Loading...
38D-045 (4) 24 HARLOW AVE BP-2019-0711 CAIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:38D-045 CITY OF NORTHAMPTON Lot,-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Pfrmit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:INSULATION BUILDING PERMIT Permit# BP-2019-0711 Project# JS-2019-001161 Est.Cost:$4000.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const,Class: Contractor: license: Use Gtr i BEYOND GREEN CONSTRUCTION 074539 Lot 55 (sg.,$.): 4181.76 Owner: BULL CAROLE zoning:URB(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT.- 24 HARLOW AVE Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413)529-0544 WC EASTHAMPTONMA01027 ISSUED ON.12113/Z018 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSULATION IN ATTIC AND BASEMENT 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 Occuaancy Signature: FeeType: 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 �N RECEIVED The Commonwealth of Massachu efts Board of Building Regulations and S nd s F R Massachusetts State Building Code, 7 0 C IC PALITY OF BUILDING INSPE 7 U E R AMPTOK MAOI 60 Building Permit Application To Construct,Repair,R evised Mar 2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: ., q11 Pate Applied: 4-yI KJ /&5 Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1�.1 Pro erty Address: ( 0.0 1.2 Assess, D p&Parcel Number "�� 'l'hit pff _ 1.1 a Is this an accepted street yes no Map Number Parcel umber 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Propos 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: Cc ON't E)1.-,,1 No��-hax�n�p�-on{��- Q l aCe L Name(Print) City,State,ZIP QUA low / l���-30LA 5a3a No.and Street Telephone Email Address SECTIO 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units' Other )i Specif}c U)t?_ 0 Brief Description of Proposed Work-2: C-1-06 Q,i r Q CL I `\ o �-� I� l �u IpobZC� \ n U\ufion lve a ' - vcl r iW0.1I 0� SECTION 4:ESTIMATED CON RUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ 9 i 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 $ Total All Fees-$ Suppression) Check No. unt: Cash Amount: 6.Total Project Cost: $ 14,W-Cl ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) SEAN R JEFFORDS 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 City/Town,State,ZIP M Mason ry 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) n (a' �� 519 /0 C,� /� Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 13 Terrace View seannbevondgreen.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.152.4 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 1&kA(n cd Czl r�f n C o o stfu ct`v r` to act on my behalf,in all matters relative to work authorized y this building permit application. Su 0-+4-ack)-ed 1,0 /. f h e Print Owner's Name(Electronic Signature) Date 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 t g f my knowledge and understanding. _Sean Jeffords f O P1 he Print Owner's or Authorized Agent's Name(Electr c e) 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.masLgov/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"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 L bl Name (Business/Organization/Individual): on::J Grem CLnstfuc-+, Address: 13 —rcc+ o c-e p, ` ,� City/State/Zip: hone#: �--� ��' -5QJ '0664"I Are you an employer?Check the approp ate box: ( � ©\0 ),'� Type of project(required): i.Rl ern a employer with V/ employees(full and/or part-time)." 7. E3 New construction 2. ama sole proprietor or partnership and have no employees working for me in $. E]Remodeling any capacity.(No workers'comp.insufance required.) 9. ❑Demolition 3.Q I am a homeowner doing all work myIntractors If.