30A-052 (5) 61 LIBERTY ST BP-2019-0384
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:30A-052 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Categorv: INSULATION BUILDING PERMIT
Permit# BP-2019-0384
Proiect# JS-2019-000623
Est.Cost:$2585.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groun: BEYOND GREEN CONSTRUCTION 074539
Lot Size(s4.ft.): 15594.48 Owner: WATSON DAMIAN A
Zoning:j1RB(I0Q)/ Applicant. BEYOND GREEN CONSTRUCTION
AT.- 61 LIBERTY ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON:9/28/2018 0:00:00
TO PERFORM THE FOLLOWING WORK.-AIR SEALING ESTIMATED 62.5 CFM/ EXTERIOR
DOOR WEATHER STRIPPING DOOR SWEEP, ATTIC FLOOR - 6" OPEN BLOW CELLULOSE,
DAMMING DOOR - 2" THERMAL BARRIER POLY, KNEEWALL 4" DENSE PACK CELLULOSE, RIM
JOIST - 2" THERMAL BARRIER
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; re ii int Fireplace/Cbimucy:
Rough: Q-111 Insulation:
Final; oke; Final;
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY
OF ITS RULES AND REGULATIONS.
Certificate of Occupancy signature:
Feer e: ate Pgid:: Amol�n
Building 9/28/2018 0:00:00 $65.00
212 Main Street,Phone(413)587.1240,Fax:(413)589-1272
Louis Hasbrouck a Building Commissioner
RECEIVED �IvsvGloiOalv
The Commonwealth of Massachusetts
2018 Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUMCIPALITY
USE
DEPT. F BUILDING INS Pe it Application To Construct, Repair, Renovate Or Demolish a Revised Mar 2011
N THAMPTON,MA 07060 One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: jay 3 Date Applied:
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors p&Parcel Numbers
1.1a Is this an accepted street?yes no_L )Map Number Parce umber
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:
Zone: _ Outside Flood Zone?
Public 13 Private❑ Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record•
�)aw.', CI r , U3&A-�bc\ IV Or n ,Wl O k U(o 2
Name(Print) C itv a*.,*.. ZIP
No.and Street Telephone Email Address
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 01 Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units. Other V Specify:\Y3Q Q4MEJ
Brief Description of Proposed Work2: W 1 n Ai m C�: " ry r
U� WL?Crl 1�n f I- ` OC7 r Q� — 11 l Ui-
r- a 1,n
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:$_(t,"__Indicate how fee is determined:
2. Electrical $ ❑Standard City/Town Application Fee
❑Total Project Costa(Item 6)x multiplier x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $
Su ression Total All Feej:$
6.Total Project Cost: $ p
Check No. (� Check Amount: _Cash Amount:
13 Paid in Full ❑Outstanding Balance Due:
I<
t-105 c
ITC06 <<��p � (EMM. c 0
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
SEAN R JEFFORDS
License Number Expiriftion Date
Name of CSL Holder
List CSL Type(see below)
13 TERRACE VIEW
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 Mason
ry
RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN@BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) A ( -I
I „ 5 9 1
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View seanbeyondgreen.biz
No.and Street Email address
Easthampton,MA 01027 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...........❑
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 Bwood C Te m Ca nS"t'rt l(A oq
to act on my behalf,in all matters relative to work author^ize +y this building permit application.
`)ee ct_ia00ed
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
By entering my name below, I hereby attest a ains and penalties of perjury that all of the information
contained in this application is true and a best of my knowledge and understanding.
_Sean Jeffords
Print Owner's or Authorized Agent's Name(ElectrOlic 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. og v/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 Please Print Legibly
Name (Business/Organization/Individual): k )cd Cl u f fl 00n,5 (f-j 0r\
Address: 13 -�u(a cy V I tco
City/State/Zip: �j V�-1,(I� Phone#: �� ' 5)9-
Are you an emplover?Check the appropriate box: Type of project(required):
1. 1 am a employer with _employees(full andlor part-tune).* 7. [:]New construction
2.❑I am a sole proprietor or partnership and have no employees working for the in 8. []Remodeling
any capacity [No workers'comp.insurance required.]
