Loading...
HomeMy WebLinkAboutBLD-20-831 11 • t'} ✓ Y SHEDS LESS THAN 150 SQ FT SHALL BE ace use onto SHEDS � p s '- PLACED A MINIMUM OF 30 FEET FROM THE O 3/ s yo vim ~ FRONT LOT LINE AND A MINIMUM OF 6 FEET FROM=1� FROM THE SIDES AND REAR LOT LINESAin„tint c a]a^,^.!!,.L it'4�7 Pcnun expires 130 days front °j KV4.7. 4'"' is:;ue Jute EXPRESS SHIED PERMIT AP.PLICA:FION TOWN OF YAR!b1OU11I Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 !,5`1 (508) 398-2231 Ext. 1261 - CONSTRUC T ION ADDRESS: 149h _ _ pliz vet44. . /4A -_--_ 026 73_.-- ASSESSOR'S INFORMATION: M tp: 3 7 Parcel: 75 NAME 4 PRfSi:N I ADDRESS TEl.. G6a.14'L 67 01ism ( 44 iT D 1 1-s`�3-21.S-D.. c'+t�r1 ttAAc t C)tt; �t3L )� .s,,,� Sj_UJ'�. NAM �, NiAII.ING ADDRI-SS Ti-I. ti ntaw�//P .✓� 5W.414.9.10 Mg 019o7 � 0 Rc•�idential IiCununcrcial Est.Cost of Construction 5 ett< *2 J1 J0 Home Improvement Contractor Lie.y Construction Supervisor Lie.i `5 — /2 L°3 S 1Voiknwn's Conaf;risation Inswauce: (cheek one) -1 1 am the homeowner I tun the sole proprietor X1 have Worker's Coitperu ation Insurance e Insurance Company Name, ..ADO .fii.i GiletiL._. i\15. 1 Worker's Comp.Policyd Awe &k0`7 3 Z-.1p_6320 /9 A SfMD INFORMATION New Size 1, x IY x H Corner Lot: Yes No Per Town of Yarmouth Zoalnt By-Lint,Sec 203.5 E: ,Side and rear setbvc1s for accessory buildings less than 150 s luare lee(said single store. shall he 6 fie/ *17 all ilisrricLi hurl :::: caseniser1?jet Co arorller liuildin - -- 27/sloesace existing Size 1: x iii a 1f *The debris will be disposed Of at: . t S 6%co �/ �S L Location or Facility I declare under ptualtics of perjury that the summits herein contained arc true utd collect to the best rif n %knowledge and belief 1 undcrsiaui that an,false amwertq s+•ii1 be just cause fir deiiai or revocation of my license and for prosecution under M.G -.t h.263.Section I Applicants Sign ire Cy Gate. tt1?.111 °oilers.Si ;attire(or attach i tit)_ Date: !) r? / I ,lppntveri Dale' OV Nt(1 linildw,Dirk or de. Lr.1,U1,ADDRESS: Zoning,urstt ice_. ilisturical District: , Yes No Flood Plain Zone: - Yes No Water Resource Protection Dix Tier Within 100 ft.of Wei lantk•'''''' - Yes No '1'es No "*Note:t.,.on:mettation rec.iety required if within 100 1.or wetlands tl' II:' Department of Industrial Accidents . _. it Office of Investigations 00'41=- 600 Washington Street """.-----1 Boston,MA 02111 .,,,, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /[�L v/jLG/e!?13,L , TNC r Address: 6 41, f4 N lvi7'I4-►2-C-►1 �`T1-ze. U +! 7' City/State/Zip: S't AilipSco-�'/� /h9, age? Phone#: ''t'/ 1-8/EO Are you an employer? Check the.appropriate box: Type of project(required): 1.N I am a employer with 4. El I am a general contractor and I 6. (="New construction employees (full and/or part-time).* haie hired the sub-contractors 2.IllI am a sole proprietor or partner- listed on the attached sheet t 7• [2] Remodeling ship and have no.employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9• Ei Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its . • required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or'additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.n Roof repairs insurance required.]t employees. [No workers' ' comp..insurance required.] 13 Other vv' AIL .b&rwo o-t - Aa *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: C t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I.am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A Trill. m(-'UA'L 5i.iE> ur= (.e fri ' f b."1 Policy#or Self-ins.Lic.