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. # :