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Home My WebLink AboutMiscellaneous - 85 Waverley RoadW Instructions 1. All sections of this form must be completed in order to comply with MassDEP notification requirements of 310 CMR 7.15 and Department of Labor Standards (DLS) notification requirements of 453 CMR 612 Commonwealth of Massachusetts Asbestos Notification Form ANF -001 A. Asbestos Abatement Description 1. Facility Location: CIAIBIELLO 83 WAVERLY RD. Name of Facility Street Address NORTH ANDOVER MA 01845 City/Town State Zip Code N/A N/A Facility Contact Person Name Worksite Location: 2. Is the facility occupied? r Yes r No 0000000000 Telephone Facility Contact Person Title MTCHEN 100213278 Asbestos Project # F-� Project Revision F7sect Cancellation Building Name, Wing, Floor, Room, etc. jAW05 2015 Tovk" lN{7F !'f ;1411L4�, 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 G No MassDEP Use Only 4. Blanket Permit Project Approval, if applicable: 5. Non -Traditional Asbestos Abatement Work Practice Approval, if applicable: 2. Submit Original 7813372117 Form To: Telephone Commonwealth of 6. Asbestos Contractor: Massachusetts NEW ENGLAND SURFACE MAINTENANCE Asbestos Program DLS Certification # P.O. Box 120087 Name Boston, MA 02112- WEYMOUTH 0087 AA000144 City/Town AC000196 DLS License # 7, JOHN P. VALLIQUETTE Name of Contractor's On -Site Supervisor/Foreman $, RICHARD K BOWEN Name of Project Monitor 9, FU ENVIRONMENTAL INC Name of Asbestos Analytical Lab 10. 1/7/2015 Project Start Date (MM/DD/YYYY) 7-3 Work Hours - Monday Through Friday 11. What type of project is this? MA State Approval ID # Approval ID # 850 WASHINGTON STREET Address 02189 7813372117 Zip Code Telephone Contract Type: R-1 Written r Verbal AS060773 DLS Certification # AM061044 DLS Certification # AA000144 DLS Certification # 1!7/2015 End Date (MM/DD/YYYY) N/A Work Hours - Saturday & Sunday F Demolition F Renovation r Repair r Other -Please Specify: Revised: 11/13/2013 Page 1 of 4 Commonwealth of Massachusetts 100213278 Ll Asbestos Notification Form ANF -001 Asbestos Project # Project Revision Project Cancellation A. Asbestos Abatement Description: (cont.) 12. Abatement procedures (check all that apply): Glove Bag Encapsulation F Enclosure rDisposal Only [Cleanup F Full Containment r Other - Please Specify: 13. Job is being conducted: r Indoors Fj Outdoors 14. Total amount of each type of asbestos Containing materials (ACM) to be removed, enclosed, or encapsulated: 250 Linear Feet (Lin. Ft.) Boiler, Breaching, Duct, Tank Surface Coatings Lin. Ft. Sq. Ft. Pipe Insulation 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: AS REQUIRED AS REQUIRED Square Feet (Sq. Ft.) Transite Pipe Transite Shingles Transite Panels Other - Please Specify: LINOLEUM Lin. Ft. Sq. Ft Lin. Ft Sq. Ft. Lin. Ft Sq. Ft 250 Lin. Ft. Sq. Ft 17. For Emergency Asbestos Operations, the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization (MM/DD/YYYY) Waiver # Name of DLS Official 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 r yes F No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachusetts 100213278 Ll Asbestos Notification Form ANF-001 Asbestos Project # Project Revision Project Cancellation S. Facility Description 1. Current or prior use of facility: RESIDENCE 2. Is the facility owner -occupied residential with 4 units or less? Yes ❑ No 3. CIAIBIELLO Facility Owner Name NORTHANDOVER City/Town 4. N/A Name of Facility Owner's On -Site Manager NORTH ANDOVER City/Town 83 WAVERLY RD. Address MA 01845 0000000000 State Zip Code Telephone N/A Address MA 01845 0000000000 State Zip Code Telephone 5. NESM 850 WASHINGTON