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18C-072 771 BRIDGE RD BP-2019-0724 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18C-072 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categ_oa: INSULATION BUILDING PERMIT Permit# BP-2019-0724 Proiect# JS-2019-001187 Est. Cost: $4462.00 Fee: $91.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sq.ft.): 19209.96 Owner: ZAVRAS BENTREWICZ KATHERINE Zoning.URB(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT: 771 BRIDGE RD Applicant Address: Phone. Insurance: 13 TERRACE VIEW (413) 529-0544 O WC EASTHAMPTONMA01027 ISSUED ON:12/18/2018 0:00:00 TO PERFORM THE FOLLOWING WORK.-AIR SEALING, DAMMING, PROPAVENT, HATCH, THERMAL BARRIER POLYISO, BATH FAN HOSE , ATTIC FLOOR, OPEN BLOW CELLULOSE 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 12/18/2018 0:00:00 $91.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner �--z�v L/-.tet ©/l/ The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR MUNICIPALITY Massachusetts State Building Code, 780 CMR USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: 1,4 Date A plied: ' LVlti ` 205'5 / lz-le-ie Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers 7-1 1 Dri.iae. R� 1VOA�am, ,M� C��o �QG O 7;;- 1.la Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) 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,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system 13 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: y cw t �3e�trees►�z �'r�r-�-h0.m�J ��M A p v CX-Q Name Pnnt) City,State,ZIP 7l rkdl At L4G- ' - 1T 11401 No.and Street VTelephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Units Other P-Specify: Z(. -4i1 /l Brief Description of Proposed Work2: ozTA- 'i Mi "Glk Ch - ` p SECTION 4: ESTIMATED CONSTR TION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ 1. Building Permit Fee: $ _Indicate how fee 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 $ Total All Fee Suppression) Check Not- Check Amount: Cash Amount: 6.Total Project Cost: $ la �, l 'a 0 Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) /7 5. 6�� b3� SEAN R JEFFORDS l I 1 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 City/Town,State,ZIP M Mason ' , RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-529-0544 SEAN@DEYONDGREEN.BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) `G 1--,�-/1 Lp 5 l� Sean R Jeffords-Beyond Green Construction HIC (Registration Number Expiration Date HIC Company Name or HIC Registrant Name 13 Terrace View seannu,beyondgreen.biz No.and Street Email address Easthamton,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 ..........X No...........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize 6w}a n d G Y t f n 0-Q►N i r v&h,, to act on my behalf,in all matters relative to work authorized by this building permit application. See CO-tc(ck-ed Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'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 ac a best of my knowledge and understanding. _Sean Jeffords Print Owner's or Authorized Agent's Name a rc ignature) Date 11 NOTES: 1. 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.jzov/dps 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"maybe substituted for"Total Project Cost" The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information �1 c Please Print Leeibly Name (Business/Organization/Individual): o n d C re'f°t l 010(K. tla c+ o c Address: 3 ex <JA-) ' / City/State/Zip: Phone#: U/ Z ,50 9 - 0S � `'1 Are you an employes-9 Check the appropriate box: d Type of project(required): t am a employer with _employees(full and/or part-time)." 7. ❑New construction 2.—❑�c 1 am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity,[No workers'comp.insurance required] 9. ❑Demolition 3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]? 10E]Building addition 4.❑lam a homeowner and will be hiving contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole l l.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.F-1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.n Roof repairs These sub-contractors have employees and have workers'comp.insurance.: t n l0 eri 6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14 OtherU)Vf py'1 1 lA 17��1 152,§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box#I 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. tContractors 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. 