9. ❑Demolition
3❑1 am a homeowner doing all work myself[No workers'comp.insurance required.]'
10[]Building addition
<1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 1 1.Q Electrical repairs or additions
proprietors with no employees.
12.0 Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑hoof repairs
These sub-contractors have employees and have workers'comp insurance: ' �1e
6.r-1 we are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other lx/ i ' 40,1
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box P1 must also fill out the section below showing their workers'compensationpolicy information.
t 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 subcontractors have employees,they must provide their workers'comp.policy number
I am an employer that is providing workers'compensation insurance fur my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: 5 60 CC 7 0005 I Expiration Date:_ _ 9
Job Site Address: C City/State/Zip: 'J U•
Attach a copy of the workers'compens tion policy declaration page(showing the policy number and expirati n date).bou-(-a,
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.
I do hereby certify under the pains and pe es ry that the information provided above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town gfficial.
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#:
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Massachusetts Department of Public Safety
Board of Building Reguiations and Standards
License: CS-074539
Construction Superv;ser
SEAN R JEFFORDS ;r,
13 TERRACE VIEW
EASTHAMPTON MA 01027
Expiration:
Commissioner 11128/2018
f
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: 05/09/2020
13 TERRACE VIEW
EASTHAMPTON,MA 01627
Update Addreas and Rctum vara.
SCA 1 0 20WS/17/ /
Office of Consumer Affairs&Business Regufai5ow
HOME IMPROVEMENT CONTRACTOR *a, Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Regi ration Expiration Office of Consumer Affairs and Business Regulation
191746 05/09/2020 One Ashburton Place-Suite;301
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFORDS
13 TERRACE VIEW
EASTHAMPTON,MA 01027 Undersecretary Not valid without signature
AFFIDAVIT
Horne Improvement Contractor Laxv
Supplement to Permit Application
Sa",zitd Affidavi.Fa Ho cin yet ti mcac Coutraciu:Pcsrni:A�pliwtioa
For Office Use Only
Per€rs:No.:
Date;
-No.t. '42 A, require8 That the Pire-Gonstruction, alteratictD;, renovation, repair, modernization, cup-`veiS10
improimment,removal or demolition or the constructional of an addition to any pre-existing Owner occupaea.
building-.ontaisting at least one but no mor than four dwelling unit,or to structures which are adjacent to sucl3
re;i'a-'lice or buildings be done by registered contractors.vwiffi=Min exceptions,along With other rcuuirements-
T}Te of Work. WeatherizationInst. Cost: __-- --- .
Address of Work ��`U _._ k` 0 O r+V M w O l(U'a-
0-,x ers Name:
Date of Permit 1 Application:
T hereby czrtify that:
i
�egn'stravon 15 not required for.lie following reason{s}:
Work excluded by IQw
Job under$500.00
Building Dot owrt-T occupied i
Owner pulling own perrmt
Other(specify)
_ ---
Not-ice s hereby giver:that:
$` OWNERS PULLING THEIR OWN PERMIT OR DEALIAiG Wl"1H CJIv1tEC;ISTERi;D CONTRACTORS
FOR APPLICABLE HOME IiVIPROIVENIENT WORK DO NOT I-IAVI:✓ACCESS TO THE
A-RBITRATION PROGRAM OR GUARANTY FT?rKD UNDER'k?r:i_^. 142A-v iJ
Signed under penaifies of vejury:
I hereby apply for a permit as tate agent of the owner:
Date: Contractor: BEYONE-1 GREEK,CVNS i RUCTION Reg_4:_13i 279
OR: SEAN €z jEF>=ORDS
:ct°,,v i_hsta ding the above notice,!Eby apply for a permit as the owner of the property.