#: 4 U1 C t.{007 a7,99 c 3a014t 4 Expiration Date: 07 I2 q 1 ZO Job Site Address: I T I TY .y i City/StateiZip:`/,qiz. iv ih4, d Z/.P 73 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.-152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of.this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert j under the pains and penalties of perjury that the information provided above is true and:correct. Signature, ,i/a 2 Date: g/7413 Phone#: 71/- la)7- t 9 ily . Official use only. Do not write in this area,to be completed by city,or town official. City or Town: Permit/License# Issuing Authority(circle one): • 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Commonwealth of Massachusetts ° ( Division of Professional Licensure �� Board of Building Regulations and Standards Construttidri{SUpervisor CS-106035 M Expires: 05/28/2021 GIOVANNI C NARD PO BOX 45628, SOMERVILLE MA 0216 " • 1 Commissioner ^,(.,� •�� ,7- 109F?�9�S Construc:ion Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl Ac g CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) —��1 08/29/2018 1THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Christopher Kennedy NAME: Farquhar&Black Insurance Agency PHONE (781)599-2200 FAX (781 581-3940 (A85 Exchange Street-Suite 101 E-MmAILo, : (A/C,No): ) ADDRESS: Chris@FandBlnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# Lynn MA 01901-1475 Crum&Foster Speciality Ins Co INSURER A: P tY INSURED INSURER B: Safety Insurance 39454 Federal Environmental Group Inc INSURER C: AIM Mutual Ins.Co. 646 Humphrey Street INSURER D: INSURER E: Swampscott MA 01907 INSURER F COVERAGES CERTIFICATE NUMBER: CL1882911780 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDlYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A EPK118849 08/30/2018 08/30/2019 PERSONAL&ADVINJURY $ 1,000,000 GENII AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 5,000,000 X POLICY jE7 LOC PRODUCTS-COMP/OP AGG $ 5,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED 5901892 03/21/2018 03/21/2019 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) _ _ PIP-Basic $ 8,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER C D ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A AWC40070329032018A 07/29/2018 07/29/2019 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDE (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Cointractors Pollution&Asbestos Liability A EPK118849 08/30/2018 08/30/2019 Each Occurrence 5,000,000 Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE r� I 4// ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD A 9 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08/05/2019 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Greg Bates,CPCU NAME: Farquhar&Black Insurance Agency PHONE (781)599-2200 FAX (781)581-3940 (NC,No,Ext): (A/C,No): 85 Exchange Street-Suite 101 E-MAIL greg@FandBlnsurance.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Lynn MA 01901-1475 INSURER A; Crum&Forster INSURED INSURER B: A.I.M.Mutual Ins. Federal Environmental Group Inc INSURER C: Safety Insurance Company 646 Humphrey Street INSURER D: INSURER E: Swampscott MA 01907 INSURER F: COVERAGES CERTIFICATE NUMBER: CL18122712223 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD, POLICY NUMBER (MM/DD/YYYY) (MM/DWYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 5,000 A , EPK123928 08/30/2018 08/30/2019 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY JE LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Pollution Liability $ 5,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ C OWNED X SCHEDULED 5901892 03/21/2019 03/21/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? '"---- - (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Proof of Liability Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 41 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACcPec.® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/05/2019 —JrHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Chris Kennedy FARQUHAR& BLACK INSURANCE AGENCY INC (A NoPHONEEat): (781)599-2200 I_saC,No): E-MAILDESS: Chris@fandbinsurance.com 85 EXCHANGE STREET-STE 101 INSURER(S)AFFORDING COVERAGE NAIC LYNN MA 01901 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: FEDERAL ENVIRONMENTAL GROUP INC INSURER C: INSURER D: 646 HUMPHREY ST UNIT D INSURER E: SWAMPSCOTT MA 01907 INSURER F: COVERAGES CERTIFICATE NUMBER: 433055 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR _ - - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE I ,OCCUR DAMAGES(RENTED PREMISES(Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _. POLICY r ..l JECT r LOC PRODUCTS _.-- PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ �Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE _ $ DED r RETENTION$ X $ WORKERS COMPENSATION I STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N '--- — ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A AWC40070329032019A 07/29/2019 07/29/2020 — --- - -- ----- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Federal Environmental ACCORDANCE WITH THE POLICY PROVISIONS. 646 Humphrey St AUTHORIZED REPRESENTATIVE Swampscott MA 01907 Daniel M.Crc y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD • :., f • • • • • i• Scanned by CamScanner t� t. s T Asbestos Identification Laboratory Batch: 44837 `' O 165 New Boston St., Ste 227 4 art_:; ` f Woburn, MA 01801 r 781 932 9600 o [ Iiii .,15) tiWeb:www.asbestosidentificationlab.com Email:mikemanning@asbestosidentificationlab.com 0 Lab Code: 200919-0 .t/Cg1‘ July 25, 2019 James Morando Project Name: 149 Main Street, Yarmouth, MA Federal Environmental Group Inc. Project Number: 646 Humphrey Street Unit D Date Sampled: 2019-07-25 Swampscott, MA 01907 Work Received: 2019-07-25 Work Analyzed: 2019-07-25 Analysis Method: BULK PLM ANALYSIS EPA/600/R-93/116 Dear James Morando, Asbestos Identification Laboratory has completed the analysis of the samples from your office for the above referenced project. The information and analysis contained in this report have been generated using the EPA /600/R-93/116 Method for the Determination of Asbestos in Bulk Building Materials. Materials or products that contain more than 1% of any kind or combination of asbestos are considered an asbestos containing building material as determined by the EPA. This Polarized Light Microscope (PLM)technique may be performed either by visual estimation or point counting. Point counting provides a determination of the area percentage of asbestos in a sample. If the asbestos is estimated to be less than 10% by visual estimation of friable material, the determination may be repeated using the point counting technique. The results of the point counting supersede visual PLM results. Results in this report only relate to the items tested. This report may not be used by the customer to claim product endorsement by NVLAP or any other U.S. Government Agency. Laboratory results represent the analysis of samples as submitted by the customer. Information