Loading...
24A-032 5 BLACKBERRY LN BP-2017-1118 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:24A-032 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-2017-1118 Project# JS-2017-001904 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.): 10802.88 Owner: MARTINEZ JOE Zoning: URA(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT: 5 BLACKBERRY LN Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 O WC EASTHAM PTONMA01027 ISSUED ON:4/6/2017 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: FeeType: Date Paid: Amount: Building 4/6/2017 0:00:00 $71.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2017-I 118 APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 Q PROPERTY LOCATION 5 BLACKBERRY LN MAP 24A PARCEL 032 001 ZONE URA(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Bee Paid /� Building Permit Filled out Fee Paid Typeof Construction: IMPROVE ATTIC INSUL 0 CODE AND AIR SEALING MEASURES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 074539 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON IN¢O$MATION PRESENTED: 6-"*—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 Iemoliti in D- .y V7 Signf Building O tela 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 40k Contact Office of Planning&Development for more information. AVN i 7r; The Commonwealth of Massachusetts • Board of Building Regulations and Standards FOR r . Massachusetts State Building Code, 780 CMR M�IUSE LITY � < Q Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 \ - One-or Two-Family Dwelling �N,/ < ' This SecA�on For Official Use Only I I Building Permit Number. 17 i i l d Date Applied: �/(.i l 1 7 / Building Official(Print Name) Signature fff 111 Date SECTION l:SITE INFORMATION 1.1 Property Address: 1.2 Assesso_711ap&Parcel N bers 1.1a Is this an accepted street?yes no O\Dly() Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Arca(sq R) Frontage(R) 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 0 Private 0 Check ifyes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: _Ice \.kv fle(__ NO nam f-1-tC I'M VI o 10lO c) Name(Print) City,State,ZIP dSb # i L -e a03-3urt-D0(03 --- No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) ❑ Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other BL�S4 �} p�ecify:\)Q0.--he( i SECTION 5: CONSTRUCTION SERVICES SConstruction Supervisor License(CSL) SEAN R IEFFORDS l d0 n c J O7q -3Cl g8 j I'd License Number Exlmtir 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 l&2 Family Dwelling City/Town,State,ZIP M Masonry RC. Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-529-0544 SEANrd1BEYONDGREEN.BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I 3 I g j Ci Ca 49 c/j Scan R Jeffords-Beyond Green Construction HIC Registration Number Expiration ate I Ile Company Name or HIC Registrant Name 13 Terrace View seanni bevondereen.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,e.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 APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize a Ely -tell Co )I SA1(k SA- (k (,{- I O(\ to act on my behalf, in all matters relative to work authorized by this building permit application. see O 1 cher 3j LA I Li- Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest un//d��,,rr,,the pains and penalties of perjury that all of the information contained in this application is true ankaiCyrite'[o the best of my knowledge and understanding. Sean Jeffords 3 / LI Print Owner's or Authorized Agent's Name(Electronic Signature) Datc 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 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 to_- ft Department ofIndustrial Accidents 1 Congress Street,Suite 100 = t— fr _t=yy Boston,MA 02114-2017 $.--v.- www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/organizatioNmdividuap: Q1,cJJGfCk C y c€v'\ C Of& rfljc \or' Address: V3 -TC r tf CVC 2 V A PA a J _ Ciry/State/Zip: a a_A-y-Il \ ay�lt)pne#: u\?- Jet V - bS�—'�� Are you an employer?Check the appropriate box: O l(ret. Type of project(required): I.R1 am a employer with 3 employees(fun and/or part-tine)• 7. ❑New construction 2.0'ama sole propñetor orparthership and have no employees working for me in 8. ❑Remodeling any month/ [No workers compinsurance required-1 9. El Demolition 101 am a homemmer doing all work myself 1Ne workers'comp.insurance mree requred)' 4.171I am a homeowner and will won be hiring contractors to conduct all woon my property. q will 10❑Building addition ensure that all contractors timer have workers'compensation insurance or are sole IL❑Electrical repairs or additions proprietors wile no employees. 12.❑Plumbing repairs or additions 5 1 am a general contractor and I have hired the subcontractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurances 13.