36-140 (9) 256 BROOKSIDE CIR BP-2017-0725
GIS n: COMMONWEALTH OF MASSACHUSETTS
Map:Block:36- 140 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-2017-0725
Project# JS-2017-001197
Est.Cost:$2000.00
Fee: $71.00 PERMISSION IS HEREBY GRANTED TO:
Const_Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 15071.76 Owner: HOUGEN SARAH
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT: 256 BROOKSIDE UR
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413)529-0544 () WC
EASTHAM PTO N MA01027 ISSUED ON::11/29/2016 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 11/29/20160:00:00 $71.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-0725
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EAST/IAMPTON (413)5290544()
PROPERTY LOCATION 256 BROOKSIDE CIR
MAP 36 PARCEL 140 001 ZONE
THIS SECTION FOR OFFICIAL.USE ONLY:
I BRly IT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT t� n^
Fee Paid ff / W
Building Permit Filled out
Fee Paid
TvpeofCons action: IMPROVE ATTIC INSULATION TO CODE&AIR 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
Dernof 14n 0
/499 -77
Si_ (Au'di _ ci 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.
SL, The Commonwealth of Massachusetts
•
la p Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
b�..•' USE
/`.., z Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
le
N This Section For Official Use Only ///�
i( g Permit Number: ,419-• / /- 70,15— Date Applied: //;R//
C-----'js--./4'1:uilding Official(Print Name) Signature Date
SECTION I:SITE INFORMATION
1.1 Property Addres : 1.2 AMap& Parcel Numbers
.E26(0 &'D S eiC e;( Assessors. cIDrrnce,uAn _
I.1a Is this an accepted street?yes no 01 app.- Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq R) Frontage(R)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.OE.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: Outside Flood Zone?
Public❑ Private❑ Check ifyes❑ Municipal 0 On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
/-keen Toren(' M 14 O((xoa
Name(Print) City,State.ZIP '
&a0 &oO side c(r. _ 4o3-330-3405
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 Specify:W(CPI-Y1e(I r Cxi'10 n
Brief Description of Proposed Workr: i'ON(I)J. 04-1-11., 1nS UAQ*11:cs *13 CCCkC 4-
0A( SeCtiOncj rr1CCASLefC.S- __ ___
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 1. Building Permit Fee:$ 1 I 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) Total All Fees: $ 11 �[
Check No.IQO kheck Amount: "l�1 Cash Amount:
6.Total Project Cost: $ 62000
❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES /I e",
5.1 Construction Supervisor License(CSL) CS_ 31(A ek I 1)9 8 I 1 L
SEAN RIEFFORDS
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 SEAN(a_7B7.EYONDGREEN.BII Insulation
Telephone Email address
U Demolition
5.2 Registered Home Improvement Contractor(HIC) I
Zia 761 (9/pi0(1, J
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expirratlion Date
HIC Company Name or HIC Registrant Name
13 Terrace View seen@beyondpfeen.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 CONTRAC/TOORI APPLIES FOR
J'BUILDING
/PERMIT /
I,as Owner ofthe subject property,hereby authorize ef0 00Ot Greer) 06701 i Uatbr
to act on my behalf, in all matters relative to work authorize y this building permit application.
StlyyQkfCcJhrCI 11/f 71.k
Print Owner's Name(Electronic Signature) DDDate
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 .• '. the best of my knowledge and understanding.
Sean Jeffords 1 Vi 7
Print Owner's or Authorized Agent's Name(,-coonic 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 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.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"
The Commonwealth of Massachusetts
.1!—=74,W—e2 Department of Industrial Accidents
-mi.unt I Congress Sweet,Suite 100
S-= Boston,MA 02114-2017
apt ,,cS" wwwmass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information rP�Please Print Legibly
Name (Business/Organization/Individual): A)(�'( cit C retail �IlS tL1!Utk/l IOn
Address: I J j�I�t f� (*CQ x.11 LL) ..�r 11
City/State/Zip:lllt_�'y)(,(,(Y1QtOfl /rVe.(� Ol0�Phone#: y/,pj— s; ry - QLiIq
Are you as employer?Check(be appropriate box:
Type of project(required):
1.❑I ama employer with employees(full and/or pa n-tune)* 7. ❑New construction
2.0!em a sole proprietor or partnership and have no employees working for the in
any capacity.(No workers'camp.insurance required.] 9. El Remodeling
9. ❑Demolition
3.0 lam a homeowner doing all work myself(No workers'comp.insurance required.)'
4.0I am a homeowner and will be hiring contractors to conduct all work on my properly. Iwill JO❑Building addition
ensure that all contractors either have workers compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
SC]!an a general contactor and l have hired the sub-contactors listed on the attached sheet.
13.0 Roof repairs
Them sub-contractors have employees and have workers'comp.insurance: ql (N P�.#.hfA`I ZC(.}it�'I
re
h.❑we aacor oration and its officers have exercised their right of exemption pm MGL c. 14. Other
152,21(4),and we have no employees.(No workers'camp.insurancerequired.]
