34-005 (9) 296 TURKEY HILL RD BP-2018-1382
GIS n: COMMONWEALTH OF MASSACHUSETTS
Map:Block:34-005 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Category INSULATION BUILDING PERMIT
Permit# BP-2018-1382
Project N JS-2018-002449
Est.Cost:$881.00
Fee:$65.0o PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq.ft.): 80019.72 Owner: NAKASHIAN NICOLE
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT: 296 TURKEY HILL RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAMPTONMA01027 ISSUED ON:612512 01 8 0:00.00
TO PERFORM THE FOLLOWING WORK•AIR SEALING, WEATHERSTRIPPING, BOOR
SWEEP, KNEEWALL SLOPE, 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:
FeeTvoe: Date Paid: Amount:
Building 6/25/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED
Vass�achusctts
onwealth o:J�w
Massachusetts
z Q01B ing Reguland Standards FOR
State Buildde, 780 CMR MUNICIPALITY
USE
o Construcair, Renovate Or Demolish a Revised Mar 2011
r Two-Family ellin K
This Section For Official Use Only
Buildin P i umber: '� Date Applied:
g mi tint Name) natm� Data
SECTION is SITE INFORMATION
1.1 Property Address: 1.2 Assesim Map& Parcel Numbs
ftGla CLQ l 4 _t( 005
I.I a Is this an ace ted street?yes_ no__OjfD Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
_—
%ening District Proposed Use -- Lot Area(sq ft) Frontage(0)
1.5 Building Setbacks(D)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply: (M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zma, _. Outside Hand Zone! Municipal❑ On silt dispusel system ❑
Check ifyes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner of Record:
AI CnIQ �Gkc�shtaP� _ __N_o( OL � , a oloco 3
+an Ir nen _
Name(Print) City,Scale..ZIP
�tlPTur�a, ugd __ _____ Gn-9d�-I�e �d�
No.and Street J Tel phone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction 13Existing Building❑ Owner-Occupied ❑ Repw (s) ❑ Alteration(s)1'❑ Addition ❑
Demolition ❑ Accessory Bldg.El Number of Units_ Other WSpecify:lll f3TV1 .1�i IXz J,nn
Brief Description of Proposed Work': t. _At E6a- S_jCfM_SO OCr Nr, ZX�CLiQLS'?aJ
wt_a(.her r 4e_L ' ' Dan>,c , ce t.l_y 4U$,—
004Y _Cl r fCS41L F�bLP=1�_`:--
SECTION 4: ESTIMATED CON RUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
I. Building $ 1. Building Permit Fee:$ 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,$� (Q
Check No. Zt i, Check Amoum: Cash Amount:
6.Total Project Cost: $ gg Q 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
SFAN R 1T.PFORDS ✓jj(,
Incense -Nu_mber �%plrWlnn l7ilc
Name of CSI.Holder (,�Y
Lia CSl,lypc(sceb nw)
13 TERRACE VIFW
Type "'Besewptlm_ '
No,and Street U Unrestricted(Buildings up to 35,000 cu. ft.)
FAS'IHAMPTON,MA 01027 R Restudied 1&2 Family Dwelling
City/lbwn,Slatc,ZIP M Mason
RC Roofrn Covering
WS Window and Siding
SF Solid Pud Ruining Appliances
413-529-0544 _ SEAN/alHEYONDGREEN 1312 I Insulation
l'el hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) �l(y 1�
Ot
Sean oma ny N Beyond Green Construction HIC Registration Number Expiration Dale
HIC Company Name or HIC Registrant Name
No,and St View sea t n bevond¢rcen b z
No.and Street
Email address
Easthampton.MA 01027 413-529-0544
Cit /Town,State,ZIP 'fele hone
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...........❑
SECTION 7e:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING/yPERMIT
I,as Owner of the subject property, hereby authorize
toad on my behalf,in all matters relative to work authorized bt this building permit application.
Print Ormer's Name(Electronic Signature) Dale
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 the Tmy knowledge and understanding.
