23A-238 (4) 65 MANN TER BP-2019-0206
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.-Block:23A-238 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
Permit4 BP-2019-0206
Proiectft JS-2019-000338
Est.Cost:$3281.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sp.fl.): 6882.48 Owner: HOTT LAWRENCE R&DIANE K GAREY
Zoning:URB(100)/ Applicant. BEYOND GREEN CONSTRUCTION
AT: 65 MANN TER
ApplicantAddress: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON.8/16/2018 0.00:00
TO PERFORM THE FOLLOWING WORK:W EATH ERIZATION
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 8/16/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
O
Zy
0 m The Commonwealth of Massachusetts
n c Board of Building Regulations and Standards FOR
?_ MUNICIPALITY
o rn Massachusetts State Building Code,780 CMR USE
0
-_ ilding Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
r'o One-or Two-Family Dwelling
Thi tion For ODicial Use Only
,. $uiidmg Pe i m r: ^ � Date Applied:
r
Buil ' roial Priume) S nature ' Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Num Q
n r rvoa -) d
I.la Is this m accepted street?yes 'l\*A - \d ap NumNum a Parcel Number
1.3 Zoning Information: 1.4 Properly Dimensions:
Zoning District Proposed Use Lot Area(sq R) 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:
Zone: Outside Flood Zone'?Public❑ Privets❑ _ Check if yes0 Municipal❑ Onsite disposal sysu:m ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name 1,Print)I Q City,State,ZIP 0
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(clawkaR OW apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.O Number of Units_ I Other JP Specify
Brief Description of Proposed Work: 00 nC'-11
I P
S I
SECTION 4: ESTIMATED COASTRU#FION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I. Building $ 1. Building Permit Fee:S_(p1_Indicate how fa is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All F s'$__j0_`�
Check NoA) Check Amount:_Cash Ankh mt:
6.Total Project Cost: $ 39' 8I- 09 0 Paid in Full ❑Outstanding Baiancc Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) (y _/��U G�q I iJ
SEAN RIFFFORDS 1. b J 1 0�
License Number Exp(ralmn Date
Nmncaf CSI.Holder i I
List CSL'Fype(see below)_
13'1 ERRACE VIEW
Type Description
No.and Street U Unrestricted JBuildings u b 35,0110 cu R.
FAS'fHAMF10N,MA 01027 R Restricted 1&2 Family Duelling
ry
Cit Slate,ZIP M Masan
io,n.
RC Ruvfin Cnvrrin
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEANuaBEYONDGRE1 BIZ I Insulation
Tcle one Emailaddress D Demolition
5.2 Registered Home Improvement Contractor(HIC) ICA
Sean R J IY rds-Bevond Gran Construction HIC Registmlion Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace Vic, _ seanla�heyonderecn thea
No.and Street Furail address
Easthampton,MA 01027 413-529-0544 _
Ci /Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.6 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...........❑
SECTION 7e: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 Y a/ 1 LXJYI_SA-" on
to act on my behalf, in all matters relative to work authorized b this building permit application.
Print Owner's Name(Elegy ni,Signa(um) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under pains and penalties of perjury that ail of the information
contained in this application is true and a best of my knowledge and understanding.
Sean Jeffords
Print Owner's or Authon d Agent's Name(EI 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 gummy fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at
www.mass.eov/oc Information on the Construction Supervisor License can be found at www.mass eoY/dos
2. When substantial work is pinned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.fi.) Habitable room count
Number of fireplaces . . Number of bedrooms
Number of bathrooms Number of halfibaths
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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgow'dia
U,kriscra'Compansation Insurance Affidavit:Builders/CoatractentElectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Brant Infarmadon Please Print Lealbly
Name(3adnemV0rpvsnaa6mmNlndlvidaa0:
Address A J —r2
City/State/zip: �C ekhnw)I hone a: ( l 3
Areyua as emplayer?Check tae apprvprirte hum: jl�r, Type of project(required):
1.�A l sal a cmpkryer only-__3 cmpmyees(funeanto, sera as, 7. ❑New eonstruetum
).❑I em a mote Womicmr or peronadp and have on cmpluyca workmg far an in 8. ❑Remodeling
any cap ,ty [No workerscomp insurance rtmptird.]
R ❑Demolition
J❑l ama homemmmer dong allwaskmyx]f lNosmimo'comp mram.reairfm
a❑I ama hmiaa ma na wdl he miring wnlm:mn msoMumt all work on my pmpmy. twin 10❑Building addition
rnsarc mat all conoacmn either ae.e wakers'compenaatrvn inwranceww<aole 11.0 Electrical repairs or add itions
pmpmiaos withno anuoym, 12.0 Plumbing repairs or additions
s.❑l ama gmaralcaMwor aM l Lave nicest Nc mulwm mon,melon aha meaha stns. 13r,Roof airs
The.suM1commaturs have employecsaM Isamu wmeken'emmp imaance .
t u rW
6.❑%am scorporauon adia ofliara have commarhhoir,meninfexemexam per NGL c. 14.[!gOt crW1!
