32C-285 (7) City of Northampton
! ' Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060
Property Address: ` ` �� l�) i 1 � � S St �J o f+Y)cz� un, IUY-�-
Contractor
Name:
Address:
City, State: � ��XYI U yv\
Phone: 2 - S � �
Property Owner
Name: r (IGIC�_S "ft' �� 1'J 1\ C)
Address:
City, State: N) o U 10(oU
I, SCO-0 j e (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 lc�g
Date
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N. P. HOME IMPROVEMENT INC.
® 575 Granby Road*South Hadley,MA 01075 0
CSSi4100481 Office:413-532-7603 fax:413-532-6435 1-
MAReg#143099 Email: NPM@Verizon.net BgB
CT Reg#.0673197 NFIB Member
Name: Ct� C) C���\�") Date: (� /
Street Address:
i m NSt In� 0('0 E)
Telephone: Cell: email:
PROPOSAL FOR:
HOUS GARAGE OTHER *Specks*
-ROOF TjR-O F GUTTER °
Layers: 2 3 4 Plywood:Yes or No# C'
COMPLETE ROOF PROTECTION SYSTEMS: 1
All proper permits shall be obtained
E!kCertificates of insurance provided upon request.
P3 Proper measurements will be taken to protect home i
and property
VI NPHI will remove old roof system to wood decking � P v.F�
Provide home owner with full exterior inspection _
J4 Any unsafe or decayed deck boards or plywood will be
replaced at$3.25 per sq.foot(with customer approval)
09 NPHI will leave the homeowner with a safe and clean
environment at the end of each work day
U NPHI will perform a final clean up with a roll magnet to remove any nails left behind
II project waste shall be removed by dumpster.kdumpster far_contractor use or11y
ROOF SYSTEM
IM Install ice and water shield 3' / 6' according to MA code requirements
Al Iriptall ice r shield around penetrations,chimneys,and in all valleys
� / 8° whi or brown drip edge will be installed on rake eaves
Install precut starter strr 'n le on rakes and eaves. <qX21hetic 151b underlayment installed
WkInstall ridge vent nowc or Roll vent
D Install soffit vents
Step flashing will be installed in all necessary areas
0 Install Lead counter flashing on chimney
SHI
ifetime _Ultra Lifetime AF Ridge Cap Shingle Color
WARRANTY:NP Home Improvement Incorporated will provide the above stated homeowner with a 7 year workmanship
warranty. This estimate is valid for 15 days.
13 Extended warranty$275. per year_yr(max 20 yr total)
We Propose hereby to furnish materials and labor-complete in accordance with above
specifications for the sum of:
CU �r�uww
Total Sale: $��5y5 Down Payment$ K, 595-Se'- Balance Upon
Completion$�) °-
Acceptance: The above price,specifications and condition are satisfactory and are hereby accepted.
Payment will be 1/3 down upon signing, and balance due upon completion. Unpaid balances shall accrue
with interest at 18%per annum. Purchaser(s)will pay for all costs,expenses and reasonable attorney's
fees incurred by N.P. Home 1, provement Inc.To recover any sums due under this contract.
Signature Date
Estimator Signat /at`K {P�� Dater— Z`� Phone:
ATTENTION:Please cover all personal belongings in attic,garage or storage areas due to the possibility of room eb is or dust
coming through cracks of wood decking.N.P.Home Improvement Inc.Will NOT be responsible for debris or dust in the attic or
storage areas.
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Dear Building Department,
Please send permit back to Beyond Green Construction when it is ready.
Mail to:
13 Terrace View
Easthampton, Mass 01027
Thank you!