Date: __ Owner: _ __---_--� _ �_ Tel.#
BEYOND GREEN
CONSTRUCT ' ON
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE OF
MASS ACH3�SETTS DEBRIS DISPOSAL PROVISIONS OF
MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT NUMBER
FOR DEM OLI T IONI WORK IS THIAT THE DEBRIS
RESULTING FROM THIS WORK $HALL BE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILM AM DEFINED BY MGL 011.1;
S150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MAS
CONSTRUCTION SITE ADORESS-
lQ 1 Lc' UItA8a . 0 -�k-�n �y� .b ►v� �-
TO BE DISPOSED AND TRANSPORTED BY-
BEYOND GREEN CONSTRUCTTO�,; or
ALTERNATIVE RECYCLING
SIGNATUR. -- ----
DA 6 E
s,
Permit Authorization
mass save Form
Site ID: 3554501 Customer: Danliar! Watson
I, �( � wobsde\ , owner of the property located at:
(Owner's Name,printed)
61 Liberty St Northampton, MA 01062
(Property Street Address) (City)
hereby authorize the Mass Save a Energy Services Program assigned Participating Contractor listed
below to act on my behalf and i a building permit to perform insulation and/or weatherization.
work on my property. i
Owner's Signature:
Date: •13 Zo►g
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:
Rev.102015
i
I
1
Page 4 of 4
IIC WARRANTIES
The flC warrants as follows.
A. Materials and workmanship will meet or exceed the specifications in CLEAResult's Materials and installation Standards.
B, The Work and the materials furnished by the IIC will conform to the requirements of this Contract.If there be a detect in workmanship or
niatertals,or any damage caused by its subcontractors or employees is discovered within one year after completion of the Work irrtclud,ng
deanup'�,the IIC will.at its own expense,at its option.remedy,repair,correct,replace,or cause to be remedied;repaired.corrected cr
replaced such detect or damage.
CUSTOMER RIGHTS UNDER M.G.L.C 142A
Customer has the following rights under M.G.L.c. 142A;
i
j A. At the time of signing this Contract.the Customer shall be furnished with a copy of it.No Work shalt begin prior to the signtwj of this Contract
by the Customer and CLFAResuft,
B Any party may bring an action to enforce any provisions of Mass.G.L.c. 142A or to seek oarnages or the Customer may request that a dispute
be decided under the terms of a private arbitration program approved by the Secretary of the Executive Office of Consumer Affairs ane
Elusmess Regulations.
Cu Customer may have the right to be compensated from the Residential Contractor's Guaranty Fund for actual losses incurred as a result of a
d registered contractor's or sutxontractor`s conduct found by a court to be work performed in a poor or unworkmantike manner or which violates
certain laws`dr the protection of consumers within 6 months after the Customer has obtained a judgment or arbitration award and has
exhausted customary reasonable efforls to collect the judgment or award.
i,
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City of Northampton
Massachusetts
DEPARTD-MNT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building l'
Northampton, MA 01060
Property Address:
Contractor
Name:
Address:
City, State:
Phone:
Property Owner
Name:
Address:
City, State:
I, (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 1 have
provided the property owner with a copy of this affidavit.
Contractor signature
Date
City of Northampton
/:•}1.� �`\, �",, � SSG•!
Massachusetts
A ;
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building U6sC�
^" Northampton, MA 01060
Property AddressU bf X_u SA - �R o Y cx)Le ANO U� Q(_P c)
Contractor
Name: or-06 (ca) (!6CL+(U0j:10r1
Address: _ '� :Ufro cz V) 6th
City, State: L 0 S--h n_M 0j]L�D '�&Vy o)o-(�—�
Phone: u 1 3- S oD 9 -C7GJU
Property Owner OC
�,�
Name: ( n I (An J/l' ('� S Or)
Address: �0
City, State:
I, S(Cln )f (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 �/ I
RECEIVED
OCT - 3 ?_018
DEPT OF 13 II-DING INSPECTIONS
NORTHAMPTON,MA 01060
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