10D-002 65 WATER ST BP-2019-1088
GIS#: COMMONWEALTH OF MASSACHUSETTS
a :Block: IOD-002 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categorv: INSULATION BUILDING PERMIT
Permit BP-2019-1088
Project JS-2019-001771
Est.Cost:$3846.00
Fee' $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.class: Contractor: License:
Use Group' BEYOND GREEN CONSTRUCTION 074539
Lot Size(su.ft.): 40075.20 Owner: URBANK ROBERT M&ELLEN COGEN
Zoning, URB(100)/RR(0)/ Applicant. BEYOND GREEN CONSTRUCTION
AT.• 65 WATER ST
AnalicantAddress: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON:4/2/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:INSULATIONNVEATHERIZATION DOOR SWEEP,
ATTIC FLOOR, ATTIC SLOPE
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: Qil: 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 Occuoancv sieuature'
FeeTvoe: Date Paid: Amount:
Building 4/2/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
Board of Building Regulations and Standards AS
Massachusetts State Building Code,780 CM I T1
Building Permit Application To Construct, Repair,Renova[ Or r 101
One-or T"-Family Dwelling
This Section For Official Use Only
Buil digg Permit Numberg10lCl, LU Date Applied:
UIn.J /25$ 1112— t4 t1EPT.O�WaDINO INSPECtIr -�9
aawauPyu.teaataea
Building Official(Print Name) Signature
SECTION 1:SITE INFORMATION -
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
lrF l� lAfrst N0fJ'y'0mWx\M 1A fop O®�
Lla Is this an accepted sheet?yes no 0\OS 3 Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Am(sq fl) Fmmup(ft)
1.5 Building Setbacks(R)
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.O.L c.40,4 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public a Private o Zone: _ Outside Flood Zone? Municipal c On site disposal system o
Check if yeso
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
l�rCer+ urtx)n� Tt'LW)((,s 0rx) ,(�nAowc3
Name(Print) Ciry,Stale,ZIP
(o5lu'ohersl- k� 3-bao- I30�
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check a6 that apply)
New Construction o Existing Building o Owner-Occupied o I Repairs(s) o I Alteration(s) o Addition o
Demolition o Accessory Bldg.o Number of Units_ I Other ^Specify: C '2 �Jn
Brief Description of Proposed Works: OOr,6)" 'fn15o. r of
^{ r T ' irYl Oiar Ln" VO IC ' M Oji -- smnl
(L
r o LCAT ii" W IO �cAecr
SECTION 4:ESTIMATED CONSTRUCTION COSTS Gley ha„ 6)c SS
Item Estimated Costs: Official Use Only CoA 1 to
It-
(Labor and Materials
1 Building S 1. Building Permit Fee:S 6�Indicate how fee is determined:
2.Electrical S o Standard City/Town Application Fee
o Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: S
4.Mechanical (HVAC) S List:
S.Mechanical (Fire
Su ressipn $ Total All Fees:$ (o S
Check No.(JIEQChmk Amount: Cash Amount:_
6.Total Project Cost: $ 38 , cI a- maid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
a�ppri t ATT'�c F LrALr hr'1C st ooeE
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /1 S_ �l(A cJJ 7 Q ( I a 8'IS
SEAN R IEFFORDS C I
License Number Expipa ion Dale
NameofCSLHOIder -r -
List CSL Type(see below)
13 b0E CE'VIEW -
'I Type Description
No.lend S[[nnncppetpp '' j U Unreepiided Buildinga to 35,000 cu.R.
EA�THAMPI'ON MA p Iopps R Restricted l&2 Funnily Dwelling
Citn7'own,Stara ZIP C Roofing Covering
—.1 WS Window and Siding
LNP'
SF Solid Fuel Burning Appliances
413-529-0544 SEANC)BEYONDGREENBIZ l Insulation
Telephone Email address D yDemolition
52 l
Registered Home Improvement Contractor(HIC) t:�1 ) .71 / 4!, SIV
scaA I tT d -B d C C t d' HIC Regisbation Number Expirelion Date
BIC Company Name or HIC Registrant Nemo
73 Terrace View scartAbewndiaggn biz
No.and Street Email address
Easthamoton.MA 01027 413-529-0544
Ci /Town,State,ZIP Telephone
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 OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1,as Owner of the subject property,hereby authorize .PJJOnl-
to act on my behalf,in all matters relative to work authorized by this building permit applicat1i
na- �'1eolt �1 s / l
Print Owner's Name(Electronic Signature) Date
SECTION 7b: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 no and the best of my knowledge and understanding!