L i
Nicole Jeffords Project coordinator
Beyond Green Construction
413.478.8631 nicole@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
I
Titij- of X rt Mutton --
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x
�x DEPARTMENT OF BU14DINC INSPECTIONS
212 Main Street - 4unicipal Building
Northampton, MA 01060
LOUIS HASBROUCK BUILDING MMIT FEES Phone: (413)587-1240
BUILDING COMMISSIONER Effective Julys 21, 2008 Fax: (413)587-1272
DEMOLITION $ 20.00 ACCESSORY S RUCTURE
$ 35.00 PRINCIPAL BUDDING—Residential
$200.00 PRINCIPAL BUILDING-Commercial
*NEW CONSTRUCTION $ .50 per square foot for 15'floor
.30 " " 2ne floor
.20 " " " '/2 floors,attic,basement,garage
STRUCTURAL ALTERATIONS IN ALL USE GROUPS
$6.00 per thousand dollars of estimated cost or fraction thereof,
with a minimum fee of$5 .00
$25.00 WOODBURNINGSTOVE
*NEW ACCESSORY STRUCTURES one hundred twenty(120)square feet and over
$ .20 per square foot witl$z minimum fee of$25.00
*NEW ACCESSORY STRUCTURES under one hundred twenty(120)square feet
$25.00 per inspection
*SWIMMING POOLS $30.00 for above ground
$60.00 for in-ground
*SIGNS&AWNINGS $30.00
*DECKS $50.00
REPLACEMENT WINDOWS $35.00
SIDING&ROOFING
Residential $35.00 per structure
Commercial $55.00 min.per structure�R$6/K of estimated cost
TENTS $25.00
*ZONING REQUEST FORMS $15.00 (includes home occupation registration)
REISSUE OF LOST PERMIT $25.00
CERTIFICATE OF ANNUAL INSP. $100.00 (minimum)
Temporary Certificate of Occupancy $25.00
PERMITS REQUIRING ONLY 1(1)INSPECTION WILL BE A MINI UM OF$25.00;ALL OTHERS WILL
HAVE A$50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO TI"E ORDER OF THE City of Northampton
AND SUBMITTED,WITH THE COMPLETED PERMIT APPLICATION,TO THE OFFICE OF THE BUILDING
INSPECTOR. WORK STARTED WITHOUT PERMIT IS SUBJECT 70 DOUBLE NORMAL FEE.
!! NO CASH -CHECKS OR MONEY ORDERS ONLY !!
*Filing deadline is 12:00 pm(noon)on Wednesday.
Department use only .
City of Northampton Status of Permit
Building Department Curb Cuk/Dnveway Permit.
212 Main Street Sewer%SepticAvailability
Room 100 Water Ill Availability ;
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Piot/5ite Plans` m
Other Specify � _
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2.PROPERTY OWNERSHIPIAUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name rint}, Current Mailing Address:
IS
Signature Telephone
SECTION 3:-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Date
Building Permit Number. Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
AdV\
BEYOND GREEN
CONSTR L CTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSETTS DEBRIS DI POSAL PROVISIONS OF
MASSACHUSETTS GENERAL LA CHAPTER 40 SECTION
541 A CONDITION OF BUILDING PERMIT NUMBER
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM THIS WORK SHALL BE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111,
S150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
CONSTRUCTION SITE ADDRESS
110 Williams St Northampton, t4A 01060
TO BE DISPOSED AND TRANSPOIRTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE
DATE 11/20/15
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
p I Congress Street,Suite 100
Boston,MA 02114-2017
cwM °•v,. www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Lezibly
Name (BusinessJOrganization/individual): BEYOND GREEN CONSTRUCTION /SEAN JEFFORDS
Address. 13 TERRACE VIEW
City/State/Zip:EASTHAMPTON, MA, 01027 Phone#:413-529-0544
Are you an employer?Check the appropriate box: Type of project(required):
1. I am a employer with 3 4. [] I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, E]Demolition
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp.insurance. 9. Building addition
required.] 5. We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs
insurance required.]# c. 152,§1(4),and we have no WEATHERIZATION
employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box 91 must also fill out the section below 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.
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.
