17D-026 (9) 77 STRAW AVE BP-2019-0318
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-026 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-2019-0318
Project# JS-2019-000514
Est.Cost: $681.99
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq.ft.): 16335.00 Owner: NAYAK ANAND P&POLLY FIVEASH
Zoning:URB(100)/ Applicant. BEYOND GREEN CONSTRUCTION
AT. 77 STRAW AVE
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (4139-0544 O WC
EASTHAMPTONMA01027 ISSUED ON.9/16/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-HOME AIR SEALING BASEMENT SILLS RIGID
BOARD 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 9/16/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
7vsu( j 1`l0�
C�l The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
o.' Massachusetts State BuildingCode 780 CMR MUNICIPALITY
4o (�� USE
>C -o Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
MI One-or Two-Family Dwelling
-- This Section For Official Use Only
3 uildir mit Number. — " al IDate Applied:
Building O ficial-(Print Name) 'Signature Date
SECTION I: SITE INFORMATION
1.1 Property Address: I (� 1.2 Assessor Parcel Numbers
t1
l.la Is this an accepted street?yes no U 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.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: i Outside Flood Zone? Municipal❑ On site disposal system ❑
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
ftnc-.,(��t 0.1 C_ r Q� Vt. A, Or OG a
Name(Print) City,State,ZIP
J-1 �5+yu uJ A!P
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check aU that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other &-Specify: lti l l L)-
B ief Description of Proposed Work2: Cv1, 1 S
n5 uu o
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:$ Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Suppression) Check
All Fees:
Check No. _Check Amount: Cash Amount:
6.Total Project Cost: $ (Q g 0 paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) C _0��t �j S� ,
SEAN R JEFFORDS CJ 1 U
License Number Exp iration Date i
Name of CSL Holder
List CSL Type(see below)
13 TERRACE VIEW
Type Description
No.and Streett,s
U Unrestricted(Buildings up to 35 QO cu.ft.
EASTHAMPTON,MA 01027 R Restricted 1&2 Family Dwellin" { r
T
M Masonry w
City/Town,State,ZIP
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN@BEYONDGREEN BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) j 9 )-Jq�o �5 9
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration ate
HIC Company Name or NIC Registrant Name
13 Terrace View sean@beyondgreen.biz
No.and Street Email address
Easthampton,MA 01027 413-529-0544
Ci /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...........❑
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 0� u ! L.Jvn
to act on my behalf,in all matters relative to work authorized4 this building permit application.
-5e e C0
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attNo West
ins and penalties of perjury that all of the information—0
contained in this application is true and of my knowledge and understanding.
_Sean Jeffords
Print Owner's or Authorized Agent's Name(Electro 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. o� v�Information on the Construction Supervisor License can be found at www.mass.goy/dpss
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
1 Congress Street,Suite 100
Boston, MA 02114-2017
p
.J www.mass., dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pltnmbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
ticant Information Please Print Legibly
Name (BusinesJOrganization/Individual):
Address: ` rraj 1CC C CA Q-t V/
City/State/Zip:,Q a(Yl Phone#: q i 3 " 5a C - L 15LI
Are you an employer?Check the appropriate box; Ua Type of protect(regained):
1.1�4 lama employer with—3—errrployces(HI and/orpar-time)." 7. El New construction
2.❑I am a sole proprietor or partnership and have no employees working for mc in 8. Remodeling
any capacity [No workers'comp insurance required.]
t 9. ❑Demolition
3.F-]I am a homeowner doing all work myself[No workers'comp.insurance required]
10 ❑Building addition
4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions
proprietors with no employees.
12. Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractars listed on the attached shcct. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp insurance.
6.❑We are a corporation and its officers have exercised their right orexettrption per MGI_c. 14.JS Other 0Zj-jl'(,fl 7
152,§1(4),and we have no employees.[No workers'comp insurance required.] 1
*Any applicant that checks box f:1 must also till out the section belok:,showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
'+Conttrrctors that check this box rust attached an additional sheet showing dw metre of the:tub-crxwboori anal State o k-ther or not thotc vrtiti!t?z rve
employees If the tub-caru=tan have employee%:they ment provide their mercken'Lom p policy eutmbe-
I ani an employer that is providing rs orkert'comrperxsadon imurauce fi r my employee& Below is the policy and job AAr
information.