Sean Ieffords
Print Owner's or Authorized Agent'sN ectronic 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 he found m www.mass.gov/dos
2. When substantial work is planned,provide the informationbelow:
Total floor area(sq.ft.) (including garage,finished basementlattics,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'my be substituted for"Total project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,AM 02114-1017
wsswainassgow'dia
V11ttirkers'Compensation Insurance Affidavit:Bufiders/Contractors/Elechicims/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Aoolicaot Information � Please Print Legibly
Name(BuainesdOrganiwfioNlndfvidwl): Be.l4 fl Y cj C7( f f") co Y1S 1 LI�AC1S()r1
Address: 13 TC1(GN4 Vitt )
City/State/Zip: E'CISI-ha n 'wlt4 Phone#:
Are yo..a eom Ao 'cheek me appropriate box: 000-':� Type of pirvi(required):
1.®lama ambym in anpioym(full enNor pn-rive).• 7. ❑Newconslrvetion
2.❑Imamv pwpnerororrerowrhipa MvemevploymworkiM formai• 8. E]Remodeling
any c ipmesy INowvrkcrs'crap.imunmc rcquaM.]
3,r7I ma homcownerdoing all mark myself[No workers'comp insurance required.]' 9. El Demolition
4.❑1 m a humowvmeid will be hhing mnoanors m mMmt all wvhm my ProM1Y 10 E]Building addition
twill
m
more datall ammuworkers'orkers'wmpemetioniwrnme or sterol, I1.❑Electrical repairs or additions
p1opn`m15"N no mpbym' 12.❑Plumbing repairs or additions
5.❑Ian. now lcomnmorand l lave hued the aubmvtrecmn Laudon Ne atutiod ohm 13.❑Roof repairs
'ITmesubconracmrshave mploym aid have wo,kvi wrap irtuvaxet �." ..,
b.❑We macormraum sodiu otfimshave exacisN Nekrighr ofacmgion pm MGL c. 14.1JOther �AfPa4L �
152,11(4),and we have m mp1mym.(No work<ri comp.imun oo mgmmul I
•Any applicant that chicks box#1 mart also all our the vection below showing their workors mivpensaion policy insinuation.'Nommwners wlo submit tha amdavu indicating they am doily alt work sed Nm an,o anile cormacma mnu submit anew amdavit mdcoing smh.
ICmaecmrs Nei checkthis box most ancient an unditioml ahem slowing the tum,of the subcmbxmn and den,wMher or not rhes,imides have
employees. If rhe subconbacm have mploym,they mud provide Nair workeri comp.polky shun.
lam an employer that isprovidingworkem'rompemation brsuraecefor my employees Below UfhepolieyandlMshe
information. f, '/� ,J
Insurance Company Name: I t/V (Q�, u (Ll m 5 u m ✓ u
u
Policy#or Self-ins.Lic.#: ,�LIUCC 70005I Expiration Dater _
fob Site Address: 10-) �I o-Or S1 City/Sta ip: 1�'J' - O Nq
Attach a copy of the workers'eompensedon policy declaration page(showing the policy number cad exptr tion date).
Failure to secure coverage as required under MGL c. 152,425A is a criminal violation punishable by a fine up to$1,500.00 V
and/or ono-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 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 thepains and penalties ofperlury that the information provldedabove is nue and correct
Signature: Date:
Ph ne#:
Official use only. Do not write In this res,to be completed by city or town ofjiclaf
City or Town: Permit/License At
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.CityrFown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
i
C...n of Massachusetls
Division of Professional Licensure i
Board of Building Regull1aattions antl Standards
. ConshA6l�t{J\1p�NlAOr j
CS-074539 �> 007�
Expires: 1 V282020 j
SEAN R JEFFORDS
13 TERRACE VSEW
EASTNAMPTON�JA
Commissioner
I
�><2eparrunw�uaeec �e a�C�/f/jcauaer'
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home improvement Contractor Registration
Typo: Corporation
BEYOND GREEN CONSTRUCTION INC. Registration: 191746
Expiration: 051092D26
13 TERRACE VIEW
EAST'NAMPTON,MA 01021
upd.re aua,me,,,m aaw.n e.ra.
su.t u aA+ 7
H
tlfIMCoroums IMlNAMlrss NTR RpuNaon l
ONE1OVEMENTCONTRACTOR - bduni,a0onvelitlforc.lndvi0uafusa oNY
TYPE CorpuabNoi,u,CmRir Aflats OfouMrMrm to
calciumRxibundion OtOn of ComumarAMln aM Ouainw RagulNon
191145 05012020 Ona AshOurton Plaza-Suite lam:
BEYOND GREEN CONSTRUCTION R!G Bouillon MA 021M
SEAN JEffORDS
13 TERRACE VIEW
EASTHNot wild Without Signature
EASTHAMPTON,MA 01071 Vim,
.9Pi Llny.."
