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Home My WebLink AboutMiscellaneous - Exception (65)February 22, 2011 Town of North Andover Public Health Dept 1600 Osgood St Building 20, Suite 2-36 North Andover, MA 01845 Crawfort U.S. Property & Casualty Robert Pageau, AIC, Director New England Service Center c;,(h,i --1 L011 TOWN OF NORTH ANDOVER Notice of Property Loss Under M.G.L. 139, Section 3B RE: Insured: Kathleen Reckendorf & Ryan Zannini Loss Location: 40 Carty Cir, North Andover, MA 01845 Insurer: Preferred Mutual Insurance Company Insurer Reference: 11002891 Policy Number: PHOO 100812612 Type of Loss: Water Loss Date: 02/03/2011 Our File Number: 1789551 Dear Sir/Madame: Crawford & Company has been retained as independent insurance adjusters by Preferred Mutual Insurance Company to investigate a first party property loss presented by their insured. Our initial investigation has determined loss or damage to the above referenced property may either exceed $1,000.00 or cause MGL, Chapter 143, Section 6 to apply. Under Chapter 139, Section 313 of the Act of 1977, you are hereby notified that a claim payment of more than $1,000 is expected. If any notice under MGL, Ch. 139 Sec. 313 is appropriate, please contact the undersigned immediately. We thank you in advance for your assistance in this matter. Respectfully, CRAWFO & COMPANY Adam Lucas Property Adjuster CC: Building Department Preferred Mutual Insurance Company EXCELLENCE IN EVERYTHING WE TOUCH 204 Second Ave 0 Waltham, MA 02451 0 Tel: 866-641-8175 ■ Fax: 800-651-3743 ■ www.crawfordandcompany.com 42 Broadway Wakefield, MA 01880 Tel: 781-245-4403 800-649-6160 • FAX 781-245-1892 T(- W_i'v OF NlOFTH ANL)' " V 130APD {3F HEALTH � DEG 2' 91, 2003, Dear Health Officer, -+ Please find enclosed copy of the DEP Notification which is verification of an Asbestos Removal being performed in your district. If you require any further information, or have any questions, please -contact Asbestos Free, Inc. at 781-245-4403. Thank you, Frank L. Arsenault President FLA/b Nameaauanriir................................................................................................................... Tlrk.............._.. _ .................................... .. Wailer %............................ ...................................._. _ 15. Do prevailing wa a rates149.',§'2.G.project?, 0 apply as per M.G.L. c. 27, or 27A - F to this ro ect?_ O Y,es. ONO. _ Rev. 6A2 Commonwealth of Massachusetts - . Asbestos Notification Form -- ANF -001 1 71 '`iBOA O bg9�A " 9 I ._ 774387 I Asbestos Abatement Description �►Ff�� ,.: _ k> _.J- 1. Facility location: �t Jeff Duboff 31 Carty'Circle INf1AUCi10Nf - •......,.................................................................................•..•..... ..............•.•........,.,........... »................,........,......................•............ti......._ Nmr Ad...•drus ~ �- 01845 978-258-0668 No..•Andover,„MA 1. All sections this of _• ... .................... . . form must be completed cld/lowrt A�;w ...I.a................_................releprlone................................................._...._._ In order to comply with INDepartment of Kitchen, Hallway, & Bathroom (1st Floor) ................................................................................... Environmental . ttrlstls Crt worAslfe bntlon7 building name, % wrnp, ib x. tow _......... _... .._ Protection nollli reouiremerts of 31010 CMR C 2. Is the facility occupied? ®Yes O No 17.15 (ton working days prior notification is 3. Asbestos Contractor: requaed ofany "emert pro0o:and he Asbestos Free, Inc. 42 Broadway ,Department of Labor /wmr -Addirs'; ...................................................................................._....................—...._._ and Industries Wakefield, MA 01880 (781) 245-4403 nolilicalion requirements of453 CMR 6.12 (lenCllypown da)sprior notiralionb ......................................................................................•................•.................................................................,....................................... -- j1Q00� INepl►orlt required o/ANr AC000133 Writ ten abatementpro%ed greater ................................................................................. Ow Uuee linear or Conrrad r wine ) /'Pe ( nAerbal squareleat), 4. On -She Project Supervisor/Foreman: i2. Submit Original Form Terry Sha rke AS 51070 'To: ommoawealth of .arrr ............Y................,y............................. ............................. .................. Ai oil ..................... ... Massachusetts Asbestos B. Project Monitor: Program P.O.B. 120087 Boston, MA 02112- 1,0087 ................................................................................................. LYI Grtlacalbn / 6. Asbestos Analytical Lab: 3. This form maybe used [or notifying the Environmental Remediation Services AC000122 ..................................................................................................... U.S. Environmental N�me..............................................................................................._. ProloctionAgency Region aI cerancallon / _ -- I of asbestos demolitionl 7. Project start date 1_/ 9 /24end dale 1 / 9 p 91' speciticwork hours (Mon. -Fri.) 7-5 renovation operations _ (Sal. Sun.) subject to NESHAPS (40 CFR Subpart M). 8- What type of project is this? (circle one): dmwi#on law/,, Irronbbo otlierlexp4/n) raosoiussol�y .,. 9. Describe the asbestos abatement procedures to be used (circle): ploveeao enchsan►unca,rynmrn deaap Ndalcaeml erwdasuJanon d/spolsalonly otner(wbin) Dawe 10. Is the job being conducted 99indoors O outdoors ? reTnu ala :7—= 11. Total amount of each type of Asbestos Containing Materials (ACM) to be handled on pipes or ducts (linear IL) surfaces (square Il.) 800 ' or other to be removed,. enclosed or•encapsulated: linearlsquare Ieal i•• boird,breadrinp; duel Griksuff"'coati coatings _/ tl>ermal, solid core pipe .. corrupated or layered paper Pipe insulation. ....i.n.w..la.li.o.n hwlatinp awenf.spray-on fireprooring ...., ' _/ —J/ bowet/spra coatings •• cloh, woven rabrks ...... odwr (Please dnatbe)........... —/ baruile board, ►rail board ...... _ J floor tile _/B.