regarding sample location, description, area, volume, etc., was provided by the customer.Asbestos Identification Laboratory is not responsible for sample collection activities or analytical method limitations. Unless notified in writing to return samples, Asbestos Identification Laboratory discards customer samples after 30 days. Samples containing subsamples or layers will be analyzed separately when applicable. Reports are kept at Asbestos Identification Laboratory for three years. This report shall not be reproduced, except in full, without the written consent of Asbestos Identification Laboratory. • NVLAP Lab Code:200919-0 • Massachusetts Certification License:AA000208 • State of Connecticut,Department of Public Health Approved Environmental Laboratory Registration Number:PH-0142 • State of Maine,Department of Environmental Protection Asbestos Analytical Laboratory License Number:LB-0078(Bulk)LA-0087(Air) • State of Rhode Island and Providence Plantations. Department of Health Certification:AAL-121 • State of Vermont, Department of Health Environmental Health License AL934461 Thank you James Morando for your business. Michael Manning Owner/Director July 25,2019 James Morando Project Name: 149 Main Street,Yarmouth, MA Federal Environmental Group Inc. Project Number: 646 Humphrey Street Unit D Date Sampled: 2019-07-25 Swampscott, MA 01907 Work Received: 2019-07-25 Work Analyzed: 2019-07-25 Analysis Method: BULK PLM ANALYSIS EPA/600/R-93/116 FieldID Material Location Color Non-Asbestos% Asbestos% LabiD 1 Wall 1st Floor Laundry Room multi Cellulose 10 None Detected Non-Fibrous 90 498677 2 Ceiling 1st Floor Laundry Room multi Cellulose 10 None Detected Non-Fibrous 90 498678 3 Barrier Paper Roof, Roofing Material black Non-Fibrous 70 Detected Chrysotile 30 498679 4 "Green" Insulation Roof, Roofing Material green Cellulose 100 None Detected 498680 5 "Black" Rubber Roof, Roofing Material black Non-Fibrous 100 None Detected 498681 6 Black Apshalt Shingles Roof, Roofing Material black Fiberglass 20 None Detected Non-Fibrous 80 498682 7 Black Asphalt Roof, Roofing Material black Non-Fibrous 70 Detected Chrysotile 30 498683 8 Wall Rm#110 multi Cellulose 10 None Detected Non-Fibrous 90 498684 9 Ceiling Room 110 multi Cellulose 10 Detected Non-Fibrous 90 Chrysotile < 1 498685 10 Flooring Room 110 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498686 11 Wall Room 172 gray Cellulose 2 None Detected Non-Fibrous 98 498687 12 Ceiling Room 172 multi Cellulose 10 None Detected Non-Fibrous 90 498688 13 Flooring Room 172 Bathroom multi Non-Fibrous 80 Detected Chrysotile 20 498689 14 Wall Room 173 multi Cellulose 10 None Detected Non-Fibrous 90 498690 Thursday 25 July Page 1 of 4 FieldID Material Location Color Non-Asbestos% Asbestos% ' LablD 15 Ceiling Room 173 multi Cellulose 10 None Detected Non-Fibrous 90 498691 16 Flooring Room 173 Bathroom multi Non-Fibrous 80 Detected Chrysotile 20 498692 17 Wall Room 174 gray Cellulose 2 None Detected Non-Fibrous 98 498693 18 Ceiling Room 174 multi Cellulose 10 Detected Non-Fibrous 90 Chrysotile < 1 498694 19 Flooring Room 174 Bathroom multi Non-Fibrous 80 Detected Chrysotile 20 498695 20 Wall Room 175 multi Cellulose 10 None Detected Non-Fibrous 90 498696 21 Ceiling Room 175 multi Cellulose 10 Detected Non-Fibrous 90 Chrysotile < 1 498697 22 Flooring Room 175 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498698 23 Wall Room 176 gray Cellulose 2 None Detected Non-Fibrous 98 498699 24 Ceiling Room 176 multi