05-016 (8) •
123 AUDUBON RD BP-2018-0002
GIS#: COMMONWEALTH OF MASSACHUSETTS
:Bloc
Mapk:05 -016 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: REPAIR BUILDING PERMIT
Permit# BP-2018-0002
Project JS-2018-000005
Est.Cost:$18000.00
Fee: $182.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 25918.20 Owner: WEIL BENJAMIN SOLOMON&LISA MICHELLE RASCO
Zoning: RR(I00)/ Applicant: BEYOND GREEN CONSTRUCTION
AT: 123 AUDUBON RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAM PTONMA01027 ISSUED ON:7/5/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:ICE DAM REPAIR, REPLACEMENT OF
SHINGLES AND ROOF LINE TRIM, AIR SEALING TO CODE AND NEW 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 7/5/2017 0:00:00 $182.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-0002
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 Q
PROPERTY LOCATION 123 AUDUBON RD
MAP 05 PARCEL 016 001 ZONE RR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvneofConstruction: ICE DAM REPAIR, REPLACEMENT OF SHINGLES AND ROOF LINE TRIM,AIR
SEALING TO CODE AND NEW 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
INFpRMATION PRESENTED:
V 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
Demolition Delay
11 /17
Signature of Building Official 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.
i
_ The Commonwealth of Massachusetts
Board of Bng Regutid Standards
FOR
Massachusetts Building State Buildinglaons Code,an780 CMR MUNICIPALITY
M USE
I Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
Ci : I This Section For Official Use Only
iinglPermit Number. Date Applied: __
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1I ly P�rty g re n L- C 1.2 Assessoyc M1lap&Parcel NumJteeys
a K1 0.00t t IPO" Cl'j (JI
I.I a 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(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:
Public 0 Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1�..o�twner'of Record: 5
KPn yJ21\ _ Leena t YO 3
Name(Print) City,State,ZIP
la34Lautbun9caai _ 931- 5& -3'438
No.and Street 'telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building❑ Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other 0 Specify:
Brief Description of Proposed Work': Ire awl rt CrfY pl�.cerktr F_rE 5t4 kSernd
hoc tan f___ —kr 'n . Aj.t' c,a r - rude etr6 t 0 art
— --
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs:
(Labor and Materials) Official Use Only
I. Building $ 1. Building Permit Fee:$]9J2 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: $
Check No.irj.3ki eck Amount: Cash Amount:
6. Total Project Cost: $ i%U f OR) 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) J C_ O—)L f �3� i106 i 3
SEAN RJEFFORDS _.-
License Number Expiration ale
Name of CSL Holder
List CM.Type(sec 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
Masonry
City/?own.State,ZIP M
RC Roofing Covering
WS Window and Siding
_- - - SF Solid Fuel Burning Appliances
413-529-0544 _SEAN(u1,BEYONDGREEN.BIZ I _Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(H IC) i3IalCj Ifi 1 413
Sean R leffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View ___ scannbcvondereen.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. 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
I,as Owner of the subject property,hereby authorize nYj bnC ( cc c Go I KT\ 1 &ck icy-\
to act on my behalf,in all matters relative to work authorize by this building permit application.
see a-I d-et a u1! ?
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 ac u the best of my knowledge and understanding.
Sean leffords 6 /30f
_ (
Print Owner's or Authorized Agent's Name( °Ironic 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. I 42A.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 basemendattics,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
R _ .l Department of industrial Accidents
es T,=:
E' —.en,_ 5 1 Congress Street,Suite 100
. r
Si_ ��r_ . Boston,MA 02114-2017
>s� wwsamass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electrician/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information , Please Print Legibly
Name (Business/Organization/Individual):
lndiv
ual): f)9A innol ('I ce en Ccn3\YUc_ On
Address: A� \-('flOQQ V V Q). 3
City/State/Zip: O-\ nacT\gcl..)hi`\Nn‘1'C Phone#: I\3- 5�=t-G6�-l�-C
Are Yoe aa employer?Check tthee appropriate box: O\l� ' - Type of project(required):
I.art am a employer with 3 employees(full and/or part-time)! 7. ❑New construction
2.0!ao a sole proprietor or permashi*and have no employees working for mein 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.l
3.0 I am a henwowner doing all work myself[No workers'comp.insurance required.l' 9. El Demolition
x.❑lama homeowner and will be hiring contractors to conduct all work on my property. 1 will 10 Building addition
ensure that all contactor tither have workers'compensation inmmnee or are sole 11.0 Electrical repairs or additions
p0pfC1O1 with no employees. 12.0 Plumbing repairs or additions
5.0I am a gaol contractor and I have hired the subconmacmrs listed on the attached sheet
These subeamrectmshave employees and have workers'comp.immmce 13. oof airs
T
CP
60 We are a corporation end is offices have exercised their right of exemption per MGL c. 14. Other ttrt to.hii 1
152,11(4),and we have no employees.[No workers'compimmure required.]
