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17C-015 (8) 57 LAKE ST BP-2016-1018 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17C-015 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-2016-1018 Project# JS-2016-001720 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.): 9321.84 Owner: STANAVAGE ROBERT A Zoning: URB(100) Applicant. BEYOND GREEN CONSTRUCTION AT. 57 LAKE ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 O WC EASTHAMPTON MA01 027 ISSUED ON:2/17/2016 0:00:00 TO PERFORM THE FOLLOWING WORD.INSTALL ATTIC INSULATION POST THIS CARD SO IT IS VISIBLE FROM THF, 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: i Building 2/17/2016 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner i File#BP-2016-1018 APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON01027(413)529-0544 Q PROPERTY LOCATION 57 LAKE ST MAP 17C PARCEL 015 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid mt Building Permit Filled out Fee Paid Typeof Construction: INSTALL ATTIC INSULATION New Construction Non Structural interior renovations Addition to Existin 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 INFOTION PRESENTED: _ pproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDE,R:§ 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 Other 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 lay Sie o frui 16in jKff icia r 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. DEPT.v^F[;U:,- iiJSP"CTUJ Na;of;t:ahsin , 60 The Commonwealth of Massachusetts Board of Building Regulations and Standards FOR Massachusetts State Builditjtg Code,780 CMR MUNICIPALITY USE Building Permit Application To Construct',Repair,Renovate Or Demolish a Revised Mar 2011 One-or Two-Famdy Dwelling This Section For Official Use Only Building Permit Number: Date Applied: Building Official(Print Name) Signature Date SECTION 1:SIT INFORMATION 1.1 Property Address: lap 2 Assessors Map&Parcel Numbers 7 Lake Street Florence, MA 01062 1.1 a Is this an accepted street?yes no 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 14formation: 1.8 Sewage Disposal System: Public 13 Private 13 Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Ch k if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner`of Record: Robert Stanavage Florence, MA 01062 Name(Print) ty,State,ZIP 57 Lake Street 4113-320-6548 No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply) New Construction❑ Existing Building❑ Owner-Occttpied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition 13 Demolition ❑ Accessory Bldg.❑ Number of limits I Other l%Specify:Weatherization Brief Description of Proposed Work2-IMPRnVF ATTI( INSI11 ATInN To CODE AND AllB SEALING MEASURES SECTION 4:ESTIMATE CONSTRUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I.Building $ 1. Budding Permit Fee:$ Indicate how fee is determined: dt St"dard City/Town Application Fee 2.Electrical $ ❑ToW Project Costa(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ S --- Suppression) Total All Fees: CheckiN eck Amount: Cash Amount: 6.Total Project Cost: $ 1 �� 0 Paid in ull 13 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS-074539 XTQQNXM 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 Roofing 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 Email address Easthampton,MA 01027 413-529-0544 Ci (Town,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..........LXX No...........0 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 BEYOND GREEN CONSTRUCTION to act on my behalf,in all matters relative to work authorized by this building permit application. SEE ATTACHED SIGNATURE AUTHORIZATION FORM 2/5/16 Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under themi s -penalties of perjury that all of the information contained in this application is true and accurate to b o y knowledge and understanding. SEAN R JEFFORDS 2/5/16 Print Owner's or Authorized Agent's Name(Electronic Signa ) Date 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.p,ov/oca Information on the Construction Supervisor License can be found at www.mass,ggv/dps 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 "= Office of Investigations 1 Congress Street,Suite 100 Boston,MA,02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit;,Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organizationllndividual): 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.O 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. ❑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' 9. E]Building addition [No workers' comp, insurance comp.insurance. required.] 5. F] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no WEATHERIZATION employees. [No workers' 13.0 Other comp.insurance required.] *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. Insurance Company Name:NorGUARD INSURANCE COMPANY Policy#or Self-ins.Lic.