Sean Jeffords _ lI`3_I ��
Print Owner's or Authorized Agent's Name(Iilecnoni�NOTES.:
Dale
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. ovg /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 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"maybe substituted for"Total Project Cost'
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www massgov/dia
Wil.cluers'Compensation Insurance Affidavit:Builders/Contractors/Electrician&Mlumben.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A li t
Information Please Print I.eatbiv
Name lDu;;�.�organimlerMml+eiaaall: �_�C L2�2_ '�.L1Y]sS+=Y � C22.v..
Address: !.'
City/State/Zip: C ,,,� Phone#: 5 r�- ()b N N
Areyou an employer.Cheek cue.ppmprinnbx. Il�-e Type of project(required):
L�Imvaemploymwnh_�_eodev,c«r(full An"panaurc) 7. ❑New construction
z.❑Iunaml[prgwielmar pemrmahip ami nave rw amptoy«.wmYiryl rm rre in R. ❑Remodeling
anye'alvaic INOwiwkers colon inawuwe mlwd.i
3.❑I amahomemmudoi2c s1nmk M udf pioourken'verrrp rmumrce redacted 1' 4 ❑Demolition
4,L]Iaae hommwnnmdwilt bchirine coni wrsmcmrdmtau«ork on mY Rupmg'. I«ill IO❑Building addition
mcchar an mmracmrs eiNm hav[workne wmpcmmian rmmerce or am w![ IL❑ Electncalnpans or additions
pmprxonra wilh rw er,lv,a c. 12.❑Plumbing repairs or additions
5.❑Iam re veno.,orad!IInar hired rA.- lined mr be gaMf a lett 13.❑ROofrepalR
Thesee.Iveorwrors hav[ump!gm and have wwkeWeaenp immer'e%
14.(�Other�]Q {�P,�u
fi.❑weare acnrli viuoR Mv[ex[rcire rleirripe efae�rion per MCL r. Vn
152,41(4),anddeve h
e havee n
no npluysm INo workers'wrap imwveersyuirN.j
•An,appinoalthm eheeksbon al mart atm fill outdfiv etiorrfinava showim Neir uankaas'mm asonvoiribe,erfmmtion.
�Ilnnrnwnw wlw aWmut Nit affu4vir vdicarina aeY art drains na wmkeM Nsss has auuiM cmraecbtimul submit a rew arfavir irdisaing such.
%fonbixNrs III61[M:k Nit Mrr inurl anv[bN m aGlilitmN abed flewmg rh[marc of Nc NbtiMIMIMf amt nttl[wMhn m rM IMre gllllin Mv[
mnploym It the aubavnaxwnlav[e�laym,tleymw Ro.ilc eMa amkers'umq PWaY wrnba•
/ant an rmployer that isprovidixg workers'cnmpeasadon insurancefor my employers Below is thepolicy andlol,site
information. //��
Insurance Company Name: N 0
Pot icy horSrif-ire-I.ic.k:__ 5&UJfC_o _,��- __. - Expiration Date:_
Joh Site Addreds.29—le ./� L gcK _ CityiscudZip:-�Qr� )wxvl-
Attach a copy of the workers'tompe livib n policy declaration page(showing the policy number and expire date).
Failum to secure eovemge as required under DAGL a. 152,§.25A is a criminal violation punishable by a fine up to 51,500.00
and/or m ecyear 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 DDA for insurance
coverage verification. ON ma
I do hereby certify under the pains and a riry fiat me infornmdon provided above is nue and correct
Datc____
Phone
Official use oidy. Do not write in this arra,to be caarpleled by rill,m town effaial.
City or Town: ,._- -__PermittLicense it
Issuing Aulbority(circle mul
1. Board of Health 2.Building Department 3.City?own Clerk 4.Electrical inspector 5,Plumbing Inspector
6. Other
Contact Person: Phone#:
i
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 11M1SI20te
� Ate_,
1� /
Office of Consumer Affairs and Business Regulation
W? 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
TVpe: Individual
Expiration: 629/2018 Tra 288957
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW _
EASTHAMPTON, MA 01027 - -- -
Update Address and return cord.Mdark reason for change.
Address 'i. Renewal Employment - Lost Card
xe. r, mewvv
✓�/4 °.(A License ar regiurafen unlit for mdn dual use only
/C 1Tegmahun
`.HOME IMPROVEMENECONTRACTOR before the expiration date. If found return to.
