35-160 (8) 779 RYAN RD BP-2018-1231
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map'Block:35- 160 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-2018-1231
Proiect4 JS-2018-002199
Est.Cost: $533.00
Fee:$65.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group BEYOND GREEN CONSTRUCTION 074539
Lot siae(sa.ft.): 43385.76 Owner: RICE BETH M&JAMES W
onin : Applicant: BEYOND GREEN CONSTRUCTION
AT. 779 RYAN RD
ApplicantAddress: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAMPTONMA01027 ISSUED ON.5/2212018 0.00:00
TO PERFORM THE FOLLOWING WORK:AIR SEALING AT EST 62.5 CFMSO PER HR,
INSULATE REMOVAL, RIM JOIST 2" THERMAL BARRIER POLYISO
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:
FeeTYoe: Date Paid: Amount:
Building 5/22/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
—ry,4A'/A'kn--
REGEIVEDThe Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
F, A , USE
2��ildi g PTan Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
DEFT OF BUILDING INSPEDIIDNS This Section For Official Use Only
Applied:
t mg Official(P" ame) Sinature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: L2 Assessors Map&Parcel Num
ricl n Rd NOMyim1Dn,�� yrs
�T
L I a Is this aq accepted street?yesMa_ no_Q�C 1,p2 P 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.O.L c.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Name(Prinrt)� ]City,
,(Jtam�,ZIP
Nu.andNu.and titrectT "telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ 1 Existing Building❑ Owner-Occupied ❑ Repairs(') ❑ Akemtron(s) ❑ Addition ❑
Demolition ❑ AccessoryBldg.❑ I Number of Units`, • nr. Speciify:_UieoflgInZ.O.41jv ,
Brief Description of Proposed Work': Pp I_JeLLAjo O.,F- t', S P _
In L I n kl lis � 0014Cy.A ( l F ' .. f f Er \ I
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:$� Indicam how fee is determined:
2.Electrical $ ❑Standard City/town Application Fee
❑Total Project Case(Item 6)x multiplier,x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire S Total All Fees: ____L05
S cession) y(.tfC
CCheck No.J` heck Amount`Cash Amount.—
6.Total Project Cost: S 533 .5, D D ❑Paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES -
5.1 Construction Supervisor License(CSL)
SFAN R JEFFORDS
License Number �' Expiration Date
Name of CSL HoIdn fnp f -rt
List CSI.Type(see below)'
13 TERRACE VIEW
Type DesCrlpljon,
No.and Street U Unresuiged uil d b to 35,000 eu.fl.)
EASII[AMP FON,MA 01027 R Restricted I&2Farm DweIIm
City/Town,Slate,ZIP M masonty
RC Roofin Cwerin
WS Window and Sidin
SF Solid Fuel Burning Appliances
413-529-0544 SE NBEYONDGREEN.BIZ 1 Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 'J '1,Q `- an I Ij
Sean R Jetfords-Bevond Green Construction HIC ReegigtJrntion `Number Expirtion Date
IIIC Company Name or HIC Registrant Name
13 Tgraee Via. seanla�bevond¢men iz
No.and Street Email address
Easthampton 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 Nn...........❑
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_�Q,U("y,'lU cif 1-.0 P n $,A)I xhoa
to act on my behalf,in all matters relative to work authorize by this b� uilding permit application.
,S, e 0-k+CxCA P _- -- to it
Prim Owner's Name(Eleehonic Signature) Date
SECTION 76:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby pains and penalties of perjury that all of the information
contained in this application is true quiMA a best of my knowledge and understanding.
15 I
_Sean Jeffords I I
Print Owner's or Authonzed Agent's Name(Elec onic 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 nor 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.eov/dos
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
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-1017
wsvw.massgov/dia
ulk': Compensation Insurance Affidavit:Builders/ContrmtorsfElectricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY,
ADplicaat Information p Please Print Legibly
Name (Businc.srorganirationllndividua0: l7PA.�l7Y�� �'112f.n C6t�S`fr-�Gtion
Address: eg-( CQ \J V-0
City/State/Zip: Phone#: �13" 5' 1 —o'S14Y
Arepun as empwyer."Check the appmprlrae M,n DN O)�J Type of project(required):
I.EZ[am a enploycr with 3 employees(inn and/or pan-cure)- T ❑New construction
2.❑l em a sole propritlmorpemership and havcw employees workbag arncin g. ❑Remodeling
any capeary [Nouarteri camp immanee re,rud.)
3.❑I on a homemmerdi ing all work myidf[N.roxkers'wrap.rewxxc ,uhed]' B. ❑Balding n
4.❑1.xh....wneruid win be burn ymp�m, 10❑Building addition
g wnnacton rocandtar.i wank cis . Twill
entire rano all<onmcmrseiticerhare wvrkcrs'wmpcnseriun irsurawmr are wk ILE]Electrical repairs or additions
pmpdao ,nor an cmployeea. 12.❑Plumbing repairs or additions
slama yerel coramctormd l hurt hired dm -manac
sunwo luted on the maohed arra. 13.0 Roof repairs
❑TM1esarcsub-mmrazwrshave employees and Mve wohvi camp insurance:
6.❑ av
We o corporation end in offices he eaemad per their right of exemption MGL e. 14.[J Othe t
154 91(41 and we lave no emp6.y. IHo workers'con,.ir®oance.ox,wed I
*Anymsu
applicant that checks box al must also fill ora rhe hoist tela,showing their workers,compensation policy infomurion.
v Haruwaos who bmit thistionn it adrana,they are womanworkend dcen hire outsidecontractors must submit a.am&,.,oulaxong inch.
