10B-106 (5) 2 FLORENCE ST BP-2019-0434
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 10B- 106 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-2019-0434
Proiect# JS-2019-000701
Est.Cost: $1814.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sg.ft.): 57934.80 Owner: BLACK ROSEMARY RACHEL
Zoning:URA(100)/ Applicant: BEYOND GREEN CONSTRUCTION
AT. 2 FLORENCE ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTON MAO 1027 ISSUED ON.1011212018 0:00:00
TO PERFORM THE FOLLOWING WORK.-AIR SEALING, ATTIC FLOOR INSULATION,
OPEN BLOW CELLULOSE, DAMMING
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:
FeeTyue: Date Paid: Amount:
Building 10/12/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
Nsv�A-4
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
ALITY
n Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
m One-or Two-Family Dwelling
CZ This Se hon For Official Use Only
'g m uildi it Number: ' Date Applied:
Q
Building cial(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assess p&Parcel Numbers
Ien s+ r*, ion Ir — 10
1.1 a Is this an accepted street?yeses.\�n \C. ap 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,>i 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ Zone: — Outside Flood Zone? Municipal❑ On site disposal system ❑
Check ifyes❑
SECTION 2:- PROPERTY OWNERSHIP'.
2.1 wner'of Record:.
Name(Print) City,State,ZIP not �
--2�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORW(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(s) ❑ Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other V-Specify:W e a+rj-ej/'f ZGt C)
Brief Description of Proposed Work : ' � r S(0--L I r1 f3j- O PCr h
ktQA LV-)
-'\k) .
(
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 $ 6
Suppression) Total All Fees:
Check No.W7 Check Amount: Cash Amount:
6.Total Project Cost: I $ LI '9(A] 0 paid in Full 0 Outstanding Balance Due:
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
SEAN R JEFFORDS cs- (r l�)( �
"A C�?�A
License Number Expiration Date . ,l 0-
Name
"Name of CSL Holder r ' .."' ?' ;
List CSL Type(see below) x-.
13 TERRACE VIEW i
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft:
EASTHAMPTON,MA 01027 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Malo j
RC Roofing Coveringi
WS Window and Siding
w
SF Solid Fuel Burning Appliance's - -- -• -�
413-529-0544 SEAN@BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) � �1�Au F J 9 /„O
Sean R Jeffords-Beyond Green Construction HIC Registration Number —Expi�ratiionDate
NIC Company Name or HIC Registrant Name
13 Terrace View sean(a7bevondgreen.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
I,as Owner of the subject property,hereby authorize /Q(_
to act on my behalf, in all matters relative to work authorized this building permit application.
see cU+((Lhed
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby a pains and penalties of perjury that all of the information
contained in this application is true here*
e best of my knowledge and understanding.
_Sean Jeffords
Print Owner's or Authorized Agent's Name(Eldl6onic 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.mgK.gov/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 basementlattics,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 02114-2017
www massgov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print LIgibly
Name (Business/Organization/Individual): nGrfrnC n
Address: � 3 -�u (-cp. \r i C i 2
City/State/Zip: CCA Cl Phone#:
Are you as employer?Check the appropriate box: 0 �0-1-4 Type of project(required):
1.f 1 am a employer with_ La employees(full and/orr part-time).* 7. n New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in $. E]Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.Q 1 am a homeowner doing all work myself[No workers'comp.insurance required.]t
10 Building addition
4.❑I 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 II.E]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-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance.t 13.Q Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�'Othet�V
152,§1(4),and we have no employees.[No workers'comp.insurance required.] v
*Any applicant that checks box#I must also fill out the section below 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.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer tkat is providing workers'compensation inmirance for my emp(oyeex Below is the policy and job site
information. ��``
Insurance Company Name: o f H 10 n o
Policy#or Self-ins.Lic.#: �� i Expiration Date: 104
Job Site Address: �Yl f1V{ City/State/Zip: ! �rV
Attach a copy of the workers'compensation policy declaration page(showing the policy number and espimtion da 1.
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. .0110111
I do hereby certify under the pains and pe that the information provided above is true and correct.
S_ianai re: Date:
Phone#:
Oficial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
I
Massachusetts Department of Public Safety
Board of Building Regulations and Standards i
License: CS--074539
Construction Superr sor
SEAN R JEFFORDS i
13 TERRACE VIEW
EASTHAMPTON MA 41027
.� ... Expiration:
Corrmmissio�er ti"2&d2�is
i
r
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: 05(0912020
13 TERRACE VIEW
EASTHAMPTON,MA 01027
Update Addreas and Return card.
20"-05117
Office of Consumer Affairs&Business071
HOME IMPROVEMENT CONTRACT Registration valid for Individual use only
TYPE:Corporation before the expiration date. If found return to:
Reallj aF tion Exviration Office of Consumer Affairs and Business.Regulation
191746 05/09/2020 One Ashburton Place-Suite 1301
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFOROS --
13 TERRACE VIEW
EASTt-4M0PTON,MA 01027 Undersecretary Not valid without signature
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Permit Authorization
A)W-F*k,I
aSS Save Form
S;sre-�rx�s t+srr.,; rn ��rvuicnrq
Site 1D: 3452342 Customer: RACHEL BLACK
Rat.kz 13Lac l
I, ,owner of the property located at:
(owner's Name,printed)
2 Florence St APT B Northampton, MA 01053
(Property Street Address) (City)
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:
Date: 08/20/1-8
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:
For office use only
Rev.102015
AN�N
BEYOND GREEN
C O N STR U CTI 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@beyondgreen.biz
Thank you!
Nicolejef fords
Beyond Green Construction I Project Coordinator
Cell:413.539.17281 Office:413.529.0544
13 Terrace View,Easthampton(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