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17A-248 (9) 98 LAKE ST BP-2017-0803 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-248 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-2017-0803 Project# JS-2017-001340 Est. Cost: $2000.00 Fee: $71.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sp.ft.): 16552.80 Owner: BROWN MAREN T& PATRICIA ANN MORRISON Zoning: URB(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT: 98 LAKE ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 () WC EASTHAMPTONMA01027 ISSUED ON:12/21/2016 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: FeeType: Date Paid: Amount: Building 12/21/2016 0:00:00 $71.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-0803 APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 Q PROPERTY LOCATION 98 LAKE ST MAP 17A PARCEL 248 001 ZONE URB(100V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST / ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT c)/ Fee Paid (` Building Permit Filled out Fee Paid x.._ '✓ Typeof Construction: 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 OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION PRESENTED: 1 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 Demoli io ela:4# �/t 1‘-611 Signature of B i ng 0 ml 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. File#BP-2017-0803 APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 0 PROPERTY LOCATION 98 LAKE ST MAP 17A PARCEL.248 001 ZONE URB(I0{fZ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filed out Fee Paid Typeof Construction: improve imniejnstto 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 t Plot Plan THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN RMATION 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 Rom CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Dem7n Del y er to; Signature of� fficial 'cat late ' .-- 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 40k Contact Office of Planning&Development for more information. The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR . cn MUNICIPALITY ), Massachusetts State Building Code, 780 CMR USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 Ga (j.` One-or Two-Family Dwelling • W `.'� This Section For Official Use Only Bui ding Permit Number: Date .plied: Building Official(Print Name) 'gvamre Date SECTION l:SITE FORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 4a7 LLLC-n S+ CIOveru e1 LA0 0 t Oloa I.1a Is this an accepted street?yes no Map Number Parcel Number 13 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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public 0 Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system 0 Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: MCMCIX ecc. m Flo% Co ) MowLQ Name(Print) City,State,ZIP G5' Luxesk- Los-". 8(o-0701 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition ❑ Demolition 0 Accessory Bldg.0 Number of Units Other GT'Specify: LEQta,{4'1Cf I Wit(in Brief Description of Proposed Work I PIO N(a) { OTA--"Is C ,(SSU.&CO-1(‘)^ V-(') (bets_ ruti civ SPrt.(i.J m{Ck.cs(Let'.\ SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only SLabor and Materials) 1.Building $ I. Building Permit Fee:$ 1( Indicate how fee is determined: 2. Electrical $ 0 Standard City/Town Application Fee 0 Total Project Co&(Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ I Check No.1O(tiI Check Amo ift Cash Amount: 6.Total Project Cost: $ aQ (9 0 0 Paid in Full 0 Outs KN : :alance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) C S _ �-1 I`-I n C?C H ///a s/i co SEAN R JEFFORDS . / -�> License Number Expiration Date Name of CSL Holder ( e 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 Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-529-0544 SEAN@BEYONDGREEN.BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 13i a-7 9 Co_ / Q f)8' Sean R lefords-Beyond Green Construction HIC Registration Number Expiration Date HIC-Company Name or HIC Registrant Name 13 Terrace View seannbevondcreen.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. 152.9 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 1PERMIIT- I,as Owner of the subject property,hereby authorize U(7d C7 reCons-fru( o 1 I U C�c to act on my behalf,in all matters relative to work authorize y this building permit application. Q cd*ac neQ1 1911 Le 1/ w 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 ace best of my knowledge and understanding. Sean Jeffords / 0 Ji (pin Print Owner's or Authorized Agent's Name(Elect ic 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.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 =:ge—,4/ Department of Industrial Accidents ?eiyl='pp I Congress Street,Suite 100 t= t � 'RL 3 Boston,MA 02114-2017 Tery,W�q www.moss.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbera. