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Home My WebLink About0255 MAIN STREET (HYANNIS) - Health 255 MAIN STREET Hyannis A= 327 - 247 ..................... --- Massachusetts Department of Environmental Protection BWP AQ 04 (ANF-001.) ` 100303739 �. 3Z��Zl'1'�'Asbestos Notification Forth Asbesto:iProject# I Project Revision F . Project Cancellation A. Asbestos Abatement Description 1.Facility Location: CAPEBUILT 255 MAIN ST LLC 255 MAIN ST �''� Instructions 1.All a.Name of Facility b.Street Address _r' sections of this form BARNSTABLE MA 02601 SOB4184155 must be completed In order to comply with c.City/Town d.State e.Zlp Code f.Telephone MassDEP notification GARY BARBER OWNER REPRESENTATIVE requirements of 310 CMR 7.16 and g•Facility Contact Person Nome h.Facility Contact Person Title Department of Labor Worksite Location: Standards(DLS) THROUGHOUT THE HOUSE notification I.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied? R a.Yee r b,No CMR 6.12 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)? 17 a.Yes r b.No MaesDEP Use only 4.Blanket Permit Project Approval,if applicable: Data Received Approval ID# 5.Non-Traditional Asbestos Abatement Work practice Approval, if applicable: Approval ID# 6.Asbestos Contractor: AIR SAFE INC 22 WILLOW STREET a.Name b.Address CHELSEA MA 02150 9783395361 c.City/Town d.State e.Zip Code f.Telephone AC000464 h.Contract Type: 17 1.Written I—2.Verbal g.DLS License# 7 JAIME E AMAYA AS060847 a.Name of Contractor's On-Site Supervisor/Foremen b.DLS Certification# 8 KEVIN CLIFFORD AM000092 a.Name of Project Monitor b.DLS Certification# 9 FIJ ENVIRONMENTAL INC AA000144 a.Name of Asbestos Analytical Lab b.DLS Certification# l 0. 3/13/2019 4/12/2019 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7AM-5PM 7 AM-5 PM c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday 1 1.What type of project is this? r' a.Demolition F b. Renovation r' c. Repair r— d. Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 L0/Z0 39dd GIAVG Zhb56££8L6 0Z:6T 6TOZ/8T/£0 Massachusetts Department of Environmental Protection 100303739 BWP AQ 04 (ANF-001) Asbestos Protect # Asbestos Notification Form r" Project Revision Project Cancellation A. Asbestos Abatement Description: (cent.) 12.Abatement procedures(check all that apply): . W: a.Glove Bag r b.Encapsulation r" c. Enclosure r d.Disposal Only r e.Cleanup Pr f.Full Containment f g. Other-Please Specify: 13.Job is being conducted: 17 a. Indoors 17 b.Outdoors 14 a,Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 12530 1.Linear Feet(Lin.Ft,) 2.Square Feet(Sq.Ft.) b.Boiler,Breaching,Duct, c.Transite Pipe Tank Surface Coatings 1.Lin.Ft. 2.Sq.FL 1.Lin,Ft. 2.Sq.Ft, d.Pipe Insulation e.Transite Shingles 50 1.Lin.Ft. 2.Sq.Ft. 1.Lin.Ft 2.Sq.Ft. f. Spray-On Fireproofing g,Transite Panels 1.Lin.Ft. 2.Sq.Ft 1.Lin.FL 2.Sq.FL h. Cloths,Woven Fabrics L Other-Please Specify: 1.Lin.Ft. 2.Sq.FL j.Insulating Cement VAT MASTIC GLAZ SKIMCOAT 12480 1.Lin.Ft 2,Sq.FL 1.Lin.Ft. 2.Sq.FL 15. Describe the decontamination system(s)to be used: THREE CHAMBER DECON 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2) (g): 8 MIL POLY 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: a,Name of MassDEP Official b,Title of MassDEP Official c.Date of Authorization(MM/DD/YYYY) d.Waiver 0 e,Name of DLS Official f.Title of DLS Official g,Dale of Authorization(MM/DD/YYYY) h.Waiver# 18. Do prevailing wage rates as per M.G.L. c. 149, § 26,27 or 27A—F apply to this r a.Yes 17 b. No project? Revised- 11/13/2011 Noe,7.of4 L0/£0 39dd QIl1dQ ZPPSGE68LG 0Z:61 6TOZ/8T/£0 Massachusetts Department of Environmental Protection 100303739 BWP AQ 04 (ANF-001) Asbestos Project# Asbestos Notification Form r Project Revision r Project Cancellation B. Facility Description 1. Current or prior use of facility; RESIDENTIAL 2. Is the facility owner-occupied residential with 4 units or less? 17 a.Yea r.. b. No 3 CAPEBUILT 255 MAIN ST LLC 255 MAIN ST a.Facility Owner Name b.Address HYANNIS MA 02601 5084184155 c.City/town d.Stale e.Zip Code f.Telephone 4 GARY BARBER 255 MAIN ST a.Name of Facility Owner's On-Site Manager b.Address WANNIS MA 02601 5083855941 6.City/Town d.State e.Zip Code f.Telephone 5,N/A N/A a.Name of General Contractor b.Address NIA MA 02601 1111111111 C.Cltyrrown d.State a.Zip Code f.Telephone N/A 9.Contractor's Worker's Compensation Insurer N/A 12131/2019 h,Policy# i.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 6,Sq 3 a.Square Feet b.