31A-045 (3) 261 CRESCENT ST BP-2020-0373
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A-045 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-2020-0373
Proiect# JS-2020-000635
Est. Cost: $5000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 6969.60 Owner: CRESCENT BRIGHT PHILLIPS LLC
Zoning: URB(100)/ Applicant. BEYOND GREEN CONSTRUCTION
AT. 261 CRESCENT ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMAO 1027 ISSUED ON.9/23/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSULATION AND WEATHERIZATION
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 9/23/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
B and of Building Regulations and Standards FOR
SEP 2 0 2019 M issadbusetts State Building Code,780 CMR MUNICIPALITY
USE
Building P rmit kpplication To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
One-or 7ivo-Family Dwelling
NORTHAMPTON,MA 01060 This Section For Official Use Only
Building Permit Number: - Date Applied:
.� . aatS oq
Building Official(Print Name) Signature
SECTIO 1:SITE INFORMATION
1.1 Property Address: 1.2 Assess rs Map&Parcel Numbers
alak Ctescc" } .N()(+f- m� 3
1.1a Is this an accepted street?yes Map Number Parce Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I 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:
I f( f)tdschf r ` f 1 0 C+1(c stn)O+7 KA
Name(Print) City,State,ZIP
.AOI (,r3L-n,131 - a8o0
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) ❑ TAddition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work':
R.,
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 FeeIJ Check NoCheck Amount: Cash Amount:
6.Total Project Cost: $ Wo ❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) j� CJ^ b--1 LA 5 11 -03h.?3 h 8
SEAN R JEFFORDS l.. V
Name of CSL Holder
License Number Expiration Date
-
13 TERRACE VIEW W List CSL Type(see below)
Type L Description
No.and Street U Unrestricted Build igs.upto 35,000 cu.f
EASTHAMPTON MA 01027 R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Coverin
WS Window and Siding
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) i G, f 71 ' 5 /�
Sean RJeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View a bevondgreen biz
No.and Street sear
Eastham ton.MA 01027 Email address
P 413-529-0544
Ci /Town,State,ZIP Telephone L.
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 b this building permit application
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under pains and penalties of perjury that all of information
contained in this application is true and accura o e best of my knowledge and understanding
_Sean Jeffords Z I q
Print Owner's or Authorized Agent's Name(E i ignature) iDate
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.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dos
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
x 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 Legibly
Name (Business/Organization/Individual):_�onC,� CafCco �) l i-rye�t on
Address:_ ) 3 �PX(aV Q '\(J e Lk i
City/State/Zip: E Phone#: 13- 5 JCj -OS i-1 Lf
Are you an employer?Check the appropriate box: \ 0 3
Type of project(required):
1.R I am a employer with_employees(full and/or part-time).* 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.)
3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9 ❑Demolition
4. am a homeowner and will be hiringcontractors to conduct all work on m 10 ED Building addition
❑I
y property. I will
ensure that all contractors either have workers'compensation insurance or are sole I I.[]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 shccL
These sub-contractors have employees and have workers'comp.insurance.t I3.❑Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14. Other_�,)� P rl Z C(+
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
tAny applicant that checks box#1 must also fill out the section belo%v showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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 is providing workers'compensation insurance for my employees. Below is the policy and job site
information. ^ o
Insurance Company Name: 'V arquar6 mur n 'm
v
Policy#or Self-ins.Lic.#: C1 d00 Is ( Expiration Date: — a6
Job Site Address:(D? S(uyf (�1 - City/State/Zip:
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.
1 do hereby certify under the pains enaldes ofperjury that the information provided above is ue and correct.
Signature: Date: Ce
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#:
Commonwealth of Massachusetts
` Division of Professional Licensure f}
Board of Building Regulations and Standards
Construction Supervisor
CS-074539 Exp i res: 11/2812020
SEAN R JEFFORDS .
13 TERRACE VIEW
EASTHAMPTON MA 01027 >`
Commissioner
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02103
Home Improvement Contractor Registratior
Type: Corporation
Registration: 191746
BEYOND GREEN CONSTRUCTION INC. Expiration: 05!09/2020
13 TERRACE VIEW
EASTHAMPTON,MA 01027
Llpdate Addrena and Return Card.
SC.41 0 2040-05/17
'7t%r` r�nn�rlrurra//r!• f�c::r:^fin r/L.
Office of Consumer Affairs✓&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corcoraticn before the expiration date. If found return to:
Regi tsration Ex1piration Office of Consumer Affairs and Business Regulation
191748 05/09/2020 One Ashburton Place-Suite 1301
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFORDS
13 TERRACE VIEW Not valid without Signature
EASTHArtPTON,MA 01027 Undersecretary,
Home Impro-,em nt a csntracto=Lau
Supplenient to Permit Apniicadw,
Su yuwcc'1t'TidxvE;Fc iiax imys 7e� tcat Cane-.o;? a c 1ppiici ni.