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organivationfndivid ,(ual): , /,QV'1qPacer, COnick o Address: I •D, Tar (C&(- V t e-A-0 City/State/Zip: SCIS-MC.X' l�i�fl �A Phone#: 13 - sag -0S--{ q Are you an employer?Check the appropriate box: O\oOT Type of project(required): 1..Zan a employer with 3 employees(fun and/or pan-cone)• 7. ❑New construction 29I am a sole proprietor or partnership and have no employees working for me in 8. 9 Remodeling any capacity. No workers comp.insurance required.] 3 l em a homeowner doing all work myself(No workers'comp.insurance required l' 9. ❑Demolition insurance 4,El l am a homeowner and will property.be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electncal repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.9 lam a general contractor and l have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'compinsurance t h.❑we are a corporation and itsofacers have exorcised their right orexempionpemMC c. 4. Other\ Q0.1 herZe k}an 152,¢I(4).and we have no employees. No workers compinsurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'conwensation policy inromution. a Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors mm check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. lithe sub-contractors have employees,they must provide their workers'comppolicy number. 1 am an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. /, ' I ,l /� y^' y-� /� Insurance Company Name: Cv< Iv, 1O L4 Cu SCA e I I ISUAra nC Policy#or Self-ins.Lie.#: S W E C 7 �S I Expiration Date: Job Site Address: LCLXQ LS-f-1"e el- city/state/zip: OVt ictiA C1 DCo Attach a copy of the workers'compensation policy declaration page(showing the policy number and expireth{n 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. I do hereby certify under the pains, •d . s of perjury that the information provided above is true and correct wow Alm Signature: / / tt�� Date: I I I I 1 \ Phone d: 3"- 5a `l - _t� Lfj "V Official use only. Bo 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 Suggmtcd Affidavit For Home Improvement Contactor Pnmur 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. Type of Work: Weathherization Est./ Cost: f� Address of Work: P uce 34 I (oYcyn(e�MA �1l CUa Owners Name: tit n �.e.n Date of Permit(Application: I a- ¶ up ( 1 co ._ 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 a s of as the 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. #: ®, Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-074530 Construction Supervisor SEAN R JEFFORDS 13 TERRACE VIEW EASTHAMPTON MA 01027 r? Expiration: Commissioner 11I2t'018 , Cr Crl'2:'% v t ' "6 i(',1 tr S„ 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 Ti0 288957 SEAN JEFFORDS _ . SEAN JEFFORDS 13 TERRACE VIEW - -- "- ----_-- EASTHAMPTON, MA 01027 - - --- - --- Update Address and return card.Mark reason for change. Address f` Renewal Employment r— Lost Card SCA. i ffiebin nun,un.mdd a/ /i £WJrk/C Office or Consumer Affairs H Business Regulation License or registration valid for individual use only `y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: J2 t Registration: 131219 Type: Office of Consumer Affairs and Business Regulation - -r" Expiration: 6129/2018 Individual 10 Park Pisa-Suite SPlO Boston,MA 02116 SEAN JEFFOROS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON.MA 01027 - --- -"- -- - - -- Undersecretan Not valid without ignature 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 BE REMOVED FROM SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111, S1SOA. FACILITY- ALTERNATIVE RECYCLING, NORTHAMPTON, MA CONSTRUCTION SITE ADDRESS- q 8 L -e 5 - .- I Or me e,r-1 A o (Da TO BE DISPOSED AND TRANSPORTED BY- BEYOND GREEN CONSTRUCTION or ALTERNATIVE RECYCLING SIGNATURE YY DATE ( II lD/j I/1 ec:, City of Northampton.feae Massachusetts -17 DSPARneNT OF BUILD^"' INSPECTIONS `i ? 212 Nate Street • temicipal Building rr��-+��1 r Jae Northampton, t be. 01060 Property Address: qi� Lc:W. L5+ , -r iorencL� JF\4 u\ k0.1 Contractor a7_ Name: Y3C t nC* R rccn Construction3 'T Address: I C r rare v l City, state: ct stirs 03/Yl Pit 1(\ ; M P-1 O I Oa] Phone: `112)^ 5a4' OBI-11-1 Property Owner -r7 Name: �' ACUtX JJ(`fl,U(\ Address: C� $l L.C-u F City, State: 4 iD1€ rl �� r e1GLDa I, Sean 3e r( (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 0 I I C)// (G RISE60 Shawmut Road, Unit 2 I Canton,MA 02021 1339-502.6335 ENGINEERING www.RlSEengineering.com OWNER AUTHORIZATION FORM I, /J2t: 0 2-2./ Lt /U • (Owner's Name) owner of thethproperty located at: 9 LKtyl $T . (Property Address) )%L/K01'Gir4 ' G/CE 2 tPv/roperty 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. The Permit will be secured by the insulation contractor, at no additional cost. It is the homeowner's responsibility to close out this permit by con cling t ' unicipality at the completion of this work. owners Signature 72-/) /i� Date / 6.2016 dir\ 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! NicoHel-ords Beyond Green Construction 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