17C-058 (8) 190 CHESTNUT ST BP-2019-0205
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mao:Block: 17C-058 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-2019-0205
Project# JS-2019-000337
Est. Cost: $776.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 14897.52 Owner: WHITTIER SARAH JANE
Zonlne: URA(100)/ Applicant: BEYOND GREEN CONSTRUCTION
AT: 190 CHESTNUT ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 (1 WC
EASTHAMPTONMA01027 ISSUED ON:8/16/2018 0.00:00
TO PERFORM THE FOLLOWING WORK.WEATH E R IZATI 0 N
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 MAYBE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occwancv Shmature:
FeeTvoe: Date Paid: Amount:
Building 8/16/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
o The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
$ m Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
uilding Permit Application To Construct,Repair, Renovate Or Demolish a Revised Mar 2011
am _ One-or Two-Family Dwelling
i H N This Section For Official Use Only
a
Biiading itN "o;I[ri Date Applied:
0
l
Buildi O ' (PrintN ) Si stun Dale
SECTION 1:SITE INFORMATION
X1.1 Properly Address: 1.2 Assessors Map&Parcel Numbers
j r heSm�,t,} SA . U0fA-V)l1 Yon 1-7 t,
L 1 a Is this an accepted street?yes M o'M Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposedtlu Let Area(sq ft) Frontage(ft)
1.5 Building Setbacks(ft)
Front Yard Side Yards Rear Yard
Required Pmvidcd Required Provided Required Provided
1.6 Water Supply:(M.G.I.c.40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private O Zone: _ Outside Flood Zone! Mmucipd❑ On site disposal system ❑
Check if yes[]
SECTION 2: PROPERTY OWNERSHIP'
2.1Owner'of Record:
Salt 4h C.uln'i-k—i P r _ ___ 46M
Name(Print) Carr�h�(1�y`ti1�0 L
No.and Street Telephone Email Addnsa
SECTION 3:DESCRIPTION OF PROPOSED WORK'(duck aff Mat apply)
New Construction❑ Existing Building❑ Owner-Occupied Cl I Repairs(s) ❑ 1 Aftermion(s) ❑ 1 Addition ❑
Demolition ❑ Accessory Bldg. 13 Number of Units_ I Other �!—Specify: I eP fi-+`7 P.Yl LO-�i
Brief oescriptionofProposed Work': Uj CAX- P f
C14Or )t4 k2j L,21
SECTION 4: ESTIMATED CONSTRLI 'TION COSTS
Item Estimated Costs: Official Use Only
Labor and Materials
1.Building S 1. Building Permit Fee:$__ �indicate how fee is determined:
2. Electrical $
E3 Standard City/To"Application Fee
❑Total Project Cost'(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) S List:
5.Mechanical (Fire $
Suppression) Total All Fees:S
. Check No. eek Amm:ouCash Arrromlt:
rI
6.Total Project Cost: S O Paid in Fuil 13 Outstanding Balance Duc:
SECTION 5: CONSTRUCTION SERVICES
5.I Construction Supervisor License(CSL) (1 C ���
SEAN R JEFFORDS hJ l o
I.iccnsc Number Expiration Dare
Name of CSI,I[older .+
List CSL"fype(seebelow)�
13 TERRACE VIEW
Type Description -No.and Street U Unrestricted(Buildings up in 35,000 cu. 0.)
EAS LHAMP'[ON.MA 01027 R Restricted 1&2 Family Dwelling
City/To".State,ZIP M Mason
RC Roofin Cuverin
WS Window and Siding
S17 Solid Fuel Burning Appliances
413-529-0544 SEANn.BEYONDGREEN BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contnetor(HIC) (e I-'1 L) / G
Sean RJeffendv-Beyond Green Construction HICRegistmtion-b-- Enpi lion Una
HIC Company Name or HIC Registrant Name
13 1eo.c View sean(dbevoin rg cen biz
No.and Street Email address
Easthampton.MA 01027 413-529-0544
Ci /Town,State,ZIP Tele hone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L,c. 152.5 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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT ORCONTRACIT�OR APPLIES/FOR BUILDING/PERMIT ,� 1
1,as Owner of the subject property,hereby authorize Leo
to act on my behalf, in all matters relative to work authorized this building permit application.
_ S[e 0-Mched
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 We and best of my knowledge and understanding.
Sean Jeffords
Print Owner's err Audrorized Agent's Name(Ele 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 fireplacesNumber 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"
The Commonwealth of Massachusetts
ulkrkers'Campensation
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-1017
www.ntassgov/dia
Insurance Affidavit:Builder✓Contactors/Eleetricims/Plumbe".
TO BE FILED WITH THE PERMITTING.AUTHORITY.
A lie nt( f .tl y� G �n /y n�1� Please Print Legibly
Name (Business/0rganiratipNfndMdual): AADt'1 d Ci r C k f l lir/n5- nA c7 O n
Address: ICR
City/State/Zip: W ) Phone#:
Are y.aa employer Clerk nekifewnnedM,: lel lo') -7 Type of prujeet(required):
12�I an a ergkryer wM J employees lfun elod/or perr,ukoe).- 7. ❑NewconsWetion
2.❑lmamleprapdelmmp. hipand MveWtmpiyMwmkhta fnmeln 8. ❑Remodeling
on,mpact, INo workers'comp nova n e wquoed.l
q. El Demolition
3.0lame Mmemmer doing all wwk myself lNe.vwken'nxnp.iMons.required l
4.r-1I m a homeownerendwill M Miring CM1r.mnrs m cmduci a1 wok on MY pearoarY_ I will ID L]Building addition
wore wrap rmtmemneiHla Mve wodrns'mmpenxtion imumrcewarc sole II.❑Electrical repairs or additions
pegaictm wim m,cmpiny«,. 12.❑Plumbing repairs or additions
s F1 Im.gcoand eoaxmreN l be-Mired deIiemdw rhe ma:hN Shee
rrcx wh.eommrmm Mveemploym ma Mre workc i mm�n imoraea: I3.❑Roof rep urs
their 6,F-1 We are a corprontion and in ofFceet neve Mo,ert d nine ofmcar can per MCL c. 14.[�Other ln1>Ct h1.1'1�'t. U
152,61(4),and we have m empluyem_[No workers'come rt
p insurancqu rad) n
'Any aWle.nr w1 chinks Mx#1 mua al,n fill out IM uelion hint':elwwirg(heir wrrkeri mmprnsnion pnlicY Nanmlim.
'flomeawoas who wMdt 0u emdavhi heron,they me doi,y.a workand Wum hurt Quaid,,conrrwmre man u.beoua nw etgdu.it Ndicning auch.
:('onaecmm tl,a c1�kHsu ha,mat.mcbadm tllircmel
wahmshectanwhgeMnMi mdue wM.we 'mre aM,Wewbnhn rrtna tMmeewitia M¢re
onPioY+. Itdu:mbwnlncrms Mvecmpbywa.Hey mwr porNc Meir ' mp.poling n1mrM
lamenewployerfhoisprvt4i&gworhen'cwnpemafioninsrronceformyeMWOYeea• Bebwrs mepelia7 mNjob aXr
information. c
Insurance Company Name:#:---La
/� ( �JU-y �_/_— q _,
Policy 7l co-Self-ins.Lic.A: :�✓VC-C30 _� _ Expiration Date:—�(�_(/._/__
/h� /l I n +v, , ,6 y l�r (,h��
lob Site Address: I�V �� 11 W l� l�I - City/State/Zip:I LI b r=L(�l�Y,—�1�/��-(��
Attach a copy of the workers'compensation policy declaration Doge iahowiag the policy number sed eaphatiod date)''ll/
Failure to secure coverage a i required under MGL c. 152,425A is a criminal violation punishable by a tine up to$1,500.00 V i O(00�
and/or ant-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 violmor.A copy of this statement may forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby Cory
that the information prowded ebow fa nae amd carrert.
Sgnamre:� _ Date:_
Phone lt: --.--
Oficial use only. Do not write in this arra,to be cuagdeted by city or town official.
City or Town: Permit/Liceuse It
Issuing Authority(circk nee):
I. Board of Health 2.Building Department 1.CilyRbwn Clerk 4.Electrical Inspector 5.Plumbing Impactor
6.Other
Contact Person: Phone#:
i
i
ases pepariment of Sa Safety
Bocardrd oof f Building no
Reguiatmns and
Standards
License. Ce T'de39
Construction 5upervlscr
13 TE R JEFAC'F RDS
IEW
EASTHAMPTON I 3
F15TNAMPTON MA 0107?
w - Expirahom
Commissioner �rassala
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
Reglstraton: 191746
BEYOND GREEN CONSTRUCTION INC. Expiration rt 05+09;2020
13 TERRACE VIEW
EASTHAMPTON,MA 01027
uptlme ac.r—and nctmn WrO.
Office of Consumer Allaire 8 GONTR A TOR n
HOME IMPROVEMENTatron Cj08 ,a before
eepirat vuld to IndividualrieIfF.useonlya
TYrialim nation Office of
Affairs
a dBu retum to:
R o�ffi Expra['on d' Office Consumere-suite 1301 easiness Regulation
191746 OSI0912020 � one AshWrtan Fece-5aRe 1301
BE YON CREEN CONSTRJCf ION INC_ Boston,MA 02108
SEAN JLGCOROS
13 TEFIRACr VIEW -
_,. nrrrinv,mla mgz] Uncersecr�ay Not valid without signature
1 Q L Une�-r n�,C{- bk , ti o n-fr�c�rY�tt�'1 ,w�a9 e t uLc3
�a�tav� l�Y��-�-�er
43��+5
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City of Northampton
i
Massachusetts
Y
1 �AR2}ffiiT OF BOILDIA6 IaSPSCTIORS 7.
212 Main 3tc t a l Cipal a IcUW ac>
((y� Northampton, M 01060
Property Address: � -lb QA 0( Vo Q-0\x)ToL , MV4bl0lD2-
Contractor
Name: &,L40OC LIW-0 COrIS(-r-U0 ,1770(\
Address: 1,^3,�, ,, ''�1f, tcC a vo a,-)
CC
City, State: �'V 1 l (\ Iy\�vk C)\ \nom
Phone:
Property Owner !1
Name: Sa`rCICh1Ak1'VQJ(
Address: ��Ll C.k1ZS��1�cS�
City, state: N 0 4An CiM N4-\
I, Sea(\ 36`0i6` (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 s 3 I /S
D.Sign Emel ID:OBB818A4BME FDSAB4C DMD54DCW
Permit Authorization
mass save Form
Site ID: 3436224 Customer: SARAH WHITHER
SARAH WHITTIER
owner of the property located at:
(Owriefs Name,printed)
190 Chestnut St Northampton, MA 01062
(Property Street Address) (City)
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: 9 �—
Date: 7/23/2018 1 08:20 EDT
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:
cor DRfce uze cmv
Rev.102015
AWN
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!
Nicalejeffords
Beyond Creen Construction I Project Coordinator
Cell:413.539.1728 I Office:413.529.0544
13 Terrace View,Easthampton I www.beyondgreen.l lz
Beyond Green Construction "Leaders in Energy Efficiency" Phone:413-529.0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539