152AI(a),aMwmhamxnaempluma, lNoworkea'comp insurareerequittd)
'Any amicanm mat ehpks lnm#1 must alo,till out The action belac showing lbeim workers'mmpen tram policy Intnmatlon.
m Ilmneownas wlw means this affnavit am icaung nay as doing all wok and Ren hitt muscle contractors must submit a arca annumn indicating such.
t(muntnclom ih r chttk oris Mx must amaaM an anoitio sal shxtaluwmg use mnaorthu suh.cvawactao sand flare wheyhw ormt dursemitia lava
employ®. utke wbcwnrombn Ivveempinym,rMY muR amideaheir nukns'rrnp pdsy meake.
I am an employer that isproviding workers'comprnsNion insarancefor my employees. Below is tttepolky andjob she
information.
Insurance Company Name: cc '7 /U�
Policy 0 or Self-ins. Lic.#: Jw-cc _I0y �_� Expiration Date:_
Job Site Address: eJ V�-t G.n n -�CYV 0 C4 Csty/Stateizip: V 0 r4i-)arylg" N 0,
Attach a copy of the workers'compensation policy deelaratlon page(showing the policy number and expiration date).
CJ\Olna
Failure to secure coverage as required under MGL c. 152,f25A is a criminal violation Punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify ander thr pain.,and fiery rho the information provided above is nue medeerrect
Signature:_ ___- Dale:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official.
City or Town:_. _ Permit)Licenseit
Issuing Authority(circle o se):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
® Massachusehs Departmert of Public Satiety
Hoard of Building Regulations and Standards
Lli CG
oJstructlon Su pe[v=sa.
SFAN R JEFFORM
13 TERRAC`VIP_4b'
EASTHAA PTON MP. 01021
i
Expiration
Comm�ssiocer z'3s<zcs:-
/ fi•'o ��,nU _ _ ice ._ . ..
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
BEYOND GREEN CONSTRUCTION NG. Registration; 191746
Exp
13 TERRACE VIEW iration; WWI
EASTHAMPTON, MA 01027
nsMn,e eume�e oma eow.�mom.
r
omH M1.IMPROVEMENT
M PR O Ano a eu wyyuulepan
HOMEIMPROVEMENTat,orr LM.. _, .Y Regise fire expiration
if nI found
uee deMy
TYPE CorooraIwa , before the Consumer
Cate. a found return to:
RC991--L 0EQ¢3t�C � OfficenAstr Oansumere-Side 13 Business RegWetion
131746 05109/21120 On¢Ashburtan Place-Suite 130'
BEYOND GREEN CONSTRUCTION ING Boston,MA 02108
SEAN JEPfOROS NL:rcC..��—._..
13 TERRACE VEN ---
EA6n'.Am�"CI.*•; x'027 undersecretary Not valid xithoufi Signature
�� I � I�-�u�,�.,�
-t� �,aa xa� Uu�v-� S�
-e�� �d,�-��,fi�@� �'
��rno
�7va 'UcduPr } noM �raa�a� uu-Y)ri! GO
Doa3Sign Enadow ID:BF9A15EGF6C"B3E-A07A-299E12D571AF
Permit Authorization
-PIT rTr
mass Save Form
Site ID: 3413638 Customer: LAWRENCE HOTT
LAWRENCE HOTT ,owner of the property located at:
(owrer's Name,pnmed)
65 Mann Terrace Northampton, MA 01062
(PrDpemstr Address) KAY)
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: Eyoiretf 1f4yr
333FDF4G7414E8.
Date: 5/1612018 14:31 EDT
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
cm orr�;.u:.cav
Rev.102015
City of Northampton
/ ''` Massachusetts
i
060?ARTT OF BUILDING INSP=XONS Z
\ 212 Main BT Bet • M�ninip l
Mohd am n, M 01060
Property Address: l05 Man n '�erra c.2 YV0Y am�D�.,Nn�1
U\O�-o a
Contractor
Name: gL(jo c) C7YCGYl Ct)nS --r Lc orl
Address: 7crram Vi t'k' ) _
City, State: L 0'�1MCLL -:v +-0/) (!v1 FF O I Oa �
Phone:
Property Owner .1N
Name: LO
Address: eto 5�N an V� TeX-(Q
City, State: �N011 �-Yl�"-C, Y V) WAA 01OCO2"
I, S�Ct ✓n e Al jrdj (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
Date '