Insurance Company Name:NorGUARD INSURANCE COMPANY
Policy#or Self-ins.Lic.#:SEWC585439 Expiration Date:APRIL 21,
Job Site Address: 110 Williams Street City/State/7ip: Northampton, MA 01060
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 penalties of perjury that the information provided above is true and correct
Si ature: Date: 11/20/15
Phone#: 413-5290544
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#:
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SECTIONS: CONSITUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-074539 XTQQ4 11/28/2016
SEAN R JEFFORDS License Number Expiration Date
Name of CSL Holder
13 TERRACE VIEW List CSL Type(see below) U
No.and Street Type Description
EASTHAMPTON, MA 01027 U Unrestricted(Buildings up to 35,000 cu.ft.
—_ --- R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC RoofinR Covering
-- WS Window and Siding
413-529-0544 sean @beyondgreen.biz SF Solid Fuel Burning Appliances I Insulation
Telephone Email address _ D Demolition
5.2 Registered Home Improvement Contractor(HIC) 131279 6/29/2016
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View _ sean @beyondgreen.biz
No.and Street 413-529-01544 Email address
Easthampton, MA 01027
City/Town,State,ZIP Tel ne
SECTION 6:WORKERS'COMPENSATION INISURANCE 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..........CXX No...........17
SECTION 7a:OWNER AUTHORI TION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACT R APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize BEYOND GREEN CONSTRUCTION
to act on my behalf,in all matters relative to work authoriz4d by this building permit application.
SEE ATTACHED SIGNATURE AUTHORIZATION FORM 11/20/15
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 to the best of my knowledge and understanding.
SEAN R JEFFORDS 11/20/15
Print Owner's or Authorized Agent's Name(Electronic Signature Date
NO ES:
I. An Owner who obtains a building permit to do his/her pwn work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(11IC)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 v/oca Information on the Construction Supervisor License can be found at www.mass.gov/dys
2. When substantial work is planned,provide the inform ton below:
Total floor area(sq.ft.) (in uding 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"
e Commonwealth of Massachusetts
_ _boa of Building Regulations and Standards FOR
Mass chusetts State Building Code,780 CMR MUNICIPALITY
USE
Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: Date Applied:
_Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
110 Williams St Northampton, MA 01060
1.1 a Is this an accepted street?yes no Map Number Parcel Number
13 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use v Lot Area(sq ft) Frontage(R)
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 yesE3
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record: ton, MA 01060 Northam
Bernadette Giblin P
Name(Print) City,State,ZIP
110 Williams Street _ _ 413-584-6175 _
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ 1 Repairs(,) ❑ 1 Alteration(,) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other I%Specify:Weatherization
Brief Description of Proposed Work-Z:IMPROVF ATTIC INS[11 AT1QN T(LCnf)F AND AIR SEALING
MEASURES
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ 5 Indicate how fee is determined:
2.Electrical $ 1%Standard City/Town Application Fee
❑Total Project Cos?(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All F s: l0 s�
6.Total Project Cost: $ �R i Check N Check Amo �-/ Cash Amount:
�� ❑Paid in u 1 ❑Outstanding Balance Due:
File ,r 1311-2016-0736
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON01027 (413)529-0544 Q
PROPERTY LOCATION 110 WILLIAMS ST
MAP 32C PARCEL 285 001 ZONE URC(111Z
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 7,_jx�7 It
Building Permit Filled out
Fee Paid
=I\_peof Construction:_INSTALL ATTIC INSULATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074539
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
roved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project:_ Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received& Recorded at Registry of Deeds Proof Enclosed
O(her Permits Required:
Curb Cut from DPW _Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
moliti ela
Signa re of Bui i O fic' Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
110 WILLIAMS ST BP-2016-0736
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma,,:Biock: 32C-285 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-2016-0736
Project # JS-2016-001235
Est. Cost: $1000.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq_ft.): 3484.80 Owner: GIBLIN BERNADETTE M
7ouin URC n 1 / Applicant: BEYOND GREEN CONSTRUCTION
AT. 110 WILLIAMS ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON.121712015 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 Signature:
FeeType: Date Paid: Amount:
Building 12/7/2015 0:00:00 $65.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner