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35-099 79 DREWSEN OR BP-2019-0040 GIS#: COMMONWEALTH OF MASSACHUSETTS MU.Block: 35-099 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INSULATION BUILDING PERMIT Permit# BP-2019-0040 Project# JS-2019-000054 Est Cost:$3263.00 Fee:$65.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group BEYOND GREEN CONSTRUCTION 074539 Lot Size(sa ft.): 9016.92 Owner: MCPARTLAN DEBORAH zo_nine. Applicant: BEYOND GREEN CONSTRUCTION AT: 79 DREWSEN DR Applicant Address: Phone: Insurance: 13 TERRACE VIEW (413) 529-0544 0 WC EASTHAMPTONMA01027 ISSUED ON.-7/W2018 0:00:00 TO PERFORM THE FOLLOWING WORK.AIR SEALING, WEATHER STRIPPING,ATTIC FLOOR, HATCH, BATH FAN 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: Home Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: M 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 Slenature: FeeType: Date Paid: Amount: Building 7!9/20180:00:00 $65.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck-Building Commissioner ECENED jTh Commonwealth of Massachusetts B and f Building Regulations and Standards FOR '. JUL M ssac usetts State Building Code, 780 CMR MUNICIPALITY USE Bttdlfpli tion To Construct, Repair, Renovate Or Demolish a Remed Mar 1011 NRTNPMPTON.MA010fi0 bEP1.OF BUIL a-or Two-Family Dwelling O This Section For Official Use Only Building it umberOV-11- Yo Date Applied: / t ORrci Pr t e) Sig-lme Dam SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessor"ap&Parcel Numbe -1L.P4�f. NOf-11'1 m per+-'�^ -�-�- I.I a Is this an accepted street?yes_ ne OI Oto cel D, Map Number ParumbN er�9 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use I.ot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(D) Front Yard Side Yards Rear Yard Required Provided Required Provided RI-4oned Provided 1.6 Water Supply:(M.G.I,a 40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ /one: —,_ Oucide Flood Zoae9 M Check if yes❑ unici 1❑ On site dis aal system Of SECTION 2: PROPERTYOWNERSHIF' 2.1 Owner of Record: a hra MCna�l n NOq�i lv r} 61 d� Name(Print) �� City,Slate,ZIP —1 CL_0rC,�,0.SJ11_ C Ufl�-(a95-C_70 — Nt,mad Street Telephone Limit SECTION 3: DESCRIPTION OF PROPOSED WORK'(check a6 that apply) New Construction E3 Existing Building 13 Owner-0ecupied ❑ Repairs(s) 13Allemtion(s) 13Addition ❑ Demolition ❑ J Accessory Bldg.❑ Number of Units Other HSpccuy:WeCA4-0er,'7QJ4f Brief Description of Proposed Work: ( -O&L_n 4X FM!_o tX _ Itor tJ Wr SFc'a DD.� O 'fhofM l tiesLia. M. Qom_-�[� _O 4li 0D AXAY.Zk-F r SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ 1. Building Permit Fee:$ _Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier_x 3. Plumbing $ 2. Other Fees: $ 4. Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees:rj — Su ression) �f / q Check No.�_Chec�k Amount JX Cash Amount 6.Total Project Cost: Is 3 193 - ( ❑paid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CIS _C� C) C�A•^„ 1 r' a 0 rI"$ SEAN R 11- TFORDS J O- License Numbr Expiration Date NamCSLTI.Ider _ List CSL 7 ype(scc Isblbw7 13 TERRACE VIEW Type Description No.and Street U Unrestricted Buildin m 35,000 cu.R. EASTHAMPTON.MA 01027 R Resvicted I&2 Famil Dwellin City/Tuwn.State,ZIP M Masov RC Roolina Ccvcrin WS Window and Sidin SF Solid Fuel Burning Appliances 4I3-529-0544 SEANnJ3EYONDGREEN BIL I Insulation Tel one Email address D Demolition 5.2 Registered Home Improvement Contractor(HIC) I -1 I l f LV 5 .a Sean R lelfords-Bevond Crcen QmsyucCon HIC Regislmtion Number Expirmi n Date JIIC Company Name or HIC Registrant Name 13 Terrace View M itke ade Pn.lo, No.and Street Email address Easthampton MA01027______ 413-529-0544 _ Ci /Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 6 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 ofthebuilding permit. Signed Affidavit Attached? Yes ..........X No ..........