Loading...
17A-084 (3) 15 CAROLYN ST BP-2016-1398 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-084 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-2016-1398 Project# JS-2016-002410 Est. Cost: $3000.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sq. ft.): 13808.52 Owner: DAUBE JONATHAN Zoning: R1(100)/URA(100)/WSP(93)// Applicant: BEYONDGREEN CONSTRUCTION AT. 15 CAROLYN ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 O WC EASTHAMPTONMA01027 ISSUED ON.512512016 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 4 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 5/25/2016 0:00:00 $78.00 212 Main Street, Phone(4 1.3))587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File# BP-2016-1398 APPLICANT/CONTACT PERSON BEYOND GREEN CONS RUCTION ADDRESS/PHONE 13 TERRACE VIEW EAST14AMPTON01027(413)529-0544 O PROPERTY LOCATION 15 CAROLYN ST MAP 17A PARCEL 084 001 ZONE RI(100)/URA(100)/WSP(93)/ THIS SECTION FOR OFFICiIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT F Fee Paid - Building Permit Filled out Fee Paid T_ypeof 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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved 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 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 Demolition Delay 7 L Sig uil ing O' fficia1 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. RECE�VEC� Th Cot imonwealth of Massachusetts 1r' Board f B ilding Regulations and Standards FOR Ulf P11 Massac ius s State Building Code, 780 CMR MUNICIPALITY USE aticn To Construct,Repair, Renovate Or Demolish a Revised Mar 2011 -or Two-Family Dwelling This Section For Official Use Only Building Permit Number: D'to Applied: Building Official(Print Name) Signature Date SECTION 1: SITE INFORMATION 1.1 Property Address: 12 Assessors Map&Parcel Numbers 15 Caro ku In kQ C-Q Awit Gl t) 1.1 a 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 Y'rds Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone In ormation: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Public❑ Private❑ Check if yes❑ Municipal❑ On site disposal system ❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Reco J on Name(Print) City,State,ZIP 5 C arcS�- No.and Street IJ Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK (check all that apply) New Construction❑ Existing Building❑ Owner-OccWied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg. ❑ Number of Tits Other 51 Specify:W(�ckk"e67-Cvt On Brief Description of Proposed Work : f V t? nskklcutod- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Bui ding Permit Fee:$ '77 Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ s ❑Tot Project Cost (Item 6)x multiplier x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Suppression) Total All Fees:$ '7 � Check NoC? Check Amount: Cash Amount: 6.Total Project Cost: $ zC�� 0 paid;in Full 0 Outstanding Balance Due: t SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) �c, 7 SEAN R JEFFORDS C� 01/"IJ8 9 I 0 lv License Number Expiration Date' Name of CSL Holder List CSL Type(see below) L 13 TERRACE VIEW Type Description No.and Street U Unrestricted(Buildings 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 SEAN a@BEYONDGREEN.BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) 3 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 Cit /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 ..........X No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOUR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize , A00CJ to act on my behalf, in all matters relative to work authorized y this building permit application. bee cA-m( .h c/ 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 acc to est of my knowledge and understanding. _Sean Jeffords , Print Owner's or Authorized Agent's Name(Electrons 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.mass.gov/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 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" The Commonwealth of Massachusetts Department of Indiistrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mastgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaulicaut Information Please Print Legibly Name(Business/Organization/Individual): , i K I i Pircm Address: 13 R r r CA V City/State/Zip: tM L'la 010 hone#: Ll I,3— 5 )1 - 0 5 y Are you an employer?Check the appropriate box: Type of project(required): 1.ffI am a employer with —3 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired ft sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees acid have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurahce.# required.] 5. [] We are a cor oration and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I l.❑Plumbing repairs or additions myself.