Cellulose 10 Detected Non-Fibrous 90 Chrysotile < 1 498700 25 Flooring Room 176 Bathroom multi Non-Fibrous 80 Detected Chrysotile 20 498701 26 Wall Room 178 multi Cellulose 10 None Detected Non-Fibrous 90 498702 27 Ceiling Room 178 multi Cellulose 10 Detected Non-Fibrous 90 Chrysotile < 1 498703 28 Wall Room 179 multi Cellulose 10 None Detected Non-Fibrous 90 498704 29 Ceiling Room 179 multi Cellulose 10 Detected Non-Fibrous 90 Chrysotile < 1 498705 30 Flooring Room 179 Bathroom multi Non-Fibrous 80 Detected Chrysotile 20 498706 31 Wall Room 211 multi Cellulose 15 None Detected Non-Fibrous 85 498707 32 Ceiling Room 211 gray Cellulose 20 None Detected Non-Fibrous 80 498708 Thursday 25 July Page 2 of 4 eIdID Material Location Color Non-Asbestos% Asbestos% 'LabID 33 Flooring Room 211 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498709 34 Wall ROOM 212 multi Cellulose 20 None Detected Non-Fibrous 80 498710 35 Ceiling Room 212 multi Cellulose 15 None Detected Non-Fibrous 85 498711 36 Wall Room 214 multi Cellulose 15 None Detected Non-Fibrous 85 998712 37 Ceiling Room 214 multi Cellulose 20 None Detected Non-Fibrous 80 498713 38 Wall Room 215 multi Cellulose 25 None Detected Non-Fibrous 75 498714 39 Ceiling Room 215 multi Cellulose 20 None Detected Non-Fibrous 80 498715 40 First Layer Flooring Room 215 Bathroom multi Cellulose 40 None Detected Non-Fibrous 60 998716 41 Second Layer Flooring Room 215 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498717 42 Glue Under Tile Flooring Room 215 gray Non-Fibrous 100 None Detected 998718 43 Wall Room 216 multi Non-Fibrous 100 None Detected 498719 44 Ceiling Room 216 multi Cellulose 25 None Detected Non-Fibrous 75 498720 45 Flooring Room 216 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498721 46 Wall Room 217 multi Cellulose 20 None Detected Non-Fibrous 80 498722 47 Ceiling Room 217 multi Cellulose 15 None Detected Non-Fibrous 85 998723 48 Wall Room 218 multi Cellulose 15 None Detected Non-Fibrous 85 498729 49 Ceiling Room 218 multi Cellulose 20 None Detected Non-Fibrous 80 498725 50 First Layer Flooring Room 218 Bathroom multi Cellulose 40 None Detected Non-Fibrous 60 498726 Thursday 25 July Page 3 of 4 FieldID Material Location Color Non-Asbestos% Asbestos % LablD 51 2nd Layer Flooring Room 218 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498727 52 Wall Room 219 multi Cellulose 25 None Detected Non-Fibrous 75 998728 53 Ceiling Room 219 multi Cellulose 20 None Detected Non-Fibrous 80 498729 54 Flooring Room 219 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498730 55 Wall Room 220 multi Cellulose 20 None Detected Non-Fibrous 80 498731 56 Ceiling Room 220 multi Cellulose 20None Detected Non-Fibrous 80 498732 57 Flooring Room 220 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498733 58 Wall Room 221 multi Cellulose 25 None Detected Non-Fibrous 75 498734 59 Ceiling Room 221 multi Cellulose 25 None Detected Non-Fibrous 75 498735 60 Flooring Room 221 Bathroom multi Non-Fibrous 70 Detected Chrysotile 30 498736 Thursday 25 July End of Report Page 4 of 4 04_ X/t1Analyzed by: Batch: 44837 CHAIN OF CUSTODY Page / of E3 Client: €L frlu?Ai / 'PcC. CVR" itn(,t EPA/6001R-93/116 -. around 'me Sample Method Address:4gtf kiwi) $ r Asbestos Identification Lab Less3 Firs . ��a ,� hulk Project Site &#Si,JAP. IMA OIRO'7 165 New Boston St. .E ��Same Day ��>` l asoil S o Phone/email address: J4^W,' ‘,` ev"cltlrTo" 1 Suite 227 < sL °s Next Day Wipe Woburn, MA 01801 PgPAd Wk-.4\`4-ell" ,ti .e.,. Two Day Point Count (781)932-9600 ri�r�A�tris ContactM2'S VC) 7�'l5 www.asbestosidentificationtab.com Stop on 1st Positive? Yes/No Relinquish /date: //f Date Sampled: Notify Method: Mail' -MaiIN rbal/> Received �'1q Anayzed By: ��. -"ze BATCH# � � Rev O6/16 a #of Samples Rec d: Date: !rj/i.