17B-017 (7) 429 BRIDGE RD BP-2017-0071
GIs a: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17B-017 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-2017-0071
Project d JS-2017-000131
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. R.): 25918.20 Owner: SINGH JAGDISH&BALBIR SINGH
Zoning: URB(1001/WP(41/ Applicant: BEYOND GREEN CONSTRUCTION
AT: 429 BRIDGE RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0
EASTHAMPTONMA01027 ISSUED ON:7/21/2016 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 tt 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 7/21/20160:00:00 $65.00
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0071
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON01027(413)529-05440
PROPERTY LOCATION 429 BRIDGE RD
MAP 17B PARCEL 017 001 ZONE URB(100)/WP(4)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /` 5 SOL 5-
Fee Paid yE CPL
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existim
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
INFQRMATION 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
emolitioonnDelay
7ture oo' I nil. ng 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.
---�c)
The Commonwealth of Massachusetts
20\6 :oard of Building Regulations and $tandards FOR
U
�1. 6 assachusetts Stale Building Code,780 CMR MUNICIPALITY
USE
.1 r Itij n• • pplication To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
Oat\ B.-%cloy Rd NOfthGtrc1U1•MR
I.la Is this an accepted street?yes no 010100 Map Number Parcel Number
1.3 Zoning Information: 1.4 Property 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.U.L c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: Outside Flood Zone?
Check if yes❑ Municipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
JQQd\slr\ 5'in5h N0rxYt)...te\pton. tArN a\Ocpc
Namelvnnt) City,State,ZIP
4a9 'Sfidge Rd, 413-5$10-o-too
•
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑
Demolition 0 Accessory Bldg. 0 Number of Units Other 11. Specify: (1JPCWt en?'0.-44 Zn
Brief Description of Proposed Work': cnQcOVQ O.�'c\C \C\&UCtm on -o Cxl e -h
akc sea\ enc ores
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 1. Building Permit Fee:$fa 5 Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
❑Total Project Co&(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Tonal All F s:$ (0.5Check No.7 Check Amount: Cash Amount:
6.Total Project Cost: $' \ i 000
0paid in Full 0 Outstanding Balance Due:
SECTION5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS- 011-1 S3q 111- F 1 a0 I b
SEAN R JEFFORDS
License Number Expiration Date
Name of CSL Holder
List CSL Type(see below)
13 TERRACE VIEW -
Type Description
No.and Street H Unrestricted(Buildings up to 35,000 cu.f.)
EASTHAMPTON,MA 01027 R Restricted l&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN EYONDGREEN.BIZ I Insulation
B
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 313-IG• _ (Q (aG1�ly
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sear{ beyondareen.biz
No.and Street Email address
Easthampton MA 01027 413-529-0544
City/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 BUILDINGyPERMIT 1,,,1�
I,as Owner of the subject property,hereby authorize PP t X)fy d. C fte n Con a, i LAQ IU()
to act on my behalf,in all matters relative to work authorize this building permit application.
see o-AAOShuh (9 - 3C)- Ito
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 accui'4 to the best of my knowledge and understanding.
Sean Jeffords
4 L0 —30 —
Print Owner's or Authorized Agent's Name(Electronic 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. ova Information on the Construction Supervisor License can be found at www.mass.gov 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"may be substituted for"Total Project Cost"
l\ The Commonwealth of Massachusetts
-.;-- DeparnnentoflndastrialAccidents
1e—==; f
r /fie=$i Office of Investigations
r. '�''= 600 Washington Street
}'�� : Boston,MA 02111
..^' www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Bustness/Organifatiomindividual): S f'frj C-of p PXI (onSti uc,i-1 C 1)
Address: 1 3 JF,C A;
City/State/Zip: C(dJ-YIIC�,t�,jti ,'liN\1-1 Phe e#: L113 - DmadC — b (.-3--(1-4
Are you an employer?Check the appropriate box: •
l.®.I am a employer with .3 4. ❑ I am a general contractor and I 'type ofprolect(requlre�:
employees(fulland/or tree." have hired the sub-contractors 6. ❑Now construction employees
2.❑ I am a sole propitiatorlisted on the attached sheet 7.or partner- ❑Remodeling
ship and have no employees These sub-conbectors have g, 0 Demolition
working for me in any capacity. employees and have workers' 9. 0 Building addition
[No workers'comp.insurance comp.insurance._
required.] 5. 0 We are a corporation and its I0.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1 LQ Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MOL
12.0 Roof repairs
insurance required.]t c. 152,41(4),and we have no
employees(No workers' 1313_0/her weGo-he.YI rC'41 en
comp.insurance requiired.]
^Any applicant that checks box#1 must also fill eat the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they ere doing ell work and the,,hire outside matadors vast submit anew a9Neva iediealing suck
/Contractors that cheek this box must scathed an additional sheet showing rhe name of the s uubantracmrs and shoe wheats to not nese emiaa hare
employees. lithe sobvmnlncien have employees,they net provide their worker'amp.policy number.
Iam an employer that is providing workers'compensation imamate for my employees. Below is the policy and job site
Infonnaaon. �1
Insurance Company Name: N( ir(li,AI-LiCI I li,SUiC'C i'1( e
Policy Self-ins.LIC.# S LV F: C
#m 1000 5 1 Expiration Dec: / — I — / 7
lob Site Address:LId 9 Bridge Rd City/state/Zip: Nnr-ttlQ.tn' "\Mft 6tO(00
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 MOL c. 152 can lead to the imposition of criminal penalties of 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. 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 cerdfy ander the pains .p. f of perjury that the hafornmdon provided above is true and correct
Signature: Date: Co -3 0 —1 LO
Phone#: Li 13 — 51/4m)1`= L u L4
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 Si:
City of Northampton
MassachusettsA.
I - {.
DEPARTMENT OF BUILDING INSPECTIONS s1
i
€ 212 Nein Street e Municipal Buildingc+
Northampton, MA 01060 vHV woo'
Property Address: . . s(Kk. ' IRO 0( as %• • ii Vr O \ O bU
Contractor en
Name: loe 1AO(-6 PI COnsiTVc\IOn
Address: I3 wl- e(rare V )
City, State: Ea 5-1-11 claw-,et y\ ; M A 01041
Phone: 14I ?,- 5aa- 051-1y
Property Owner
Name: , nYc d.1Sh y yci
. ,
Address: 919 nrCoe. Rd
City, State: RI dr4hcmp --0n , MA
0\ O co0
I, ScCn cert-Ord
(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 al- Ali-
Date
(o - SO- ( lo
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggested Affidavit For Home Improvement Contractor Pcmdr 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
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. 9
Type of Work: Weatherization Est. Cost:
Address of Work: ya f 10 RC:I IJOrkill ttj MI C)
Owners Name: )0,s CACj.A j nSri
Date of Permit/Application: - 3(1)-- ) v)
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: c
I hereby apply for a permit as the agent of the owner:
Date: 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.# :
itMassachusetts-Department of Puhllc S:nfety
Board of Bullding Regulotoos and Standards
cin„ i S „ .ei?
License CS-074538�
SEAN RJEFFOROS ”
13 TERRACE VIEW ';g+'
EASTHAMPTONMA,
J..L.4, , cx ,rat e,
Sonnmssjoner 1112812016
- C%het(otntolteaI oiktmJillrYGJeCSC
% Office of Consumer Affairs and Business Regulation
t
e���, 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 629/2018 TM 288957
SEAN JEFFORDS
SEAN JEFFORDS - - - "-
13 TERRACE VIEW — —_-- _-- ---
EASTHAMPTON, MA 01027
Update Address and return card.Mark reason for change.
Address -- Renewal I Employment r Lost Card
SCP 1 0 10Md511
r77.-Y nTil.ne flt,rrdaL yr-f6.A: -L.rdG
,:.,:as Office of Consumer Mhos&Business Remo/Men License or registration valid for individual use only
,::,,, HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 131279 Type:
1Office of Consumer Affairs and Business Regulation
41
! Expiration: 6/292018 Individual 10 Park Plaza-Suite 5170
Boston,MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW _
EASTHAMPTON,MA 01027 I ndersrcretary Not valid without signature
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-
4a 'A c‘c c `.tuck PQGf-11nnmctcn ,�d} D \oLoo
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING -\
SIGNATURE
DATE (0-�O -1lo
RISE60 shawmet Road,tarn 21 Canton,MA 02021 1339.6024335
ENGINEERING waRlErnattalnoortnanom
OWNER AUTHORIZATION FO
_' t
APR 23 2016
I. i\CaLIS 1l�lG�f , _
(Owner's Name)
owner of the property located at
A2,9 1? &N (Zoe
_ (Property Address)
VI_AKEAN\c� , Ma - d 1 c)62
(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
27N.. C
Owner's Signatu
{ 22.),)
Date