'Any applicant that checks box al must also fill out the section below stowing their workers'compensation policy infatuation.
t
Hammonds who submit this affidavit indicating they are doing an work and tae hire onside contractor must submit a new affidavit indexing such.
tenni/etas that check this box must attached an additional sheet showing the name of the subcootxmrs and stat whaba not tiros amities have
employees. if the submnbacwm have employees,they must provide their workers'amp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. 'l �r
Insurance Company Name: VC��1 cA�C&ICk 9S 111 al canes/
Policy#or Self-ins.Lia#: nf 5 LCC . Expiration Date: I -1 11 �e
Job site Address: 13 3 t'tua V.hum 7v(,(. city/stateaip: L ce d 5 A*I d1u53
Attach a copy of the workers'compensation policy declaration page(showing the policy number andexpirationdate).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violatioppunishable 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 da hereby sorttfy under the pain .y '!�1perjury that the information provided
above
,i`s true and correct
signature: ) Date:
Phone#: 1,13-Sc>'a-tkS(-f
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 X.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
Suggasted AffideviL Fur rum:imprev,297=li CDTICSCLOc ppncn'on
For Office Use Only
Permit No,:
Date:
Note 142 A, requires that the Areconstruction, alteration, renovation, repair, modernization, conversion,
1 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@ he done by registered contractors,with certain exceptions,along with other requirement
Type of Work: LXctc 1IL414 Jr r tif5 Est Cost: ) 5 1 LW'__.
Address of Work: ( At lc6x0 Recta t e/a S th:_.
Owners Name: Ir✓Li (//
Date of Permit/ Application:
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 pul ling 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. 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 H JEFFORDS
Net withstanding the above notice, I hereby apply for a permit as the owner of the property.
Date: Owner: Tel.#:
W 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 11128/2018
,, y,.. tine l t'JI"[reef lr c(U//t
Office of Consumer Affairs .and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration'_ 131279
Type: Individual
Expiration: 612912018 Tri 288957
SEAN JEFFORDS
SEAN JEFFORDS .—_..._._ __.. _ . .
13 TERRACE VIEW
EASTHAMPTON, MA 01027 - - -- -------
Update Address and return card.Mark reason for change.
sca c � Address r Renewal 1 Employment i.._ Lest Card
zmso=,.,
' t, I nette,A,SE
e
UR d'Consumer&fairs&BusinessRestitution License or registration valid for individual use only
'MOMS IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Reytstredon: 131279 Type- Office of Consumer Affair and Rnsinecs Regulation
44 Expiration: 6!292018 Individual IO Park Plan-Suite 5170
Boston.91A 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027
-- - --"—
Clltl n:creterV Nut valid without signature
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSEJ IS DEBRIS DISPOSAL PROVISIONS OF
MASSACHUSH LS GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT NUMBER
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM THIS WORK SHALL DE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111,
51.50A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON; MA
CONSTRUCTION SITE ADDRESS-
' o . • i to L etLAS
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
I
A-
SIGNATURE —�. ...
DATE £pu 11'
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) k �p I a g
SEAN R JEFFORDS _1 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 SEANBEYONDGREEN.BIZ I Insulation
(a1
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I - i s-j 9 j p /a 9/I 8
S R J ff rd -B d G C sfNcti HIO Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View seanCdbevondgreembiz
No.and Street Email address
Easthamotoa MA 01027 413-529-0544
City/Town, State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.S 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 APPLIESFORBUILDING PERMIT
I,as Owner of the subject property, hereby authorize nil C7 re r n Cons+-r(Act?0 ✓)
to act on my behalf,in all matters relative to work authori by this building permit application.
Benjamin Wed Oren 4...2) 6/30/2017
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
Print Owner's or Authorized Agent's Name(Electronic 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 be found at
www.mass.eov.oca Information on the Construction Supervisor License can be found at www.mass.aov rips
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"
City of Northampton
+ Massachusetts a <
D[PARMIE T OF bOISDDW ISSPcnxass ¼!)
North ton, bl 01060
Property Address: ) aa. PUOi LAY1.)n Q-c LL' e(I,S)(v\-urY
Contractor
Name: I 't,{ flCA reCn CO n5"11-
'1 VC hD(1
Address: � T r(rare V i e,.J
city, state: Ca si*1'1 ca,prk v\ M ya o t oar
Phone: 4I ? 5aq- o51-It4
Property Owner
Name: den u1/4) -� 1
Address: t r3 3 \ J\CX UL\00 XC-1
city, Sttate: \--Qt'c,.sr \\A+\
I, Sean tQ -t-(Jr(i3 (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
r
Date G /30I ll
dr.\
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!
NicoleJeffords
Beyond Green Construction I Project Coordinator
Cell:413.478.86311 Office:413.529.0544
13 Terrace View,Easthampton 1 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