� 12. , Describe the decontamination sysle'rn(s) to be used: ........................................................ Stage Decon 13. ................................................ -- ...................................................................................................................... Describe the containerization/disposal methods to compveilhh 3310 MR 71 a d 5 All ACM to be doubled bagged in m � 1I. latiel�e�s��s�4�ival Bags 11, .............................. -- ........ 1 VI LlllolyalW)' f1JUJu1v0 ►1 ................................................. ALL -'141;n, l.�rCIG:I:/IrJ, 1;1,a DEF QIIV i LI VIII<:Ia10 wive W dVdIUA1CU lr1C vrllyurrcy: ..............•.........................................................................................•........... QWo/Autborltatlon......................................................................... ................................................... wAfwr% _— ..............___ Nameaauanriir................................................................................................................... Tlrk.............._.. _ .................................... .. Wailer %............................ ...................................._. _ 15. Do prevailing wa a rates149.',§'2.G.project?, 0 apply as per M.G.L. c. 27, or 27A - F to this ro ect?_ O Y,es. ONO. _ Rev. 6A2 Facility Description . 1. Current or prior use of facility: Residential 2 Is the facility owner -occupied residential with 4 units or less? M Yes b No 3. Facility Owner: ` SAME .............................................................:............. . .............................................................................................................................. Clry/fown..................................................................................................................................rel.............................. ...... 4. Facility's Owner's On-Slle Manager: .......ess ....•.................................. Name Addr Clfy/lown..................»...................................................................0....................»........_.».»...... .. •5. General Contractor. ....................................................................................: Nmne............................................................ Address Cly%%owrr......................................................................................Z•................................................................................................. ............ 1pcodiAkphone The St. Paul Cos 883X2253 May 21, 2004 Contractors Workers Comp. Insurer Policy/ brp.Otle 6. Wil -It Is the Slee Of the facility? , (sq II) (I of 110016) ,-Asbestos Transportation and Disposal 1. Transporler of asbestos -containing waste material from site to temporary storage site (i1 necessary) to final disposal site: Asbestos Free, Inc. 42 Broadway Wakefield, MA 01880 (781) 245-4403 .................................................................................................... . C!!y/Town..................................................... .Telephone 2. Transporter of asbestos -containing waste material from removal/ temporary storage site to final disposal site: ecoverx Expresso Inc...•• 180 Canal Street ` ..................... ..............................r............................................................... NameAdcln u Note: Transfer Boston, MA 02114 (617) 523-7740 irow;i.................•........................................................... c.! .............................................................. ... ... ..... Stations must ....................................................... TNephone ""' comely with the 3• Refuse transfer station and owner (if applicable): ' Solid Waste Divisionregula- ......................•.•.•....•.....•......•..........•............... tions 310 CM/t n*....•....•..•• Nan* ..•....•....•.•......•............................................•........................................................ •MOress • 18.00 ................................................................. ........................................ 1�............ ncaosae... 4. Final Disposal Site: B..,F.I. Imperial.Landfill 11 BoS g. s Road . toratlon A1enk Impetlal,.PA • 15126 •724-695-0900 Ad.............:................................ dress............................................................................................................. ........................................................................ . . . . . _T�ep A7 code ......................................................... ---------- 146 t,llda; elgr•,ad h6reby stales, u;,dc; tFc per -„!cc �! ; erju�, #hat he/Rhs has raid the Commonwealth of Massachusetts for the Removal, Containment or Encapsulation of Asbestos*',' CMR 6.00 and 310 CMR 7.15, and that the information R Laicegu this notification is true and correct to is the best of his/her knowledge and belief. ontained Frank L. Arsenault ................................... �Ct vGdC ecember 23, 2003 Note: Contractor Aua/airedspna%ure...................................................................... must sign this /ormforDLl .................... Qtk :...• .President Asbestos Free, ........................ Inc. (781) 245-4403 notification Aulrloryrltle """"'••••• •••••••••••• purposes nepnsenring ........ .............................................. 42 Broadway Wakefield, HA 01880 ........� "tddress .................................................................�o»�r.................... - ........................................................... Iryir Fee exempt (City, Town, district, municipal housing authority, owner -occupied residential of four units or less )?Or"y'es O no Sticker I (from front of form): 774387 .