29-410 (6) 105 SANDY HILL RD BP-2017-0808
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:29-410 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-2017-0808
Project# JS-2017-001360
Est.Cost:$3000.00
Fee:$78.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group; BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq.It.): 12414.60 Owner: PINSONNEAULT BRIDGET C&GREGORY J PINSONNEAULr r
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT: 105 SANDY HILL RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON:12/28/2016 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 or 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 12/28/20160:00:00 $78.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-.Building Commissioner
File#BP-2017-0808
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 0
PROPERTY LOCATION 105 SANDY HILL RD
MAP 29 PARCEL 410 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: IMPROVE SULATION 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
INFO3M�✓1ATION 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
Deliti. P
A'", /4.17-7a'
Signallinf Buil.m_Ofyicia 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.
A. The Commonwealth of Massachusetts
1"" ��tt,r, Board of Building Regulations and Standards FOR
�- en % is Massachusetts State Building Code,780 CMR
MUNI
`IIPEALITY
I r�. Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
N One-or Two-Family Dwelling
This Section For Official Use Only _
Building Permit Number: Date Applied:
- Building Official(Print Name) Signature ..W Date �^
SECTION l:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
i05 , ohci Hal Rd fiCrence, Na
"'
1.1a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(R)
1.5 Building Setbacks(R)
Front Yard ! Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.Lc.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private A Zone: ,_ Outside Flood Zone? Municipal❑ On site dispual system
Check ifyes0
SECTION 2: PROPERTY OWNERSHIP'
1 owner'of Record:Pir OPculi T IQ!en c e Mii G
j Uco a
NamEW
City,State,ZIP
IDS Nljl Rd Los-sett-I /5
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building 00�' Owner-Occupied 0 Repairs(s) ❑ Alteration(s) 0 Addition 0
BriefDemoliti
n 0
ssory
0 Number of
nits
ther 0
Description'`ro...seed Wok2:2: )i OVtS UW IC )4n&(JSS.4j cf' CM`�,UQr000k
{�
SECTION 4:ESTIMATED CONSTRUCTION COSTS
.._ Estimated Costs:
ItemOfficial Use Only
Labor and Materials)
I.Building $ 1. Building Permit Fee:$ 7 rindicasow fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
— 0 Total Project Costs(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire ^ -- '—
Su•pression) $ Total All Fees:$�-. 7d...... (tb
Check No.1�\ Check Amount: Cash Amount:
6.Total Project Cost: $ 30 00 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C S _1 32�t !) ;;za>
SEAN R JEFFORDS l., t
License Number Expiration Date
Name or CSL Holder
List CSL Type(see below)
I TERRACE VIEW --..
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.lid_
EE S_ $AMPTON.MA 01027 R _ Restricted I&2 Family Dwelling
City/Town,State.ZIP J M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-5294344 SEANO EYONDGREENBIZ I Insulation
Tele.hone Email address D Demolition
5.2 Registered Home Improvement Contractor(RIC) 2 '} 9
t., I C'rji
Man R let-Fords Beyond Green Construction HIC 'egistration Number `k'/Expiration Date
HIC Company Name or Hie Registrant Name
13 Terrace View _ seanabevondgteen.bv.
No.and Street Email address
Bann ton MA 01027 40-529t0544
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.e. 152.4 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit wilt 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 BUILDING PERMIT
s Ow
the
Ira of
subject he(sn att proffers b worr zuthorizedonCI €re en C OISki uc.* l U
property,hereby
authorize
by this building permit application,
See c CO eO! _ /91r9//
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 aft of the information
contained in this application is true and accurst t, st of my knowledge and understanding.
Sean Jetfords // 9/
Print Owner's or Authorized Agent's Name(Electron'3Signature1 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. 142k Other important information on the HIC Program can be found at
wwwmass eowoca Information on the Construction Supervisor License can be found at www.mass.Rovidps
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. tt.) 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 OP=
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
lb ft Department of IndustrialAccidents
1 Congress Street,Suite 100
tv;,:r—= � Boston,MA 02114-2017
2 ti�a9`o' www.mass.gov/die
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please PrintLegibly
Name (Business/Organization/Individual): PpCAJ rrJ1 ( f Cn CViy -u.nt7,0C\
Address: 13 �Terfet( C. l/ �
City/State/Zip: E.C1.3)-)nO. iWili 1/ N\`i� Phone#:
Are you as employer?Cheek the appropriate box: O\ CType of project(required):
1 am a employer with 3 employees(fun and/or part-ohne)• 7. ❑New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. LI Remodeling
any capacity.[No workers'comp.insurance requi ed:I
3 am a homeowner doing all work myself[No workers'comp.insurance rzquhMJ' 9. ❑Demolition
10❑Building addition
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contactors either have workers'compensation insurance or are sole 11 ❑Electncai repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5 I am a general contactor and I have hired the sub-contactors listed on the attached sheet.
