25-003 (7) 140 RIVERBANK RD BP-2019-0949
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-.Block:25 -003 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Categorv� INSULATION BUILDING PERMIT
Permit# BP-2019-0949
Proiect4 JS-2019-001585
Est Cost,$1687.00
Fee:$65.0 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Sin(sp ft.): 14679.72 Owner: KIMBERLY PARK
Zoning, Applicant. BEYOND GREEN CONSTRUCTION
AT.- 140 RIVERBANK RD
ApplicantAddress: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAMPTONMA01027 ISSUED ON:3/6/2079 0:00:00
TO PERFORM THE FOLLOWING WORK:WEATHERIZATION - AIR SEALING, ATTIC
FLOOR, BATH FAN, DAMMING, HATCH
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 MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of OccuoancY Sienature:
FeeTYDe: Date Paid: Amount:
Building 3/6/20190:00:00 $65.00
212 Main Street.Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
RECEIVED �N , 7rUni
AR :., 5 2019 The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code,780 CMR MUNICIPALITY
DEPT F6Lll Di m6 Irv5PFOr1ONS USE
rvo TrewP�o�.. +A ift Application To Construct,Repair, Renovate Or Demolish a Revised Mar 1011
One-or Two-Family Dwelling
This Section For Official Use Only
Building PermitNumber: - I "R ate A plied:
4L/10 //2" // ` // 3-6-Zolq
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Pro erry Address: 1.2AssI Map&Parcel Numbe
Lla Is this an accepted street?yes no Mta Map Number Parcel Number
1.3 Zoning Information: D\(-1_p O 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 Retuned Provided RNI Provided
1.6 Water Supply: M.G.I.c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Oubide Flood Zone?
Publico Private o Check if yeso Municipal o On site disposal system c
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'otR
Ic,m rl� `�c r� fU0YC1 m�iGJ� rAy} 6\C( ao
Name(Pit) city,State,ZlP
Itio R� veor QncR6 _ 3' - ��$3
No.and Street Telephone Emnil Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction o Existing Building o I Owner-Occupied o I Repairs(s) o I Alteration(s) v Addition o
Demolition o JAccessoryBldg.c, Number ofUnits Other�u Specify:]/JQO-, "t-1 ZG�tio
Brief Description of Proposed Work': lin t St - (oO ✓ r
2 4 ixi e toic)
w n A to -19 `
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Oficial Use Only
(Labor and Materials
1.Building $ 1. Building Permit Fee:$ (o5 Indicate how fee is determined:
2.Electrical $ o Standard CityMwn Application Fee
o Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Su cession $ Total A'I.I�FF e{f (OS
6.Total Protect Cost $ V Check 't l(Check Amount Dash Amount:_
0 In Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES I
SECTION 5: CONSTRUCTION SERVICES
j 5.1 Construction Supervisor License(CSL) J
. '" �"�(,�cJ7 Q ( 1 a 8 )l8
SEAN R fEFFORDS lJ I
License Number Expiration Date
Name of CSL Holder
List CSL Type(sce below)
13�RACE VIEW
Type Description
No.and Street U Unms[rined Buildin u b 35,000 cu.R.