[No workers'comp. right of oxen ption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4) and we have no employees. o workers' 13.('2]Other Z GL1 l i comp.ins 4:0 required.] *Any applicant that checks box#1 must also fill out the section below showing t it workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and n hire outside contractors must submit a now affidavit indicating such. tContractors that check this box must attached an additional.sheat showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they roust provide their workers'comp.policy number. zs�e�-fa - I am an employer that is providing workers'compensation Insurance for my employees. Below is the pollcy and job site Information. Insurance Company Name: 00y' LkCkrC( r) S(t r CCP C 1C Policy#or Self-ins.Lie.#: w EC 1 o Did Expiration Date: Job Site Address: � �l�[ "S t ' City/State/Zip: t� CXnc G 1 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 MOL 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. Ido hereby certify under the pains and penal'es of Jury tha#the information provided above Is true and correct. Signature: a cJ' 00— 1 LO P e#: _ �J a — o �(4 Official use only. Do not write in this area,to be completed city or town ofJlclal City or Town: P rmit/License# Issuing Authority(circle one): 2.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1�! Massachusetts -Department of Public Safety f Board of Building Reguiiations and Standards Constructi'"11 )l'7 iuC License: CS-074,09 SEAN R JEFFORI} .. 13 TERRACE VIIIW EASTHAMPTONMA.. WO Expiration Commissioner 11/28/2016 Office of Consumer Affairs a d Business Regulation 10 Park Plaza - uite 5170 Boston, Massach;setts 02116 Home Improvement Contractor Registration Registration: 131279 Type: Individual Expiration: 6/29/2016 Tr# 254174 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON, MA 01027 - -- --- --- Update Address and return card.Mark reason for change. Address Renewal ] Employment Lost Card SCA?. w 20M-05111 � Office of Consumer Affairs&Busihess Regulation License',or registration valid for individul use only g3 -- ME IMPROVEMENT CONTRACTOR Obefore the expiration date. If found return to: J 0 stration: 131279 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 1` xpiration: 6/2912016 Individual 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 Permit 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 constructional 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 building@ be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Weatherization Est. Cost: ( 3�j Address of Work: Jc� (�' ( 1�q 'Y-\ = of W C Q, NqC) C)(D �- Owners Name: Date of Permit 1 Application: - lG 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: 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 541 A CONDITION OF BUILDING PERMIT NUMBER FOR DEMOLITION WORK IS THAT THE DEBRIS RESULTING FROM THIS WORK HALL BE REMOVED FROM SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111, S 150A. FACILITY- ALTERNATIVE RECYCLING, NORTHAMPTON, MA CONSTRUCTION SITE ADDRESS- TO BE DISPOSED AND TRANSPORTED BY- BEYOND GREEN CONSTRUCTION or ALTERNATIVE RECYCLING SIGNATURE DATE 5 a � two mass saveUM�R savings thw.V+enaW tftemy PERMIT AUTHORIZATION FORM I, JONATHAN DAUBE ,owner of the property located at: (Owner's Name,printed) 15 CAROLYN ST FLORENCE (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Progra assi ed Participating Contractor listed below to act on my behalf and obtain a building permit to pe rm ins lation and/or weatherization work on my property. X Owner's Signature e � r S Date FOR CSG OFFICE USE ONLY Conservations Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Di For Office Use Only Rev.12132011 City of Northampton 'f r•.. :. ` ,asks ...a! �,. Massachusetts DEPARTMENT OF BUIIGDING INSPECTIONS !gyp 212 Main Street • Municipal Building 0R 4`a Northampton„ MA 01060 Property Address: 1S Cir ala n STTL°r-t 4--Jorcrwe, t-kyi Contractor Name: RouarrA Arfcnn iT Address: O City, State: S` 'Ir'1 Gc n(�1Z V� t.�y� 010a] Phone: aa- o5yu Property Owner Name: YlC'A�'{�1(� Address: City, State: --F (o Y /fit p O I, 'Sean ) Y' (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 5-ac)--t ca BEYOND! GREEN C( € „� I , N Dear Building Department, Please send permit back to Beyond reen Construction by mail or via email when it is issued. If you have any questionsl regarding this building permit please call my cell @ 413-478-8631. See details b6low. Address: Beyond Green Construction 13 Terrace View Easthampton,MA,01027 Email Address: nicoleibeyondgreen.biz Thank you! cr/cole�?e ca-6 ; I Project Coordinator Cell:413.478.8631 Office:413.529.0544 13 Terrace View,Easthampton I www.beyondgreen.biz i i 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