25C-141 (7) 47 ORCHARD ST BP-2018-1296
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C- 141 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory-INSULATION BUILDING PERMIT
Permit BP-2018-1296
Project# JS-2018-002308
Eat.Cost: $3534.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Grouo7 BEYOND GREEN CONSTRUCTION 074539
Lot Size(sp.ft.): 10018.80 OWner.- OSHINSKY RACHEL
Zoning: URB(99) Applicant.• BEYOND GREEN CONSTRUCTION
AT: 47 ORCHARD ST
ApplicantAddress: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 (1 WC
EASTHAMPTONMA01027 ISSUED ON:6/7/2078 0:00:00
TO PERFORM THE FOLLOWING WORK:ATIIC FLOOR - 6" OPEN BLOW
CELLULOSE,DAMMING KNEEWALL 2"THERMAL BARRIER POLYISO, KNEEWALL SLOPE - T
FIBERGLASS BATTING, AIR SEALING AT EST 62.5 CFM50 PER HR
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 Sianature:
FeeType: Date Paid: Amount:
Building 6/720180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
47 ORCHARD ST BP-2018-1296
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:25C- 141 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeorr INSULATION BUILDING PERMIT
Permit# BP-2018-1296
Proiect# JS-2018-002308
Est.Cost $3534.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group BEYOND GREEN CONSTRUCTION 074539
Lot Size(sg ft.): 10018.80 Owner: OSHINSKY RACHEL
Zoning: URB(99)/ Applicant: BEYOND GREEN CONSTRUCTION
AT.- 47 ORCHARD ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON.617/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.ATTIC FLOOR -6" OPEN BLOW
CELLULOSE,DAMMING KNEEWALL 2"THERMAL BARRIER POLYISO, KNEEWALL SLOPE - 6"
FIBERGLASS BATTING, AIR SEALING AT EST 62.5 CFM50 PER HR
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 Sienature:
FeeTvoe: Date Paid: Amount:
Building 6/7/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
R IVED ��`_
The Commonwealth of Massachusetts
b Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Pen fit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
DEP OF suaoaas INWEGM I One-or Two-Family Dwelling
toed
This Section For Official Use Only
BZPe it Number: ' l 1 Zq Date Applied:
mi rint Name) Signature Date
SECTION I:SITE INFORMATION
1.1 Property Address: 12A M &Parcel Number y
LI°l C7rCh3fCd_bF ).1� A1QM-D'SW\V.t.4'k
l.l a Is this an accepted street?yes_ no_LLjtLO Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq to 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:
Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ Ou site disposal system ❑
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
L_Q Y 1nSkU _ NOta namnn 6\CA9
Name(Print) city,Slale,7.IP r
L-1G o r �5�- Ei r�5-'(-CIV
No.and Street 'telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied (3Repairs(s) 10Alteratica(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.L3 Number of Units _ Other 6Specify:
Brief Description of Pro osed Work': (— tt Y1tia
1 - rt \ - l\So — lov \
G-k ea
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials
I. Building $ 1. Building Permit Fee:S 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: S
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire
Suppression) Total All Fees: 1
2' ' Check No. Check Amount:__Cash Amount:
6.Total Project Cost: S 353U 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES -
5.1 Construction Supervisor License(CSL)
SEAN R JEFFORDS
License Number Ex it It t
Nameof(1SI.Ilolda
List CSl.Type(see below '_. _ _ _
13'1'ERRACE VIEW
Type _ Description '
No.and Street U Unrestri<ted(Buildings u to 35,000 cu. It.)
EASMAMPI'ON.MA 01027 R Restricted 1&2 Family Dwelling
M madienry
City/town,State,LIP
RC Rwrfin Covcrin
WS Window and Sidin '
SP Solid Fuel Burning Appliances
413-529-0544 SEAN nBEYONDGREEN BIL I Insulation
'telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) , I
Sean R Jelroili-13"rad Green Construction HIC Registration Number Expiration Date
HIC Company Name or I I IC Registrant Name
13'Idonee View _. seantStbm'ondereenbz
No.and Street Final address
Easthampton.MA 01027 _ 413-529-0544 _
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 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR AP,P�L_IE-S1 FORBUILDING PERMIT �- ,,, 1
1,as Owner of the subject property,hereby authorize 6CLA U 2k \ I f Q e(-) l Q)03 i�J.�l\Cl
to act on my behalf,in all matters relative to work authorizedthis building permit application.