��! Temp in Celsius= "i.y, Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) a c 4t O Field ID/ o .rya a) (Client o .'' 0 co V E o u) Reference) Material/Location 2 c o co o o w as o cn m 0 0 at ffi m d N HA, Q :.r 4- .c L T6 N Q Q 3 W t U Q L ) 0I V �- - tL 5 `o E +� Asbestos . a .E c m 0 m at ? _ c o U 2Q h ti Minerals , < 0 w a m tL II ..L LL .y 11 2 cn o z Material .\A Chrysotile + I \ r. Amosite {- U r /N 76,, Crocidolite cJQ Location i :;; o . E Tremolite C1 Anthophyllite t�t �j 'z_ L h,- v"� Actinolite [ • Material \` Chrysotile 4 ti d ��C AiAmosite Crocidolite Location , CACC 1 st Tremolite Anthophyllite (0 e Lv�O � Actinclite L MaterialChrysotile 1.�t f,L rCrc L NC ,(Ssr I.stO r � Amosite 400" ,/J�,,,.� tJ n j,L �1/ Crocidolite Location l/ t Tremolite Anthophyllite 70 y 1 . 3 i itakeQ ( Actinolite q q mall" VARMCAPAAA a MIN Page of 1 3 Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) 0 O Field ID/ y o ea cn j2 e (Client v N '` a N °o Reference) Material /Location la O $'4.1 o w o tn a, 0 2 at a p d d y = O •.7 = as 0 r .. ir 0 0 E X 1 Asbestos N o & ) 8 a c = v 1:' ti it ur m a 1_.Minerals < g II ii E U z cn o z° iLMaterial 'a y y�tven0 Chrysotile Gl Amosite ! 4 " `i y Crocidolite Location J lT Tremolite Anthophyllite 'O(7 54.):/ Y�IA�n `t�C Actinolite Materi I Chrysotile ..11--5- ti� t0,y a R0.6,gC.:.Q. tt Amosite G, Crocidolite Location Tremolite Anthophyllite fit ti 0.14.425(4.0.{.... Actinolite 4 .t. MateriaLIChrysotile �VN LES Amosite (1, 1J F- Crocidolite d— • Location Rd�P i' f6. of Tremolite Anthophyllite IC' j�� 64 ` Actinolite - (� Materia • Chrysotile 30 i� t 1 f 4001. wC !Ssi 153� t. 7 Mock . -Ir. „ Amosite } "13'iI AlCrocidolite Location Yr `fir C1 Tremolite Anthophyllite 70 Ns Actinolite Material ! l` Chrysotile _ C\ Amosite �` gI ei&L ,v f Crocidolite Location RM 1 6...4 ( Tremolite ( Anthophyllite to to Actinolite I Page of 1 .. Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage (%) a c 0 4* O Field ID/ v, o R h (Client h �, c 0 E o v, m Material /Location m °� c 0 ac, `� �' 0 0 Jjr1 Reference) .0 c o p W O N 0 15 co a o i m co .c 0 o .- fl a, oiii 0 o E x Asbestos H o ' a, - 0 c o - c c 0 0 H II: Minerals < 2 iu in in o. �I -L LL 'a o = to 0 0 Material �( -� Chrysotife -LU (.t) it ff-4.40}� NC_ /SAS'/' v 6 . /ict riAmosite 7. ck ��` / Crocidolite Location Q iM. !7 k `� Tremolite Anthophyllite jt C7X /1.Q1.J��Y� Actinolite [3 4 jpMaterial VitAL, Chrysotife 41D �i Amosite Location `'� 115 a,� Al "" Tremolite e Anthophyllite (b Qe Actinolite LL Material �A Chrysotile 1� ( , et t- an NC i 7 (Thz �) y yv"P-3 5 (AL Ai kir, Amosite P.,Crocidolite Location `15 fr Y Tremolite Anthophyllite (U C 21 — Actinolite L'� T /.. Material r^I„o Chrysotife 10 IL r a°•105L Svc t.w.5s0 / Amosite i` Yt / µc Ai Crocidolite n Locatio `^ t75 ` '';`" /J Tremolite Anthophyllite 7 6 Actinolite Material Chrysotile Z'')-- ,2. 