43-099 (3) 11 WHITTIER ST BP-2017-0955
GIS P: COMMONWEALTH OF MASSACHUSETTS
Map:Block:43 -099 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-2017-0955
Project JS-2017-001643
Est. Cost: $3000.00
Fee: $77.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 83199.60 Owner: MYINT SOE
zoning Applicant: BEYOND GREEN CONSTRUCTION
AT: 11 WHITTIER ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 () WC
EASTHAMPTONMA01027 ISSUED ON:2/21/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:IMPROVE ATTIC INSULATION TO CODE AND
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 221/20170:00:00 $77.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File# BP-2017-0955
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-05440
PROPERTY LOCATION II WHITTIER ST
MAP 43 PARCEL 099 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid *1 /
Building Permit Filled out `"'ll
Fee Paid
TvpeofConstruction: IMPROVE ATTIC INSULATION TO CODE AND 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
INF9RMATION 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
liemof - .Delay
��%moi/ a(-/7
r ili'g 'ficial 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 and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number. _the— (7 -go-s- Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
i,Nhi++;ersi .-FinencejC' 010(.0j.-
I.
lao-L I 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 f) 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?
Municipal 0 On site disposal system 0
Public❑ Private❑ Check ifyes0
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: . �� ��
(S(me_ Myini MVS b 0(.9a
Name(Print) City,State,ZIP
1v vC( S+. 14 �x3�1 781a
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(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 W Specify:(A)Cc&4hcrs?&iien
Brief Description of Proposed Work': l(Yl CCv2 ClIrl&1.3.Ck*kOn *T) C(Th -2
Wit( cur . P WI at: m ect(.vrt$
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
I.Building $ 1. Building Permit Fee:$ -7-7 Indicate bow 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:$ 7 7
Check No. 4a eck Amount: Cash Amount:
6.Total Project Cost: $
3 000 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C5-07(439
SEAN R JEFFORDS 1
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
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN(5BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) /3 %9 '7 9 �D /�ji?//x
Sean R Jeffords-Beyond Green Construction IC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sean(dbevondareen.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.f 2SC(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 APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorizenz�DmA_ CI C'eej l C OcS"�i (/ '1DM
to act on my behalf,in all matters relative to work audio ' by this building permit application.
&e aktacincel .21/5/77
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 accurate to the best of my knowledge and understanding.
Sean Jeffords � 9//ss// 7
Print Owner's or Authorized Agent's Nam' rs fw ignature) 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. I 42A.Other important information on the HIC Program can be found at
www.mass.eov/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 ofhalf/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
Department of Industrial Accidents
rebs&" I Congress Street,Suite 100
_1:er. Boston,MA 02114-2017
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
ADDiicant Information Please Print Leefblt
Name (Business'Organizatiodmdroldua0: �f(d C rtn C(9051-`liK-Al or\
Address: i 3TOTO.C�t.,. VI tui
C
City/State/Zip: CCIl S'1�Q1Y1DIU1 t /�1UL\ Phone#: Li 13 - LCOS 1--C).--
Are you as employer Check at appropriate box: O\03 1 Type of project(required):
t home employer with employees torn and/or pet-tffie).? 7. 0 New construction
2. I am a sole proprietor or parairsbip and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required]
in lone homeowner doing all work myself[No workers'comp.insurance required.]' 9. ❑Demolition
14.0Ianahomeowner and will beEncontactors I will 0 Building addition
more that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with w employees. 12.0 Plumbing repairs or additions
5.0 i ran a gereml contractor and l have hired the sub-contemns luted on the attached sheek 13.0 Roof repairs
02411/,,
irs
Theabe
summectors have employees and have waiters'romp.insurances I4. OtherlNtrs l01(I L(A4110n
6.0 We are a corporation and in officers have exercised then right ofuemplon per MCL c.
152,11(4),and we have no employees. No workers comp.insurance required.]
*My applicam that checks box#1 must also fill out the section below slowing their worker'compensation policy information.
a Horne/mum who submit this affidavit indicating they are doing all wotk and then hie ouandecontra'tom must submit a new affidavit indicating such.
tfonvectoa that check this box must attached an additional sheet showing the none of the sub-contractors and sore whether or not Nose entities have
employees. If the sub-contactors have employees,they must provide their workers coop.policy number.