Registration'
131279 ^' , TYW Office of Cmsmase Aff + rs
vsnd R. mes,RegvErtion
Expiration: 62912018Istual 10 Pmkl'lan Suileo170
a Boston.MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 - — d -t - _ -
Ond ruaretery dott and without signature
AFFiDAVi L
Hume Improvemerri f ontractor Law
Supplcmcnt to Pe:mii App{ication
ti l ra�.a � nw«*,. c o .o_r„m re pFwazlon
ter Office Use Only
PemtitNo-
Uatr,-
T t e +Z - rt guttas iha[ the r eoonsvui tion,- alteration, renovation. repair. modemizntlon, cm - :ri..,
il,zpz,e nL r mu at or demob ion w the consLrucuonal of an addition to any pre-existing owner u fumed 1!
bUildlUeoteitbUg at least ore a t no more than fou, dweltmK unit or tc structures which are ad.acenr o such !�
� r sio i a'bictld ny be done b�regisrcr�lco�� cer�rs,ivitt ei trru ea.,-p ions along vath otlrc� regn c h_,i
Type of Work: Weatherizalion Est.Cost
_
Address c;Work
O,I7-Pa--
O meraName:
La e of 1'ertci[ Application: �_�_� ____ -
i net^np ceti :+[hat
Reg)sha[ion is not required iof She fuliowing reason (s):
W rk excluded,by law
.lou under .+X00,! ) I
Buodingnajo.vnes oc�urved
Ownerpullmg ewn permit
MILT(9pe6A')
.1nt e;r is hsmb; giver. that
FOWNL'RS PCILLUN6 THEIROWN' PERMi l ORDP_Ai ro W LH I-Ngr- IS1 FRED t rN�CAi TORS
II I
OR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE'.ACCESS TO THC.
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL,C 2A- J�
S gree+ aider perednes of Penury j
I heehy appl4 lo,a pennit s hcagent of Iie owner:
Datc: Co- r 9
aRNLI � RFr3127
OR: SEAN A JEFFpRDS
20 .-nsne-i .kc nbrve, noics,i ser-h) apph fo-aperxnit as the owner of the property.
Data Owncc rad.# t
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 `iISPOSAL PROVISIONS OF
MASSACHUSET15 GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT NUMBER
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM TH15 WORK SHALL BC REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL Cill,
S150A.
FACILIIY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION .SITE ADDRESS-
TO BE DISPOSED AND TRANSPORTED BY- 0-Io0a'
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE_._._/ ,, /
DATE _.. __SL! '' _.-..._
Permit Authorization
masssave Form
Site ID: 3410605 Customer: NICOLE NAKASHIAN
I, Jennifer Clarson , owner of the property located at:
(0wnees Name,Printed)
Turkey Hill Rd Northampton, MA 01062
(Property Street Address) (Cny)
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: Jennifer Clarson
Date:
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:
.cr M'i:e L'se^.rly
Rev.102015
AN�N
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 @ 413-539-1726.See details below.
Address: Beyond Green Construction
13 Terrace View
Easthampton,MA, 01027
Email Address: nicoie0beyondgreen.biz
Thank you!
Nicolejejfrn-cis
Hcyoml Grecn Constntction I Project Coordinator
Cell:413.539.17281 OtSce:413.529.0544
13 Terrace View,Easthampton I www.beyoadgreea.biz
Beyond Green Construction "Leaders in Energy Efficiency" Phone:413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74639
---� City of Korth=Wton
Md88dCt1ll80tfS
60- & y
l `�y DSPdtt�aT OF SOSS =G INSP&C=Dss t
x 212 ifain 9txeet • Mmi^z' }pilAipQ
NotF}.®ptwa, M 01060 .
Property Address: AGTL(IK�cw hal'K
Contractor
Name: _ CJPUafIC�A -�rC'eYl COfIS-Y1'VC.'}-'t01�
Address: _I J � �tirl�(�fQ �l{ �1�
City,State: Eayrh aA'o P-k) \ M O 102-1
Phone: q 121— 5aQ 0 51-4�1
Property Owner NsYIfar\I C�,P N ktU
Name: II II
nt
Address: q L0 Uj iI I �d
City, State: NOr1 Yl(AMuM Y AA- O1Qco �
I, S e Ckn (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
Date to/� 8 (