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11A-071 (13)
47 EAST CENTER ST BP-2020-0090 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: I IA-071 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:ROOF BUILDING PERMIT, Permit# BP-2020-0090 Proiect# JS-2020-000144 Est.Cost:$7500.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sq.ft.): 30012.84 Owner: Paul Bradish zoning: URA(100)/ Applicant. BEYOND GREEN CONSTRUCTION AT. 47 EAST CENTER ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 Q WC EASTHAMPTONMA01027 ISSUED ON.7/23/2019 0:00.00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF 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 7/23/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner e Commonwealth of Massachusetts oar of Building Regulations and Standards FOR JUL 2 2 2019 assa husetts State Building Code, 780 CMR MUNICIPALITY USE Building Permi App cation To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 -,p cTIONS One-or Two-Family Dwelling N©RTNAMPTON.MA 010 Thie 'on For Official Use Only Buildini Permit Number: - ate A plied: ZUJ 0�O5� � Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers 1.1 a Is this an accepted street?yes no Map tuber 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: 1?01 AA r dA3 h Lctd 3i M or Name(Print) City,State,ZIP L�l ECL Sfi ,e,rL,k-e r 54 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of UnitsOther Specify: Brief Description of Proposed Work': •'F (r v0f 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 Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fe�q: Check No. "t� Check Amount: Cash Amount: 6.Total Project Cost: $ ''� l,SUI) ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) (f; C_ b �LA 5S 9 � � � � � 8 SEAN R JEFFORDS l�J lJ _I License Number Expiration Date Name of CSL Holder 13 TERRACE VIEW List CSL Type(see below) Type Description No.and Street U Unrestricted(Buildings up to 35.000 cu.ft. EASTHAMPTON,MA 01027 R Restricted I&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Sidin SF Solid Fuel Burning Appliances 413-529-0544 SEANna BEYONDGREEN BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) G, j 7 Sean R Jeffords-Bevond Green Construction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 13 Terrace View sean@beyondgreen.biz No.and Street _ Easthampton,MA 01027 Email address P 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 to act on my behalf, in all matters relative to work authorized by this building permit application SPS c ke a j Print Owners 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 best of my knowledge and understanding. _Sean Jeffords rized Agent's Name(Ele o gnatur Print Owner's or:Authorized 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.mass.tov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dus 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.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organization/Individual): I'l Cannn Address: �j T&CQ City/State/Zip: ��- X 011. 1M hone#: ��" � u5Y4 Are you an employer?Check the�jppropriate box: Type of project(required): l.�1 am a employer with V�/employees(full and/or part-tune)." 7. ❑New construction 2.F]I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 [] Building addition 4.F-]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 11. Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.F-1 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.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other n 21 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Ct— *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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: tJ 0 r z u / 'l Policy#or Self-ins.Lic.#: �uu Cal zj Expiration Date: ( "— y Job Site Address: - ` t� S �i ('{rl {� e� City/State/Zip: e r1j) . M ( 1 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenaluesof'pei jury that the information provided above is true and correct Signature: Xj Y4 Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Home lmu- vee ent cantractor L a r Supplement to Permit Appiicatio� S;igiµatel t;ttidxvi:'rc:Ham:itr.