❑Roof repairs 1 - 6.0 We are a corporation and in officers have exercised their right of exemption per MCL 1410 Other We,, / 'u1 r \ 152,§I(4) and we have no employees.I No workers comp insurance required.) `Any applicant that cheeks box k l must also fill outae section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit mdicating such. :Contractors that check this box must attached an additional sheet slowing the name of the sub-cunt/actors and state whether or not those entities have employees. If the subcontractors 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 polity and job site information. '� res (� 1 1 h Insurance Company Name: 11V'O`11O .AC (C\ ()SUS-lac (C Policy#or Self-ins.Lic.#: Soy\ /`'I) l(( X)S\ Expiration Date: Job Site Address: 5 b\ac ' Lm City/State/Zip: J O(1\ek_tyv0 /otic- Attach a copy of the workers'compensati I tontolicy declaration page(showing the policy number and expiration ate).c\0 ctp 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 ratify under the pains and al ' perjury that the information provided above is true and correct Signature: C,` 1 Date: 3 Ic;l{ II ]- Phone#: UP J- 5;3B- O -/`'k A 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 if: ig 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 Expiration' Commissioner 111282018 i. e f Be'117•� 7 er:/,;'l n �,/ LCzAzici71E.1e/ Office of Consumer Affairs and Business Regulation t. ., 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 131279 Type: Individual Expiration: 6/29/2018 Trie 288957 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW -- - - EASTHAMPTON, MA01027 - -- -- -- update Address and return card.Mark reason for change. Address Renewal 1 Employment l-_ Lost Card SCA: fa 2O'-OS:: ipnn on? es a ��' __ Office of ARmBunResulahn. License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR Wire the expiration date. If found return to: �- Registration: 131279 Type: Office of Consumer Affairs and Rosiness Regulation -u .,' Expiration: 6292018 Individual 10 Park Plaza Suite 5170 Boston.MA 02116 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON,MA 01027 i..ndersecrOFFY Not valid without signature AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application Suggvacd AfftdxviL Fu Horn lmpmvcrcut Con vnot Ponwl AppGcffioc For Office Use Only Permit No.: Date: Fr Note 142 A, requires that the Areconstruction, alteration, renovation, repair, modernization, conversion, II1 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 I fI residence or building@ be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Weatherization Est. Cost: Address of Work: J Ij10•C L C Lc e., _LIN 0-31Y .4 Sit Cit., Co Owners Name: ,A De NAaQc Date of Permit/Application: 3 I D c'JSP I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S 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 NO HA '. ACCESS TO THE i ARBITRATION PROGRAM OR GUARANTY FUN P- . 1 to GG 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.k : 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. #: _ a' BEYOND GREEN CONSTRUCTION DEBRIS DISPOSAL AFFIDAVIT IN ACCORDANCE WITH FHE COMMONWEALTH OF MASSACHUSEI IS DEBRIS DISPOSAL PROVISIONS OF MASSACHUSEI I5 GENERAL LAW CHAPTER 40, SECTION 54, A CONDITION OF BUILDING PERMIT NUMBER FOR DEMOLITION WORK IS THAT THE DEBRIS RESULTING FROM THIS WORK SHALL 8E REMOVED FROM SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111, 5150A. FACILITY-. ALTERNATIVE RECYCLING, NORTHAMPTON, MA CONSTRUCTION SITE ADDRESS- b OI4 cH. Lx NCr I - it/VA-10 Cl Ute_ o TO BE DISPOSED AND it{ANSPORTED BY- BEYOND GREEN CONSTRUCTION or ALTERNATIVE RECYCLING a I SIGNATURE _ DATE 3/9q/17- City of Northampton ? i. �,� eAaasactnsetts "' . ,,10, F� 3ffiaA�T of 3#UILDIHG nrsezcmrwrs s ' 232 Hein Street Muni, M010 Ntildivg �, 1C Nertree®ptenNA 03060 Yp� '^�' Property Address: L o( C U1 V�)Ofd p ry 'Y o {\)C\Ay O IG(r c) Contractor �^ Name: riPtA,p. nc* P recn ConStruc:t-(on Address: 1 3 1 r(Care V city, state: EttSi-in a nCITY\ ; Mr OIoal Phone: Lf 13- 5aq- 054q Property Owner 1 Name: ,J( Q ��(kfklf�7_ Address: F9 G\CkCK-C0P_.CRL. nGn-(�2 city, state: 'N�'(` OOTV�li(l i vAri Q (Xo() I, J e an (_)Qt-r(Jr( (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 c=am Date 3 / (-{I l i- Permit Authorization 1r",Ti mass sa' Form T , Site ID: 50255332 - Customer: Joe Martinez L ` Joe Martinez ,owner of the property located at: (Comer's Name,Mrtld) S Blackberry Ln - Northampton Ipropeny Street Adbessl (CRY) 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: >./ ..� - Date: Cl /2-51/' FOR CLEAResult OFFICE USE ONLY CLEAResult has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date ®° CLEAResult a 50 washmgon Street,Suite 3000 a Westborough,MA 01581 • 1800-080-7412 pT For011iceu..Onty Rev. 102015 N