44-065 975 FLORENCE RD BP-2017-0676
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mae:Block:44-065 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TOTHEGUARANTY FUND (MOL c.142A)
Category:INSULATION BUILDING V ILDING PERMIT
Permit# BP-2017-0676
Project# JS-2017-001104
Est.Cost:$3000.00
Fee:$8300 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Ilse Group BEYOND GREEN CONSTRUCTION 074539
Lot Size(su.fk): 11848.32 Owner CHASE MARK&THERESA
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT: 975 FLORENCE RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544(1 WC
EASTHAM PTONMA01027 ISSUED ON:II/16/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:IMPROVE ATTIC INSULATION TO CODE &AIR
SEALING MEASURES
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 11/16/2016 0:00:00 $83.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File tt BP-2017-0676
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTIHAMPTON (413)529-0544 Q
PROPERTY LOCATION 975 FLORENCE RD
MAP 44 PARCEL 065 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fe as.id if f 3
Building Permit Filled out
Fee Paid
TYneof Construction: IMPROVE ATTIC INSULATION TO CODE&MR SEALING MEASURES
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
INFORMATION PRESENTED:
Approved_ 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 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
joeDemolition D-
f� 7/`/,.._
Signa - of Building Official 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.
_ The Commonwealth of Massachusetts
a Board of Building Regulations and Standards FOR
l :
.;
p Massachusetts State Building Code,780 CMR . MUNI
CIP LII Y
g
Lt."'
Application To Construct, Repair,Renovate Or Demolish a Revised Mar?Ot t
El
.in Permit Number: One-as Section
For
lL7wallUse
ei g P
BuildingPermit
This Section For Official Use Only
__ Date Applied:
Building Official(Print Name) Signature Date
SECTION I:SITE INFORMATION
LI Property Address:: , 1.2 Assessors Map&Parcel Numbers
97c) +Orrice ?d - lpr lci1 im {)iDGA..
L Aa Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq It) Frontage(ft)
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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public C3 Private❑ Zone; ,,,,,,,,,,,,, Outside Floud Zone'? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
� • --flue/nu. ) MY o1ocQ . _
0I7Name tint)-lore .Ic\ Rol City.State,ZIP e
No.and Street 'telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK°(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) O Addition ❑
Demolition ... _.-
0 Accessory Bldg.0 Number of Units Other ;� Specify:_Mat
Brief Description of Proposed Work': Ct1Q((TI'P CS-�'�i C \y^x�\,t\Com-\„r;�{$ "-�? COCSe
t -: , tf__....Ctnt\ YNleS 3A,C ._ ._._ -. __....
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Estimated Costs:
Item (Labor and Materials) Official Use Only
I.Building $ I. Building Permit Fee:$ 3 Indicate how fee is determined:
2.Electrical $ ” ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ _ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire y
Suppression) $ Total All Fe sic i?Z 3 Qi
Check No.16 N/ Check Amount: D7 Cash Amount:
6.Total Project Cost: $ 300 0 i 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
•
5.1 Construction Supervisor License(CSL) C'S -
-11-t
L.1 53 //as' /j
cei
SEAN R JEFFORDS l J
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
13 TERRACE VIEW
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.)
EASTHAMPTON,MA 01027 R Restricted 1&2 Family Dwelling
Masonry
City/Town,State,ZIP M
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 _ SEANrdIBEYONDGREEN.BIZ Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 4 31079 co/ani/ / i
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sean@abevondgreen.biz No.and Street Email address
F th to MA 01027 _ 413-529-0544
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152. 4 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 X 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 1 �1 ,Fd, k j recti rQ Ac
to act on my behalf,in all matters relative to work authorized by this building permit application.
tee eChccA (//4-I)J �o
Print Owner's Name(Electronic Signature) Date
SECTION lb:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest der pains and penalties of perjury that all of the information
contained in this application is true and u the best of my knowledge and understanding. yy
Sean jeffords '.)) '1 ' 1 c
Print Owner's or Authorized Agent's Name(Elect nic Signature) Date
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 Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www mass eov/dos
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"
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hush a on ofthe vnor s°eampeasatim pa!ey idealoOtien Imp(s vnatbz the Imlay somber and erpfrnhee ).
Failure to swore coverage as required sailer Sectiao 25A of mat e.152 ran lead to the imposition of ramps'vemtfiies ala
Snaupto 51,500.00 sailor aaeyearlapisor asweil as cM p'ant'ies kitetra offa STOP TC OWeR.mad a fine
of to$250,00 a day againstfaet<ioiatr. a&advised that a copy of this gamiest raw beforwarded to are Office of
investigations of the DIA f,rinso coverage�sverification.
