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10B-093 (10) I FLORENCE ST BP-2020-0327 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: IOB-093 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Porch Repair BUILDING PERMIT Permit# BP-2020-0327 Project# JS-2020-000547 Est. Cost: $3000.00 Fee: $84.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sq. ft.): Owner. GEIS PENNINGTON Zoning: URA(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT. 1 FLORENCE ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 0 WC EASTHAMPTONMAO 1027 ISSUED ON.9/11/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.PORCH REPAIR 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 9/11/2019 0:00:00 $84.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner RE The Commonwealth of Massachusetts iW4 Board of Building Regulations and Standards FOR SEP 1 0 2019 Massachusetts State Building Code, 780 CMR MUNICIPALITY USE B I ildin Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011 DEPT.OFD One-or Two-Famil Dwelling NORTHAMPTON.MA 01060 This Section For Official Use Only Building Permit Number: 7 Date Applied: LA r I sCl. Building Official(Print Name) Signature� Date SECTIO 1:SITE INFORMATION 1.1�Prooper�ty AddrLZe �� 1.2 As��sprs Map&Parcel Num % 1.1 as Is this an accepted street?yes no 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 Owner'of Record: ;hnu C-7u S edS Name(P ) City,State,ZIP 1 &0nv+-<54 X113- 303- 03 as No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition ❑ I Accessory Bldg.❑ Number of Units Other ❑. Specify: Brief Description of Proposed Work':_ ' 7, 6�,r"6 pct ( +r\'� ppc \J,) �MQ ppt atm �, +C�( 1gp rn�cnoc drn Abe c� U nds t n�u 0.Co\v m oa\c �bsndr ,\S a C s �s � bo a a Cat T tOpc CA— 'c SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials 1.Building $ 1. Building Permit Fee:$ -7)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: S 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire Suppression) $ Total All Fees;,$ 6.Total Project Cost: $ Check No.�N Check Amount: Cash Amount: _ ❑Paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES I'5 ,AA,/) la-J P"./ 4' 'US ta.J SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1' S_ (D- 1LA 5?J 9 8 I(8 SEAN R JEFFORDS 1. Name of CSL Holder License Number Expiration Date 13 TERRACE VIEW List CSL Type(see below) Type Description No.and Street U Unrestricted(Buildin up to 35,000 cu.ft EASTHAMPTON,MA 01027 R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and.Siding SF Solid Fuel Burning Appliances 413-529-0544 SEANABEYONDGREEN BIZ I Insulation -Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) _ 4 5 /� Sean R JefPords-Beyond Green Construction HIC Registration Number Expiration Date MC Company Name or HIC Registrant Name 13 Terrace View seannabeyond een.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.252.§ 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...........O 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 &Own lf,in all matters relative to work authorized b this building permit application ' L31) 9 a(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby,attest unde thepains and penalties of perjury that all of information contained in this application is true and acc the'best of my knowledge and understanding _Sean Jeffords 11V4 M3119 Print Owner's or Authorized Agent's Nameo c Signature) ate NOTES: I. 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.g—ov/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"maybe 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 Leeibly Name (Business/Organization/Individual): AelAond areeo� (1 n,s-�^Y�( - on � Address:_ ) 3 I P�(a� Q i e l_t City/State/Zip: PUSOOCIMQtDCLJtiO, Phone#: (413- 5 3ci -QS Ll Lf Are you an employer?Check the appropriate box: Q Type of project(required): 1.2 1 am a employer with_CO employees(full and/or part-time).* 7. ❑New construction 2.F-1 1 am a sole proprietor or partnership and have no employees working for me in $. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.[:]I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. El Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on m 10[]Building addition ❑ g Y property. [will ensure that all contractors either have workers'compensation insurance or are sole I LF]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.[]I am a general contractor and 1 have hired the sub-contructors listed on the attached sheet. 