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16C-001 (3) 352' t1 SPRING ST BP-2017-0250 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block: 16C-001 CITY OF NORTHAMPTON Lot:-001 Permit: Building Category: Weatherization BUILDING PERMIT Permit# BP-2017-0250 Project# JS-2017-000430 Est.Cost:$1000.00 Fee:$0.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION Lot Size(so.ft.): 146710.08 Owner: KENT CHRISTOPHER B TRUSTEE Zoning:URA(100)/WSP(100)/ Applicant: BEYOND GREEN CONSTRUCTION AT: 364 SPRING ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 () EASTHAMPTONMA01027 ISSUED ON:8/30/2016 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: FeeTvpe: Date Paid: Amount: Building 8/30/2016 0:00:00is/0046-•o0 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck-Building Commissioner RECEIVED AUG 2 5 1016 The Commonwealth of Massachusetts Board of Building Regulations and Standards MUNICIPALITY DE- .� Ai WGINSPECTIONS Massachusetts State Building Code, 780 CMR --� ; • ON MA 01060 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 Appli=i: Building Official(Print Name) '*'. a Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map& Parcel Numbers 353- .5n(- (St. -c-kt1'(e2(Ice,r' c CACAO- 1.1a Otp- 1.1a 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 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 0 Private 0 Zone: Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: c0h0)6' q—Cr IOLeft2;f,6% (,j\ Name(Print) City,State,ZIP 3ba SQ\\r . (octS` 51 No.and Street Telephone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction❑ Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition 0 Demolition 0 Accessory Bldg. 0 Number of Units Other Specify:V)PCk-fl c1 Brief Description of Proposed Work2: Q CoU C O.tf C k Ir\ k(-fit 0 CO cL ' Cx-ocr du( Se a,\ 'mestw(`e_ SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$ (g C.,_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 Fees:$ LOS 00 Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ I 0 Paid in Full 0 Outstanding Balance Due: SECTION C'5: CONSTRUCTION SERVICES I 5.1 Construction Supervisor License(CSL) S _() )LA sa � I 1 a�) 1 (O SEAN R JEFFORDS 1, License Number Expiration ate Name of CSL Holder List CSL Type(see below) 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 Masonry City/Town,State,ZIP RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-529-0544 SEAN@BEYONDGREEN.BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I3 i a 7 c (1J Ia e Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 13 Terrace View sean@bevondtreen.biz No.and Street Email address Easthampton,MA 01027 413-529-0544 City/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 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 b zed OYICk G`1 tt rl C,O TU . to act on my behalf,in all matters relative to work authori by 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 the pains and penalties of perjury that all of the information contained in this application is true and acc e t' best of my knowledge and understanding. _Sean Jeffords Print Owner's or Authorized Agent's Name('Electr. is 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"may be substituted for"Total Project Cost" Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify 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: - T o Pi- K-e A) Name(P' t) Lt 'r 1 Current Mailing Address: Telephone S gnature 2.2 Authorized Agent: Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit 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 • Cfitg . of Nor-t1 intptun _ massartlugrug <; * ► �. I j" I{��7 z•: ° DEPARTMENT OF BUILDING INSPECTIONS a,•.r,, 212 Main Street • Municipal Building rsvie.1%• , Northampton. MA 01060 HFSBRULOS OCK 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 1s`floor .30 " " " " 2nd floor .20 " " " " %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. !! NO CASH -CHECKS OR MONEY ORDERS ONLY !! *Filing deadline is 12:00 pm(noon)on Wednesday. City of Northampton / NAM 0, . . 4.A.