16C-003 (12) 334 SPRING ST BP-2020-0482
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16C-003 C 1 TY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:chimney rebuild BUILDING PERMIT
Permit# BP-2020-0482
Proiect# JS-2020-000821
Est.Cost:$5000.00
Fee: $97.50 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 43864.92 Owner: LANGMUIR JONATHAN
Zonin : URA l00)/WSP(100)/ Applicant. BEYOND GREEN CONSTRUCTION
AT. 334 SPRING ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON:10/18/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-DEMO BRICK AND INSTALL NEW STAINLESS
CHIMNEY
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:
FeeType: Date Paid: Amount:
Building 10/18/2019 0:00:00 $97.50
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
j Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
CT S 201 wild' g P it Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
9 One-or Two-Family Dwelling
n�At OF 's Section For Official Use Only
'VO 7- Nsmb '' Date Applied:
o,oF�
Building Official(Print Name) SignatureO I
8n at
SECTIO 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Num s
l.la Is this an acce ted street?yes no Map m r Parcef Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(tit)
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❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2. Owner'of Record:
Name(Print) V City,State,ZIP
�3cA ®t1��1Ca S�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ I Repairs(s) ❑ Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units Other ❑ Specify:
Brief Description of Proposed Work': i it GONA 1115*aVr
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building $ 1. Building Permit Fee:$ 4R.50 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:$ °f ]• y
6.Total Project Cost: IS 5Ul33 Check No. Check Amount: Cash Amount:
❑Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /� CJ_ o--1 LA 5�p f a$ (8
SEAN R JEFFORDS l� V _I
Name of CSL Holder License Number Expiration Date
13 TERRACE VIEW List CSL Type(see below)
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.
EASTHAMPTON MA 01027 R Restricted 1&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(-1,BEYONDGREEN BIZ I Insulation
Tele hone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 1 G, ' ,71 , �o 5�C/
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View
No.and Street sean@haondareen.biz
Eastham ton.MA 0102? 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...........13
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
to act on y behalf,in all m tters relative to work authorized by this building permit application
4iy
Own s Name(Elec m�Cignature) ate
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest unthe pains and penalties of perjury that all of Information
contained in this application is true and acc e o the best of my knowledge and understanding
_Sean Jeffords (D
'17bg
Print Owner's or Authorized Agent's Name o 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"
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street, Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information (L � ° Please Print Legibly
Name (Business/Organization/Individual): U( ,t('�A Gi(,e'Pr) acx�til eAi or\
Address: 3 TQC r Cke V 1 v�
City/State/Zip: -0-,�A h m -'On h/1 1A Phone#:
Are you an employer?Check the appropriate box: 0 v33.'} Type of project(required):
1:Y�4 am a employer with employees(full and/or part-tune).* 7. ❑New construction
2. 1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.]
9. F1 Demolition
3,Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10 []Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. [wilt
ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions
proprietors with no employees.
12.L]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.-
6.F—]We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other lrliPGl e t 1 7: - \ C,�
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.
+Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
;Contractors 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. Q 1 t 1 r
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date: I ' I c,2 0
Job Site Address: 33LL �(1 nCl� C5 City/State/Zip: -Vin(cc�cQ,�-k f\
Attach a copy of the workers'com1pensatiiitWpolicy 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 du hereby certify raider the pains and rt !ties of pet jury that the information provided above is true and correct.
Sipnature: Date: C
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#:
f
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Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Constrpctlon Supervisor
CS-074539 4 ires: 11/2812020
SEAN R JEFFORDS
13 TERRACE VIEW
EASTHAMPTON MA 01027 ti
Commissioner
t
191- Q11KWJq1C1n
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
Registration: 191746
BEYOND GREEN CONSTRUCTION INC. Expiration: 05(0912020
13 TERRACE VIE'111
EASTHAMPTON,MA 01027
Update Addrena cmd ncturn caro.