1 am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site information. Insurance Company Name, rV Of qC� 1 n( ((, Y / I Policy#or Self-ins.Lic.# W. S eC1 V d Us( Expiration Date: /— Job Site Address: I � 1 d�k P d City/State/Zip:I hV 0(-,h a Cl t � �- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A 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. 1 do hereby certify under the pains and ven&Ws ty that the information provided above is true and correct Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official 4 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#: a f f Commonwealth of Massachusetts ! Division of Professional Licensure Board of Building Regulations and Standards Conrvisor l 3 CS-074539 E spires: 11/28/2020 i % a SEAN R JEF�,Og�R�D,,S,, 13TERRACE EASTHAMPTONA ;0 7 *` W, f Commissioner , i Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1341 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation 91746 BEYOND GREEN CONSTRUCTION INC. Registration: 5IM 13 TERRACE VIEW Ekpiration 0 0510912020 EASTHAMPTON,MA 01027 Update Addreaa and Return Card. SCA 1 0 2OM4W7 Office of Com unm Affairs&Business R anon BIOME IMPROVEMENT CO R Registration valid for Individual use only TYPE:Cornora8an before the expiration date. If found return to: Howsk"n Eyniration office of Consumer Affairs and Business Regulation 191746 05/09/2020 one Ashburton Place-Suite 1301 BEYOND GREEN CONSTRUCTION iNC. Boston,MA 02108 SEAN JEFFORDS �-- 13 TERRACE VfEW EASTHAMPTON.MA 01027 UnNot valid without signature Undersecretary A IiTl Supplement to-Ponnit APD 11cadc--, 'T Office Use Onl-, 7=- o.: r--W, mi.jdemizatiop, con-v- 142 n a teratim en -A, TIO-quiR.6 tiht- di AreconsMiddo 1 r o unprovemzn-�removal or dernoliii'on or ihe constmcdonal of an addition to any pre-existing owner occupied luildinz ciuuta�, g at least one but uo mare than foltz dw-,Uiag unit,ortc,str=turcs which=adjacent to L--,ch '�Si a-c-ricetbuiicLz nev bc bv reg-istered contrac-t).rs,'ViLh ceftm excoptions,zl ong viLhfit4:er roquiro-ments- I VVeafherizabo-ri Est. est: v _jv.Mers'-Name: ate I .-0'Permi",i Application: L-7��y that: Prmt,ann is u ired f;,v tze Joll ci;inr, reasson(s): %Vurk exciluded by law ob imder S 5130-00 -Lia;nL Dcy Z17 Occupied q -'IoLice Z: here-by given that: UW1,74ERS PULLING THEIR OWN PE-RM-1 T C-F J1 i:A i,- W 1 T U N REC!;,z:,,TE REO C 0 W—RA CT OR FOR APPLICABLE HOME UvLPROV7-FAENVORK D'--'NOT HA TO THE F -C �:N-D U AR-BY1 RATION PROGRLA,14 OR GUAR.A.'t\,:,Y I eS of pfjUry: h,—,eo:v apply fop a permit as the agent of the Q'Wacr: Contractor 131279 Date: Reg OR- S=-Atlll R J;-::-FTz0PDS �he 0%,me.-&the Prope."t-Y. lie sbe-ve wtice,I heemby wply 53r a;Xrmi' Tall. AV\ BEYOND GRED RU C T DEBRIS DISPOSAL AFFIDAV17 TKI ACCORDANCE It-.!T-r" MASSACj;LS S DES IS r'S s"?:i_ .tf't S:IONS z MASSACHUSETTS GENERAL u'hW CHAPTER 40 SEC7.71,3 54. A. CONDITION �F BUILDING ?EPK--:- ��yy { ;p���(�'^` FOP DEMOLITION �f�['O R-K 3= _�.F,AT --:Hi'-IL 5E }�E YDR�T_y FROM THIS VVOT'�K SITE AND DISPOSED OF N A PRDPE. La" 110ENS "-- WASTE DISPOSAL. FAC:L.T Y' AS DsEFIN=—J B'Y' FACILTITI ALTERNATIVE RECYCLING, NORTHAMPTON, MA XI A1C `�-- U n, �A 0► 0 c�C� _ BE DISPOSED AND TRANSPORT ED BY- 3EYOND GREEN CONSTRUCTION Or .-iLTERNATIVE RECYCLING SIGNA7URt— DocuSign Envelope ID:065A64C9-ECOF-4DA8-84DO-6964C3D5C559 AmPermit authorization rMSS S21W Form s> ,--W rffWWCV Site ID: 3559904 Customer: KATHERINE ZAVRAS-BENTREWICZ Katherine Zavras-Bentrewicz owner of the property located at: (owner's Name,printed) 771 Bridge Rd Northampton, MA 01060 (Property Street Address) (City) 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. DoeuSlpned by: Owner's Signature: '��"t' was—U°c,41vrwivy Date: 11/28/2018 1 9:35 AM EST ar��a�+s�s���reea�r�+r+ssooasewessareeaiAs�ar�ats��+eas�s�sser�e�� e� �����a�� � e��� 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: Page 1 of 1 For Office Use only Rev.102015 City off Mort?"maiRpton '• c ��``;=`• Lc5S3^ iLSE'tS � ' ---•••,R :3 "�> > t 72�t a`s�S GF B _1r1�2Z7G �iSSPEC11OC7S V-- 212 212 Main street Q bwaicipa2 Sui2ding res '•�= ~�; Y ``f Iiorilaampton. bSL 02060 Property ,ddss: PA Con ractok Marne: U fi ni n, is City, State: toS Gum/ t)r\ :t a O,o;-- Phone: �J ' a SUILi Pr cperbf Ounleg Address: city, state: L O (4 ( I-002 J �1� 0 I L o o 1, S f Gtt� ��� (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 of�davkt. Contractor signature Date a