See a-V-ac act, - -- 5 �2 1$.-
Pnnt Owners Name(Electronic Signature) Dale
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my time below, I hereby attest under th I ins and penalties of perjury that all of the information
contained in this application is one and ac est of my knowledge and understanding.
Sean Jeftbrds TJ
—_—__ --_. _ - _..--..___
Print Owner's or Authorized Agent's Name(Elcclr cSignamrc) 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. ow/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.IV) (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 halfibaths
Type of heating system _ Number of decks/porches
Type of cooling system Enclosed_____Open_ Open
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 01114-1017
www.massgov/dia
Ulkirkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Lisdilly
Name IHusmnyOreanocitimi ladividua012: [ e k ino(:A (2 Q✓1 �O ,I C'ifl c)'1
Address: -TU Ma- Vi 6JJ
City/State/zip: Phone#: U I3 5aq -05 U LA
Areyoue.amployeC Check Ue appmprine Ma: V�karq- Type of project(required):
I. lama enpkov with�enployea'(m11 esW/ar penana")- 7. ❑New construction
2. ams.mlepmpdmmmpmteshipaWMv poempioyeeawoh gfornain S. E]Remodeling
ins capacity.[No workms'comP'ma.e n nt on,ti st)
3.❑Iamahm
oeownerdoin,allwnrkmyself lNowmkers'comp_imv2rcesequimll' 9. ❑Demolition
a.❑I am a hommwner and wdl x hidn 10 E]Building addition
8 run iso n m candacull wink ce my ,spnly. I will
um met all wnu.mon eimer have workers'compensation insmarce or are sole lL❑Electrical repairs or additions
'o,",noo wim m e iploycea. 12.E]Plumbing repairs or additions
5.❑I am i ge nakon minorend I have hued the subaanmectms fined an the ane:hM ahem. 13.❑Roof repairs
i .subcomragm5 have employeesand have workers'comp.Insurences
6n we are a corporation and its officers have execood meir rials,ofounavion per MGL C.
l4''+' _ther V1
152,¢I(al,and we have no employees.INo worken'rump.insurance regnmi j
•Any aulknot thin checks Mx ill moat also fill out the section below showing their workm'compenmion policy inmmnown.
'Homeowners wM submit muaRMvh indicting tMy K doi�all wmkaM ttsn hue outride<ono-ecmrs must submit a new affidavit kdiuring such.
i('nntraemn.met eMxkmis hm must mechd en additional shret showing meoune of the suboontracbn arW stmt whMm m not mac rntdics lout
.nployem. Ifthe sobconwcmrs havc employees,mry must provide Meir workers'comp.policy numM.
I am an employer thatisproviding workers'compensation insurancefor my employees Below is thepaliey andjob site
information.
Insurance Company Name: n (ICr ✓�
Policy#or Self-ins/.L'ic.#: Su)(-C7 OcS I Expiration Date:
Job Site Addmss: `RC1 QrC4 /WCSI '�f City/State/Zip: NQ��w,v�rvl�)
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MCL 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. ang No
I do hereby certify under the pains andANMJffMMftUurY that the mformation provided above is nue and correct
Si nature: Date:
Phone#:
Oficial use only. Do not write in this area,o be completed by city or own ojTwot
City or Town: Permit/License#
Issuing Authority,(circle one):
I. Board of Health 2.Building Department 3.Cily/Town Clerk 0.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Penon: Phone#:
z_ J
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-074
Construction Supervisor
SEAN R JEFFORDS
13 TERRACE VIEW
EASTHAMPTON MA 01017
Expiration:
Commissioners 11118/[016
Office of Consumer Affairs and Business Regulation
t "
10 Park Plaza - Suite 5170
-" Boston, Massachusetts 02116
Home Luprovement Connector Registration
Registration: 131279 -
Type: Individual
Expiration629/2018 Tr0 288957
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW _ _ -
EASTHAMPTON, MA 01027 - -- --- -
Update Address and return card-Mark reason for change.
Address I Renewal .-:j Employment - Lost Card
, -
orire nsame nrt &BUNaiI au iiii .// License.,registration mlid far mdn-daal usciod,
,
note.
