Name/Building Location b. Building # c. Wing d. Floor e. Room 4. Is the facility occupied? ✓] Yes ❑ No Asbestos Contractor: (ALL STATE ABATEMENT PROFESSIONALS a. Name PLAISTOW —� 03865 c. C' /Town d. Zip Code AC000331 f. DOS License Number 1J. SCOTT CURLEY h. Facility Contact Person 6 JEFF VALCOURT a. Name of On -Site Supervisor/Foreman 7 AIR TESTING SERVICES a. Name of Pro'ect Monitor 8 AIR TESTING SERVICES a. Name of Asbestos Anatvtical Lab 9 04127/2006 a. Project Start Date (mm/ddfyMJ 7-3:30 c. Work hours Mon -Fri. 10. a. What type of project is this? El Demolition 0 Renovation ❑ Repair [] Other, please specify: 11. a. Check abatement procedures: F" J Glove bag j Enclosure El Cleanup Full containment [❑ Encapsulation [l Disposal only O Other, specify: 4 WILDER DRIVE SUITE 12 b. Address 6033780600 e. Telephone Number g. Contract Type: ✓Z Written ❑ Verbal b. Describe WET METHODS b. Describe 12. Is the job being conducted: ❑ Indoors? [✓ Outdoors? Ga�To'"Top �� 0 anf001 ap.doc -10102 Asbestos Notification Form - Page 1 of 3 N Commonwealth of Massachusetts pz Asbestos Notification Form ANF -001 A. Asbestos Abatement Description (cont.) ■ 100031351 Decal Number 13. Total amount of each type of Asbestos Containing Materials (ACM) to be removed, enclosed, or encs sulated: �—Tl 1600 b. Tomoo ►her sura 'aces square c. Boiler, breaching, duct, tank = surface coatings Lin. ft. e. Corrugated or layered paper Sq. ft. pipe insulation Lin. ft. Spray wall board ft oa g. -on fireproofing Sgt�J j. Other, please specify: Lin. ft. L j Cloths, woven fabrics L ------I Lin k. Thermal, solid core pipe 4 (JOHN BERTHOLO insulation Lin. ft. d. Insulating = = cement ft.Lin. f. Trowel/Sprayer ft. Sq. ft. coatings ft,Line h. Transite board, 3 GEORGE SCHRUEWDER SqL 1600 wall board ft oa Lin. Sgt�J j. Other, please specify: NORTH ANDOVER, MA 101845 1 c. C' /Town d. Zip Code R. 1. Specify 4 (JOHN BERTHOLO 14. Describe the decontamination system(s) to be used: PROVIDE AN ADEQUATE DECONTAMINATION SYSTEM. 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (a): 16. BLE 6 MIL POLY For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: b. Title d. DEP Waiver # f. OS Official Title f–�---- ---- - --, h. DOS Waiver#Waiver# 17. Do prevailing wage rates as per M.G.L. c. 149, § 26, 27 or 27A—F apply to this project? ❑ Yes' No B. Facility Description 1. Current or prior use of facility: RESIDENCE 2. Is the facility owner -occupied residential with 4 units or less? ❑✓ Yes Q No 3 GEORGE SCHRUEWDER 71 ELM STREET a. Facility Owner Name b. Address NORTH ANDOVER, MA 101845 1 c. C' /Town d. Zip Code e. Telephone Number area code and extension 4 (JOHN BERTHOLO 43 TICKLEFANCY LANE a. Name of Facility Owner's on-site Manager �1 b. On -Site Mance er Address ,SALEM, NH 103079 603-339-1465 c. CitylTown d. Zip Code e. Telephone Number (area code and extension) ■ anf001 ap.doc -10102 Asbestos Notification Form - Pa e 2 of 3 ■ Note: Transfer Stations must comply with the Solid Waste Division Regulations 310 CMR 19.000 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 o. raminy uescription (cont.) a. Name of General Contractor If c. C!/Town�� f. Contractor's Worker's Comp. Insurer 6. What is the size of this facility? 100031351 Decal Number b. Address 1 e. Telephone Number area code and extension p. Policy Number h. Exp.Date(mm/ddtvvvvl 2500 2 a. Square Feet h Numhar of flnnrc %,. Asoestos i ransportation and Disposal 1. Transporter of asbestos -containing material from site to temporary storage site (if necessary): ALL STATE ABATEMENT PROFESSIONALQ a. Name of Transporter PLAISTOW, NH 03865 c. City/Town d. Zip Code 2. Transporter of asbestos -containing waste material IJ.O.B./ROLLOFF, INC. b. Authorized Signature a. Name of Transporter CHELSEA, MA� c. C' !Town 02150 d. Zip Code 3. 1 N/A 1ASAP, INC. a. Refuse Transfer Station and Owner c. C' /Town !( d. Zip Code 4. TURNKEY LANDFILL (WASTE MGT NH) a. Final Disposal Site Location Name g. Address 7 ROCHESTER NECK ROAD PLAISTOW, NH c. Final Disposal Site Address NH e. State 03839 f. Zip Code D. Certification The undersigned hereby states, under the penalties of perjury, that he/she has read the Commonwealth of Massachusetts regulations for the Removal, Containment or Encapsulation of Asbestos, 453 CMR 6.00 and 310 CMR 7.15,,and thatthe infbrmaton contained in this notification is true and correct to the best of his/her knowledge and belief. 4 WILDER DRIVE, STE 12 b. Address (603) 378.0600 e. Telephone Number from removal/temporary site to final disposal site: (PO BOX 6037 b. Address (617) 387-1495 e. Telephone Number b. Address e. Teleohone Number JUDITH BEREZANSKY a. Name_ OFFICE MANAGER b. Authorized Signature 04/13/2006 C. Posftion/Titled. 78-0600 (603) 378_0602______j Date (mmfdd/vwd 1ASAP, INC. e. Telephone Number f. Representing 4 WILDER DR, STE 12 g. Address PLAISTOW, NH ,03865 h. City/Town i. Zip Code ■ anfOOlap.doc • 10/02 Asbestos Notification Form • Page 3 of 3 E