EASTHAMPTON MA01027 R Restricted lffi2 Famil Dwellin
City/Town,State,ZIP M Magi
na
RC 'RoofingCDvering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEANABEYONDGREEN BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 19 )
7M I 5 IG
Seen R leffords-Bevord Green Consmction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
L3 Terrace View seen[a)_bevondemen b'z
No.and Street Email address
Easthampton.MA 01027473-529-Q 44
Ci /Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.4 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 7s:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property, hereby authorize nn C� �7(P.G/1 00) J" t"/lrl
to act on my behalf,in all matters relative to work authorized y this building permit application
See QE4LlCeC� ? (7/(1
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATI N
By entering my name below,l hereby ane er the pains and penalties of perjury that all of 4 information
contained in this application is tree m to to the best of my knowledge and understandingi �,
Son]etfords ' a ( 7 /1( 1
Print Owner's or Authorized Agent's Na lectronic 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)Frogman),will not have access to the arbitration
program or guaranty fund under M.G.L.a I42A.Other important information on the HIC Program can be found at
www.mass env/oca Information on the Construction Supervisor License can be found at www mass eov/dos
2. When substantial work is planned,provide the information below:
Total Door area(sq.ft.) (including garage,finished basemenNattics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bativooms Number ofbalf/baths
Type of heating system Number of decks)porches
Type of cooling system Enclosed Open
3. "Tom]Project Square Footage"maybe substituted for"Total Project Cost"
The Commonwealth ofMassachusetts
Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,MA 02114-2017
wwwmassgov/dia
Wil.rkers'Comphousation Insurance Affidavit:Builders/ContractorsMec icims/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information /'� Please Print Legibly
Name(BucneuvorgeniaatioNtndividual): T,A"AJn( Kh V feQ'n COn,5"r -k(Z fC O(1
Address: i3 -TafCap �ruk-)
City/State/Zip: Phone#: E 3 - tag -0�Cfo
Are you so employer?Check Ike appropriate box: 6 (]a Type of project(required):
L®lame employer with–(P—anploycas(fWl7. ❑New construction
2.❑Imsskpmpnsm marhipmd nmmployeowotkhy tbrmcin 8. E]Remodeling
any mWity.(No m,ikxx'comp.insmu,ce regvbai.]
3.❑ m
1muhacmvnerdoingxlwwk MyattINoworkers'carp-uxwoxvrequired.]t 9. [1 Demolition
4.❑iema Mivoowvcmd winxhidngrana.nonmcaMot nlwok on nu'wooatr. twin 30❑Electical repaion
gimme Wtall contsacmn<aherhavo wokers'compemetioniwmceaart sole ll.❑Electrical repairs or additions
M,ovemn wiw no employes. 12.L]Plumbing repairs or additions
5.❑I ma consul conmctm mat have bred tha suhmpmcmp lined on to ahachod shceL 13. Roof repairs
Thea aubconlmcton hum empioyam and have wokers'comp.a.,s
6.❑Wean. a maieo aodisomcera have exorcised Ann nab,of exemption per MGL c. 14.�0[he[ l/.�C YI�w zW 1 ✓�
[52,11(4).and we have vo anployees.iNo wmrketi comp.immmce nautnal]
'Any ap ih m dot neck box al sun also fill out the rmnon below shoo tog their wnrken'compm stion policy intonation.
I Homeowners win sWmdt this atRdmit indication they am doing all wok and then him onside cotmmtoa mot submit a new affidavit mdmairy sub.
1Conbacmn tlut chock this box moat ebachad an additional sbect showing the acme aore subconmemrs end smte whether in an twee mdtles have
employers. Ifthe submmotc o share engbyoes,any must provide can, woken'comp.polity nanber.
I am an employer thmisproviding workers'rompensadon insurancefor my employees Belawlsrhepolicyandlobshe
information.
Insurance Company Name: )0 9(A A y- 1 (kr0, nn,e
Policy#or Self-ins.Lic.#: p5WPC.7000s Expiration Date:` I- I - � r0
Job Site Address: X40 Rw ,2,QbQnl Ra a City/Stste/Zip: IVyf'�'1 T�In)� -
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 04K)
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 herby certify under the pans an fperJuy that the informadon provided above is nue and cm rect
Signature Date:
Phone#
Official use only. Do not write in this arra,ro be completed by city or town olgiciat !
i,
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department J.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
i
Contact Person: Phone#:
3
i
O rWon of Pmh os Maal Licem tts
�1 Division of Requi ion.Licensure
Board of Building Regulations antl Stargartls
ConstyGlr(�t1ISilpMwr
CS-074539 _J 4pires: 11f2512020
i � w
SEAN R JEPF.OROB w
10 TERRACE -
EASTHAMPTOWMA}.. 7,
"/hO SA-I O2\S
Commundoner ✓"" /a, '
I
��ie �pa7nz�eUort�cr-ea�a oo��G�aQ�tzc�u�e:�
Office of Consumer Affairs and Business Regulation
One Ashburton Place-Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
BEYOND GREEN CONSTRICTION k4
C. Re omtion: 181746
Ex{Rragorc 05/0gYL020
13 TERRACE VIEW
EAST74AMPTDN,MA 01027
V P[Iele/ltleem m�tl RYIYen taN.
Cv
$G1 8 NFf6Y(!
