17C-019 (2) 96 NORTH MAPLE ST BP-2017-1422
GIS it: COMMONWEALTH OF MASSACHUSETTS
Man:Block: 17C-019 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULAUON BUILDING PERMIT
Permit# BP-2017-1422
Project# JS-2017-002355
Est. Cost: $3000.00
Fee:$79.00 PERMISSION IS HEREBY GRANTED TO:
Const, Class; Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. tt.): 18556,56 Owner: HILL KAREN
Zoning:uRtit109)/ Applicant: BEYOND GREEN CONSTRUCTION
AT: 96 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMAO1027 ISSUED ON:617/2017 0:00:00
TO PERFORM THE FOLLOWING WORK: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 a 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:
FeeTyue: Date Paid: Amount:
Building 6/7/20170:00:00 $79.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-20I7-1422
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529.0544 0
PROPERTY LOCATION 96 NORTH MAPLE ST
MAP 17C PARCEL 019 001 ZONE URBOOBL
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
€yNCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ��
"hamPaid /I IA
e Permit Filled out 1D' ( .JJ
Fee Paid -1
Typeof Constriction: ATTIC INSULATION _
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:
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
De ,* ition Delay
Sis o Bu dingo tci: 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 MOL 40A.Contact Office of
Planning&Development for more information.
The Commonwealth of Massachusetts
FOR
Board of Building Regulations and Standards MUNICIPALITY
Massachusetts State Building Code,7S0 CMR USE
Building Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 201/
One-or Two-Family Dwelling
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
910 NC7lw W Q\e o; -C\ovencip MFt ,_r, X11
I.I a Is this an accepted street?yes, no O f(}(p c Map Number Parcel NumhY?
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq it) Frontage(ft)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(MMI c.40.§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: ___ Outside Floodyer❑Zone?
Cheeckk if yesMunicipal 0 On site disposal system 0
SECTION 2: PROPERTY OWNERSHIP
2.1 Owner'of Record:
SCSeYCU CAO TenCe- W1W 61Qts
Name(Print) City,State,ZIP
Sts Navy, Maple sr 23190- Od-6B'`\
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) ❑ Alteration(s) ❑ Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units Other Specify; fQ{ 'NQ1(ir& Oh
Brief Description of Proposed Workc:IlYN/cfCr 4 • .a ' " .. ., i t7c nct
ui{ S ttiYS- D`e(v .te '
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
I.Building $ I. Building Permit Fee:$ j 7 Indicate how fee is determined:
2. Electrical $ 0 Standard City/Town Application Fee
0 Total Project Costt(tem 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees:
Check No.(2213heck Amount: 1 Cash Amount:
6.Total Project Cost: $ 30o0 ❑Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) // C ' I
W—V�`M c�3 \ " IaY IX
SEANRJEFFORDS
License Number Expiration Dale
Name of CR.Holder
List CSL Type(see below) x/(
13 TERRACE YIEW
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.)
G.ASTtIANil?7g1N MA 01027
Restricted 1&2 Family Dwelling
City/Town,State,ZIP - R RfmMasonryCoveri
aog ng
WS Window and Siding•
SF Solid Fuel Burning Appliances
413-529-0544 SEANBEYONDGREEN.BIZ .. 1 Insulation
CM
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) j3/9 ci t /1y9/�t
Scan R Jeffords-Bevond(lrcen Construction HMC Registration Number Expiration Date
I iIC Company Name or}LIC Registrant Name
13 Terrace Y(ew_ scunanbevondgreen.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...........0
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize tr, ever") COs;rU 6_t n
to act on my behalf,in all matters relative to work authori -• by this building permit application.
3C,cathes.cbcd, Leh 11
Print Owner's Name(Electronic Signature) Date
SECTION 76: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 . �v - t . best of my knowledge and understanding. I
_Sean Jeffords ' I 1 _ j 1
Print Owner's or Authorized Agent's Name(El- I •nie 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 he found at
www,mass.aov/oca Information an the Constriction Supervisor License can be found at www mass e<w/dos
1 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 ofMassachusetts
It=?-'sem Y Department of Industrial Accidents
r=::11p ; I Congress Street,Suite 100
�. = I;i=a Boston,MA 02114.2017
www.ntass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contraemn/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information k r- Please Print Legibly
Name(Business/Organization/Individual): ..y
Y)l�A,iCS(_ `'�, r('S'.y1 �7Y1.J his ki Or
Address: 13 c'"�fsV'}( fQ{.C'. N.tie/0.j/0.j c1- 05
City/State/Zip: CLQ '�'10..'�f,ot-ir\)\"�l�- Phone#: f 1 5 L{'`{
Are you as employee Cheek;my�<appropriate hex: 010a1A Type of project(required):
mli
1.fllaa npioyer with. I employees(toil a°Nor pn.tin).* 7. Q New construction
2.9!ame sole proprietor orpnMnvship and have no employees working for me at 8. ❑Remodeling
any capacity.[No workers'comp.insurance requires)
l.Qthomeowner
n a homeowner doing all wok myself[No workers'camp.awning squired?' 9. LI Demolition
4.01 akm
area neoweerand will be hiring contractors to +twtaft weskonmy property. I will 0 9 Building addition
ensure that all contractors tides have wo kilo compensation insurance or are sole 11.0 Electrical repairs or additions
proprietor"with no employees. 12.0 Plumbing repairs or additions
5.91am*gamaicwactm and I have hired the sub-convectors listed on the cached shat 13.O Roof repairs
'hesesuiscontractors have employees and have woken mag
comp.ieries: np
6.9 Weun
at apgmo°mofficers ditsoffihavicexatisedthrrybrofaeaptiwpmMOLc. !#.�GhC[ Ir n Uti �l t a
152,41(4),and we have nn employees.[No workers'compMinim=required.)