❑ SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT,, I I,as Owner of the subject property,hereby amhorize 0 nd C -Ifn CO r),5hiLQ1 -l'O n to act on my behalf, in all matters relative to work author:. by this building permit application. �eP cc �hfc/ . -- ^�a g FYint Owner's Name(Eleclmnic Signature) Date SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION By entering my name below,l hereby artFcs, pains and penalties o(perjury that all of the information — contained in this application is true anbest of my knowledge and understanding. Sean Jeffords _ 4 1 ) )8 Prim Owver's or Authorized Agent's Name(Elature) Daze 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 wwy.mass.gov/qca Information on the Construction Supervisor License can be found at www.mass eov/dos 2. Wben 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.fl.) Habitable room count Number of fireplaces_ Number of bedrooms _ Number of bathrooms_ _ Number ofhalf/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" iLll The Commonwealth of Massachusetts Department of ludustrial Accidents I Congress Street,Suite 100 Boston, MA 02114-2017 www.massgowdia VW.rkera'Compcnsution Insurance Affidavit Builders/ContractorstRil t,icia.Mumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A,,Iica.t Information Please Print Leeibly Name lHudves=,orP�aaatloa�laaivia�ap:_��Q_n�. Ell'{fl'1�O_r�3 t3uCk'lO'� Address: of I ck City/state/zip: �(\ Phone Are too as emplover•Check she apprapri.0 boa: Type of project(required): r PqAanaoVk,,crwim_aanPwyea(rwlawor Pervaime4" T ❑New construction 2.❑lam wlepmpne urpansnipandhaeomemployces waning tbnrcin 8. ❑Remodeling awcaPca, INowvrkeri rmcomp,es., r itarodl 9.3.❑lamaM1omcwner doing allwork myself(No swrkms'mmp.buamixe rtgvircd.)' 10 Building addition ❑DemOhn tia a❑Iamahomevwveranawalbemtingmtit :wrsmcoMu anwmkonmypmpem [will we dun abl wnvacmm ddsr have wohers'rompcimuon inmrwrewme sole 11.❑Electrical repairs or additions P` 'ncto"with m'""Pl"yCeS'- 12.❑Plumbing repairs or additions sIanageneml cmmacm.anal nave n�dme.ase�mua<m.li:ad on mr arwonm:nrn. - iksesub-commcmrs ha.eemvloyecsand be.e worker,'anmp.is mmrcc 13.❑Roof repo,[rs 6 E We are a corsaitain and iu officers have exereoci]their right ofexemplim,per MGL<. 14�Orh¢rt�"'v-z/-`J'1vs✓y� v'—v lir,§ (a),andwebavenocmplwees.INoworkers camp Inarciewcus kroll 'Ar,a,,1a,mt da checks Iron ab muu atm llb om the v.<tion belay showing tnmr workers'mmpenmlion pnlirY infnmmtion. 'llm who sulanil this attidevir mdicasing mey arc doing all whh and then hire ounkle vonmxnrs mon zubmitaruw effdavit idical gsma. :("cmtmctors mnPloYenNhecsbuilkerozrancatowrsmMwe,vcmcNmcphlendyrev,dthey catutshpootvsdheowdwinigr Ure deme ofmtM srils, "uamcmbersr end sten wh nr nm those¢mitt¢:M1vvc I an,an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information. Insurance Company Name: Policy h or Self-ins.Lic.#: k.J yw�� `���.�\/.L ty _. Expiration Date: ((.,�� f Job Site Address. -)9 C(Ci A.S , ®Y' _City'Smte/Zip:_Lv_o (+v)�.