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16B-060 (11)
9 HAYWARD RD BP-2020-0977 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 16B-060 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 P E RM I T Permit# BP-2020-0977 Proiect# JS-2020-001655 Est.Cost:$985.00 Fee: $65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sa.ft.): 15333.12 Owner: ADAMS BRIAN Zoning: URB(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT. 9 HAYWARD RD Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413)529-0544 O WC EASTHAMPTONMA01027 ISSUED ON:3/3/2020 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL ATTIC INSULATION 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 Sip-nature: FeeType: Date Paid: Amount: Building 3/3/2020 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner v ' z The Commonwealth of Massachusetts X0 i Board of Building Regulations and Standards FOR D c Massachusetts State Building Code, 780 CMR MUNICIPALITY o g _ Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011 One-or Two-Family Dwelling g m This Section For Official Use Only �' Buil n 'Permit Number: o a - 7 _ D to Applied: z L_ �s5 3-Z-Zd ZU Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1;P,roperty ddress: 1.2 Assessors Map&Parcel Numbers C/ O 4 1- a7N QJ N � o/ .A1n4NN M 4 n 1� 1.la Is this an accepted street?yes no Map lber 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 OWNERSHIPI 2.1 Owner'of Reco d: 3r , AV, ATIA Al0!, "W rah MA 01062 Name(Print) I City,State ZIP <ff No.and S et 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 Units Other 0-Specify: wYtif'+er, Z . o� Brief Description of Proposed Workz: h S o I I a f {, L ,°,n S a(y ,-0h 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 $ Su ression) Total All Fees: /IS Check No. Check Amount: Cash Amount: 6. Total Project Cost: $ ��j ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 ConstructionC'Supervisor License(CSL) LS _ 07c1 5 31 11 Z,52ozo SecA h R 3 c r o J S License Number Expiration Date Name of CSL Holder CIA List CSL Type(see below) I � 1T-frac,- V,' cw No.and Street Type Description C a 51 AlA 0 1 n Z 7 U Unrestricted(Buildings u to 35,000 cu.ft t �i` 'At 1 R Restricted 1&2 FamilyDwelling City/Town, tate,ZIP M h4aso nry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances '1 5 Z`1 d S S Stu ti�bk�H i cc h K1 i Z I Insulation Telephone Emai address D Demolition 5.2 RegisteredHome Improvement Contractor/(HIC) l9 1 7 g 5 l 9 i z c zv I .� 7 c c U h 5iGR HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 11 J c,C« r- S -K ti U b ,.e No.and Stre 0" /\l,+ 0104,7 r-�15 S 11 0 5`l y Email address Ci /To 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 .......... 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 authorizeC�D V d YG„� t%o HS i v �- o►'t to act on my behalf,in all matters relative to work authorized by this building permit application. ,�et', 1-/ 111 / z o z o Print Owner's Name(Electronic Signature) Date SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby alt under the pains and penalties of perjury that all of the information contained in this application is true curate to the best of my knowledge and understanding. ZZozv Print Owner's or Authorized Agent' 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.niass.p-ov/oca Information on the Construction Supervisor License can be found at www.mass.goy/dpss 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 balf/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 1 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 (( 1 Please Print Legibly Name (Business/Organization/Individual):C G t t c 0 ti�r ✓c r r� Address: t t<<r u c c V City/State/Zip: /M4 to Z 7 Phone#: � t1 5 7- c� D _ 9 Ll Are you an employer?Check the appropriate box: Type Of project(required): L�m a employer with _Z employees(full and/or pan-tune).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in g, 0 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F-11 am a homeowner doing all work myself f No workers'comp.insurance required.]t 10 0 Building addition 4.O 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.F� Electrical repairs Or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.O I am a general contractor and 1 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 w ru rr, z-t?, v 152,§1(4),and we have no employees. [No workers'comp insurance required.] IL *Any applicant that checks box#I must also fill out the section belov,,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. I Insurance Company Name: T v c 1) r c C Policy#or Self-ins.Lic.