24C-152 (2) 39 ARLINGTON ST BP-2016-1091
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map.Block:24C- 152 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit# BP-2016-1091
Project# JS-2016-001871
Est. Cost: $1000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 9583.20 Owner: RUSSELL PATRICIA LEE
toning URB(100) Applicant. BEYOND GREEN CONSTRUCTION
AT. 39 ARLINGTON ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTON MA01 027 ISSUED ON.-311812016 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL ATTIC INSULATION
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 3/18/2016 0:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1091
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTO�;01027(413)529-0544 O
PROPERTY LOCATION 39 ARLINGTON ST
MAP 24C PARCEL 152 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074539
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO TION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding I Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Dem lition
�Z�
Sign of Bui din fficial Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
Ofase sena
oPOM4 c K
LiJ cm
ul p
UJ ; > The Commonwealth of Massachusetts
..� Board of Building Regulations and Standards FOR
LUMassachusetts State Building Code,780 CMR MUNICIPALITY
k , i-
USE
z Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
LL
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION l:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
9 Arlington St Northampton MA 01060 _
LI a Is this an accepted street9 yes no Map Number Parcel Number
1.3 Zoning Information: 1,.4 Property Dimensions:
Zoning District Proposed Use y Lot Area(sq ft) Frontage(fl)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Patricia Russell Northampton, MA 01060
Name(Print) C,_State,ZIP'
39 Arlington Street _ _ 4_13-584-2074 _
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units I Other IX Specify:Weatherization
Brief Description of Proposed Work?:IMpgo VF AT INSI11 ATInN To R-38 AND AIR fiEAI ING
MEASURES
SECTION 4:ESTIMATED!CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I.Building $ 1. Building Permit Fee:$�_Indicate how fee is determined:
2.Electrical $ 19 Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:------
5.
ist:_ __-5.Mechanical (Fire $ ---------
Su ression) Total All wo `
Check Nok Amount: Cash Amount:
6.Total Project Cost: $ �l�o L ❑Paid in ❑Outstanding Balance Due:
r
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-074539 11/28/2016
SEAN R JEFFORDS License Number Expiration Date
Narfie of CSL Holder Y
List CSL Type(see below) U
13 TERRACE VIEW
No.and Street Type Description
EASTHAMPTON,MA 01027 u Unrestricted(Buildings up to 35,000 cu.ft.) a,moi
R Restricted 1&2 Family Dwelling
Cityfrown,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
413-529-0544 sean@beyondgreen,biz SF Solid Fuel Burning Appliances
I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 131279 6/29/2016 GOMM&
Sean R Jeffords-Beyond Green Construction -
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sean@beyondgreen.biz
No.and Street Email address
Easthampton, MA 01027 413-529-0544
Ci !Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes..........QKX No...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize BEYOND GREEN CONSTRUCTION
to act on my behalf,in all matters relative to work authorized by this building permit application.
SEE ATTACHED SIGNATURE AUTHORIZATION FORM 3/7/16
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information
contained in this application is true and accurate to the best of my knowledge and understanding.
SEAN R JEFFORDS 317/16
Print Owner's or Authorized Agent's Name(Electronic
�tT�� Date
V NOTES:
I. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the I-lorne Improvement Contractor(111C)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the 141C Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can he found at www.mass,gov/dlls
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system_ Enclosed Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
I
The Commonwealth of Massachusetts
Department of Industrial Accidents
Ogee of Investigations
1, 1 Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lep-ibly
Name(Business/Organization/Individual): BEYOND GREEN CONSTRUCTION /SEAN JEFFORDS
Address:13 TERRACE VIEW
City/State/Zip: EASTHAMPTON, MA, 01027 Phone#:413-529-0544
Are you an employer?Check the appropriate box: Type of project(required):
1.0 1 am a employer with 3 4. I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.E3 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have $. Demolition
working for me in any capacity. employees and have workers' 9. E]Building addition
[No workers' comp. insurance comp.insurance.