�����'rp�` Attach ao copy ofthewrkers'compensation policy declaration page(showing the policy number and expiration date).t� IVv ' Failure to secure coverage as required under MGL a L52,§25A is a criminal violation punishable by a fine up to 51,500.00 and/or ane-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine crop to$250.00 a day against the violator.A copy ofthis statement b arded to the Office of Investigations of the DIA for insurance coverage verifcation. I do hereby certify under the pains and per at the information provided oboe¢is true and correct. Signature__ Phone# Official use only. Do not write in this area,to be completed by city or town official. City or Town' PermittLieense# _._ Issuing Authority(circle one): 1. Board of Health 2.Building Department J.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone q: i Massachusetts Department ofnd S't Safety Board of Building Reguia[ions and tandartls 1 GnU,License: CS-0T4539 ` 5.na90n Slly'2:FISp: SEAN R JEFFOROS 13 TERRACE VIEW EASTNAMPTON MA 01021 Commissio^.er- 111201201s I P✓ //YG B Wr7�at d'f2��1(Ir Ct lL�j `�/�..���f'.11'it t;I'r•�C./-P��T Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Corporation BEYOND GREEN CONSTRUCTION INC. Regietration: 191746 20 13 TERRACE VIEW Expiration. 05/09/20 EASTHAMPTON,MA 01027 ..... .........fieNm GON. 011ka M GMW Tttnr.✓/l Al(alrs A We HOME IMPROVEMENT ,�..,FT Registration valid for lMlviduel use only TYPE: a11f' before Me expkation date. Ntound retum to: ROgja(ra[IgnOffice at Co...,Attar.antl Business Regulation 191748 OY0g2 One Ashburton Plats-Softs 1301 BEYOND GREEN CONSTRUCTION INC. @oeton•MA 02108 SEAN JEFFORDS 13TERRACEVIE'N NOL VBIId without signature EASTHAM�iON,MA p1027 Undersecretary 9 I _ ,� e 1' e.�oiC. d bL City of Northampton Kassachusetts ' Jr, � ■( 3 D6PAND OF NrrILNING INSpY TXMG 212 Hain St eet a a ioipal a ild np vj. pC (� Northam n, M 01060 37\ Property Address: 1 ` bA)S('O �-f, Contractor Name: IEL4o- d C ( eeo Cona- )C-I or, Address: 1 �J �'(-'(1Q("2 V i CW City, State: C�CG4� Y4C11�'�](jV\ l O\0"T�' Phone: ,( 0\ - 0SLAL1 Property Owner Name: C�* (A �(�rYbC+1ClY� Address: City, State: �! _ 1, 500,0 Jed-Fo�c� (contractor) attest and affirm that the budding I intend to insulate does not have any open air(knob and tube)wiring in the spaces to be insulated and that 1 have provided the property owner with a copy of this affidavit. Contractor signature Date I I t k s ''4>.��� Permit Authorization mass save Form Site ID: I, 3413%3Customer: DEBRA MCPAULAN QrUS, yda /'ev-) ,owner of the property located at:. YYY��• (Ow.eN.M.Dfi�dl 79 Drewsen Dr Northampton, MA 01062 (napes U.dAdd.l IUM 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 onmy property. �® ❑((L�y(�-�y �n owner's Signature: 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: 800ABO-7412 Email: so.oRa W.0M, Rev.102015 A BEYOND GREEN C O N S T R U C T I O 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 @ 413-539-1728. See details below. Address: Beyond Green Construction 13 Terrace View Easthampton, MA, 01027 Email Address: nicole@beyondgreen.biz Thankyou! McolejefJords Beyond Green Co ut' o,to l i Protect Coordinator Cell:413.539.1728!Office:413.529.0544 13 Terrace View,Faathamplan I www.beyondg'eea.biz Beyond Green Construction "leaden:in Energy Efficiency" Phone:413-529-0544 13 Terrace View Established 1998 www.BeyondGreen.biz Easthampton, MA 01027 CSL#74539