#01 Floors Note: of rary storage C. Asbestos Transportation & Disposal of As conta inittp waste material Is only 1 Transporter of asbestos-containing waste material from site of generation: mate allowed at the place r a.Directly to Landfill or V b.To Temporary Storage Location/Transfer Station of business of a DLS licensed Asbestos contractor or a transfer AIR SAFE INC 22 WILLOW ST station that Is c.Name of Transporter d.Address permitted by MassDEP and CHELSEA MA 02150 9783395361 operated In compliance with Solid e.Cityrfown f.State g.Zip Code h,Telephone Waste Regulatlons 310 CMR 19,000 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: SERVICE TRANS GROUP 301 OXFORD VALLEY RD SUITE 8038 a.Name of Transporter b.Addrese YARDLEY PA 19067 8779999559 c.Clty/Town d.State e.Zip Code f,Telephone Revised; 11/13/2013 Page 3 of 4 L0/V0 39dd QIAVG ZVV56668L6 0Z:6T 6TOZ/81/60 Massachusetts Department of Environmental Protection �100303739 +� BWP AQ 04 (ANF-001) Asbestos Project# r Asbestos Notification Form r' Project Revision r Project Cancellation C.Asbestos Transportation&Disposal: (cunt.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: AIR SAFE INC 22 WILLOW ST a.Temporary Storage Location Name b.Address CHELSEA MA 02150 9783395301 c.City/Town d.State e.Zip Code L Telephone 4.Name and location of final disposal site(asbestos landfill): MINERVA LANDFILL MNERVA ENTERPRISES,INC a.Final Disposal Site Name b.Final Disposal Site Owner Name 8995 MINERVA DRIVE c.Address WAYNESBURG CH 44668 9783395361 d.CNy/Town e.State f.Zip Code g.Telephone Not*:Contractor must sign this form for DLS notification purposes D. Certification - DFW DFW "I`certlfy that I have personally 1.Name 2.Authorized Signature examined the foregoing and am PRESIDENT 2/28f2019 familiar with the information 3.Positlon/Tltle 4.Date(MM/DDIYYYY) contained In this document and all attachments and that, based 9783395381 AIR SAFE INC on my Inquiry of those 5,Telephone 6.Representing individuals immediately 23 WYCHWOOD DRIVE LITTLETON responsible for obtaining the 7.Address 8,Clty/rown information,I believe that the MA 01460 Information Is true,accurate,and g State 10 Zip Code complete. I am aware that there are significant penalties for submitting false Information, 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 doomed valid unless payment of the applicable fee is made." I Revised: 11/13/2013 L0/50 39dd QIAVQ Zbb966E8L6 0Z:6T 6TOZ/8T/E0 Massachusetts Department of Environmental Protection 100303739R1 l BLlWP AQ 04 (ANF'-001) Asbestos Project# Project Revision Notification f1 project Revision r project Cancellation A. Asbestos Abatement Description 1.Facility Location: CAPEBUILT 255 MAIN ST LLC 256 MAIN ST Instructions 1.All a.Name of Facility b.Street Address sections of this form BARNSTABLE MA 02601 5084164155 must be completed In order to comply with c.Clty/rown d.State e.21p Code f.Telephone MassDEP notification GARY BARBER OWNER REPRESSENTAME requirements of 310 CMR 7.15 and g.Facility Contact Person Name h,Facility Contact Person Title Departmen of Labor Worksite Location: THROUGHDUTTHE HOUSE Standards 1DLS) notification 1.Building Name,Wing,Floor,Room,etc. requirements of 463 2.Blanket Permit Project Approval, if applicable: CMR 6.12 Approval ID# 3. Non-Traditional Asbestos Abatement Work Practice Approval, MessDEP Use Only if applicable: Approval ID# Date Recelved 3/18/2019 4/17/2019 a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 7AM-5PM 7 AM-5 PM c,Work Hours-Monday Through Friday d.Work Hours-Saturday 8 Sunday B. Other Project Revisions: Note:Temporary storage of Asbestos containing waste materiel Is only allowed at'he place of business of a DLS licensed Asbestos contractor or a transfer station that is permitted by MaseDEP and operated in compliance with Solid Waste Regulations 310 CMR 19.000 Note.Contractor must sign this form for DLS L0/90 39dd QU V(I Zhb56££8L6 0Z:6T 6TOZ/8T/£0 I Massachusetts Department of Environmental Protection 100303739R1 BWP AQ 04 ANF-001 - Asbestos Protect# Project Revision Notification W. Project Revision r Project Cancellation CEl I . Certification DFW DFW '1 certify that 1 have personally 1.Name 2.Authorized Signature examined the foregoing and am PRESIDENT 3/11/2019 familiar with the Information 3.Posltlon/Tltle a.Date(MM/DD/YYYY) contained In this document and all attachments and that,based 9783395361 AIR SAFE INC on my Inquiry of those 6.Telephone 6.Representing Individuals Immediately 23 WYCHWOOD DRIVE Lrr LEfON responsible for obtaining the 7.Address B.City/Town information,I believe that the MA 01460 information is true,accurate,and g.State 10.Zip Code complete. 1 am aware that there are significant penalties for submitting false information, 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." y TlnvirA�• 1 1/17/1(111 •• Dino � of 1 L0/L0 39Vd QIAVG Zhb56E68L6 0Z:6T 6TOZ/81/E0