24D-313 (2) 98 BANCROFT RD BP-2019-0712
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24D-313 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-2019-0712
Proiect# JS-2019-001162
Est.Cost:$4086.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sg.ft.): 21605.76 Owner: O'SULLIVAN ROISIN E&MATTHEW J SKELTON
Zoning:URA(100)/ Applicant: BEYOND GREEN CONSTRUCTION
AT: 98 BANCROFT RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-05440 WC
EASTHAMPTONMA01027 ISSUED ON:12/13/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSULATE KNEE WALL AND WALLS INTERIOR
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 12/13/2018 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-..Building Commissioner
�i�/sUGf4 T/Oi✓
Ji I 0
The Commonwealth of Massachusetts
M`! Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
J
cVV) I
ri rn uilding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
n N One-or Two-Family Dwelling
D
o
M8 This Section For Official Use Only
0)--4
Bulldin it Number: , r7 a- Date Applied:
z
N
ui mg cial(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Pro erty Address: 1.2 Assessors Map&Parcel Numbers �'
a g f�i- Rd Nor�haw�p i�r�a ��� �2
1.1a Is this an accepted street?yes no Ol l UZ) 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,§54) 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(Print) City,State,ZIP
9E 6an mfi (Rbad 59U-Re 8D
No.and Street Telephone Email Address
SECTION,3:DESCRIPTION OF PROPOSED WOR10(check all that apply)
New Construction❑ .Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units I Other,, Specify:Wd CL--�'YW`i Z6_'K4z>n
Brief Description ofPropose Workz: k ' - l U U y-Ylex" ip
d 400 e '"Ck'k L5 nn ► *
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:
❑Standard City/Town Application Fee
2.Electrical $'' ❑Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$
Check No. �6t unt: Cash Amount:
6.Total Project Cost: $ ( '� 0 ❑paid in Full Outstanding Balance Due: I
Wk
6 0 (�
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) S—
y� (A CJ3 t( ag 18
SEAN R JEFFORDS lJ
License Number Expiration Date
Name of CSL Holder ► /
List CSL Type(see below)
13 TERRACE VIEW
Type Description:,-'• '
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.
EASTHAMPTON,MA 01027 R Restricted 1&2 Family Dwelling
M Mason
City/Town,State,ZIP RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN(a),BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 0� ,-I1 1 CP I a0
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View seanAbp3Londgreen.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 G?J_A 0oCd Gy-t c oq
to act on my behalf,in all matters relative to work authorized by this building permit application.
See 0_,7ycsp
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I here r the pains and penalties of perjury that all of the information
contained in this application is the best of my knowledge and understanding.
_Sean Jeffords
Print Owner's or Authorized Agent's Name(Electronic 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.jzov/oc Information on the Construction Supervisor License can be found at www.mass. og v/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"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 Legibly
Name (Business/Organization/Individual): nj?l In C neY l'1 Tor.S'FaA O�
Address: 13 Te- (rack, y I e_w
City/State/Zip:. ASkhc�, Phone#:
Are you an employer"Check the approp ate box: � Type of project(required):
1.E4 1 am a employer with_�ernployees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 Q 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 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs
These sub-contractors have employees and have workers'comp.insurance.: ,^ /
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[Z Other�QCCT I f fj'tT7 n
152,§1(4),and we have no employees.[No workers'comp.insurance required.)
*Any applicant that checks box#1 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 sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that isproviding workers'compensation insurancefor my employees. Below is thepolicy andjob site
information.
Insurance Company Name: n S a rGA 0
Policy#or Self-ins.L-ic.#: 1!LA Expiration Date:
Job Site Address: 9to 1"QrYJOO � W)aj City/StateJZip:
Attach it copy of the workers'compensation policy declaration page(showing the policy number and expiration 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 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 ma be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains a ury that the information provided above is true and correct
Signature: Date:
Phone M
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License# f
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#: 1
t
Massachusetts Department of Public Safety
®' Board of Building Regulations and Standards
License: CS-074639 4
Construction Supervisor }
SEAN R JEFFORDS
13 TERRACE VIEW
EASTHAMPTON MA 01027 {
Expiration:
Commissioner 11/2812018
i
R
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
BEYOND GREEN CONSTRUCTION INC. Registration: 191746
13 TERRACE VIEW Expiration: 05I0912420
EASTHAMPTON,MA 01027
Update Addreae end Rotum Gare.
SCA1 c 201vi-05/17
r.��r�r%nriirr:r.rnrrr��f r/^�fal.:nr•� i'J .-
Office of Consumer Affairs&Business Rego
NOME IMPROVEMENT CONTRACTOR � Registration valid for Individual use only
TYPE:Corporation before the expiration date. If found return to:
Rggistrallon Office of Consumer Affairs and Business Regulation
191746 05/09/20 One Ashburton Place-Suite 1301
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFORDS �----
13 TERRACE VIEW
EASTHAMPTON,MA 01027 Undersecretary Not valid without signature
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TO BE DISPOSED AND TRAII'ISPORTED BY-
xEVONV GREEN C-ON51777P.,UCTION or
,kLTERNATIVE RECYCLIN
DATE:
DocuSign Envelope ID:2463C76A-F3FA-4S9E-921D-290D9FCBDC47
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I, Matt Skelton
(Owner's Name)
owner of the property located at:
98 Bancroft Road ,
(Property Address)
Northampton, MA 01060 ,
(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..
Dowd nea W.
me s nature
10/29/2018 i 6:24 PM EDT
Date
RISE Engineering,a Division ofThieisch Engineering, Inc.
60 Sha mut Road Unit 2 1 Canton,MA 020211339-502-6335
unu,at 01CGnnainaarine enm
City of Northampton
Massachusetts
DEPARTNMT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building J`s'•., bpD
Northampton, MA 01060
Property Address: 1 &Oc(44 Roark
Contractor 2,, .
Name: r� Ond 6(e-els ( oY1S+YUC-Ih()f)
Address: 13 -�C.f rC<kyAtA-0
City, State: � pf����n O I 0 a-4
CA
Phone: �J' a�'C' t�
Property Owner
Name: k c(:L+ ,s k- to n
Address: NarauO-�+ oa8
City, State:
I, (JAS (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 /3 m
BEYOND GREEN
CONSTRUCTION
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!Project Coordinator
Cell:413.539.1728!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