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License CS-074539 ,y
SEAN R 3EFFORI)S ({
-
13 TERRACE VIEW '4 t: fl
EASTHAMPTONMA S
.97%,d
commissioner 11/28/2016
, (1 4? C/'a7Y1,nwit,vea7(A o/CitJii eckeie(4
3
Office of Consumer Affairs and Business Regulation
,a 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration'. 629/2018 Tru 288957
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 Cv 20M 0511
_ //s mer //sR ss Re motion /i License or registration valid for individual use only
rz
S> OR fC AN &6 ss Reg 1 duo g
HOME IMPROVEMENT CONTRACTOR before theexpiration date. Iffound return to:
3`- _ Registration: 131279 Type: Office of Consumer Affairs and Business Regulation
,y a Expiration: 629/2018 Individual 10 Park Plaza-Suite 5170
Boston,MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW _ ,_
EASTHAMPTON.MA 01027 _-- -- -it ---
Undersecretary Not taldwithout signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggested Affidavit Fos Home Improvement Contractor Permit Application
For Office Use Only
Permit No.:
Date:
Note 142 A. requires that the Areconstmetion, alteration, renovation, repair, modernization, conversion,
improvement, removal or demolition or the constructional of an addition to any pre-existing owner occupied
building 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 [��� 1'l Est. Cost:
Address of Workq 7S 2°!4i Die n ce — OrE Q C C.a_�ti� (' ( Q(Q
:1- �-
Owners Name: Tin feSQ CO CL2
Date of Permit/Application: I (/1]) (So
I hereby certify that:
Registration is not required for the following reason (s):
Work excluded by law
lob 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 UN a L C. I42A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date: Contractor: BEYOND GREEN CONSTRUCTION Reg.* : 131279
OR: SEAN P JEFFORDS
Not withstanding the above notice, I hereby apply for a permit as the owner of the property.
Date: Owner: Tel. # :
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-
Q 3 5 1 Iore.rl(e._ kcj cif) ence I N 6_1)(0(d7D
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE_,,,,,,
DATE 11 /- (/( c/
Mr City of Northampton
Massachusetts (
1 DEPARTISERT OF BUILDING IRSFBCTIORS V r
212 Main Street • Maics:el sodding t
trr (�� c� Northampton, rNS 01060 n rr7tn; _n v.
Property Address: `{ 1✓ -t 1 re t`)E2 PCC? -"1v ri°��f 1 +t �? �(0 a
Contractor
Name: el
g recn Con$i-r3/4)c-Vi on
Address: I P(rare V3/4 lau
City, State: 4.- SW1A.xn Pit1nIMw 0)001
Phone: `-t I 5 k- 0 SqL4
Property Owner
Name: -
{y —Thc rep (M c@
Address: `t("7�5' f Jjyr fl( e, 2d
`1'
City, State: ) O\(P in r A �" . 0 1(\i( 0
I, Se i;l n C )P 1"'CT rcU (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.
/7
Contractor signature
Date n
Permit Authorizationdresdls
'
massn
a Form
. eormacfga
• `4111111.11r
•
Site ID: 500050252989 Customer: THERESA CHASE
I, THERESA CHASE ,owner of the property located at:
(Owner's Name.printed)
975 Florence Rd FLORENCE
(Property Street Address) (aryl
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
Owner's Signature: /[\
Date: /°/H//6
FOR CLEAResult OFFICE USE ONLY
CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor Date
❑1'❑
CLEAResult • 50 Washington Street,Suite 3000 • Westborough,MA 01581 • 1800-480-7472 1
•
For Office use Only
Ar:\
BEYOND GREEN
CONSTRUCTION
Hello,
My name is Nicole Jeffords, I am the Project Coordinator at Beyond Green
Construction. We have been assigned to do the weatherization work at your home
for the Mass Save Energy Efficiency Program.You may have already received our
Welcome Packet,which is used to introduce ourselves. Otherwise if you haven't
already you should see our Welcome Packet in the mail very soon and you will hear
back from me in the couple days for scheduling and to do an intake on your home. If
you have any questions please let me know and I will get them answered for you.
We look forward to working with you on your project for greater comfort, lower
utility bills and a lesser impact on the environment!
Attached to this letter is a permit application that we will need signed by you
and mailed back to us.Please complete this at your earliest convenience and
return back to us using the envelope provided.
Thank you and have a great day!
Nicole Jeffords I Project Coordinator
Beyond Green Construction
413.478.8631Inicole@beyondgreen.biz
Beyond Green Construction "Leaders in Energy Efficiency" Phone:413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539
Pp4661 Mrskiis 1 : m' pe S avi
36 --fkke e f /1/Mplaza,
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I City of Northampton
BWlding DepaRrneni
Plan Review
pp t 212 Main Street
(rk I + i Northampton, MA 01060
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