49-020 (11) 343 GLENDALE RD BP-2017-0525
GIS=: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:49-020 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-2017-0525
Project JS-2017-000856
Est. Cost: 53000.00
Fee: S79.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot size(sq. ft.): 43560.00 Owner: BROWN MELYSSA
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT: 343 GLENDALE RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EAST HAM PTO N MA01027 ISSUED ON:10/19/2016 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:
FeeTvpe: Date Paid: Amount:
Building 10/19/2016 0:00:00 579.00
212 Main Street.Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0525
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 0
PROPERTY LOCATION 343 GLENDALE RD
MAP 49 PARCEL 020 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid /�
Buildine Permit Filled out
�
Fee Paid
Typeof Construction: IMPROVE ATTIC I U TION TO CODE&AIR SEALING MEASURES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildine 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 ATION PRESENTED:
pproved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:ys
Intermediate Project: Site Plan AND/OR Special Pennit 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
Demolition Delay
/&12—W
an e l.! fticiaC l . 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
4 '.0 Board of Building Regulations and Standards FOR
^� Massachusetts State BuildingCode, 780 CMR MUNICIPALITY
b USE
Dr; iding 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: Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
3 L3 C Itnclfjle p-04 FlorencC, t1/4AM
1.1a Is this an accepted street?yes no 01 U l07 Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use lot Arca(sq ft) Frontage(R)
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 0 Private 0 Zone: __ Check Flood Zone? Municipal 0 On site disposal system ❑
if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
reit\ SS(A arcwn -F.lotenct imor b\Ct)—
Name(Print) City,State,ZIP
343 Cllename R4 al3-9a3-a89.
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg. 0 Number of Units Other Et-Specify: 1a)QCk2ONt )CO-1-hO^
Brief Description of Proposed Work2: 9(t4 OS C \y ct \11- O\ an COdce_ anc',)
(A1r SeCC.Inoi ImCIASl$A S •
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
I. Building $ 1. Building Permit Fee:$ /9 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 $ —
Suppression)
Totalr/All Fees:$ 7g
Check No. q heck Amount: Cash Amount:
6.Total Project Cost: $ 3000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) (S '-)lJ J— 1 �I /98 Ij
SEAN RJEFFORDS
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 I&2 Family Dwelling
Masonry
City/Town, State,ZIP M
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEANI&BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I (01(99/18
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sean'y)bevondareen.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.S 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
I,as Owner of the subject property,hereby authorize e)cA CO Cl E (e en (O n Stfw(#10 ✓1
to act on my behalf,in all matters relative to work authorized by this building permit application.
She ek.-k-fracneek /0 Is/f tt
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 arc to e best of my knowledge and understanding.
Sean oJeffords b Ste
Print Owner's or Authorized Agent's Nae(Ele onic Signature) Date
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 1.1 til 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.gov/dns
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) (Including garage,finished basementattics,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"
ttt. The Contazonwealtlt oft}dussucitusettc
is_ el, Depttelteaatofgadensteia1Accddenas _..
F 7- 7.*t,'aaw-iiJ'+, Office q;Investigations
F 6f0B t019,.K4 n 0211Street
+5'msc`vF.v .1f� �fluZ
i). wWWS2assgvv/dW
Wasters'Coaumensation astarance Mffl4avate Btaildenfiegatraetarsineettielansirksabers
Airam&laffo€sastiere Please PrintLealbiv
Name(BusinncsiQrgardmtioM ::�
ndividual): r JO:n:4,l; \'v 1'a eiTh, r i-''(lJ'T111'vTl i.: 1'‘
Address: 112.1 \:l ,i 1 Ci( L V.
i \ei a
(1031
City/State/Zip: ll,iinC.",0 i \'k7YL_'-ITh!\lr� Li 13 - aCi- L 70,L4 c
Ars yea ea employer? act the appopriattie boa: TYLvo o€pt'olast(sa:umrod): —
1.alamaemployer with 3 4. Q I am a general contactor and 6. Naw txotemiction
caployees[Pit and/or aarbdime).c have hired the sob-conhactuta
2.Q I am a sole proprietor orrparhser listed on the attached plied 7. 0 Remodeling
ship and have no employees These sub-contractors have S. Q Demolition
wolfing for me is any capacity. employees and have workers' 9. Bui[No workers'comp.insurance comp.koarra11C Q tdjmg addition
recanted.] S.Q We area corporation and its 100 Metal;epees or addifioms
3.0 l an a homeowner doing ail wet officers have exercised their 11.0 Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MOL ?Z.Q Roof repairs
insurance required.]t c. 152,§1(4) andwehaveno - -
eurpioyees.Thiowolars' 13.&0tey v'vI i%.`l'Y1i.�1FP -L,.• t-.n.
comp.insurance required.]
'Arty appliceattbatchert¢boxg1 mastulmml suttee sermon below showing laceration'eompeomnoapoary intomauoo.
.1 Fnmeewnva!vho submittids affidavit indicating they&edoiag all work and Menhir,ntatderantmotosmmtmt*anmvaaveia cedhiswdc
tConimcMis that duck tae boxmast sundae=additional sheet showing thenatmofthe saidcoularclos®ddmbwhmhm or notthosomides have
emdoyes. If IS sub-connasols bawl empleyeos,they nmst provide deb woden'comm.pdbysmmber.
foga an enrioyer Matto preehn wo:irea'conwe<:sagton.fassraneefornzy employees. Below f the polo,and fob sae
it formation.
