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23A-021 (6) 19 PARK ST BP-2018-1220 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-.Block:23A-021 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Gategory ,NSULATION BUILDING PERMIT Permit# BP-2018-1220 Proiect# JS-2018-002180 Est.Cost: $1500.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group BEYOND GREEN CONSTRUCTION 074539 Lot Size(sp ft.), 7187.40 Owner: GALENSKI STANLEY J 1R&BONNIE GALENSKI&KATHY J TRENARY Zoning: URB(100)/ Applicant BEYOND GREEN CONSTRUCTION AT. 19 PARKS ApplicantAddress: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 0 WC EASTHAMPTONMA01027 ISSUED ON.•5/18/2018 0:00.00 TO PERFORM THE FOLLOWING WORK:INSULATE FLOOR BETWEEN FIRST AND 2ND FLOOR FROM THE EXTERIOR 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 4 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: FeeTyoe: Date Paid: Amount: Building 5/18/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner M801LOING The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Building Code,780 CMR MUNICIPALITY USE it Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 OF One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number. ./ —/dela Date Applied: Building Official(Print Name) gnatme Date SECTION 1:SIT NFORMATION 1.1 Property Addrea: I.2 Assessors Map&Pam]Numbers i I� Qcuy si �ivaQX PQI MA 010.aa A3A C61 L Is Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Aroa(sq R) Frontage(R) 1.5 Building Setbacks(B) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(MAL a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Pni ac❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Chock ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: rccuer�s �IOvpl���lr��+ (DIOQqa Name(PrivQ City,Stow,ZIP I`7- s+ No.and Street Telephone F:meh Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ NumberofUnits Other H Specify:Lp.UQbpn) Brief Description afProposed Work': a—N 0( 3loco;,d SECTION 4: ESTIMATED CONSTRI&TION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) I. Building $ 1. Building Permit Fee:$ Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Su ression Total All Fees(�I 5 Check No. a�Chec� k Amount: Cash Amount:_ 6.Total Project Cost: $ Soo 13 Paid in Full 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) SEAN R 1FFPORDS \ �— v License Number Expin d Dow • A Name of CSL holder 1 / List CSL'I'ype(sec below) y\ _ 13 TERRACE VIEW Type Description No.and Street U Unrestricted(Buildings up to 35,000 cu.R. EASTHAMPTON,MA 01027 R Restricted 1&2 Family Dwelling City'Town,Slate,ZIP M Mason RC Roofing Covering WS Window and Sidin SF Solid Fuel Floating Appliances 413-529-0544 __ SEANaBEYONDGREEN.BIZ I Insulation I eleebone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) A Scan R leffords-Beyond Green Construction \ on Dale HIC Company Name or I HC Registrant Namc HIC Registration Number Expirati 13'1 enmee View wan@bevondreg�b•< No.and Street Email address Easlhamolon MA 01027 413-529A544 Ci /Town,State,ZIP 'Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.5 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 1,as Owner of the subject property,hereby authorize �.UOne,� C-�rrv� LY(yl$k'(1.1 'j0✓\ to act on my behalf,in all matters relative to work authoriu� y)1�permit application. See cAt'c&L—yd, 5�1 5118 Print Owner's Name(Electronic Signature) Date SECTION 7h:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,1 hereby attest maler!!kpams and penalties of perjury that all of the information contained in this application is true and best of my knowledge and understanding. _Sean Jeffords Print Owner's or Authoriecd Agent's Name(EI is 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.gov,'oca Information on the Construction Supervisor License can be found at www.mass.uov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.fl_) (including garage,finished basemenl/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 ofMassachusefts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-1017 www.mass.gov/dia Wil.orkerst'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ADolicent Information Please Print Legibly Name IBtamam9or,anirstitmmaivianap: tie y — Ute r) ft r PJ-RA 0�j On Address: &p V I City/State/Zip: Phone#: Are you as employer."Check me appmpehoe 0014Type of project(required): I.alunaanpI'vu."h employees(fun anNor(amtorc7• 7. ❑New construction 2.❑I em a We loopnerm or grmership and have no employees working for me in 8. E]Remodeling any capacity [No workers comt.insurance is,miM.] 1.❑l ama haeower,darn,all work mwa yself(No workers' p.i....amyuired.l' 9. ❑DemOhdan m 4.❑1 am a homeowner and will belourbi mnaamom ton o cduct ell work mn mnry.y ptupI will ID E]Building addition comor mmall c.ouseemerhaveworkers'campmantam insurance or ore sae IL❑Electrical repairs or additions pvpdemrs wear on,employees. 12.❑Plumbing repairs or additions 5 l am a annual conuarer and I Inure hued are subcontrxmm load on the member shin. -❑ U.❑Roof repairs Thea sub-coauclomhave employees and have workers ramp.insmaricet fi.❑We are a cnammuoo mM in officers have ezerciud their right of uempian per MGL c. 14.