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34-005 (9) 296 TURKEY HILL RD BP-2018-1382 GIS n: COMMONWEALTH OF MASSACHUSETTS Map:Block:34-005 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A) Category INSULATION BUILDING PERMIT Permit# BP-2018-1382 Project N JS-2018-002449 Est.Cost:$881.00 Fee:$65.0o PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor., License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sq.ft.): 80019.72 Owner: NAKASHIAN NICOLE Zoning: Applicant: BEYOND GREEN CONSTRUCTION AT: 296 TURKEY HILL RD Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 0 WC EASTHAMPTONMA01027 ISSUED ON:612512 01 8 0:00.00 TO PERFORM THE FOLLOWING WORK•AIR SEALING, WEATHERSTRIPPING, BOOR SWEEP, KNEEWALL SLOPE, THERMAL BARRIER POLYISO 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: FeeTvoe: Date Paid: Amount: Building 6/25/2018 0:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED Vass�achusctts onwealth o:J�w Massachusetts z Q01B ing Reguland Standards FOR State Buildde, 780 CMR MUNICIPALITY USE o Construcair, Renovate Or Demolish a Revised Mar 2011 r Two-Family ellin K This Section For Official Use Only Buildin P i umber: '� Date Applied: g mi tint Name) natm� Data SECTION is SITE INFORMATION 1.1 Property Address: 1.2 Assesim Map& Parcel Numbs ftGla CLQ l 4 _t( 005 I.I a Is this an ace ted street?yes_ no__OjfD Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: _— %ening District Proposed Use -- Lot Area(sq ft) Frontage(0) 1.5 Building Setbacks(D) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L a 40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zma, _. Outside Hand Zone! Municipal❑ On silt dispusel system ❑ Check ifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner of Record: AI CnIQ �Gkc�shtaP� _ __N_o( OL � , a oloco 3 +an Ir nen _ Name(Print) City,Scale..ZIP �tlPTur�a, ugd __ _____ Gn-9d�-I�e �d� No.and Street J Tel phone Email Address SECTION 3: DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction 13Existing Building❑ Owner-Occupied ❑ Repw (s) ❑ Alteration(s)1'❑ Addition ❑ Demolition ❑ Accessory Bldg.El Number of Units_ Other WSpecify:lll f3TV1 .1�i IXz J,nn Brief Description of Proposed Work': t. _At E6a- S_jCfM_SO OCr Nr, ZX�CLiQLS'?aJ wt_a(.her r 4e_L ' ' Dan>,c , ce t.l_y 4U$,— 004Y _Cl r fCS41L F�bLP=1�_`:-- SECTION 4: ESTIMATED CON RUCTION COSTS Item Estimated Costs: Official Use Only Labor and Materials I. Building $ 1. Building Permit Fee:$ 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,$� (Q Check No. Zt i, Check Amoum: Cash Amount: 6.Total Project Cost: $ gg Q 0 Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) SFAN R 1T.PFORDS ✓jj(, Incense -Nu_mber �%plrWlnn l7ilc Name of CSI.Holder (,�Y Lia CSl,lypc(sceb nw) 13 TERRACE VIFW Type "'Besewptlm_ ' No,and Street U Unrestricted(Buildings up to 35,000 cu. ft.) FAS'IHAMPTON,MA 01027 R Restudied 1&2 Family Dwelling City/lbwn,Slatc,ZIP M Mason RC Roofrn Covering WS Window and Siding SF Solid Pud Ruining Appliances 413-529-0544 _ SEAN/alHEYONDGREEN 1312 I Insulation l'el hone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) �l(y 1� Ot Sean oma ny N Beyond Green Construction HIC Registration Number Expiration Dale HIC Company Name or HIC Registrant Name No,and St View sea t n bevond¢rcen b z No.and Street Email address Easthampton.MA 01027 413-529-0544 Cit /Town,State,ZIP 'fele hone 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...........