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