29-266 (4) 60 LONGVIEW DR BP-2017-0959
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-266 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorv: INSULATION BUILDING PERMIT
Permit# BP-2017-0959
Project a JS-2017-001650
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.): 22172.04 Owner: PALIVODA JOHN W&DONNA L
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT: 60 LONGVIEW DR
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAM PTON MA01027 ISSUED ON:2/22/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:IMPROVE ATTIC INSULATION
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 2/22/2017 0:00:00 $71.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck- Building Commissioner
File 4 BP-2017-0959
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 Q
PROPERTY LOCATION 60 LONGVIEW DR
MAP 29 PARCEL 266 001 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
Tvpeof Construction: IMPROVE ATTIC I LATION
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:
roved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: She 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
D -;;
Signal of Buil.mg Of Sial • 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
Board of Building Regulations anddards
Massachusetts State Building Code,780 CMR FOR
MUNICIPALITY
USE
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
[t One-or Two-Family Dwelling
Qr 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
(a0 L(Xn1ji eJLIJ LX f\ocen C¢.
1.Ia Is this an"Accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.0 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,§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 0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
is it_ •• Ii • , Plorence, A-44 OlncD 'a
ame(Print) City,State,ZIP
C D LUn3VItt,U Dr. L-02-0/0— 94-0a
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition 0 Accessory Bldg.0 Number of Units_ Other it Specify:UJ(CA>I'hc(17Cth 04
Brief Description of Proposed World: \Cr),p((a/2 LLth( I YISLU CI$((7✓l
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ I. Building Permit Fee:$ ( 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:$ _._i�__ p
Check No/022^7Check Amount:re Cash Amount:
6.Total Project Cost: $ 0 T(]
0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) Cs 1(1
_OCDC` I�I o•8 I 1 g*
SEAN R JEFFORDS i VV
License Number Expiration Date
Name of CSL Holder List CSL Type(see below) \ A •m
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( BEYONDGR>iEN,BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1J-19 /X-19 „/d(`r/1 p
Sean R Jeffords-Beyond Green Construction HIC Registration Number lExpiration( Date
HIC Company Name or HIC Registrant Name
13 Terrace View seanabevondereen.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. 152.4 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...........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR� APPLIESfFOR BUILDING PERMIT ,/
I,as Owner of the subject property,hereby authorize I&{I(A t"Jen ( on silt((�F to{n
to act on my behalf,in all matters relative to work autho by this building permit application.
See attachrntn4s 9 /13/17
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby a ' t the pains and penalties of perjury that all of the information
contained in this application is true + i ac. to the best of my knowledge and understanding. -7
a OW
_Sean Jeffords v--9 //L.?// /
Print Owner's or Authorized Agent's Name( ectronic 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.govioca Information on the Construction Supervisor License can be found at www.mass.gowdos
2. When substantial work is planned,provide the information below:
Total floor area(sq.It) (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
hE=—!/ Department of Industrial Accidents
=gin_ •• l Congress Street,Suite 100
E.
Boston,MA 0211 4-2 01 7
o+
wwwmass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Coatractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information n,j4Please Print Legibly
Name(Business/OrgaaniivatioNlndiviidduap �j/
: kAJend 1�(Cen ('O -ruct-� cDr,
Ter Address: I r rare v I ell
City/State/Zip: Fart YY‘C"' (\ /‘0%-khA Phone#: 4 \ �J� SD° L 09A 4
Are you as employer?Check the appropriate box: \09-4 Type of project(required):
IgI sora united with .3 anployses(fd and/or prwmer 7. ❑New construction
2.❑Iamasole proprietor orpartnership and have noemployees working for me in 8. ❑Remodeling
any capacity.[No workers comp.assurance required.]
3.0Iaa homeowner doing all work myself workers'coop.insurance required.]' 9. ❑Demolition
m
4.0 l am a homeowner and will be hiring contactors d
rs tocouctall work on my property. I will 10❑Building addition
ensure that all mntncwn either have woken'compensation insurance or are sole 11.0 Electrical repairs or additions
p°pnerns with no employees. 12.0 Plumbing repairs or additions
s.❑1 am a general contractor and 1 have hired the subcontractors listed on the attached sheer 13.❑Roof repairs
These sub-conuaeors have employees and have workers'comp.irtsuranceI
6.0 We area) and we
and he officersmploye have worked their right ofexe goon per MGL c.