Insurance Company Name: I/[V r ,/ / I
Policy#or Self-ins.Lic.#:_ W 1 1 _ Expiration Date:_-__ Ly
Job Site Address:_.11y1�ATCUJJ ON�L City/Stat&Zip: -R 0 eff� "4,
Attach a copy of the workers'compensation policy declaration page(showing the policy number and ezpvaties daft).
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 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. do
I do hereby certify under the pains err u jury that the information provided above it true and correct
Signature: -- -----Date_ _
Phone#: ---- -- — -- -- -----
official use only. Do not write in this area,to be completed by city or town official.
City or Town: `-____Permit/I.icense#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-074539
Construction Supervisor
SEAN R JEFFORDS {
13 TERRACE VIM''
EASTHAMPTON MA 01027
i
.. Expiration: }
Commissioner 11!28{20is i
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
Registration: 191746
BEYOND GREEN CONSTRUCTION INC. Expiration: 05109!2020
13 TERRACE VIEW
EASTHAMPTON,MA 01027
Update Address and Return Garp.
scA t0 2ok4o5ri7
office of Consumer Affairs s Business Regulation
HOME IMPROVEMENT CONTRACT Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
ReW§Uztioa ExpirationOffice of Consumer Affairs and Business Regulation
191746 05!09!2020 One Ashburton Place-Suite 1310;
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFORDS
13 TERRACE VIEW
EASTR.OAPTON,MA 01027 Undersecretary Not valid without signature
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4'i1.SSAClHlUS— 3:' J`.-:�BT.a DL:"?Pi�t&�?Y #'.Q.t 1.As tl3 ., OF
MASSACHUSETTS GENERAL L.AW CHAPTER 40, SECTION
FSR DERw Ti
`;:AT T�tE DE3RIS
RESULTING Fp0m -f,H FROM
SITE AND DISPOSED c)E T-N A PROPEP "x L.,--ESED S�
WASTE- Dl.—IDPOSSAL FACt. S.—ly
r
S1 5t0A.
DRE
TO BE DISPOSED AND TRANSPORTED By--
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE qF-CVC'-'NG
DATE
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City of Northampton
Massachusetts
( � i _ s
DEPARTMENT OF BUILDING INSPECTIONS y'•,
212 Main Street • Municipal Building J`f•., OCD
Northampton, MA 01060 SVjY �1
Property Address: fICw0 AVC rC-K)C Q ,M 0 Iy U �-
Contractor
Name: bu Jonck N
C�lfcfrr nna�nA"oo
Address: �) 1 c 1-fo CQ V I r'W
City, State: &W CCL(yW U.,j ,'M 0, C 1 C)
Phone: I �j- S US C4 LI
Property Owner
Name: pr)ar)d �j"a J<
Address: S4 aW Avg�-
City, State: ��C)t C0 C c? v'\ CO
I, S2Gl'�l �Qf�S (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 t have
provided the property owner with a copy of this affidavit.
Contractor signature
Date � ' I
.t
a r
r.:
,.��� .,�
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I, Anand Nayak
(Owner's Name)
owner of the property located at:
77 Straw Avenue
(Property Address)
Florence, MA 01062
(Property Address)
hereby authorize
. (Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
;7
i.
Owners Signature
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 ( Canton, MA 020211339-502-6335
www.RISEengineering.com
i
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Ad�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 @ 413-539-1728.See details below.
Address: Beyond Green Construction
13 Terrace View
Easthampton, MA, 01027
Email Address: nicole@beyondgreen.biz
Thank you!
Nicole Jef fords
Beyond Green Construction I Project Coordinator
Cell:413.539.1728 I Office:413.529.0544
13 Terrace View.Easthampton I 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
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