�tttv�t;at C�rtrt;,io:?i..,ait�ptui;.aie,: For fE e Use onl-v Pe nlit No.: :,rate: '�vW i4Z A, TIOQUir--s that till Arecot'isMwtieri, Sit£radon, reno-a ion, repair, c"TIoden-nization, Curiversior- Wa Fovement:removal or demob en or tl:e constructional of an addition to any pre-exis`inQ owner occupied building cicm.%ining at feast one but,moo mort than foli_r divelliug nit,or to strzac"Mres which a.e adjacent to Sacs+ :�aSCfe£tt:t',^r C�U.2lcuIIg�"JY a`1t�I:�i?T;r$II�tB�'eEi�C%ntrae=J3'S.4.'lt.�.,Lrta'tl?c',7:CC'.I?i2JLSs 8'iY[tg"ii�ili tTtt2c;z i.:3Li3x�.?t2i.P,fS. si }w of Work. r Q� Est. Lost. Date of Pere i Application: lf3neby cartHthat: is ItG i?3r?Ci for the fo: c�wing reason(sI: � o ;.xcluded by Iain job under S 500-00 Building nut owner occupied Owner pulling own per-i it 53t1?er�spec��t� Lace:s hereby given that: 0q?v R`a I'i3L3: Cr�t EIR O4?� PE1�'�Mj i Up,i?Lt�i,.i`yU Wi 1H Ul�i �;�GIS�EkE'D C€3NTlc a i 1 Ohm � FOR APPLICABLE HOME IMPROVEMENT WORK ISO:NOT HAVE.ACr':ESS TO THE ARB1 RATTt7N PROGRAM OR E'i[,ARAN Y FUND UNDER ivfG. . ^. t 412A. i fl,u^ Ct mderpengdes of perjury: I hereby apply for a permdt as he age-ut of the owner: Date: Contractor: SEYONrl)+ REEN CONSTPIUCTION 4._131 279 OR: SEAN R JEFFONDS Nat;Y ths`�-ding--he above notice-s hereby apply`bra permit as the o mn-er of the-property. Date. t"3svncr: Tel.it 4 f r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructi'ori`Supervisor CS-074539 Expires: 11/28/2020 SEAN R JEFFORDS 13 TERRACE VIEW EASTHAMPTON MA 01027 Commissioner t Office of Consumer Affairs and Business Regulation one Ashburton Place - Suite 130.1 Boston, Massachusetts 02103 Home Improvement Contractor Registratior Type: Corporation Registration: 191746 BEYOND GREEN CONSTRUCTION INC. Expiration: 05109/2020 13 TERRACE VIEW EASTHAMPTON,MA 01027 Lfpdate Address and Return Card. ..,.'i 1 is 20:0-05117 office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR (Registration valid for individual use only TYPE:Corcoration before the expiration date. It found return to: Re4istratian Expiration Office of Consumer Affairs and Business Regulation 191746 05/09/2020 One Ashburton Place-Suite 13D1 BEYOND GREEN CONSTRUCTION INC. Boston,MA 02106 SEAN JEFFORDS rZ 4G{v--- 13 TERRACE VIEW Not valid without Signature EASTHAMPTON,MA 01027 Undersecretary BEYOND GREEN CON STRUCT110 � DEBRIS DISPOSAL AFFIDAVIT TN ACCORDANCE V-��,H -0;-4V,0N`ti FAL OF MASSACH€�¢STS DEBPTS DISPOS l— -t� ?+sS Q MASSACHUSET S GENERAL LAW CHAPTER 40, SECTION 547 A CONDTI0N CE BUILDING PERIM-17 %f lUl l-E , FOP. DEMOLTON FORK IS TKAT 7-JE DEBRIS RESUL�NG FPQ-1 T4ii5 WORK 5XIALL 3F RIEMOVE SIVE AND DISPOSED OF IN A PROPER!-%( LIC-ENSPED 501 ID s tEe WASTE DISPOSAL FACILITY' AS DEFINED BY MGL C111, -31500. FAtILM- ALTERNATIVE RECycLING, NORTHAMPTON, MA J 7 1 SETE ADDRESS- BE DISPOSED AND TPANSPORTED By EYOND GREEN CONSTRUCTION or ALTERNATrVE RECYCLING SIZII�#A'�i Lie y_ DATE BEY Permit Authorization CaND GREEN CONSTRUCTION /� "LEADERS!N ENERGY EFFlpENCY" Form Job number: Customer: 1, °' � = ,owner of the property located at: (Owner's Name,printed) (Property Street Address) (City) 1 hereby authorize Beyond Green Construction to act on my behalf and obtain a building permit to do work on my property, Owner's Signature: F Date: Beyond Green Construction 13 Terrace view Easthampton, Mass. 01027. 413-529-0544 ._a G TZ1S1�`Ct�GiaS •• « t 23.2 Main Street Q ?��.ciaa2 Et hang iyort3amoton, D53 D�060 y`-3N�4�r�l�:;r roez Address: 7 - 0 An 1e r - Le(cf.S . 0 t c�Q-9- COMM 012nr Name: Ile Address: 3 �ri� Cita, See: Ect iu('. { Phone: j� � a o W.L. P"'0109b!Owner Name: I A � �rG Address: P r)� city, State: (contractor} attest and afrn that the-buildin I intend to insulate does not have arta open air(knob and tube)xiviring in the spaces to be insulated and that I have provided the proper%ty ovuner ft4th a copy of this affidavit, Contractor signature �Yl r S D ate �I