14.O Otherj,000f4lncri I C,(j 7�
152,51(4k and we have no employees.[No workers'campinsurance required]
*Any applicant that checks box el must also fill out the section below slowing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they art doing all work and dao hue outside contractors mut submit a new affidavit indicating such.
tConaactors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. lithe subcontractors have employees,they must provide their workers'comp.policy number.
1 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. �/l )/' ,,+ C
Insurance Company Name: VLQ 9(Aar C1 I aULATanre
Policy tl or Self-ins.Tic.#: c5 LU Fes' 7 000' 1 Expiration Date::— /
lob Site Address: /P 0 Lne(V I eL D or- City/State/Zip: -fIQT CX1Ce.)N -01O(0p-
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 z
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
l do hereby certify under the pains and n fperJury that the information provided above is true and correct
Signature: Date: c2 11 3 l7
Phone g: 4) 2 `JO ff;;1" O kL •j ••
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#:
•
Massachusetts Department of Public Safety •
Board of Building Regulations and Standards
License:CS-074539
Construction Supervisor
SEAN R JEFFORDS
19 TERRACE VIEW
EASTHAMPTON MA 01027
'1'i lv.4.. -•a Expiration:
Commissioner 11202011
lze. (Ct?;zrr,viiciiwect/tA ca� 7cr. Zfdadelt
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 6292018 Tri 288957
SEAN JEFFORDS
SEAN JEFFORDS •
13 TERRACE VIEW — --
EASTHAMPTON, MA 01027 -- - ----- - -- --
Update Address and return mrd.Mark reason for change.
Address [ Renewal .J Employment Lost Card
scat a mutism -
✓t t r d// 14 /•.:•(/°Mee ofConsume ARIn&BudaReg I tioy License or registration valid for individual use only
A: 1,HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 131279 Type: Office of Consumer Affairs and Busbies Regulation
0
Expiration: 6292018 Individual 10 Park Plaza-Suite 5170
Boston,MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACEVIEW ,
EASTHAMPTON,MA 01027 Undersecretary Not valid without signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggested Affidavit For Home Improvement Contractor remit Application
For Office Use Only
Permit No.:
Date:
Note 142 A, requires that the Areconstraction, alteration, renovation, repair, modernization, conversion,
improvement, removal or demolition or the constructional of an addition to any pm-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: (op L(7r ,vi 2A.. . or, -Florence, Imo OIfl(9a
Owners Name: Don r "tiled \v Q('1.CL
Date of Permit/Application: a l i3 )I
I hereby certify that: •
Registration is not required for the following reason(s):
Work excluded by law '.
lob under$500.00
Building not owner occupied
Owner pulling own permit
Other(specify)
Notice is hereby given that:
1 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 FUNDL 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.#: 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.#:
SN
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSEI IS 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-
(7 Lni vro-✓Qr_-FLDrrnct otQo :
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
•
SIGNATURE
DATE x//31/ 7
City of Northampton
lrC
Massachusetts
A' tBPac'�l OF anr.L* G 1gSPZCITCw.g
:- 212 Nan Ifreed a Muni Weal. Building C�
Northampton, M 01060 e0 adSr
Property Address: i
w +meaZirresiv7w gg
Site ID: 500050259263 Customer: DONNA PALIVODA
DONNA PALIVODA ,owner of the property located at:
Ike/s wmq Anted)
60 Longview Dr FLORENCE
lererenv Street Address) Icay)
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: ,a— Iilaiathi_,
Date: ij?/17
000000000000001>00000000000000,00000000000000 If 0000000000000000000000000
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
CLFAReSt • 50 Washington Street Sub:3000 . Westborough,MA 01581 • 1.800-480-7412ph
Formketx.omr
Rev.102015 _._.. ..
7-
.. T -4 -_
Dear BuitdingDepartment,
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!
.- _. j Project Coordinator
Cell:413.47826311 Office:413329.0544
13 Terrace View,Easthampton I www.beyondgreembiz
Beyond Green Construction "Leaders in Energy Efficiency" Phone:413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton. MA 01027 CSL#74539