Wil.—. ;HOME IMPROVEMENT CONTRACt'4A. e, BCfim.fore BEPIfaboB ffor Irruundrnix Re :
Reglstretion: 131279 a 10 Park
Consumer Affairs end eusmexs Regulation
_ y E pimtion: 62912018 Indiv a '•+..� to Park Plaza Suite 5170
Boston,MA 021166
SEAN JEFFORDS d
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 Cnderseamtap Nat a alid without signature
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Pornit Appiication
5 Sk Alld—F, H r o _. .u.w_Pmi9pPl calon
For Office Use Only
Pei'nat No.:
Date:
Nt t I - q, oxitil that the Areennstruetmn, alteration renovation, repair, modems atiorr, cot easiai ., 1
NImprovement.eraent, remount or demolition or the constructional of an addition to any pre exesting owner occupied
ru idne -.ontain ng at least one but-to more than four dwell-ng unit, ur'to.stmctures which are adjacent SUCh
n
ccs duce m bml;^ldnr he done to registerd contractors,rsffh certain exccptions_aiong with other reSut.coloit__
Type of Work: Weatherization Fsr.Cost:
Acdmss of Work lf,_QfC,{-�lG�rd {Z-}-__NO(-YV')QX-lC�"f�(ltjt}
Owners Name: G.c,4'le�l_.
Date of Permit I Application:
i hereby certify that
Ragistratren is not i2qurred For the following reason (s):
Work excluded by law
Joh under S 500 00
Baildmg not owner occupied
Owner pulling own pewit
Other fspecif,)
Vence is hereby given that.
II
OWNERS PULLING THEIR OWN PERM11 OR)EAU-,U W11:11 ulNRECtSi ERrD CON n7 As_TORS
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:
1 hereby apply for a permit as the agent of the owner:
Date: Contractor. _BEYONDOREENCONSTRUCTION Reg.$ : 131279
OR: SEAN R EFFOPDS
Not withstanding dtc above notice, i hereby apply Fora pemtit as the owner of the property.
Date: Owner: Tel. it
BEYOND GREEN
C O N S T R U C T 1 0 N
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSETTS DEBRIS OISPOSAI. PROVISIONS OF
MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT" NUMBER
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM THI5 WORK SHALL 6E REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL 0111,
S150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION SITE ADDRESS-
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION Or
ALTERNATIVE RECYCLING
SIGNATURE C lr'x _._
DATE_-- J I� __ .
--- City of Northampton _
f }}} Massachusetts m
4 F; DSPdR94�'aT OF NNrrnny I SPECUMS -�
x�$ 212 Naim Street e�MmicLBal euildinS sf J..d,��:
NoxtNmpC NA 01060
Property Address: l- q Ordn(c( Sk . NO4" oL.LLR4()n I\ IA 01000o
Contractor
Name: pupnrA Prem COnstTociior,
Address: 1 PrI�G1t'P Vivax)
City, State: L(7 Si l 1 Gc3 n PiZ 1n i Mss 010-Q-1
Phone: 9 5 a 0 SLVA
Property Owner n
Name: aCi-.� C&-�tn's
Address: qq c a)w-d S+--
City, State: NU\'( t(�1r�1�T_b� t� lU�P(l
1, SMO O C 1 P BYO rW (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 thissaaffidd�avit.
Contractor signature
i
Date C-
/ f B
Permit Authorization
11faSS SdV� Form
s.�.w.mmw�eka. .
Site ID: 3375079 Customer. RACHEL 5 OSHINSKY
�@ ( 1� }} GG'' s
Wgb, Uarlif4.�Q. .3 F4%W& Q.sa6co,Sr owner of the property located at:
(P ftftmgprMadl
49 Orchard St APT 3 Northampton, MA 01060
(F.a tVSMKAddft,) fW
hereby authorize the Mass Save Hone Energy Services Program assigned Participatir;Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherhation
work on my property.
Owner's signature: �FtAr4t
Date: ij MAtZOL8
FOR OFFICE USE ONLY
We have assigned the following Mass Save Home Energy Services Participating Contractor to the
above referenced project,
Participating Contractor Date
Name: CLEAResult
Phone: 800-480-7472
Email:
rwOrRw Ume Only
Rev.102015
AVN
BEYOND GREEN
CON STRUCTI ON
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!
Nicolejeffords
Beyond Green Construction I Project Coordinator
Cell:413.539.17281 OOlee:413.529.0544
13 Terrace View,Easthamptm I wwwlmyondgreewbiz
Beyond Green Construction "Leaders in Energy Etticlency" Phone:413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539