13.EJ 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. Otht f 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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 sub-contractors have employees,they must provide their workers'comp.policy number. I ani an employer that isproviding workers'compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Name: ,V Or WarcA I'C16u 1(l Policy#or Self-ins.Lic.#: 3u7t C 00 rJ ( Expiration Date: `` a Job Site Address:_ , �Q City/State/Zip:_ LC e�J iMYA - Attach a copy of the wot'kers'compensation policy declaration page(showing the policy number a ex tration date). P ) 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 i coverage verification. i I do hereby certify under the pains and pen e of perjury that the information provided above is true and correct. Signature: Date: 3 )11F Phone#: �. I Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# t Issuing Authority(circle one): 1 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector e 6.Other Contact Person: Phone#: Ho-me hmarove neat.;csntractor Lam S23Psiement to Permit Apaiicatio� Z,Unxted ASfdxvk Fe.Haw.:itr.t nzzrs-nt C3n[n;l Pi'*3:tA nUicaiu:- cr 0-ffiee Ilse 01171, I"emiit No.: ;mite: ;• NUGw` l'is: t"7e, ry ;.IIIvS S tialteration, --.� 'meq the Areconstrutxemn, alteration, r'euOkaG'Uii� r:pair, "ul=Aminization, ^E3Lv�ISI:�T<; R �ove..nent,remova.t car demo;itifln��e constrtac`te.�u� of an addition to aai,,pre-e.�isting cswuer occupied btutdia;r ccsxzining at feast ons but no'<T2LJ:�trtan �Lr iF. :tlisig tuiit,ter:t�struc*a:res which aTe adjacezat fq s��c3a F�Sett�E2t;P rt t?2121P_<_ia�u d'.�L?'R�;reiT StB!&£1.3?21ZC32a,4i'iili Lcrt822?vY.C:'RL2s?ZlSy fl�Qi3 ti;ih Q�t1t,CP 3t23iw'?71CTifS_ . � 1 Tvpe°2 Work.-- _ Est. Lost: z ss a ork . Fav Ye ncLai Le ---- - �,X,ners game: _ _ LI s Date of PerWit I Apniicat M: I`aereby certify that: eg?stratbn ig nut:^P. pared for me foliowing reason(s): Work--=--luded by law Job under S 500.W BuLl g-nut ow-nar occupied Ctwmr au;iirtg ow-,-parmit j Other(sneciitj} Notice is h=b-kr giveu that: G Y';?vt1RS PUL.L-IING T-tfEa GZrtrTi PF-RMIT OR DBAL NU WI J I UNREGISTERED CON' FOR APPLICABLE HOME IM-PR0V,_AC-W- WORK DO NOT HAVE.ACCESS TO THE { c p 1317ttiA711©N PROGRAM OR Gt.ARAIN Y FUND L"NDER-,f-.,rL C. I42A_ I sigwd Tu de:Penalties of getury: I hereby apply RT a pe mit as file ageui of the©;mer. Date: �'fli?tldCLt?T: SL-�`4fwL3+�!Rt Li,:CiIhfSTRU�`Tilliti 131�{�} OR: SEAN R JE=FORDS Not;Y thstar-ding'he abet.e notice,I herzby apply;or a permit as the o—per of the property. Bate: s;;nt;r: Tel.4: r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constrgction Supervisor CS-074539 Expires: 11/28/2020 SEAN R JEFFORDS 13 TERRACE VIEW EASTHAMPTON MA 01027 Commissioner Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 130' Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation Registration: 191746 BEYOND GREEN CONSTRUCTION INC. Expiration: 05/09/2020 13 TERRACE VIEW EASTHAMPTON,MA 01027 Update Address and Return Gard. ,,.4 1 -:j 2010-05117 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. It found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 191745 05/09/2020 One Ashburton Place-Suite 1301 BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108 SEAN JEFFORDS --- 13 TERRACE VIEW EASTHAMPTON,MA 01027 Undersecretary Not valid'=�sltSyC►�.$Signature AdF BEYOND GREEN CONSTR. UCT140N DEBRIS DISPOSAL AFFIDA1t`I'T IN ACCORDANCE WITIN THE -OMMONWEALTH OF MASSACHUSErS DEBP�S DISPOSAL . R+Otfs'—.) OF MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION 54, A CONDITION ^F BUILDING PER-M:T NUMBE;= FCUE1� flLI i i�Ji�f WOR IS T��AT T it DEBRIS R RESULTING FR;-,'M THIS WORK 5111ALL 55 RFM VELD FROM SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLI© WASTE DISPOSAL FAC=ITY AS DEFINTED BY MGL Cill, ,ai50A. r11 riLTW- ALTERNATIVE RECYCLING, NOR'T'HAMPTON, MA ^ tS RUt�ON SI`"'�' ;ADDRESS- —0 BE DISPOSED AND TRANSPORTED BY- 3EyClND GREEN CONSTRUCTION or ALLTERNA TIVE RECYCLING SIvNATURE DATE ._ � , alp°r � k -f 31iP'�e3:{. DF ++ %3G 1Ii31 �1yGiirS 1 1XF'r f,•` 23.2 Z'f$IIL S't+•1'_Et Q At-(3II2C17_722 8L*21d321C,j 'r'V• .;. .: ; `�� riort6amoton. LOL 01060 �sktr j�l}`j Proper,v. Address: Name: �c��r��t Address: la�(r5�r-O city, State: Ste'} , Phone: Marne: �eX0(cV, C ems+ S Address: 1 b n city, State: l�� US . 'N� b�c�U 0 (contFac-00 attest and affil rm that the buildingt intend to insulate does not have any open air((snob and tube)-wit ing in the spaces to be insulatd and that i have provided thc—prQpefiT Owner with a copy of this a-davit. Contractor signature- Date ignatureDate Adt N 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 f ords Beyond Green Construction!Project Coordinator Cell:413.539.1728 1 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