#:SEWC585439 Expiration Date:APRIL 21, a 0 I Job Site Address: 57 Lake Street City/State/Zip: Florence, MA 01062 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 MGIL 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 ry the information provided above is true and correct Signature: Date: 2/5/16 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#: Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-074539 SEAN R JEFFORQS 13 TERRACE VEKW EASTHAMPTONMA=� Expiration Commissioner 11/28/2016 L//X/e - Office of Consumer Affairs and Business Regulation n. 10 Park Plaza - Suite 5170 rte. Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 131279 Type: Individual Expiration: 6129/2016 Tr# 254174 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON, MA 01027 Update Address and return card.Mark reason for change. Address ; "j Renewal 1 1 Employment Lost Card SCA 1 G 20M-05/11 .G �1a tXnn��i�a�tuseall�r//Q'j�cr��ut•�irJF//,i Office of Consumer Affairs&Busihess Regulation License or registration valid for indietuuse only g —— before the expiration date. If found return n to: OME IMPROVEMENT CONTRACTOR egistration: 131278 Type: Office of Consumer Affairs and Business Regulation xpiration: 6!2912016 Individual 10 Park Plaza-Suite 5170 � Boston,MA 02116 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON,MA 01027 Undersecretary Not valid without signature AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application Suggested Affidavit For Home Improvement Contractor Pennit Application For Office Use Only Permit No.: Date: Note 142 A, requires that the Areconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal or demolition or the construct/ nal of an addition to any pre-existing owner occupied building containing at least one but no more than four dwelling unit,or to structures which are adjacent to such residence or budding@ be done by registered contractors',with certain exceptions,along with other requirements. Type of Work: Weatherization Est. Cost: Address of Work: 57 Lake Street Florence, MA 01062 Owners Name: Robert Stanavage Date of Permit/Application: 2/5/16 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$500.00 Building not owner occupied Owner pulling own permit Other(specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL C. 142A. Signed under penalties of perjury: _ I hereby apply for a permit as the agent of the owner: Date: 2/5/16 Contractor: BEYOND GREEN CONSTRUCTION Reg.# : 131279 OR: SEAN R JEFFORDS Not withstanding the above notice,I hereby apply for a permit as the owner of the property. Date: Owner: Tel.# BEYOND GREEN CONSTRUCTION DEBRIS DISPOSAL AFFIDAVIT IN ACCORDANCE WITH THE COMMONWEALTH OF MASSACHUSETTS DEBRIS DISPOSAL PROVISIONS OF MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION 54, 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- 57 Lake Street Florence, MA 01062 TO BE DISPOSED AND TRANSPORTED BY- BEYOND GREEN CONSTRUCTION or ALTERNATIVE RECYCLING SIGNATURE DATE 2/5/16 City of Northampton Massachusetts I' WK � y DEPARTMENT OF BUIZDIN6 INSPECTIONS y. 212 Main Street • Municipal Building Northampton, MA 01060 Property Address: �J �a�e 1� -R o(til c e , m n- (� (0(D 0 Contractor Name: P�Unfyi -1(''P,�X� C.(�(I� YU ,tl (,X) Address: I TC-r r CA Le V i e-W City, State: FCIS� ro iv--% n i oaf Phone: ` 3 or 9 — 0 5 Property Owner c 6r^ Name: Kt -,n Address: J Lck-�-Cn J - City, State: I, SPS n Jel4nr (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 Date a /5 / Department use only City of Northampton status of Permit r Building Department Curb Cut/DriV6 a` Permit 212 Main Street Sewer%SepUcAvailabilifity Room 100 INater/INell Avatlabil(ty Northampton, MA 01060 Two Sets of Structural Plans �R phone 413-587-1240 Fax 413-587-1272Pl6t/Site"..., . . btlier Specify x `amu'„� APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION This section to be completed by office 1.1 Property Address: Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Name ) __ -------- Current Mailing Address: Telephone Sig ature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 316 ESTIMATED CONSTRUCTION COSTS. Item Estimated Cost(Dollars)to be Official Use Only complete by permitapplicant 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 Commissionerllnspector of Buildings Date it-I j,•,,:y� •.Cf, (�}y� (/,!� �,y �.4ttgsttrfj us3ett� ^� `••. M. f -1 tyi x DEPARTMENT OF BUILDING. INSPE'CTIONS 212 Main Street . Municipal Building Northampton, MA 01060 LOUISHASBROU CK BUILDING PERMIT FEES Phone: (413)587-1240 BUILDING COMMISSIONER Effective July 21, 2008 Fax: (413)587-1272 DEMOLITION $ 20.00 ACCESSORY STRUCTURE $ 35.00 PRINCIPAL BUILDING—Residential $200.00 PRINCIPAL BUILDING-Commercial *NEW CONSTRUCTION $ .50 per square foot for I"floor .30 " " " 2nd floor .20 " 'A 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$55.00 $25.00 WOODBURNING STOVE *NEW ACCESSORY STRUCTURES one hundred twenty(120)square feet and over $ .20 per square foot with a 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 OR$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 MINIMUM OF$25.00;ALL OTHERS WILL HAVE A$50.00 MINIMUM. PERMIT FEES SHALL BE PAID TO THE 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 TO DOUBLE NORMAL FEE. I! NO CASH -CHECKS OR MONEY ORDERS ONLY I! `Filing deadline is 12:00 pm(noon)on Wednesday.