*Any applicant that checks box al must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractorsm ust submit a new affidavit mdicatmg such.
1Conbsctors that check this box must attached an additional sheet showing the name oft the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comppolicy number
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site
information.
Insurance Company Name: )icer Loyd(,(x(l,.I Jr' U(,(YC(_nc p
Policy#or Self-ins.Lie.#: y�U E C 1(^CO _ Expiration Date: I
lob Site Address: a 5L, 13rn0p3rd.2 (til(. City/State/Zip: -F�OY rnCe. I P'A 01 (Y")?--
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
/do hereby certify under the pains and alt perjury that the information provided above is nue and correct
Signature: �-r� �^FJ Date: /7//L/
Phone#: "1�3- �1 O51
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Segg xfN Affidavit For Home Improvement Contractor Pcmul Application
For Office Use Only
Permit No.:
Date:
Note 142 A, requires that the Areconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal or demolition or the constructionalof an addition to any pre-existing owner occupied
building containing at least one but no more than four dwelling unit,or to structures which are adjacent to such
residence or building®be done by registered contractors,with certain exceptions,along with other requirements.
Type of Work: Weatherization ..( Est. Cost:
Address of Work: f5(C SwoXSIt.-1('. C1/41 . olence ( 11A
Owners Name: iYl 0,..105
F
Date of Permit/Application_ \v J 17 j1 c.
I hereby certify that:
•
Registration is not required for the following reason(s):
Work excluded by law
Job under$ 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:
I hereby apply for a permit as the agent of the owner: �-
Date: Contractor. BEYOND GREEN CONSTRUCTION Reg. #: }31279
OR: SEAN R JEFFORDS
Not withstanding the above notice,I hereby apply for a permit as the owner of the property.
Date: Owner: Tel. #:
9 Massachusetts -Department of Public Safes,
Boars of Buivang s<ogmavons anti
menses CS-074539
SEAN R JEFFORDS
13 TERRACE VITW
EASTHAMPTON/VIA
onins-beer 11/28/2016
CD_1e r5one w-nrcleaf/% o/Q/i6.2acIuJ.e/t
= `i Office of Consumer Affairs and Business Regulation
=.:=,L, --= .a' 10 Park Plaza - Suite 5170
Q.
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 _ Employment Lost Card
SCAT 0 20NL4n
riA, 1,r'nine;,,,,„,.oAr -/4,je,<hreem
Hi
office of Consumer &Business Regulation License or registration valid for individual use only
7.
, w'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
x � 9i Office of Consumer Affairs and Business Regulation
Re Expiration:t131279 Type: g
6m-.� IB Park Plaza Suite 5170
r - 61292018 Individual
Boston,MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 1 nderseeretary Not valid without signature
a'
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSLIIS DEBRIS DISPOSAL PROVISIONS OF
MASSACHUSLI IS 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,
5150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION SITE ADDRESS-
c ALO frc()KSiCe Cif -F/Drenr.e , .klAA CIO(
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
Sr
,
SIGNATURE
DATE %// ob&
•
Permit :rtion .
6 Y�1
mass save .� �
Site ID: 50240273 Customer: Sarah Hougen
I, Sarah Hougen ,owner of the property located at:
(owner,Mame,ported) -
256 Brookside Cir Florence 01062
IRopemsbeetnmress) - (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a budding permit to perform insulation and/or weatherization
work on my property. - -
Owner's Signature: J71-
Date: kiyr/&
FOR CLEAResuf OFFICE USE ONLY
CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project:
Partldpating Contractor Date
•
oa•o
6EMesuf • 50 Washington Street,suite 3000 • Westborough,MA 01581 . 1&1 -aS0.7472 &Tr
RAMC*the Only
Rev.102015
City of Northampton
Massachusetts e�
r•
1 G f DEPARTMENT OF BUILDERS INSPECTIONS
•/ t 212 Iain Street • IWleipal euildSn9 51,r� r��'-
Northampton, NA 01060
Property Address: ;SLG 610OY5)C10 Cl r, FICr('IriCe (m ()Lcca
Contractor J.-7
Name: C7CLjerK recn ConyrrVCt on
Address: 13 eiinre V1
City, State: Ecismcanety, M w ()opal
Phone: LI I3 5QQ- 0541-I
Property Owner c \
Name: '11QJf✓�1 '1 H IlJL1�e-rl
t✓
Address: or2J(0 et-0Orc p Cl 1
City, State: Inr enre , M w- n
I, Sean t )QC(.$ (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 /I -7 I) CtJ
irsk
BEYOND GREEN
CONSTRUCTION
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!
VLLolejc(fjorcls
Beyond Green ConNt ruction I Project Coordinator
Cell:413.478.86311 Office:413.529.0544
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