--- ...,5/C ,\ Massachusetts &� *x' -,- .� { _ DEPARTMENT OF BrJILDINC, INSPECTIONS 9. . 212 Main Street • Municipal Building Jas Jpa Northampton, Ill 01060 sI'h� W011 • Property Address: 35 S p r i r)0 S-- /Or en o, ,i4 ti) o ) .9 a Contractor Name: sI." , I ■,C rec r fl r ■ 6 Address: I ' Ir Y 1Q('-e ) \A 0A City, State: FX)'S'Y1 _iii I : ►i : 010- Phone: 10.Phone: `-1 1 -- 53a- 0 St-% Property Owner Name: c'1(IStDeh,( j u1 W- Address: ,. 5fD c5pr 1 n S)- . 1D�r ev c e i M vi o - City, State: YLO(e n CQJ '� A- ())0.1) - 1, SC an 3 Q Y'C (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. 1 Contractor signature ... 4.1. Date -2 -- g-,I l..9 ir-4\ • 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 @ 413-478-8631. See details below. Address: Beyond Green Construction 13 Terrace View Easthampton, MA, 01027 Email Address: nicole@beyondgreen.biz Thank you! Nicole Ieffords Beyond Green Cnnzt-artier !Project Coordinator Cell:413.478.86311 Office:413.52 9.0544 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 te- The Commonwealth of Massachusetts Department of.ndustriaalAccidents g _ Office ofIaivestigations t-- ff-e) 600 Washington Street -kV!4:4-7 ,loxton,MA 02111 www.ardass.gov/dila 'v os1 err' Compensation Insurance Affidavit:BuilderslContractors/Blectricians/Pinmbers Anlicant Info. ation Please Pri t Le °bY I"? • Name(Business/Organization/Individual): 7 h-3. t Q (Th \M-S11 .CT-1 C., 11 J - Address: 1 lE 1 Gt( C Lr l e-tcqu City/State/Zip: CC�-0-\(-ki-Y\ . 0't'1,; 1 —Mane#: L 13 ' �at — C' t4 Are you an employer?Check the appropriate hex: Type of project(required): 1.EL/am a employer with 3 4. 0 t am a general contractor and employees(full and/or part-time). have hired the sub-contractors b. 0 New constt�ction 2.0 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' 9. 0 BuiIding addition No workers'comp.insurance comp.insurance x required.] S. J We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t 0. 152,§1(4),and we have no employees.[No workers' 13.aother r(;L--�-, 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 him 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. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and.1ob site information. insurance Company Name: NJ(IV Ci A(,L(C 1 1`11/4iS�.'1 �( 111C. i. > r Policy#or Self-ins.Lie.#: S�;Y C I CO() 51 Expiration Date: I - i - ) 7 Sob Site Address: , hd` v 7 c-As\ci cS' City/State/Zip:_�I()t ence)M(1 b I blpa Attach a copy of the workers'campensYtion policy declarat lan 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 line 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and' •a ' ,foerju y that the information provided above is true and correct. 5.ignature: ' Date: e/ ( 1 Phone#: `i I,� — �t� l (: Lt 1-4 Oficial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Elect,ical iluspector S.Plumbing inspector b.Other Contact Person: Phone : AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application Suggested Affidavit For Home Improvement Contractor Permit Application For Office Use Only Permit No.: Date: Note 142 A, requires that the Areconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal or demolition or the constructional of an addition to any pre-existing owner occupied building containing at least one but no more than four dwelling unit, or to structures which are adjacent to such residence or buildings be done by registered contractors,with certain exceptions,along with other requirements. ; Type of Work: Weatherization Est. Cost: Address of Work: 3 9, son c1�, ) �� . -V I ('t?i`�Ce_ i (L1 l ���Lp Owners Name: (-1,,h((-1,,h(\ ç�1�t`,- V-(.'n- -- Date of Permit/Application: ' I i 7 / 1 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$ 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. I42A. Signed under penalties of perjury: a I hereby apply for a permit as the agent of the owner: Date: Contractor: BEYOND GREEN CONSTRUCTION Reg.# : 31 279 OR: SEAN R JEFFORDS Not withstanding the above notice, I hereby apply for a permit as the owner of the property. Date: Owner: Tel. # :