3 / r' Amosite 1 C` �� Crocidolite Location 1Ca \1 M G —,� y Tremolite Anthophyllite -7/ YU Actinolite .f • t.; Page / of t 3 Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage (%) c _; 0 ca O Field ID/ w °(0' Client ° w ° >, c 0 E (7 H `3 Reference) Material I Location c in o o w a, o N m o 0 co v, +� .8 Q rn a, Cl) o rn m o m . iL o a E x Asbestos .D a ;, c a o a, c �- c 0 = v z t°' Li Minerals Cl) 5 w in co a (� I. ii LI ._ v I cn O Z Material e �fi Chrysotile i t,.., 1, r ;Oat_,vc f /, � //��-- Amosite Al I Crocidolite Location 1u-CjNA. (7 `6 Tremolite Anthophyllite i 0 ?U Actinolite �_ I A. i,4.30 Material Ficop,,i Chrysotile 71 Cf.: '( f anst., AJ i'S'co n Amosite ig A A y Crocidolite LOCation ('1 1 y Tremolite Ye AnthophylliteR Art-Pi , Actinolite t ,, 31 Material yWT,,,k\t Chrysotile ii / Amosite n ft .�.',. 4+� Crocidolite f�— Location ram` ` a.t\ 0/1 (..„/ Tremolite _ i V_ Anthophyllite i, :: Actinolite .1 \ &f59_, Material 03-Ak Chrysotile + JAmosite Crocidolite / Location Q,oczir% 5-� in Yi:/*\;/ Tremolite Anthophyllite1.7 Actinolite Uv Material fi � Chrysotile 7, ! —II— L Ai ,C54 JCS° �� C (( Amosite �r A � f { Crocidolite Location(fit N\ 31\ 3d I r t: fv N Tremolite Anthophyllite _ 7o 6.044-5232:1O \ Actinolite • Q. Page 8 of Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) c 0 o Field ID/ En o v tt °�' (Client w Y \ >, c 0 E o v, t0 2 Referenc13 e Material /Location p o o y Cl) o 0 Q O = Qt L V 0 �. D) O d o- 0 E x Asbestos Q- .E c a d c ? L v =o cu,_ ii Minerals Q 2 w in m a I) —(— * o i cn O z K) 5c7i, Material rlWvi Chrysotile _ R/ Amosite .�a jj uij! Crocidolite Location Q.Cx U`-N I1 © (L.- /,v Tremolite y J Anthophyllite Actinolite �� Material ``�� Chrysotile Amosite �� n I �/ Crocidolite s/1n Location �"' ` 1\1 O vj L Tremolite 'J` Anthophyllite IS ¢C� Actinolite J`"� (�] yy Material ��+\` k Al Chrysotile _ n 4, / Amosite fL • f jl" Crocidolite Location R tA, �i� O E � �fil • Tremolite V I ( Anthophyllite j S (Fs 4 Actinolite l J •Y �j 5,7 Material ``Z„�, Chrysotile � Amosite ^ tt 6, Crocidolite Location dam` t, © NIL- fTremoliter� Anthophyllite ?U 7 ` Actinolite G C/ j f Material w � Chrysotile �if{�38 Amosite /�� Crocidolite /'— Location PC P.A. ).t.5 V AIL y (C� Tremolite Anthophyllite (( Actinolite • ,, r Page s of 13 Temp in Celcius= _ Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) a o o O Field ID/ a G a _ la n' (Client 0 ai to aa)i C 0 o ,n g ca Material /Location o c 0 o a m cn v o Q Reference) n a) o w a� oCCI �, `a Q o d m V) o y 4 c o 5 c CJ 0 v = il. 0 0 - X Asbestos .Q Q- w c o a�.0 c M c m c v zo � ti Minerals < 2 iv 'm ii II ..L ir 0 = cn 0 zo Material t Chrysotile �� J Amosite // A �, Crocidolite !J Location .L j.r"� d.,5 il L !� / Tremolite Anthophyllite G �Cam0tJ Actinolite Material Chrysotile .-* QS‘r 1-6*-- - Amosite 4/j/.1 n / (IJ Crocidolite Location ¢c`r`'� A 0 a, o j Tremolite V r�1 r Anthophyllite y° •1 •7li'rV\t2+r rili ' 1 Actinolite / lR' I/ Material Chrysotile ?'D i.� .(D - _7, 4iS% co l Sars•Ak) I.44i(Z Q „k{ Amosite [ J` OP' k Crocidolite Location x 1 at 7j "r i' r Tremolite Anthophyllite 7 eer..60 .r.x%, Actinolite Material Chrysotile + 4-L4 - t� osite Ja 41W) Crocidolite .pp �1 � Location 9.004-1. ` .6 V G GY Wj Tremolite Anthophyllite /00 Actinolite Material t \ " Chrysotile 0-- W /� Amosite Crocidolite Location F� � ��� V C//. Fj� Tremolite t/ Anthophyllite /u 0 Actinolite i .s Page 10 of tJ Temp in Celcius = Stereo Scope Optical Properties RI Non-Asbestos Percentage (%) o o O Field ID/ o w o o 4 0 (Client N >, c o E o v, Reference) Material /Location a) o o w rn o w a, o 0 -� Q ..111 o = °' a s n o t CS Tv o a U- 0 o E X 4 Asbestos .a °. E c m o `m m ii v 0 ►°i ,� Minerals ¢ �° w m II L 142 1. v s (n o zo Material ceksiki Chrysotile `tia Amosite ).Yr.; Crocidolite Location icI'"-A ). t G N/ 'V Tremotite Anthophyllite 25 75 Actinolite . Material Chrysotile 0 c,; r , •f-• L Aiissa 1Ss:� S s Amosite r� 1 fj(`' Crocidolite Location met 30 L. i i Tremolite Anthophyllite 7 Actinolite I `� N q6Material iW`A\\ Chrysotile Amosite • ( CLA)C� Crocidolite Location g�C3ttv`, 11-7 © L l'- • Tremolite rAnthophyllite 7 6 "Actinolite (J `- Material Lt,`\ Chrysotile / j 7P�} Amosite p ( ` q/( �.f/' Crocidolite t' Location t j al 1 0 I'/(.