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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