:Coonse rs that check thia how must warn an addnimal shret shawute'be nonce of dp:sus-ra nmctars and orate whither nr oar dense entities hove
employes. If the tab-rontractms Fave empMYrR rlwY moat provide thein wwkvs'comp.policy numbs.
lamanenspioyertkwisprovidingwarkers'compenswioninsuranceformyemployeex Below is thepolicy andjob site
information.
Insurance Company Name: cp J�fU`C/tt'A-V--T C'a � n5ll-ra-r\� o, _
Policy#or Self-ins Lic.#: U�,7 OS1 _ Expiration Dace:
Job Site Address: --n01fC,Uri-n F-6 City/sud.(Zip: NoY}�}') n��ll�
Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp[ra 'on 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 tIFjorm of a sTOP WORK ORDER and a fine of up to$250.00 a
day against the violator. A copy of this statement ed
to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under thepains and pens hat the information provided above is trine and correct
SienaWre: �a DataPhone 4: GI - �0e _ D�L{`I
Offaml use only. Do not write in this area,to be completed by rhy 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#:
®. Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-074539o,ervi
Construction Supervisor
SEAN R JEFFOROS
18 TERRACE VIEW
EASTHAMPTON MA 01027
Expiration:
Commissioner< 1112811018
V
_ Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration'. 131279
Type: Individual
Expiration: 629/2018 T4 288957
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW - -
EASTHAMPTON, MA 01027 — - --
Update Address and mtum card.Mark reason for change
Address 'i= Renewal __! Employments Lost Card
M.vlSii
a_ Om rf trt &sunvera ReMWdart. License or rMistrntnn valid for individual use only
:---j1ROME IMPROVEMENT CONTRACTOR OefOre the expiration date. If found return to.
<'.Ug, Regrstre0on: 131279 Type. Once of Consumer Affairs and Business,Regulation
.-,Z £ E piration: fi1292o18 Intlividual �r 10 Park Plaza Suite 5170
_
P Boston.MA 02116
SEANJEFFORDS
_ SEAN JEFFORDS
13 TERRACE VIEW _
EASTHAMPTON,MA 01027 UnJe rremn 'et .lid without signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
SugBf+'�"l kill vi:Poi HmwL".,1:1 atCemmNoePen,ti�AVlYimuvn
For Office Use Only
Permit No.:
Date
Note 142 A, requires that the Areoonstructim, alteration- renovation, repair, modernization, conversion.,
improvement, removal or demolition or the constructional of an addition to any pre-existing owner occupied
Note
containing at least one but no more than four dwelling unit, or to structures which are adjacent to such
residence orbuilduig bbedonebyrenstered contractors,with certniu exceptions,along with other requirements l
Type of Work:_Weatherization Est Coat:
Address of Work:
Owners Name: _ �e \-C`C.
Date of Permit (Application 1�.P
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)_
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';
ARBITRATION PROGRAM OR GUARANTY FUND UN R C. I42A.
I
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date: Contractor. BEYOND GREEN CONSTRUCTION131279
OR:
Reg.# :
OR: SEAN R JEFFOROS
Not withstanding the above notice,1 hereby apply for a permit as the owner of the property.
Date: Owner: Tel. 9
AWN
BEYOND GREEN
C O N S T R U C T 1 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 Cill,
S150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION SITE ADDRESS-
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTIgN.or
ALTERNATIVE RECYCL
SIGNATURE _
DATE ��'
Permit Authorization
mass save Form
Site ID; ;;57757 Customer. BETH RICE
I, 3,I A,c, .owner of the property located at:
IOw�ets Yam4O�Meal
779 Rvan Rd Norhamoton, MA 01062
(Prvperty5[reet Atltlrar) ICY)
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: %c-z-
Date: -tQa/S
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractortothe
above referenced project:
Participating Contractor Date
Name: CLEAP,esu:t
Prone: 800-480-7472
Email:
Fer Cifice Use Orly
Rev.102015 ._
Scanned by CantScanner
--\ City of Northampton
� - Massachusetts �..,
a
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M..tb ptm, � 01060
Property Address: 1 r'1 RUCx,� � NO W l Cc mP�-On�M P� o f v cc;-
Contractor
Name: - 1'te n Con5tntijor-,
Address: _ is PYt''G1fP V/ 41,L)
city, sate: X0.53 h Ct Vrt O)C)4-1
Phone: (4 1 O$4u
Property Owner vv77 ,�, � �- �J
Name: t?C.�'Y) r? I C'e—
Address: 110L QCt
City, State: O\ 01n2
i, S e an k1P Ard s (contrador) 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
Date 5 b Le 10
BEYOND GREEN
C O N S T R U C T I O 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@beyondgreembiz
Thankyou!
Mcafe]ej{ards
Beyond Gruen Cunstruaion i Preleet Coordi"Wr
Cell:413.539,17281081ce:413.529.0544
13 Terrace View,PasduLoWton i ww 1"ndgteenb tz
Beyond Green Construction "Leaders In Energy Efficiency" Phone:413.529-0544
13 Terrace View Established 1998 wwe.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539