#: "� 0 U 0 S , Expiration Date: Job Site Address: y 7 V,-, I�G ^r`r"�' �7i City/State/Zip: A/ �I+ti� 0(06 5 Attach a copy of the workers'compensation policy declaration page(showing the policy number and a piration 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$250.00 a day against the violator.A copy of this state nt may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains am t ! 'es of perjury that the information provided above is true and correct. Si nature: Date: � / l f t e Z0 Phone#: �� Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: t i Commonwealth of Massachusetts '®F Division of Professional Licensure Board of Building Regulations and Standards Constr#ction Supervisor CS-074539 yY E��ires: 1112812020 1 SEAN R JEFFORDS 13 TERRACE VIEWir EASTHAMPTON MA 01027 Commissioner Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 130; Boston, Massachusetts 02108 Home Improvement Contractor Registratior Type: Corporation Registration: 191748 BEYOND GREEN CONSTRUCTION INC. Expiration: 05!09!2020 13 TERRACE VIEVV EASTHAMPTON.MA 01027 update Addreaa and Ratum Gard. SC4 f 0 2NA4 M�7[ In Crr�:in��t�n+Ffr�l�el'-lln.:r/r�n�t/fi ice of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corccrat crn before the expiration date. It found return to: Reaiscitration Expiration Office of Consumer Affairs and Business Regulation 91745 05/0912020 one Ashburton Place-Suite 130' BEYOND GREEN CONSTRUCTION INC. Boston,MA 0210$ SEAN JEFFORDS 13 TERRACE VIEW Not Valu withot� ,t signature EASTHA4:iPTON,MA 01027 Undersecreta^v HOM-e Inpro,=,,,nz:nt IanbaMr i a- SuPP-Icnw t to Per-;nit ApIpiicati L '3 i-�iiduv�_=�xcr;�.:tu.,tiav-s:�•,at C�nmt:,:o:Pcrait�ppii�cus: For Office Use On-Tv Perwit No.: Lvte i42 A. P.gttiM that the Are�cdon, Siteradon, renoVatitin, mpaz, muderi� Improv t,removal or demolit:t�n or the canstrucd;, c u�rsior.. nal of an zddition to any pre-existing owner occupied L=utldin9 Cuutammg at I8st one but nap zrto_e than foa r dwelling unit,or x>structures whici.are adjacent to s-wh `'45'rL:P'YICe.ar builaingw b--d.,i -b,r;;�?ate d c-o ntCi3cto s,4i ii:.t w"?'tajrj txGG'�?t1ons,along Yi lit:(J 2Ci rDt?iiSa':Trac t3tS_ '}Te of Work. Weatherization -iddress o>W arI& �-�a 4, /V v r} < m A - Date of Permit t-Appplicabon: Z l l / i 011 hereby cartfy that: yt*. r-on is net—,Q11 red for the fc�Ilo ng reason(s): r Work excluded by law Job under S 500.00 � Banding not owrVr occupied Owner pulling ours pzr'._.i'it Notice is h=bEF gives that: OWNERS PULIAN i THEIR.OIX PERS i OR I3EAl.iNG W1 I,-,i UrNRECrISTEREL`CQ-NTRACTf3RS i FOR APPLICABLE HOME IM-PPOV',qAffiN 'WORK DO NOT HAVE ACCESS TO THE A 3t`f'R.A F`I©IV PROGRAM OR GC:ARAN L Y FUND UNDER h1; '.C. t 42A- Sipod md6r,=aNeS of perjwy: I hereby apply for a 1 emlit as.he agent of the owner: Bate: Z L `A / Z vZpC'on'tra�tor: BEYOND BEEN CONSTRUCTION Reg.4: �3 l2?� OP, SEAN R.1EFFORDS 4-t w:#�i5,`^crdis�g_he abOve notice, i hereb- apply 1%r a nem3it as the o—ner of the property. j Date: BEYOND GREEN C 0 N S T R U C T 1 DEBRIS DISPOSAL AFFIDAVIT !N ACCORDANCE WITH THE 1GMtA,0N 11lEALTH OF MASSACHUSETTS DE P-.- DISPOSAL PRi�VIzONS OF MASSACHUSE H S GEMEF AL LAVA CHAtTTER 40, SEMON 54,. A CONDITION OF BUILDING REP-MIT NUMBED FOR DEMOLITION WORK IS THAT THE- DESRIS RESULTING FROM THIS WORK gHALL 3E REMOVED FROM, SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID MAST= DISPOSAL FACILITY AS DEFINED BY MGL 0111. 5!50A. FACI� - ALTERNATIVE ReCycLING, NORTHAMPTON, MA STROCCICN 3P"E ADDRES5c_ IJ 7-3 BE DISPOSED AND TRANSPORTED B`,'- 3EYOND GREEN CONSTRUCTION or :kLTERNATIVE RECYCLING SI%`7-NATURE------ t NATURE__ -- t oZ DATE -_.-__ . DocuSign Envelo a ID:5F9032A0-A491-4135-A60C-56DEEC52FBEE Permit Authorization mass save Form Site ID: 3939533 Customer: Brian Adams Brian Adams I, , owner of the property located at: (Owner's Name,printed) 9 Hayward Rd Northampton, MA 01062 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. DocuSigned by: JA Owner's Signature: ;L2 a "S Date: 12/13/2019 112:53 PM EST wwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwwswwwwwwwwwwwwwwwwwwwawwwwwww FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: Page 1 of 1 For Office Use Only