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10B-038 (4) 44 FRONT ST BP-2020-0083 GIS#: COMMONWEALTH OF MASSACHUSETTS MV.-Block: l OB-038 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0083 Project# JS-2020-000133 Est.Cost: $27775.00 Fee: $175.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: BEYOND GREEN CONSTRUCTION 074539 Lot Size(sa.ft.): 10628.64 Owner: BAJAK MAYA Zoning:URA000)/ Applicant: BEYOND GREEN CONSTRUCTION AT. 44 FRONT ST Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-05440 WC EASTHAMPTONMA01027 ISSUED ON:7/23/2019 0:00:00 TO PERFORM THE FOLLOWING WORK.-ROOFING AND MASONRY WORK 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 Sienature: FeeType: Date Paid: Amount: Building 7/23/2019 0:00:00 $175.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—.Building Commissioner D F 2 219 The Commonwealth of Massachusetts oard of Building Regulations and Standards FOR os�ONs assachusetts State Building Code, 780 CMR MUNICIPALITY USE 91 of A^otNo �uF ermit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011 oas"' One-or Two-Family Dwellin This 1S,ection For Official Use Only Buil 'ng Permit Number: Date Applied: CUlil3 �bS� 22-2619 Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assesss p&Parcel Number yy Ern�� + •Lrc�� 15m ` �), 1.1a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public o Private o Zone: _ Outside Flood Zone? Municipal❑ On site disposal system o Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1Owner'o Record: (111Aklk Name t) CiState,ZIP H LI fTbirltcSf q/L4-�7(4-301$ No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building o Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) ❑ I Addition ❑ Demolition ❑ 1 Accessory Bldg.❑ I Number of Units Other ❑ Specify: M�OsLn Brief Description of Proposed Work':_ .ot oc�"0 SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials 1.Building $ 1. Building Permit Fee: $ I Indicate how fee is determined: 2.Electrical $ o 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 F 5 Check No. `1 Check �tannl�hce Jh Amount: 6.Total Project Cost: $ ��S•Ut� ❑paid in Full ❑ Due: SECTION 5: CONSTRUCTION SERVICES SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) S_ �-- 4 5? SEAN R JEFFORDS 1. J t Name of CSL Holder License Number Expiration Date List CSL Type(see below) 13 TERRACE VIEW Type Description No.and Street U Unrestricted(Buildings up to 35,000 cu.8. EASTHAMPTON.MA 01027 R Restricted 1&2 Family Dwellin City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 413-529-0544 SEANna.BEYONDGREEN BIZ I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) ,G, .7 Ll �o S�� Sean R Jeffords-Beyond Green Construction H HIC Company Name or HIC Registrant Name IC Registration Number Expiration Date 13 Terrace View seannabeyond een.biz No.and Street Eastham ton.MA 01027 Email address P 413-529-0544 Ci /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...........l] SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1,as Owner of the subject property,hereby authorize to act on my behalf,in all matters relative to work authorized b this building permit application Print Owner's Name(Electronic Signature) Dake SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATI N By entering my name below,I hereby attest under a pains and penalties of perjury that all of information contained in this application is true and accurat o e best of my knowledge and understanding _Sean Jeffords Print Owner's or Authorized Agent's Name i ignature) ate 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 halFbaths 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" The Commonwealth of Massachusetts Department of Industrial Accidents F- I Congress Street,Suite 100 Boston,MA 02114-2017 r www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Nt 1 r)orl (' Conn jYL4L on Address: I C' l ro ('C 1/1 `W City/State/Zip: n al Phone#: 413 _ 5�q_D 5 914 Are you an employer?Check teppropriate box: Type of project(required): 1.®I atm a employer with employees(full and/or part-titre).' 7. F]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.] 9• El Demolition 4. nwe hiringcontractors to conduct all work on to 10(]Building addition ❑1 am a homeowner and b Y 1noPenY• I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance./ 13.)q Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors trust 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 4 _ Insurance Company Name:_N o r U a r-d h Policy#or Self-ins.Lic.