*My applicant dal checks box#1 must also fill out thesection below slowing their woken'compensation policy inflaming).
?Homeowners who submit this affidavit indicating they are doing as wok and then hire emside contracton mist submit a new affidavit indicating such.
ttonoacmrs tat check this box mast attached an addidowa!shea'bowies the same of the sub-enmities and slate whether or not dose a nnaies have
employees. Koh subcwmxmn have ,.wL,r...a,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. „,�
Insurance Company Name: IVOr4uo,Y(,} Lnsux`C-lnCf- — a�
Poli if Self--ins.Lic.a: SW eC O(Ci5l I- I ' Ip
Policy y,( Expiration Data: i
Job Site Address: "ISL UOYW MRQIC 63i Citylstate/Zip: 1Ur cite ;ma (pi CXo -
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 onayear imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.0 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 hat certify ander the,..�scir4ties of perfury that the irrformadon provided above is true and correct
Signature:
�` Date: L I ) 1 17
Phone#:
•
Officio use only. Do not write in this area,to be completed by city or town g87eiat
City or Town: Permit/L)eense#
•
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Towa Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
V_ 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
7;
"� -- Expiration:
Commissioner 11/2612018
tiJhe (00 Ji2'f7'iCJ7 ieje fll�1 a c Ct;:Jttc,4uje7t
Office of Consumer Affairs and Business Regulation - -
N ,
10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 6/29/2018 Tri 288957
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON, MA 01027 --- -- --- — -- -- -
Update Address and rerun,card Mark reason for change.
sca, 0 maws,, Address F. Renewal 7 Employment L. Lost Card
r
jAre c-winejnorriae/C/G,.0 A,.d/
otfc fC ARl A Busifes Beg1liv License on registration valid for individual Use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If fOaad return to:
Registration 131279 Type. Office of Consumer Affairs and Business Regulation
F Expiration: 6/292018 Individual Ill Park Plaza-Suite 5170
'-�.=•_° Boston,MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW _
EASTHAMPTON.MA 01027 —'-- --------Undersecretary Not No[valid without signature
............
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
S WYmtn A1Gdevir For Hmw a irocoemcnl Comecon Pmnil 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: Wealherization Est. Cost:
Address of Work: gt0 (Uvr Mo-p1P, S1- 1DYP Qe ,T�'�l� L� \GLoa—
OwnersName: 'eclat'
Date of Permit/Application:
I hereby certify that:
Registration is not required for the following reason (s):
Work excludedby 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 CONTRACT ORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL C. 1.42A.
Signed under penalties of perjury: '�
l hereby apply for a permit as the agent of the owner:
Date: Contractor: BEYOND GREEN CONSTRUCTION Reg. 4 : 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:
a
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-
Sc, Ivor-w-I mope_ st. Yiorence, oiccfla
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE
DATE Can I/ 7
City of Northampton
!/ A Mneeachuaetts
f
• CLPdRffiAS W' BaLLUTBG IF:�A.CSZ®S �1 r r.
4 212 Main Street • Municipal Building L.'11rI.
c
v�. r:10� ..
Morthempton, Ma 01060
Property Address: G 1,7 N O r-hn ivIcto t-c S+ - Th C re,n 0 C. 1 MO o oLG -3-
Contractor
Name: e(AO rt(-A -(-;recti Conyn-txi- on
Address: 33 .41- Pilaff V( tJ . )
city, state: Ea S-t-1'1 airs( 1t Y\ ;M A 01041
Phone: q I ?I- 5aS- 054u
Property Owner
Name: kCkYQir1 0111
Address: c( 0 N OYT 1W P J t Sal--
City, State: f(O l C f CC7 NI 0- 01 DDLo�
I, J e an c\p Y"Ck} (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 oc//g
Date C-0 I illl
RISE `
EO 8harnuR Road,Unit 21 Canton,IAA 00041 ,339402-6335
ENGINE:RING wwwRllewglesMYrp.,com
?Kiger
OWNER AUTHORIZATION FORM
I. Khmers Name) k '
owner of the property located at
Sir vt& !A..** s\
(Property Address
-
C5 P:AcP IA* O t o
(Property Address)
hereby authorize
(Subcontractor)
an authorized subcontractor tar RISE Engineering,to act on my behalf to obtain a bulging
permft and to perform work on my property.This form is only valid with a signed contract.
The Penni will be secured by the insulation contactor,at no additional Lost. It is the homeowner's
responsibility to does out this permit by contacting their municipality at the completion of this work.
44
Ownersgue6*
nabae
l - l 's- I -1
Date
020113
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!
NE(ate jet-Fords
Beyond Green Construction I Project Coordinator
Cell:413.478.86311 Office:413.529.0544
13 Terrace View,Easthampton I www.beyondgreen.hlz
Beyond Green Construction "Leaders In Energy Efficiency" Phone:413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539