/am an employer that t providing workers'compensation insurance for my employees Below is the policy and job site
informadon.
Insurance Company Name: 1\-,01(C iACC(Cl lflSLttCtnC€
L
Policy#or Self-ins.Lic.#: J UU`c C' 1C(DOS( Expiration Date: F---- ) (8
Job She Address: ll OhdtiCr St• city/state/zip: - \OYefCe JIU'(3,- 6\ o1 )
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 state tent t- be forwarded to the Office of Investigations of the DIA for insurance
coverage verification. A
I do hereby certify wader the pains am r7B7>T-, rJury that the information provided above is true and correct
Signature: Date:
/ /.5/i7
•
Phone X: L(/ 3'— 59 9 -Osgq
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License if
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: ,
t
t
s 7,2 �' M�JassachusetJ"1J7t;;nts Department
�ti Z of Public Safety( ex
7f_":121F�:i�
Board of Building Regulations and Standards
License: CS-074539
Construction Supervisor
SEAN R JEFFORDS
19 TERRACE VIEW
EASTHAMPTON MA 01027 S
Expiration:
Commissioner 1/IPS
10
/ y t/ f
et
,, if7??G �:IJft
Office of Consumer Affairs and Business Regulation
!J- 10 Park Plaza- Suite 5170
- Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 6/29/2018 Trt 288957
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW _-- -- - -- _- --
EASTHAMPTON, MA01027
Update Address and return card.Mark reuoo for change.
Address I— Renewal J Employment _r Lost Card
SCA 1 :: 20�o5m
1- ( BiR/ e7
_Ouon m AffairsB Business Regulation Licenseor registration valid for individual use only
7'S+--,r1HOME IMPROVEMENTCONTRACTOR before the expiration date. If found return to;
Registration: 131279 Type: Office of Consumer Affairs and Business Regulation
�Fv10 Park Plaza Suitt 5170
Expiration: 6/292018 Individual
Boston.MA 02116
SEAN—JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 Undersecretary Not valid without signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggwed Affidavit For Nom:Improvement Conmxmr Pcnmt Appliwion
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: Weatherization Est. Cost:
Address of Work: A\. \,D\W*cAe'C St• tAC nc 4S bO Coo-a
Owners Name: 30e_ (11v,11 n\-
Date of Permit/Application: c2 \CJ\\\
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)
II
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 UN .yi L 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.# : 131270
OR: SEAN R JEFFORDS
Not withstanding the above notice,I hereby apply for a permit as the owner of the property.
Date: Owner: Tel.#:
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH NE COMMONWEALTH OF
MASSACHUStI 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 THI5 WORK SHALL BE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111,
5150k
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRULI ION SITE ADDRESS-
ll Whrt#Ie y S+. -C-1ot oc.e,Mva -01D(.12 -
TO
1D(.12 -TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTIO
ALTERNATIVE RECVCLIN
SIGNATURE
DATE (9 /1 11 ,_
dim
Permit Authorization $'rhe"° i
misi
a gla
Form FA,fto„
UOamaCTOR
Site ID: 500050267367 Customer: SOE MYINT
I, SOE MYINT ,owner of the property located at:
(Owner's Nene,printed)
11 Whittier St FLORENCE
(Property Street Address) (ray)
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. /� A
Owner's Signature: S - tm-NA'
Date:: d 2" i l
0000•000000*000tO*0000000000000000000000000•0•eO 006040 OOOOOOeeeeo etre*
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
CIFAkesuk • SewazNryem Street,Suite 30W • Westborough,MA OtSate 111O0480F702 El at
For(Mu Use Only
Rev.102015
,.; n , . Toy. . .
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 @ 413478-8631.See details below.
Address: Beyond Green Construction
13 Terrace View
Easthampton,MA,01027
Email Address: nicole@beyondgreen.biz
Thank you!
._ _ _ Project Coordinator
Cell:413.478.86311 Office:413.529.0544
13 Terrace View,Easthampton!www.beyondgreen.biz
Beyond Green Construction "Leaders in Energy Efficiency" Phone:413529.0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539