For Office Use Chn1_�
Pemlit.NO.:
Date:
, ? law As I'vq iZC$5hat iLt3 �i�G'�Il3tlZiG 71}T[, aiteratiou, r movauan, r--pw. modcrni28tioi4 counversio-n-
i�rovement=remova.3.or aernoii�on a,�e cansintciivnai Of an addition to aai, pre-exisc`ttt�t:v�tner eccupiaci
buiJ.dia�v,.;ntainiag at least one but ao mcsr:t�fa�.ir u.�ailimg unit,ar_z�structF:i'es which are adjacent-rq s:sc3i
rC'SSC:c'._T7s':�.,''L�FFti(tiII��`3 QJt:e nu rC�';�tel"eCe{.CSi;tF3C:3�.'.b'2f;CC'.TCFL?F'�L�CCQitOP_Sy'tCiC+?i�'"x:`ih tlI12C.0 t',=�Ti2?i3?71L'TitS.
"vpe of NVv Weatherizabon est. ^ast: _
zfir�-� � •� t S osn_t _ � r (3 cmc)
Jwuers-Name:— - -. . scky
Date of Pent i Application_
1 crvtnV ce-tiff'tbat:
(.xistrai?on is not .:fired for the fel'Qu6ng reason fsj:
vY o&excluded by law
Job under$500.00 �
-- Bailc ng:lot ow-per occupied '
Ow-wr im-Uhn-orf,„e=mit j
Other;specie
t
Notice is hereby given. that:
0 4/]',-ERS PULL3NG THEIR ONXfiJ PERMi l OR DBAi.lNl U Wl-!7-i UNREC ISTERED C-c` NTRAC-1 ORS. ;I
FOR APPLICABLE HOME MPROVEME 'WORK DC?NOT HAVE.ACCESS TO THE
A A-RW-R- l flN PROGRI-A Ni OR GUAR.�L'-N-Y k-7-'ND liNDER MGL C. 142 A-
?grs d undo:penalties of pe.;u,y:
I hereby apply f T a Perim t as iie agewi.of+die
Dote: oi21?BCtOr SEYOT1L GREEN Cc 1N5TRi iCTii 1iti Reg. - �v-1279
OR: SEAN u EF ORDS
(l
`_got w=thst&nding-he above notice,Z her;try-apply;or a permit as the o wnr er of the property. 1
Date: Misr: Tel.#:
BEYo D GREEN
C 0 N S T R U C T s 0 N
DEBRIS DISPOSAL AFFIDAVIT
TN ACCORDANCE- WITH THE ^O;IMON'ti11lEALT-f OF
MASSA:CL,IilfS=-77 S DEBP.153 DISPOSAL PROVISIONS OF
MASSACHUSETTS GENERAL SLAW CHAPTER 40t SECTION
FOR DEMOLI T ION WORK IS THAT T'HE DEBRIS
RES'�L T ING FR!')M THI5 WORK SHALL 3E REMOVED FRO
SITE AND :I)TSPOSED OF IN A P OPERL'! I ICENSED SOLID
WASTE DISPOSAL FACIi 3TY AS DEFINED BY '!,IGL Ci iY f
_3150A.
FACTI TTY_
_
L TERNATIYE RECYCLING, NORTHAMPTON, Q9
:STRU(7_ 10N SUE ADDRESS-
BE DISPOSED AND TRANSPORTED BY-
3EYOND GREEN CONSTRUCTION Or
LTERNATIVE RECYCLING
DATE --
AWN Permit Authorization
BEYOND GREEN
CONSTRUCTION Form
"LEADERS IN ENERGY USCIENCY"
i.-A Bnv.— ;W1
Job number: Customer:
I, Le& C-e,'A-5-c k e� ,owner of the property located at:
(Owner's Name,printed)
Z�1 C<GS ccs- —{ N t ion , " 01 y 6 o
(Property Street Address) (City)
I hereby authorize Beyond Green Construction to act on my behalf and obtain a building permit to
do work on my property.
Owner's Signature:
Date: 0,*- l S f
4iiii4ilitii44!!i!itii••4i4l4l4i4!•iii444l4l44liiliilriiiii!!il4ii4i•
Bevond Green Construction 13 Terrace view Easthampton, Mass. 01027. 413-529-0544
rLt='!3ii1 O
'mac 222 PiBi a S
. `"+� tseet o ?rnnieiaz2 Sr,=�.ra A4 �� `��,=• `�
r;ozfhaaro'ton, D5� �1ti60 �vsM1, L.�tit�l'`
faSL"t'if fikdda'35^s: a lJ cm f
Nave: ,-'2 i i`e chi
Address: 3 _7 1--ir Af - V
Cit", `:ate: r, J, jzr
Tbv OU-mer
•
Gig _ aTae:
(cont,acTor) attest and afrm that the buildingi intend to
ins�.iate does nGf have any open air(knob and rube mlirirt in the s ac
provided the prPe�r OWner V01th a copy of this afdevi p es to be insulated and that i have
Contracior Signature
t
31i �
Ad�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 orris
Beyond Green Construction I Project Coordinator
Cell:413.539.1728 1 Office:413.529.0544
13 Terrace View,Easthampton I 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
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