Laurance Company Name: P'v(i';:'l1--, ,..... :J. I I-)..Y...)Y.ice;.i'i ti
Polley d or Self-ars.Lic.IL: �J\).i'--�(` . 1 :Q ' 5 1 ExpirationDate: j - I - 1
Sob Site Address: 343 etieilGla-I t P4 City/State/Zip: -HO I eoc e a MR 010(p
Attach a copy of the workers'cotape ssatios policy deetomnfan page(showing the policy numbor and expiration date).
Failure to secure coverage as required under Section 25A of MOL c.152 can lead tothaimposition of criminal penalties of
Ile up to$1,500.00 and/or one-yearimorisonment,as mil as civilpenalties in the fan of a BTOPWORIC ORDER and afne
of up to$250.00 a day against the violator. Be advised that a copy ofthis sfatementmay be forwarded to the Office of
htvestipti ns ofthe DiA for insurance coveseegeveaficaton.
Edo hereby ter*warier ihepains anripenoide. a ?hof me informationprovided above is true and correct
Signature: c�fJ/pT�fir Date: 1011/4511 (e
Phoned: LII. -.S.3)`I - 0SL1( i
j :Zit r ssamy- Da notrxhein this area,to be completed by elEy ortom official
aty o, sews: Permitiflees.-sem
i ]ss dng Authority(e'ncle one):
1.Board ofrEealtia 2.Eos'idlogDepnrtasent S.City/Tone Cask 4.FlectdleaIInspector S.PIombbrg 5zimector
G.Other
Coated Person: Phene4: .
pMassach uses Decay tof ubitcSafe-,
Scars c:3.. _ -a Sta.- rcc
L cense CS-071539
C
SEAN RJEFFORpS -
13'TERRACE VRW '%kE
EAST1HAMPTONMA
canmissmne 1112&2016
�\ n/%Ie 65() 2monioraN ClI CY JJflGJ ee..ielif
�4� Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 6/29/2018 Tr% 288957
SEAN JEFFORDS _.
SEAN JEFFORDS
13 TERRACE VIEW _ - —- - —
EASTHAMPTON, MA 01027 -- ----
Update Address and return card.Mark reason for change.
Address ' Renewal 1 Employment r Lost Card
SCA 0 2041 IY:-
17, t: ,i" f/A,r 0.....e/rr.u,
Office of Consumer affairs&Business Regulation License or registration valid for individual use only
r=„HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
[ o,Registration: 131279 Type: Office of Consumer Affairs and Business Regulation
Expiration: 629/2018 Individual 10 Park Plaza Suite 5170
Boston.MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON, MA 01027
nnner:¢ without Not valid without signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggatcd Affidavit For Home Improvement Contractor Pcntut Application
For Office Use Only
Permit No.:
Date:
Note 142 A, requires that the Areconstry ction, 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 Est. Cost:
Addressof Work: 3 c3 C(lerrQlaAk RoA -PIOIef)c( v a10
Owners Name: cte
Date of Permit/Application: (d (S (lb
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. 142k
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 R JEFFORDS
Not withstanding the above notice, 1 hereby apply for a permit as the owner of the property.
Date: Owner: ___ Tel.# :_
a'
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 DE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111,
5150k
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION SITE ADDRESS-
COr13 Oda k Pei f70rence,M,4 61 (%(o9
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE •
DATE iP 5 ti
Permit Authorization n`�
mass save Form ITITmm.Taa
a:•• •41*V41 � CONTRACTOR
Site ID: 500050228007 Customer: MELYSSA BROWN
I, MELYSSA BROWN ,owner of the property located at:
(Owners Name.Printed)
343 Glendale Rd FLORENCE
(Property street Address) Idy)
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: /1/-
/-
0000000000000000000 C)00 0000000000000000000000•000000000000000000060000
FOR CLEAResuk OFFICE USE ONLY
CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Participating Contractor Date
CIFARewN • SO W•••1•10041 street Suite woo • We#boreuah.Na O1581 • taOMa?lan gat
For Make Use day
Rev.10201S
City of Northampton
a —
teeo .6 - s,'
Q.
`t Massachusetts
L ;
0s9n Y DEPARTMENT OF BUILDING INSPECTIONS
-JMunicipal Building
'GNorthampton, Lm 01060 hr' '.V
Property Address: 3t-(3 'Cr IPnciake_ 'SOI --C-lot en(ei M1 OI DCp2
Contractor ,y
Name: t7Pt4QrnPi rCLf C.Onstruc Hon
Address: 1 3 ` T rrrorr V) 0.0
City, state: Ea 84-h 0.Jn( Y\ i M P1 O 1 Oat
Phone: 1-( I 3- 5ac1- 0 SL-1L-1
Property Owner
Name: rnPWJSSC. R1O' Jf
Address: 3(43 C1\enC'CUQ ' (-*
City, State: T f(-Arnie ) 1ti1 ‘,' C I OCo a-
I, Jean C\e Y-CU _(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 IDIS/Ie
Dear Building Department,
Please send permit back to Beyond Green Construction by mail or via email
when it is issued.If you have any questions regarding this building permit please
call my cell @ 413-478-8631.See details below.
Address: Beyond Green Construction
13 Terrace View
Easthampton,MA,01027
Email Address: nicole@beyondgreen.biz
Thank you!
I Project Coordinator
Cell:413.478.8631 I Office:413529.0544
13 Terrace View,Easthampton I www.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