❑ SECTION 7e:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING/yPERMIT I,as Owner of the subject property, hereby authorize toad on my behalf,in all matters relative to work authorized bt this building permit application. Print Ormer's Name(Electronic Signature) Dale 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 accurate the Tmy knowledge and understanding. Sean Jeffords _ lI`3_I �� Print Owner's or Authorized Agent's Name(Iilecnoni�NOTES.: Dale 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. ovg /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 Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Wil.cluers'Compensation Insurance Affidavit:Builders/Contractors/Electrician&Mlumben. TO BE FILED WITH THE PERMITTING AUTHORITY. A li t Information Please Print I.eatbiv Name lDu;;�.�organimlerMml+eiaaall: �_�C L2�2_ '�.L1Y]sS+=Y � C22.v.. Address: !.' City/State/Zip: C ,,,� Phone#: 5 r�- ()b N N Areyou an employer.Cheek cue.ppmprinnbx. Il�-e Type of project(required): L�Imvaemploymwnh_�_eodev,c«r(full An"panaurc) 7. ❑New construction z.❑Iunaml[prgwielmar pemrmahip ami nave rw amptoy«.wmYiryl rm rre in R. ❑Remodeling anye'alvaic INOwiwkers colon inawuwe mlwd.i 3.❑I amahomemmudoi2c s1nmk M udf pioourken'verrrp rmumrce redacted 1' 4 ❑Demolition 4,L]Iaae hommwnnmdwilt bchirine coni wrsmcmrdmtau«ork on mY Rupmg'. I«ill IO❑Building addition mcchar an mmracmrs eiNm hav[workne wmpcmmian rmmerce or am w![ IL❑ Electncalnpans or additions pmprxonra wilh rw er,lv,a c. 12.❑Plumbing repairs or additions 5.❑Iam re veno.,orad!IInar hired rA.- lined mr be gaMf a lett 13.❑ROofrepalR Thesee.Iveorwrors hav[ump!gm and have wwkeWeaenp immer'e% 14.(�Other�]Q {�P,�u fi.❑weare acnrli viuoR Mv[ex[rcire rleirripe efae�rion per MCL r. Vn 152,41(4),anddeve h e havee n no npluysm INo workers'wrap imwveersyuirN.j •An,appinoalthm eheeksbon al mart atm fill outdfiv etiorrfinava showim Neir uankaas'mm asonvoiribe,erfmmtion. �Ilnnrnwnw wlw aWmut Nit affu4vir vdicarina aeY art drains na wmkeM Nsss has auuiM cmraecbtimul submit a rew arfavir irdisaing such. %fonbixNrs III61[M:k Nit Mrr inurl anv[bN m aGlilitmN abed flewmg rh[marc of Nc NbtiMIMIMf amt nttl[wMhn m rM IMre gllllin Mv[ mnploym It the aubavnaxwnlav[e�laym,tleymw Ro.ilc eMa amkers'umq PWaY wrnba• /ant an rmployer that isprovidixg workers'cnmpeasadon insurancefor my employers Below is thepolicy andlol,site information. //�� Insurance Company Name: N 0 Pot icy horSrif-ire-I.ic.k:__ 5&UJfC_o _,��- __. - Expiration Date:_ Joh Site Addreds.29—le ./� L gcK _ CityiscudZip:-�Qr� )wxvl- Attach a copy of the workers'tompe livib n policy declaration page(showing the policy number and expire date). Failum to secure eovemge as required under DAGL a. 152,§.25A is a criminal violation punishable by a fine up to 51,500.00 and/or m ecyear 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.A copy of this statement may be forwarded to the Office of Investigations of the DDA for insurance coverage verification. ON ma I do hereby certify under the pains and a riry fiat me infornmdon provided above is nue and correct Datc____ Phone Official use oidy. Do not write in this arra,to be caarpleled by rill,m town effaial. City or Town: ,._- -__PermittLicense it Issuing Aulbority(circle mul 1. Board of Health 2.Building Department 3.City?own Clerk 4.Electrical inspector 5,Plumbing Inspector 6. Other Contact Person: Phone#: i Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-074539 Construction Supervisor SEAN R JEFFORDS 13 TERRACE VIEW EASTHAMPTON MA 01027 Expiration: Commissioner 11M1SI20te � Ate_, 1� / Office of Consumer Affairs and Business Regulation W? 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 131279 TVpe: Individual Expiration: 629/2018 Tra 288957 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW _ EASTHAMPTON, MA 01027 - -- - Update Address and return cord.Mdark reason for change. Address 'i. Renewal Employment - Lost Card xe. r, mewvv ✓�/4 °.