�O[he[ �1�SIM HT1(/ 152,L(4),and we have nor employees.INo workers comp.insumcemqumed.l 'Any applicant the checks box#1 mua also fill out the section bel.,,showing their workers'compelandum policy arformmiw. s Homnnwnus who submit mu affidavit mdicaing arry arc doing ill work and men ban named,mnlmewts mast submit a new affidavit irdiwram such. IConmcmrs our check arts one muss an aband an adi itiurul sheer afwwmg the outs of the subaonmcmrs read slam whMu ornot come entities have mnploym. If the orb<onnecmm have employees,may must provide areir workers'camp.policy number. I aria an employer that is providing workers'compensation insurance far my earwh yses. Below is Me pokey andjob site Information. NOrGua�d ��1SLtro0 Insurance Company Name: Policy#or Self-ins.Lurie# S(A)CO3 )7QQ0S I Expiration Date: Job Site Address: I I' Yl '�Vai \L 5� City/State/Zip: -Vio)tv)('P- If pi Attach a copy of the workers'compensation policy declaration page(showing the policy number orad 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 forth of a STOP WORK ORDER and a fine of up to$250.00 a day against the vitiator.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under fhepains andpenaldeso erjnry thin the information providedabove is true and correct Si nature: Date: Phone#: Oficial use only. Do norwrite in this a3a,m be complexed by elly or town official. City or Town: Permit/License# heading Authority(circle one): 1.Board of Health 2.Building Department 7.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: AFFIDAVIT Home Improvement Contractor law Supplement to Permit Application 9ngg�zmtl AlFtlavl:Fw Hui- For Office Use Only Permit No_: Date: r 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 orbuilding©be done by registered contractors,with ceratin exceptions,along with other requirements. Type of Work: Weatherization Est. Cost: Address of Work:_ n Jar -1'Ar( Vl t_ _t`1�AP, IC)(-p.a Owners Name. _. fl\QCA C"l( _'Lj�'Y✓1 _ ____— — ___. Date of Pcrmlt/ 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 Ownct pulling own permit Other(specify) I Notice is hereby given that: [!0!W!NEp.SPULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTLRED CONTRACTORS OR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO TI IF. 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.n 131.279 OR: SEAN 9 JEWORDS Not withstanding the above notice, I hereby apply for a permit as the owner of the property. Date: Owner: Tel. # Massachusetts Department of Public Safety Board of Building Regulations and Standards License CS-074639 Construction Supervisor SEAN R JEFFOROS 13 TERRACE VIEW EASTRAMPTON MA 0107 Expiration: Commiasionerr 11manois / rrlrfrcrzrr�e/G 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 Tru 288951 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW - EASTHAMPTON, MA 01027 — --- Conlon,Adore.and return card.Mark reason for change. Addrers r Renewal J Employment Lost Card scn-. G mevasin _ /r ume r0r)sl flu.¢ Lmense or rw4trahan valid for individual use on ly 'H I IMPROVEMENT ARI c NTRA t$ep nonthe -��- ?HOMEation: CI)NTAA(K,Tdh• before of C.oxRabantlffie. ltfoundretw R, Registration: 131279 Trpa Offire of Consumer AfOirsand Business Regulation Expiation: 81292018 hiffi at`� 10 Park Plaza Suite 5170 j)t1 B.mu.MA 02116 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON,MA 01027 g _- Onticrsccrcren� Not valid without signature BEYOND GREEN C O N S T R U C T I O N DEBRIS DISPOSAL AFFIDAVIT IN ACCORDANCE WITH THE COMMONWEALTH OF MASSACHUSETTS 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- D- E LL k Lk Flor co c4 n.tl9 NOU2- TO BE DISPOSED AND TRANSPORTED BY- BEYOND GREEN CONSTRUCTION or ALTERNATIVE RECVCLSNG, SIGNATURE G� DATE Permit Authorization BEYOND GREEN CO N S T R U C T I O " Form "LEADERS IN ENERGY EFFICIENCY' Job number: 5038 Customer: Stanley Galenski I, Stanley Galenski , owner of the property located at: (OY YaeE Name,pnYt d) 17-19 Park at. Florence, Ma (Property Street Mdress) (CRY) I hereby authorize Beyond Green Construction to act on my behalf and obtain a building permit to do work on my property. Owner's Signature: ��. �• Date: t,$0 Beyond Green Construction 13 Terrace view Easthampton, Mass. 01027. 413-529-0544 City of Northampton ' Massachusetts a ` SCI l S D3pIl Of HRIId a INSPSCTZOPS o rL au Main street o Mmimpa suildins 0�ry+�.� Noi tbavptw�, M8 01060 Property Address: `1 ' ca Y- SA �V�of P.n QQ VvkA OLO�"�- Contractor Name: t3etmnCi rQCYI COnS-11'VC�4-i !� Address: �J t r1r(arfvi >? to ) City, State: GLM Pt Y\ . MM A 0102-1 Phone: _ Li f -'0 9>L4 Properly owner Name: S�-G,n1 CAo-1Cr sx, Address: n_ Iq ,o-( sA City, State: -YIf�Y P6�c'0, �h-t Yr O ou-.4 I, S e CLO (contractor) attest and affirm that the building I intend to insulate does not have any open air((nob 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 't Date cJ Ili l 18 AWN BEYOND GREEN CON STRUCTIO N 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 @ 413-539-1728. See details below. Address: Beyond Green Construction 13 Terrace View Easthampton,MA,01027 Email Address: nicole@beyondgreen.biz Thankyou! Nicole)e,(f ords Beyond Green Construction I Protea Coordinator Cell:413.539.17281 Office:413.529.0544 13 Terrace View,Famt ptoa I www.beyondgreen.bi. Beyond Green Construction "Leaders in Energy Efficiency" Phone: 413-529-0544 13 Terrace View Established 1998 www.BeyonclGreen.biz Easthampton, MA 01027 CSL#74539