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
l
m sef. No workerscomp. right of exemption per MGL
y [ ' p 12.n Roof repairs
insurance required.] t c. 152,§1(4),and we have no WEATHERIZATION
employees. [No workers' 13.QQ Other_
comp.insurance required.]
*Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy information.
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 state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that A providing workers'compensation insurance for my employees. Below is the policy dnd job site
information.
Insurance Company Name:NorGUARD INSURANCE COMPANY
Policy#or Self-ins. Lic.#:SEWC585439 Expiration Date:APRIL 21, 3 0(C;'
Job Site Address: 39 Arlington Street City/State/Zip: Northampton, MA 01060
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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine
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 certify under the pains and penal. of 4lury that the information provided above is true and correct.
Si iynature: _ Date: 317/16
Phone#: 413-5290544
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#:
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construct-Mn Supvri isor
License:CS-074539
SEAN R JEFFOR10
13 TERRACE VUKW
EASTHAMPTOPFMA w
n — Expiration
Commissioner 11/28/2016
1 J
Office of Consumer Affairs and Business Regulation
F � 10 Park Plaza - Suite 5170
i,
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 6/29/2016 Tr# 254174
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON, MA 01027 -
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
SCA= 0 20M-05(t t
%fF1`�•Iunral�Itrt1�(�r l(i1;�nrYtaJP/1i
Office of Consumer Affairs&Busibess Regulation License or registration valid for individul use only
NOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistration: 131279 Type: Office of Consumer Affairs and Business Regulation
Expiration: 6/29/2016 Individual 10 Park Plaza-Suite 5170
Boston,MA 02116
SEANJEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 Undersecretary Not valid without signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggested Affidavit For Notes Improvement Contractor Permit Application
For Office Use Only
Permit No.:
Date:
Note 142 A, requires that the Areconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal or demolition or the constructional of an addition to any pre-existing owner occupied
budding containing at least one but no more than four dwelling unit,or to structures which are adjacent to such
residence or building@ be done by registered contractors,with certain exceptions,along with other requirements.
Type of Work: Weatherization Est. Cost:
Address of Work: 39 Arlington St Northampton, MA 01060
Owners Name: Patricia Russell
Date of Permit(Application: 3M16
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$500.00
Building not owner occupied
Owner pulling own permit
Other(specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL C. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date: 3n116 Contractor: BEYOND GREEN CONSTRUCTION Reg.# : 131279
OR: SEAN R JEFFORDS
Not withstanding the above notice, I hereby apply for a permit as the owner of the property.
Date: Owner: Tel. # :
AO�N
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSETTS DEBRIS DISPOSAL PROVISIONS OF
MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT NUMBER
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM THIS WORK SHALL BE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111,
S150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION SITE ADDRESS-
39 Arlington St Northampton, MA 01060
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE
DATE 3/7/16
R1SE s. 60 Shawmut Road,Unit 2 1 Canton,MA 02021 339.502-6335
ENGINEERING www.PJSEenginearing.com
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at:
(Property Address)
V'3
(Property Address)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.This form is only valid with a signed contract.
V
er's Signature
Date
-- City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building s p
Northampton, MA 01060 absdW' 3lJ11�a
Property Address: S 9 H O I n�c mn f" fJ0� Y-1Yl LLL N-11I H (1 O(O U
Contractor
Name: ` eu. O cA arem coristruc+lo>n
Address: 13 Terrac-e._ U) f,1j
City, State: EaA+hGl,YY11'J±Q fl , ry q d ( U?i
Phone: `'1 13- 5aq - 05 Y Y
Property Owner
Name:
Address: I �V 1
I �t
City, State: J ( rl ✓1 u
I, Sean J e f Gras (contractor) attest and affirm that the building I intend to
insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that I have
provided the property owner with a copy of this affidavit.
Contractor signature 19
Date 311 /