#: wt C Q a)-5 ( Expiration Date: ao Job Site Address: (A q` l ro l t �Z)� City/State/Zip: Lech kk(4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation-punishable by 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$250.00 a. day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and of perjury that the information provided above is true and correct. Si nature: Date: 7 1 Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: l Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr{tcti'on Supervisor i CS-074539 Exp i res: 11/28/2020 SEAN R JEFFORDS 13 TERRACE VIEW EASTHAMPTON MA 010270y 1! ;i"N'N Commissioner � Cz �GYa9;�2/13'LG'?2CC12 �C 0/4 Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1331 Boston, Massachusetts 02108 Home Improvement Contractor Registration, Type: Corporation Registration: 191746 BEYOND GREEN CONSTRUCTION INC. Expiration: 05109/2020 13 TERRACE VIE:^; EASTHAMPTON,MA 01027 update Aadreas and Rcturn cera. SCA 9 0 20A9-05/17 '"/,iP`f rr,�n�Finr,r.�i%i,, "llr.::u:•/,i.:r/G Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR [Registration valid for individual use only TYPE:Corcoraticn before the expiration date. It found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 191748 05/09/2020 One Ashburton Place-Suite 1301 BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108 SEAN JEFFORDS 13 TERRACE TERRACE VIEW Not vale withoGt signature EASTHA ,lPTON,MA 01027 Undersecretary AFFIDAV-1) Home Imnr(MMMe-Ut C(rttractor La Supplement to Permit Applic-aUac 3M-led Fa.Ha=Unpr v mcntCJnU=4,4r p=raitApniicariur Pernik,No.: Note 142 -A, rugtIirv8 tbaL t$p A-Ie onst1' ctiorl alteradai l_ rcuo-vradary rt•paht mfjderTizatiou, GE3i?r„T ililil; t �'ov�ent,remova.I or demaii�on yr�e ccnstruc^avnal of azo addition to ��;r ra-exis`ring ou-ner occuxsied '� bEutdu�CpII $St IraSY i}nC but no mo:� • � . �, p x tl�fo�:r d,�•.11in- E.riit,ar:n s«.ic:E:res vrhich are ad�accnt to s'=cE+ �es�c3.ence:1xyr�EEEIcEzr��;done br re iatere:cc?ri�c_ors,'F.'it:f's C.Z%rt"�.i13A.7eCf'Ri:aD.Ss A.iOZI�Vi'2iti tTLi'ieE'£'ti.Tillii.I7teEI�S- :i T?e Ui i4`uT lS�n s l IC l n Est. .C.OSL: , J. 3reSs a>V.'ork: Li LA -Rc)r)'t• A t LR C4 - I.-N Iers-Name: Pi0-UA, RCAI Dere of Permit i Applicatir3n tbat: (.g?stranon is not regt,.ired for to fallowing rea-%n(s). Work exeluded by law Job mailer$500.00 Building-DOT* OVrner occupied owner pulling own pewit � !Xher;Specie — - --- i ti��t cv s i-=by given that: OWNERS PULLING THEIR OVION PERMIT OR DEAL,IN G 'BVI"I -i UNREGISTERED CONI RAS.TORS FOR APPLICABLE HOME IM-PRGVENF d- WORK DO NOT HAVE ACCESS TO TIM A_RBr €2kTT©I\T PROGR-�-M OR GLAR -N—IY I-L _- . MG C- 142A- Si ipad under penaides of pie-jury: I hereby apply for a permit as the agent of the owner: Date: Contractt3_r. BEYO D GREEIN CONS T FItiJCTION Reg.# 13 1279. OR: SEAN R JE=1=0PDS i Not cY thstiL:ding`he eve notice,I hereby apply for a pmmit as the owner..ofthe property. IDatA-- Owner. Tel.i# AdF BEYOND GREEN C0NSTRUCTlON DEBRIS DISPOSAL AFFIDAVIT TN ACCORDANCE WT—TH THE r—CMMO. NWEALTH OF MASSACHL.'-SSS DEBMS DISPOSAL PROVISTONS OF MASSACHUSETTS GENERAL LAW CHAPTER 40f SECTION 54, A ONDI s ION OF BUILDING r��'uAl. NUM' FOR DEMOLITION WORK IS T±AT TME DEBRIS RESULTINC- F RQz M T415 WORK c.;YnLL 3E RMVED FROM SITE AND DISPC+SED OF IN A PROPERLY LICENSED SOLID WASTE DISPOSAL FACILITY A5 DEFINED BY �IGL. Cill. -31500. FA- RECYCLING, NORTHAMPTON, MA 7%!STP.uc--rtjGN SrTE ADDRESS- t� �5� L.e eCt�Nt!A _ BE DILSPOSED AND TRANSPORTED BY- 3EYOND GREEN CONSTRUCTION or ;kLTERNATIVE RECYCLING SIGNATURE A- DAT E Permit Authorization Form Job number: Customer: I, Maya Bajak , owner of the property located at: (Owner's Name,printed) 44 Front Street Leeds, MA (Property Street Address) (City) I hereby authorize Beyond Green Construction to act on my behalf and obtain a building permit to do work on my property. Owner's Signature: Date: June 27, 2019 i!!!•••�!i!••••!•filiiiiiii!!!•i!!•i•i•i!!i!!i!i!!i!!!!!!liii!!i!i!i• Beyond Green Construction 13 Terrace view Easthampton, Mass. 01027. 413-529-0544 AO�N 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 @ 413-539-1728. See details below. Address: Beyond Green Construction 13 Terrace View Easthampton, MA, 01027 Email Address: nicole@beyondgreen.biz Thank you! Nicote.Jef f ords Beyond Green Construction!Project Coordinator Cell:413.539.1728!Office:413.529.0544 13 Terrace View,Easthampton!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