17D-026 (5) 77 STRAW AVE BP-2017-0611
GIS#: COMMONWEALTH OF MASSACHUSETTS
Mao'Block: 17D-026 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit-. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catceorv: INSULATION BUILDING PERMIT
Permit# BP-2017-0611
Project# JS-2017-000989
Est.Cost: $3000.00
Fee: $78.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
rap_. BEYOND GREEN CONSTRUCTION 074539
Lot Size(se. ft.): 16335.00 Owner: NAYAK ANAND P&POLLY FIVEASH
Zoning: URB(l00)/ Applicant: BEYOND GREEN CONSTRUCTION
AT: 77 STRAW AVE
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAMPTONMA01027 ISSUED ON 11/1/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:IMPROVE ATTIC INSULATION AND AIR
SEALING MEASURES
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 11/1/2016 0:00:00 $78.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2017-061I
APPLICANT/CONTACT PERSON BEYOND GREEN CONSTRUCTION
ADDRESS/PHONE 13 TERRACE VIEW EASTHAMPTON (413)529-0544 O
PROPERTY LOCATION 77 STRAW AVE
MAP 17D PARCEL 026 001 ZONE URB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 6(cfP
Building Permit Filled outFee Paid
Typeof Construction: IMPROVINSULATION AND AIR SEALING MEASURES
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074539
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF_ O$MATION PRESENTED:
pproved 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
Sr ire of Bui si [Offici - 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.
The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
- -- Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
':: _I Building Permit Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
One-or Two-Family Dwelling 2,� /
m _ 2 TVs Section For Official Use Only , A t a
i.i, U _s ing Permit Number: F/v I V�� D !
o 2 ////U
"I w
Brilding Official(Print Name) gn: Date
SECTION L:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
77 ,5+raw five cinfence k4
1.1 a Is this an accepted street?yes no Iowa Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Arca(sq ft) Frontage(h)
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? Municipal 0 On she disposal system 0
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
2Mwner of Record: PA O 1 rJ
,Jame(Print) City,State,ZIP
71._5 a_Jsco
_kRut 1413- Se - 6 /76
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 0 Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s)�y❑, Addition 0
Demolition 0 Accessory Bldg.0 Number of Units Other f�Specify:WQ&4 t(i(LLf1Or
Brief Description of Proposed Workt: (05t C(-{t\C I nSV CLT-an to Cotte
ciP_a__air_ e Cl Ait\G MQ(_11),.CCS .____
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ I. Building Permit Fee: $ f'i Indicate how fee is determined:
2. Electrical S ❑Standard City/Town Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: S
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ �� {/'
Check No.100 Check Amount: 7O Cash Amount:
n
6. Total Project Cost: s e 0 Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction
SEAN R JEFFORDS Supervisor License(CSL) CC t.1 sS(3 I I D J
License Number _1 Expiration ODate
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 l&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(rilBEYONDGREEN.BI7 I Insulation
Telephone Email address I) Demolition
5.2 Registered Home Improvement Contractor(HIC) y 2 I a 1 (01991q0
Sean R Jeffords-Beyond Green Construction HIC Registration`Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sean(p(beyondereen b z
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.S 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 On{k et f efn Cnfll&'T-ori Qr'\
to act on my behalf,in all matters relative to work authorized by this building permit application.
See ail odied Iela� ll �
Print Owner's Name(Electronic Signature) Date
SECTION 76: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 accu t best of my knowledge and understanding.
PrintJeffords ` e I le / c� I to
Print Owner's or Authorized Agent's Nama.(Eleo ic Signature) Date
NOTES:
L 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(NEC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. I42A.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"
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$3e up in$1,500.00 and/or one-year inio±on-nc t,as well as civil penelfes lathe form of a STOP WORTS ORDER and a fine
oF•:,p le S250.00 a day against the violator. Be advised Mats copy ofttis stata neramay be fwwe_ded to the Office of
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IMassachusetts -Department of Public Safety
Boarc of Building Regal atcns and Standares
J.
License CS-074539
;
SEAN R JEFFOR$ ;
13 TERRACE VUW. $
EASTHAMF7O1qMA
c:orlyn'ssloner11/28/2016
r/L '&o'mnaii,wea/t/ aJCAtaa Auielli
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 131279
Type: Individual
Expiration: 6/29/2018 Tr* 288957
SEAN JEFFORDS
SEAN JEFFORDS -
13 TERRACE VIEW
EASTHAMPTON, MA 01027 - --- -- -
Update Address and return card.Mark reason for change.
Address c Renewal Employment I Lost Card
SCAT fi wiAos. 1 -"
r- /rr.umrrrrvrua/r/—(jr uaeA,Gea,
Office ur Consumer Affairs&Business Reguhdon License or registration valid for individual use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
H Registration: 131279 Type: Office of Consumer Affairs and Business Regulation
3 Expiration: 6292018 Individual 10 Park Plaza Suite 5170
Boston,MA 02116
SEAN JEFFORDS
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 -_--- _ -_— h- --- -
ruderseeretury 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 Areconstruetion, 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: 7-26t- J n've -Porehce1 NI ✓-} J0c0
Owners Name: r�n ctin d N Cuj a K-
Date of Permit/Application: [ 0/ 071) 0
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 perjury: s-\
I hereby apply for
a
r a permit as the agent of the oavner.
Date: Contractor: BEYOND GREEN CONSTRUCTION Reg.# : 131 279
OR: SEAN R JEFFORDS
Not withstanding the above notice,I hereby apply for a permit as the owner of the property.
Date: Owner: Tel.#:
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-
7 7 Skr-60,v five Threw) M ft b I c
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE
DATE IO Ic)1//b
Mac; City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
rya 212 Main street a Municipal Building
Northampton, MA 01060
Property Address: I3 Ave . ✓ —
Contractor ,�j�
Name: YX'(1 nd recti Con5i-ruci;on
Address: �C3�� ' T rrrane vl �
City, state: 1C�-S-1-h coin prI Yr ; M Y-1 O1 oai
Phone: IIA I3^ Sas- os41-4
Property OwnerI/
Name: ��1f1G��(1LvU6_i ,t
Address: 1 -7t o' IA e1 I vJL°J�('� )A4
City, State:
I, S e an3Q OY'd.1 (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 ici b j I
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