� f Tremolite Anthophyllite _ _ c Actinolite �J 5 Material vigs` Chrysotile t'.-1 -A LIB Amosite // n'__ GV Crocidolite Location ��E �` err ,r, Tremolite Anthophyllite Actinolite F r L 'IA �� /'� Lab ID# (/ (Lab Use Only) \3--\ Da �' -� ,-0 0 CO r : • r r �� r r K __ -' d m m m bil v 1m 2 m 3 o' EC o• n� r ° q', P�r i r ;- pcc _ ro %� / t r , / v II .... P (-3 9--' 93 p-,.• P. i 0 CPU . . Q5 c> u C'•, % of Asbestos Color m "ro - Homogeneity o -`.�� , -�� T\'� �\� ``\\ Texture -o --K., - — Friable D D -1 o > 0 D D -1 n > 0 D D -1 0 > o D D --1 o D 0 A > -1 0 > 0 g D a m a a 3 QI a 3 = 9. a o 3 z- I 2. m a 3I I o 3 O Q y_. p 5- g300 .3o a e 0 O" O O_ e. , , O. ifi N. 0 43 d yI atNN N . 2 N d 3 ` 0 N I I 0 co w K cofD D' N. N _ co fD. fD _ N W '< W �' `G co N O _ o N a N N rc to Cl) Asbestos % Morphology 0 `p Extinction ii m ls' Sign of Elongation o 0 ro cc.' Birefringence h ID m Pleochroism pa 6 1- Fiberglass o a Mineral Wool N _ oa CJ � ^C V Cellulose o 12-- ul Hair -a ro o Synthetic CD Other 1 cam G 16\ Non-Fibrous 1 • Page 1 3-% of 13 Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) C 0 8 O Field ID/ H o a °�' (Client°, ' a = � E o 0 Reference) Material/Location .o a0ci r Ch o o w o 4 h 1-1 J Q o ` - q .CC U O C t cs) ,- O iii 0 o E x (i Asbestos 0 o w m o co c .. _ c v 0 f- Lt." Minerals a g w N CO" a II -I- ii 'z v i U) o z0 Material j^�� „�.s".3 Chrysotile •'j w p -f L N jtai5 / Q45q ii''�� Amosite//�f c� t 0 Crocidolite Locationit0Vyn dot'_` /�L ykl Tremolite 70 Anthophyllite C?PsV 11'''1 Actinolite Material t 1pi`` Chrysotile .........*5 W Amosite N/ Crocidolite _ Location (4;01/ 99'�✓ f 1411,10 Trelite � mo Anthophyllite ^� Actinolite G� Material V mot �t . Chrysotile _ jk Amosite c‘; Crocidolite Location es:WA 0 2 0 :t 1G, 0.4 `/(......1Tremolite Anthophyllite _ ZD SD Actinolite / Materials- ,,,�C Chrysotile 7io c.j , r - --t N SS6 ICSf M S c"duF f aLY Amosite CEN nq l,-L li Crocidolite LocationQ7('�� 1'1, ,'L).(7 3 t" �`( / Tremolite 1 Anthophyllite 7° d6i4+i2Al'. Actinolite -_ Material •! `�Lt� • Chrysotile rn45,..) W r J Amosite rZ i 1/ Crocidolite _ Location (�4?01'� AA O�4 Tremolite Anthophyllite 'J S `'�,5 Actinolite l� Page i 3 of 1 3 Temp in Celcius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) o o O Field ID/ a a o (Client w :' \ T c Reference) Material /Location _o iii r o o t° E H m 0 0 Q o, a co o w cs ,c � —°tr, m o w : 0 o E X Asbestos s ° • c a, g 17, n `w O O w • . N O K 0) �- C c t e. .� x I— w Minerals et M w in in a II -�-- i° (15 = in O z P4cq Material Ge�� Chrysotile AmositeA( ��� Crocidolite it- Location 1a,\ 0 di� yv / Tremolite V ` Anthophyllite 7 S �4 ttt Actinolite L /✓ ...o4. //// � iA Material Roc) cA. Chrysotile "ic) t. i n "z,_ l s57 +SS t 1q Amosite t!�� I i�' Crocidolite r3- LOcation�cAet 1W 30 fnt1b'f� Tremolite •� lJ Anthophyllite 7G 4,4o0 Actinolite Material Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite Actinolite Material Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite • _ Actinolite Material Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite Actinolite J