SCA 1 ti� 2041-05117
.—r
'y/• �r•rrn�lr+rntrr�� '.���n;,;nrfri,t'/(.;
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Coroaraticn before the expiration date. It found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
151745 05/09/2020 One Ashburton Place-Suite 1301
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFORDS
13 TERRACE VIEW Not valid o,jtl?out SignatuTe
EASTHAMPTON,MA 01027 Undersecretary
AFF-IDAV
H4rzTE imn"o-VO 1 ent"'(Mtractor
Supplement to Permit Apniicariec
SUU t;Tidxvl;Fa.33sr3r':iPerri:Apnii;.uiaa_
For Office Use oj':
Permit No.:
dir.- ArecatnsMic ion, altercation, renovation, ►:rp: !'7.'ioderniZatjou, cor? er5ioi_ r
ttnProveme-nt,removal or demoliufen or he construe rjnat of an addition to 211,,,'Pre-existing owner occupied containing at i=st on:.but-no mor;tha,s four d,,vtUing
unit,or to sWacti:res which are adiacerit to sL-ch+
:' 5dti�lw vT t?IE;lea ng �3 CiQr n7 r$T-Stared cora.tractors}`.i&t cvtairi xcC'•I?:i*ns,along-Aith o fhc i a4 irc!.racnts. ,7
1
'-7vpeofWork- Weathefiaatio.-n ysL. most:
—2 -- __ - ---- ---
itwrass e=i�ork: 3 3 (1 S} -y. - -
�� - -
i7cYiers -
Dateof Per t i Aff lie tion --_ c)
?hereby cartify that:
(tgistradon is not r 1im. 'for the following re'--son rs;: ;
%Vb&vxcluded by law
job under$500.00 �
Bail1-ng net o"w-ner occupied
Owner pullirtg ow-n permit
z)ther speeify)
Notice is lhby given that:
V tL"!?v-E"PULL-LNG T-HEIR O'W'N PERMIT OR DEA.i ENU WITH UNREGISTERED CONTRACTORS t
FOR APPLICABLE HOME MPROVEI4F-NT RrORK DO NOT HAVE.A WESSTOTHE
A-R8I"-P-4T-T01\' PROGRAM OR GLAR4NTY FUND UNDER M _ 142A_
vtgIIK i uncle:Penaides of pejury:
I hereby apply fcF a permit as the agent of the awmer:
Date: C flI21T8Ctor: BEYOND GREEN CONSTRUCTION Rsg.4: 13 1279
OR SEM u E=;=OPDS
Net withsmr_d-ing-2-e ab -ve notice,I hereby apply;or a}permit as the own-er of the property. j
Bate: <3wn:,r: TeL# 1
AdPN
BEYOND GREEN
C 0 N S T R U C T 1 0 N
t)EBgiS DISPOSAL AFFIDAWT
IN ACCORDANCE 111 11-1 THE COMMONWEALTH OF
MASSFACHUSET-IS DEBP.3S DISPOSAL RROVIS'.0NE OF
MASSACHUSE1 s S GENERAL i'—,kW CHAPTER 40, SECT.-LON
54, A CONDITION OF BUILDING PEP-MIX NUMSEA
FGR DEMOLITION WORK IS TFAT 7-iE DEBRIS
RESULTING FROM TH4ti �'�>i R "I'll. 3F REM���l.D 3-�iO��k
SITE AND DISPOSED OF IN P PROPERLY LICENSED SOLID
WASTE- DISPOSAL FACTLI T Y AS DEFINED BY i4iGL Cl:li it
7i fJ'60A.
FACILITY-
ALTERNATIVE ttECyCLING, NORTHAMPTON, MA
SISPOSED Airs T : .NSPORTED €�Y-
3EYOND GREEN CONSTRUCTION or
-_LTERNATZVE RECVCL ING
SZGINATURE _._ --
DA71 t 1��-
CLIP
--cpRR11�.ni or t
212 Mein -mtrest 0 xa±cz�zal 8uildin
-SS •.L 1`�f
a�'so�hamn'ton, ba 01060
PrOP. Y Address:ess: 3.L
Name: ��f .�!'s� ,� '--9�i'tn
Citi,
Phone: ---. _ �" C314 L; -'-g
P'FOPGd,I jai liner
Name:
Address: -- 3 3 c�_S
City, State:
(cMractor) aitest and affirm that the-building I intend to
insulate does na,have any open air(knob and tune)%;icing in the speces to he insulated and that I have
provided the wopertcy ovvjnUr tffith a c4PU of this affidavit
Con-tr-actor signature
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