ST. Name of General Contractor Address WEYMOUTH MA 02189 7813372117 City/Town State Zip Code Telephone Note: Temporary X storage of Asbestos containing waste Contractor's Worker's Compensation Insurer material is only X 1/1/2015 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 I- Directly to Landfill or � To Temporary Storage Location/Transfer Station NEW ENGLAND SURFACE MAINTENANCE, LLP 850 WASHINGTON STREET Name of Transporter WEYMOUTH City/Town Address MA 02189 State Zip Code 7813372117 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: _ _ - RED TECHNOLOGIES Name of Transporter BLOOMFIELD City/Town 10 NORTHWOOD DRIVE t Address CT 06002 0000000000 State Zip Code Telephone Revised: 11/13/2013 Page 3 of 4 Ll Commonwealth of Massachusetts Asbestos Notification Form ANF -001 100213278 Asbestos Project # Project Revision j 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: RED TECHNOLOGIES 203 PICKERING STREET Temporary Storage Location Name Address PORTLAND CT 00000 0000000000 City/Town State Zip Code Telephone 4. Name and location of final disposal site (asbestos landfill): MINERVA ENTERPRISES MINERVA Final Disposal Site Name Final Disposal Site Owner Name 9000 MINERVA ROAD Address WAYNESBURG OH 00000 0000000000 City/Town State Zip Code Telephone D. Certification "I certify that I have personally examined the foregoing and am KEN FURTNEY KEN FURTNEY familiar with the information Name Authorized Signature contained in this document and PARTNER 12/24/2014 all attachments and that, based on my inquiry of those PositionMtle Date (MM/DD/YYYY) individuals immediately 7813372117 NESM, LLP responsible for obtaining the Telephone Representing information, I believe that the 850 WASHINGTON STREET WEYMOUTH information is true, accurate, and Address City/Town complete. I am aware that there MA 02189 are significant penalties for submitting false information, State Zip Code 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." Revised: 11/13/2013 Page 4 of 4 /o, .— MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) ° IV%Vlh An& Veda , Mass. Date 6 19 t Permit# D9- L�-/ Building Location Owner's Name t l�ohn� CtarJCfJ t6 - TIWI ype of Occupancy New ❑ Renovation ❑ Replacement FRluhQSW ttedi Yes ❑ No ❑ FEATURES ,\ 9 Installing Company Name Far-rcu :F Som T luf bro Check one: Certificate Address l I rar Mf a 60W Cr ❑ Corporation - F� i 1CMD Ha o I'3bZ ❑ Partnership Business Telephone -I -E)rl��IVI4,5l+` rte, i CVirm/Co. Name of Licensed Plumber �...JU' )iii f�"1 I ,:D INSURANCE COVERAGE: I have a cu`re�t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes LW No ❑ If you have checked yes, please . dicate the type of coverage by checking the appropriate box. A liabilityinsurance policy � Other type of indemnity ❑ Bond ❑ P Y YP Y OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: _ Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent pr ovi ' the MaMachuset tate Plumbing Code and Chapter 142 of the General Laws. By Title City/Town APPROVED OFFICE USE ONLY) Oiyn/alum of ucensea rwrnoer TypB of License: Master ❑ Journeyman 12/ License Number 5 a, ZZ Z Y Q U) fn < Z Q LU J Q� U) U) dol- U) z 0 ZZCL0w Q U) W� U)_ ~ Q Ir W (n Y d W Q a Q X U Z Q o W} Z 0 Q rn C7 M W O ` .Ll z Z w W LL ¢� H am ¢= Cl)= vai Q 0 Z O Op rn 0 0 o a� Q O Q l=- 3= IQ- 0 i M m 0\ SUB-BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Far-rcu :F Som T luf bro Check one: Certificate Address l I rar Mf a 60W Cr ❑ Corporation - F� i 1CMD Ha o I'3bZ ❑ Partnership Business Telephone -I -E)rl��IVI4,5l+` rte, i CVirm/Co. Name of Licensed Plumber �...JU' )iii f�"1 I ,:D INSURANCE COVERAGE: I have a cu`re�t liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch 142. Yes LW No ❑ If you have checked yes, please . dicate the type of coverage by checking the appropriate box. A liabilityinsurance policy � Other type of indemnity ❑ Bond ❑ P Y YP Y OWNERS INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: _ Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all pertinent pr ovi ' the MaMachuset tate Plumbing Code and Chapter 142 of the General Laws. By Title City/Town APPROVED OFFICE USE ONLY) Oiyn/alum of ucensea rwrnoer TypB of License: Master ❑ Journeyman 12/ License Number 5 4 Date. T4 2$12 TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING SACNUS� �-- This certifies that ... Z,-/ n ... ....... has permission to perform S plumbing in the buildings of . C1 A 10-r C................... at ..i.4!v r!' `� ..�...... • ... North Andover, Mass. Fee.Lic. No..1 .`f`!?.!`.''y, PLUMBING INSPECTOR 02/13/% 12:53 10.00 PAID WHITE: Armlicant CANARY: Buildinq Dept. PINK: Treasurer GOLD: File Office The Commonwealth of Massachusetts Use Only - j cn Department of Public Safety occupancy a Fee checked t BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 3/90 Nave bunk) RK APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK i 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 n0; R �� To the Inspector of fres: The undersigned applies or errTit, o perform the electrical wort ,Aeserioed below. I Owner or Tenant _ 41 Is this permit in conjunction with a uilding ermit: Yes ❑ No Q (Check Appropriate Box) Purpose of Building �� Utility Authorization No. Existing Service _ Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity /1 Location and Nature of Proposed Electrical Work `�� l �• 1 � ��J> 1 - TKVA o. of Lighting Outlets No. of Hot Tubs No. of Transformers No. of Lighting Fixtures Swimming Pool Abod E]Ingmd1:1Generators KVA No.of Emergency Lighting No. of Receptacle Outlets No. of Oil Burners Battery Units Bat No. of Switch Outlets No. of Gas burners FIRE ALARMS No. of Zones No. of Detection and Total Ranges No. of Ran 9 No. of Air Cond. tons Initiating Devices Heat Total Total No. of Disposals No. of Pumps Tons KW No. of Sounding Devices No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices Local Municipal ❑ Connection[] Other. . No. of Dryers Heating Devices KW No. of . No. of Low Voltage No. of Water Heaters KW Signs Ballasts Wiring " I' No. Hydro Massage Tubs No. of Motors Total HP 17170 - ►QQ� i 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) Estimated Value of Electrical Work $ Work to Start Signed under the penalties of perjury- FIRM erjuryFIRM NAME CROWE & SOT Inspection Date Required: Rough ELECTRICAL CORK. (Expiration Date) Final LIC. NO. A6 0 5 8 Licensee JOHN A. CROWE Signatur( yl-T,u NO. A6058 Bus. Tel. No. 8 4 5 3 — , Address 577 MIDDLESEX STREET, LOWELL, MA 01851 Alt.TeI.No. - OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage or its substantial 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 $ - -. - ic:....s..... -6 I1........ w. A. 41 t .. _ Date...... ..!'". 17 �' 28561 NORTH TOWN OF NORTH ANDOVER °L PERMIT FOR WIRING SSAcNUSE� This certifies that .......0�.hnnl �.....:F.... d.`. .......... rC ..... v<<.J....... has permission to perform ...... t ? � � �. � o . 5 .............. wiring in the building of .................... .......................... ci at ...................../ ...:..................... ,North Andover, Mass. Fee.;J�s��...... Lic. No..�F'l ...-k. . ...... .................................................................. ELECTRICAL INSPECTOR J 15.40 PAID .1 WHITE: Applicant CA /126wld1ing:35 Dept. PINK: Treasurer GOLD: File