' lin;ie Snit*6Y'9mC1t APiT ilcq)"-.2`.i
Suopizmzet to P�-,nieAw7tcacc.
,'-r Office --se On!
th'. [no alteration, rouovadoty rcpt u, hlerrvzaaan. ccs
ramoval o;dewm ; or the constructional of an addition to my,pro-cxisun¢ow,,,oxania
L--'.,16iE u%iLlrg at twat on-cut ao more.tha,i four dwc1liuR nmt,or to st uctu:es which are.adiar=t to s
.. o crouttcawrrnc Sae -- c�sCnx �.yr,�,. ...msec executions z'ez¢ motae;. rvut
ol'X,Jfzt JelEamenzafor. Si. .",USc
c.V -r. ��
mete of Vie.-mit r Appi%cation:_,�_L I� �_ -- -----
._-_ ..
.. 4>,tt sal t., g ea ,ttoP.{s):
Work excluded b}law
_
or under S 500.90
Oti3".v'ER.S PULLING THEIR Q1r.'h PE2PvE 19.".. +'.j ;M—CISLRED CON—RAC 'CAS
'Y3R 4P`2.9 TRAnONPUCAKE GY2F )
GRi2I J 07-R4 'v Vx ',DUN."2"21ERRy/Z ,ML 742 TN'
'DO NOT -MAVT ACZf-.SS II
{ ebr a„rl, e a permit as the ageni of the owner:
?ate: - _ R=< Cutds7:^,GrTIC;k 8e: 131278 i
3bO,e mtlu . t S:er,+R n -,' :pY 2 yT IIn.: w t,-.^xmer of the-rap m,. 7
aiL:Ll%: J';yna� r—#
BEYOND GREEN
CC4 '.,\ISTRUTI: N'
DEBRIS DISPOSAL AFFIDAVIT
nV`l.I
! ACCORDANCE .._..-. -. .= C'"'.qis. LTH ...-
MA.Scs.r 70, !S
MASSACHUStTS GEhE42,_ LSVd C;=A?T=R 40, SF.C71L7;.
54. A CONDMON OF BUILDING
FOP DEMOLT`Dit ,WORK ?= _;T -I_ D=BR7,
RESULTING �'JM -u_e N;n RK 5� RaMQY,-D FRG_ .
SiT_ AND DISPOSED OF -.i ! PRO'rFR'_" _:CEi4SED
WASTE DISPOSAL FAC!'.-.-v AS DEF-'`D B. . . �_
/_500.
=aLTERNATIVE RECYCLING, NORTHAMPTON, AAA
SITE ADDREZS-
o`) CACC3
BE DISPOSED AND TRANSPORTED S`.'-
=:EYOND GREEN CONS RUCTIOF =r
-i3ERtNATIVE "CYCLING
6 �
SIGNATURE_—
DA T
DATE
City Of Northampton
, Nassachusects t' -
!f,7
,r�r`.- NorthamptwaM8 61666
Propany Address: &-5 Waw (3t. wc4-nampjo4 , N,�A
Contractm-
Name- 1,75P(Mnn {orf-en
J- - -
Address: . -Is I f,r rn re \1
City, State: EaSA--h Ci Q C)Q-j
, t)n N a 0 1
Phone: L4 f
Propen"I Owner
Name:
Address: 6�
city, state: 0 ,
1, S an (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 30 (Q iCA
Permit Authorization
Affm
fnmss saw Form
ssv.ys trmq,.�.�vy.sAr>Msv
Site ID: 3611722 Customer: ROBERT URBANK
owner of the property located at:
(O es Nam%pdaed)
65 Water St Northampton, MA 01053
(Property Strea 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:
Date:
esemepesseeueeYee%uYleOeeesu Yie•�e•<eeosueYesf eMea Y®®eose Ybe®eeoa
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:
Page i of 1 ror OlNce use Only
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!
Nicole]cffmrds
Beyond Green Construction l Project Coordinator
Cell:413.539.1728 l Office:413.529.0544
13 Terrace View,Easthampton I www.beyondgreen.biz
Beyond Green Construction "Leaders in Energy Efficiency" Phone: 413529.0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539