(No workers'comp.insurance required.]f 10 0 Building addition 4.0 1 am a homeowner and will Ix hiring 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.Q Plumbing repairs or additions 5.E]I am a general contractor and I have hued the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t -, e 6.Q we are a corporation and its officers have exercised their right of exemption per MGL c. 14.�Dthe[W�(�1T r l.�I 152,§1(4),and we have no employees.[No workers'comp.insurance required.] fq "Any applicant that checks box#1 must also fill out the section below showing their workers'cot 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 time entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: rr ( (�� (�( � Ck Policy#or Self-ins.Lic.M s W ec� cDU E,I Expiration Date: Job Site Address: Oaf(Uw Irl V e— City/State/Zip: IV o (4,—v)anOm �m A Attach a 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and tf rjury that the information provided above is 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/License# 3 Issuing Authority(circle one): !Y 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other t Contact Person: Phone M 1 1 b Massachusetts Department of public Safety Board of Building Regulations and Standards License: CS-074539 Construction Supervisor SEAN R JEFFORf1SR` 13 TERRACE VIEW ' EASTHAMPTON MA 01027 I i 1 Expiration: tt Commissioner 11128/2018 i i 11 1 l b L/ �(�/ ���;�6����i�t/G'�/•�i l:-J�i'�(�'/ �'?U��JY/(fC.'.�• 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: 05/09/2020 EASTHAMPTON,MA 01027 Update Addreaa and Return Gard. SCA t % 20to605117 'M ��l/ J rC�i;est lNlir��rFr����r�i^1�n:3'•. Office Of Consumer Affairs&Business' HOME IMPROVEMENT CO ," "�r Registration valid for Individual use only TYPE Corporaoicm ` before the expiration date. If found return to: d4BiExp ration, Office of Consumer Affairs and Business Regulation 191746 05/1/207 One Ashburton Place-Suite 1301 BEYOND GREEN CONSTRUCTION INC.I Boston,MA 02108 SEAN JEFFORDS 13 TERRACE TERRACE VIEW EASTHAMPTON,MA 01027 Undersecretary Not valid without signature si S p'macn ai--I'v= .,rmnii t`ir7fiSi e i C. ..._ ,...•� c:rr�c P:.:m:: iJpt�a:it,_: For Offs U'se Ji, Ole Tj..'-Zructlo-nal o3 an addition to all;? J� � � al • .,a. I `; f, T Rv:d i o su i .. Z:e al.:... _ a'�__ _. r _.vz'•'1.1 l: tcp c'ni; •l.t;lg .1 .2 ti i23on - Est. ..rJSL: `\ tbn t: Cli4k exclu del'3 r'...__. rTNER_ PULLR'gGV THEIR Ov,"� _70R zkPPL!CAL'= 3OY ' t3 j iI i :i A- 7�'.�.'TTr`�tl4,• is^".�s,.,' :.: f ti'`� .x '?4 t' hH�4F.' r-fN,�D ^.;t..: _i.0 Aof per�urv- i `--eby ci?ppl i';-i. a e.fmilt as i1[,ugeui o ill%v`%aei: 3'i i'• v _ —_ +a _>✓,.r...Lith-.t::':,. .: ,.._-:�_`y r„Ila r v ft T n *' • = # BEYOND GREEN CON STR U CT � DEBRIS DISPOSAL FF AV A, CORDANCE k 17" THE -T MA S, 54 A. "CONDITION "",)F 3U,--,LD-,NG -PERMI -7 Vv' 0K ITTr-A-t T-IE: DEBRITIS RE-S',JLlFlNG F-PROM T,'.Hl,.�.,z "h",0'V $HA,1111-1 5E RaMOVE-D F1,1100,N. SITE AND MSPOSE'� CCIF DR,01DEMPLY _0-c- USED �oi 77, S 15;.1.x. ALTERNATIVE RECYCLING:, WORTHANUMONI MA °;ITE ADDKES�-- &f BE DISPOSED AND TRANSPOUED BY- Er 0 N D GREEN C 0 N"S 7 P ACT I f,)! or N A TU R.E—,---,— City of Northampton Massachusetts << N; DEPARTNENT OF BUILDING INSPECTIONS 212 Main Northampton HA Hipal A 01060 01060 Property Address: H ILIQw &Ve- MOO Contractor ��I /� Name: t3 f4� o ►U l�`�r Peri OloYIS'trucp Url Address: 3 -'Q,riracz i/ -ew City, State: C W WUA-'oa f0(\ , IM VA- 0)(:)D--4 Phone: Q -✓��� d�u� Property Owner Name: L7� Address: a L-A Hay- I ow f+,/C- City, State: 0 rel a rn ,IM fr 610(,00 I, se(a '-�f CG .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 I have provided the property owner with a copy of this affidavit. Contractor signature Date (ID / 31118: Adk ` 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 jAddress: nicole@beyondgreen.biz Thank you! Nicole Jeffords Beyond Green Construction!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