rs
These sub-contracors have employees and have workers'comp.Insurance. 13-❑ROOfrepat
61:1 We We aa corporation and it exercisedomcers have their right ofexemption per MGL c. 14.1Dther (,000lB")l2(( TCz'FIJIt
151,§I(4),and we have no employees.[No workers'comp insurance requird.l
*Any applicant that checks box%I must also fill out thesection below showing their workers compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit vdicating such.
:Contactors that check this box must attached an additional sheet showing the name of the subcontractors and state whets or not thou entities have
enployea. If the subcontractors 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 and job site
information. ^ I
Insurance Company Name: �AJ o rgL(Cttrd��l I f SL 1 nc e
Policy#or Self-ins.Lic.#: L5(( )F( 7t ,fr0 5 / Expiration Date: /—/ f 7
Job Site Address: /C SQ /Y/7/ Rd City/State/Zip: F/O1et)(y,.44N O/[cGo
Attach a copy of the workers'co nsation 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.
I do hereby certify under the pains and,Ceffir perjury that the information provided above is nue and correct
Signature: r� Date: /&/j 9//Phone#: LjJ 3- SSS.9 - (5 y
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 it:
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Sq.ststed Alfd v,For Ham Improvement ConyEeux Paewt Application
For Office Use Only
Permit No.:
Date: -_....._._ _
•
Now l42 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 mote 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.
jr5O uType of Work: Weatherizaton Est. Cost t
/CD Sar Ph l Yl/ ,t,w-eAf � /CCD
_.
Owners Name: erey.r Pi _ 2c net_.
Date of Permit r Application: /a//
I hereby certify that
Registration is not required for the following reason(s):
Work exchlrted 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. I42A.
Signed under penalties of perjury_ �4
I hereby apply for a permit as the agent of the owner:
Date: Contractor. BEYOND GREEN CONSTRUCTION Reg.n : )31278
OR: SEAN R JE'FFORDS
Not withstanding the above notice,l hereby apply for a permit as the owner of the property.
Date: Owner: Tel.4:
. Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-074539
Construction Supervisor
SEAN R JEFFORDS
13 TERRACE VIEW
EASTHAMPTON MA 01027 0.
Expiration:
Commissioner 11/28/2018
✓ Y,n / /,r //21
=-�' �_ s'2�i ff" .028 xj'�P� :er:71.i7 (Vg�1'L cr egr Aajetiti,
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 612972018 Trp 28895/
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW -- "-- " -
EASTHAMPTON, MA 01027 - --- -- - - --
Updnre Address and return card.Mark reason for change.
a Address Renewal k Employment r— Lost Card
SCA zc,�
ofike of Cuasumer Maws&Business Regulation License or registration valid for individual use only
--};HOME IMPROVEMENT CONTRACTOR before the expiration date. It found return to:
''+? Registration: 131279 Type: Of a of Consumer Attain and Ruthless Regulation
1..v"z-'7 Expiration: 6/2912019 Individual 1.0 Park Plaza-Suite 5170
Roston.MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 -
EASTHAMPTON,
Undersecretary yet valid without signature
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSEiiS 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-
/OS So ncli fit /I Rci Piach az, k-t A- 0 /cc0
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
c-�
SIGNATURE
DATE 1c9 //c1/% �'
City of Northampton
Massachusetts 7 l M
l.. LEPARffi!9' OF BUILDING INSPECTIONS
!!t ry 212 Main Stint • Municipal Building
Northampton, Mi 01060 Ll. f a
Property Address: ,0.5 &liY'&j /f 11 14 -F/Drence144P4 o(Q1Ga
Contractor ))
Name: An
R recn Cons-rruc; -ion
Address: I • T r rr(ACe V I Cu )
C
City, State: ED-S*-1'1 CS.VY\Pt V\ I M is O t Dai
Phone: y 12)^ 534' o544
Property Owner
Name: ktieq(ClrlA Piospnne(cuLAE
Address: (l,` J , e., nraj III I I RBI
City, State: — /Or e rI CQj M 4] n ) 0cca
I, J e eJtl`l C3 p 40Y-( (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 G
Date / g// 9// to
Is'
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!
Nico+e lef fiv is
Beyond Grecn Construction[Project Coordinator
Cell:413.470.6631 I Ofice: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