(A License ar regiurafen unlit for mdn dual use only /C 1Tegmahun `.HOME IMPROVEMENECONTRACTOR before the expiration date. If found return to. Registration' 131279 ^' , TYW Office of Cmsmase Aff + rs vsnd R. mes,RegvErtion Expiration: 62912018Istual 10 Pmkl'lan Suileo170 a Boston.MA 02116 SEAN JEFFORDS SEAN JEFFORDS 13 TERRACE VIEW EASTHAMPTON,MA 01027 - — d -t - _ - Ond ruaretery dott and without signature AFFiDAVi L Hume Improvemerri f ontractor Law Supplcmcnt to Pe:mii App{ication ti l ra�.a � nw«*,. c o .o_r„m re pFwazlon ter Office Use Only PemtitNo- Uatr,- T t e +Z - rt guttas iha[ the r eoonsvui tion,- alteration, renovation. repair. modemizntlon, cm - :ri.., il,zpz,e nL r mu at or demob ion w the consLrucuonal of an addition to any pre-existing owner u fumed 1! bUildlUeoteitbUg at least ore a t no more than fou, dweltmK unit or tc structures which are ad.acenr o such !� � r sio i a'bictld ny be done b�regisrcr�lco�� cer�rs,ivitt ei trru ea.,-p ions along vath otlrc� regn c h_,i Type of Work: Weatherizalion Est.Cost _ Address c;Work O,I7-Pa-- O meraName: La e of 1'ertci[ Application: �_�_� ____ - i net^np ceti :+[hat Reg)sha[ion is not required iof She fuliowing reason (s): W rk excluded,by law .lou under .+X00,! ) I Buodingnajo.vnes oc�urved Ownerpullmg ewn permit MILT(9pe6A') .1nt e;r is hsmb; giver. that FOWNL'RS PCILLUN6 THEIROWN' PERMi l ORDP_Ai ro W LH I-Ngr- IS1 FRED t rN�CAi TORS II I OR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE'.ACCESS TO THC. ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL,C 2A- J� S gree+ aider perednes of Penury j I heehy appl4 lo,a pennit s hcagent of Iie owner: Datc: Co- r 9 aRNLI � RFr3127 OR: SEAN A JEFFpRDS 20 .-nsne-i .kc nbrve, noics,i ser-h) apph fo-aperxnit as the owner of the property. Data Owncc rad.# t BEYOND GREEN C O N S T R U C T 1 0 N DEBRIS DISPOSAL AFFIDAVIT IN ACCORDANCE WITH THE COMMONWEALTH OF MASSACHUSETTS DEBRIS `iISPOSAL PROVISIONS OF MASSACHUSET15 GENERAL LAW CHAPTER 40, SECTION 54, A CONDITION OF BUILDING PERMIT NUMBER FOR DEMOLITION WORK IS THAT THE DEBRIS RESULTING FROM TH15 WORK SHALL BC REMOVED FROM SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY AS DEFINED BY MGL Cill, S150A. FACILIIY- ALTERNATIVE RECYCLING, NORTHAMPTON, MA CONSTRUCTION .SITE ADDRESS- TO BE DISPOSED AND TRANSPORTED BY- 0-Io0a' BEYOND GREEN CONSTRUCTION or ALTERNATIVE RECYCLING SIGNATURE_._._/ ,, / DATE _.. __SL! '' _.-..._ Permit Authorization masssave Form Site ID: 3410605 Customer: NICOLE NAKASHIAN I, Jennifer Clarson , owner of the property located at: (0wnees Name,Printed) Turkey Hill Rd Northampton, MA 01062 (Property Street Address) (Cny) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signature: Jennifer Clarson Date: FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: CLEAResult Phone: 800-480-7472 Email: .cr M'i:e L'se^.rly Rev.102015 AN�N BEYOND GREEN CON STRUCTIO N 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 @ 413-539-1726.See details below. Address: Beyond Green Construction 13 Terrace View Easthampton,MA, 01027 Email Address: nicoie0beyondgreen.biz Thank you! Nicolejejfrn-cis Hcyoml Grecn Constntction I Project Coordinator Cell:413.539.17281 OtSce:413.529.0544 13 Terrace View,Easthampton I www.beyoadgreea.biz Beyond Green Construction "Leaders in Energy Efficiency" Phone:413-529-0544 13 Terrace View Established 1998 www.BeyondGreen.biz Easthampton, MA 01027 CSL#74639 ---� City of Korth=Wton Md88dCt1ll80tfS 60- & y l `�y DSPdtt�aT OF SOSS =G INSP&C=Dss t x 212 ifain 9txeet • Mmi^z' }pilAipQ NotF}.®ptwa, M 01060 . Property Address: AGTL(IK�cw hal'K Contractor Name: _ CJPUafIC�A -�rC'eYl COfIS-Y1'VC.'}-'t01� Address: _I J � �tirl�(�fQ �l{ �1� City,State: Eayrh aA'o P-k) \ M O 102-1 Phone: q 121— 5aQ 0 51-4�1 Property Owner NsYIfar\I C�,P N ktU Name: II II nt Address: q L0 Uj iI I �d City, State: NOr1 Yl(AMuM Y AA- O1Qco � I, S e Ckn (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 to/� 8 (