4
ONHmeonwROVEMo Tcotmeayuletle� -
HONEIYPBOVENEMCOMRACrOR RyletraltonvelW for dldf.IncWdualfound
*NY
TYPIBO[I akar Old. C...nu ,Atk*."Stui NrrmW
F, p Om Ash Consumer Afkkeantl[iwlnw Reguletlm
191746 05p8R0'HI Ons AehCurtan Plan-Sake/20:
BEYOND GREEN CONSTRUCTION INC. Sw n,MA 02108
N JEFFOMS
13TERRACEIAE l211�.P
EASTH MPTO .M G , Not vBUa without slgnah"
EASTIiAMPTON,MA 0102/ Underee0reter,+
ltnr e!tnumvcrtzut'imhacmr-�.a_: '
5upplemcnt to Pcm it Apphcam..
Sayymvi.!]�C:?c.iio-e iieef_vestCmm.:,lov Pci5L9wiieciu:
T
Off
ice Lisa C3_3
.: reouues chs: lu= Areconatnoion, a:ieratj n muovauon, repair, modemizstlaq au: error- ;+
unp-over rat mmzval or demo':i;.ou or iLe cousriuctiutW of as addition to my pre-c+ustiag owner occupied
wterat waminiag at Imst one but ao mor.than four dwelling unit,or to stracta ivW6.ate adiacent to suds i
Dutldiueta ba dose��red;sterid centrac3os,+chh oemnin exception ,alongxi:t,other cvui:emen*s.
.e a.Mori: _,!v'eatherizali n E -
su „oss
o.work. IUb \V2,C
D&-e of Romilt t 4pQllcarion: r4A 1 \C)\
cz2ify that..
'g:€aaean is n^t:zq.';zed fxt"e 0FO': rg mason{s}:
excluded Sytaw
`oo:order S 5010.00
_ ._"—.Eriz I'm ecc=ed
river peliing eem permit j
-,or e is he_„by gi.ea that.
GTv'v'ERS PtFLLING THEIR OWN PERN11 +..P H?SSI L'ti RcGISTERLL CONTRACTORS
FOR APPLICABLE HOME;bLP204- u NT" ORK OO NOT HA C:C'.P.SS TO THE f
n RB.11RATION PROGRA-M OR GUARANTY -TL LN GL C. 132A.
i
�a; d'u def Nual,es ofpajwy:
11-ereby apply for a permit as the agent of the owe :
i3a.0 %oatsctar. =�'L'N_Gpe�N CGNS��tiCTION Reg.#: 13`279
CR: SEAN dEF70'9S 1
..-...=..a-d.n& -''.e soere notice.I herzby sPPSy:or rhe o:enzr of the property. �
BEYOND GREEN
CONSTRUCT : 0N
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE V.iI-: -CYIMONWEAL:74
MASSACHUSETTS DEBRIS DiSPOSA'_ PRO\iISiONS G-
MASSACHUSETTS GENERAL '.-AAA CHAPTER 40. SETi_,',
54. A CONDITION OF BUILDING REP-Mir NU3,'6T-
`__. FOR DEMOLITION 'WOR:'C I= THAT THE DEBRT'
RESULTING FROM THIS WORK SHALL DF REMOV6D FRO '
SITE AND DISPOSED OF -IN A PPOPER_Y li.CENSED SOL',
WASTE DISPOSAL FAGI_ITY AS DEFIh:FD 5Y t!GL C__
i 5LA.
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
".S RUCTION SITE ADDRES-.
luo R("trIxlnK Rd Ivorw ons
SE DISPOSED AND TRANSPORTED BY- 00P(D
3EYOND GREEN CONSTRUCTION or
ii3ERNRT2VE 3RECYCLING
SIGNATURE----
DATE
IGNATURE _DATE --
DocuSign Envel' 1 1 1 C2FCA4-F9E6d7FE-BDE3-E6D2B64
Permit Authorization
111aS5 SaV� Form
Site ID: 3587614 Customer: KIMBERLY PARK
KIMBERLEY URBAN ,owner of the property located at:
(O .e,Name,pHi d)
140 Riverbank Rd 2 Northampton, MA 01060
(Property Street Addrm) (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.
�oowe+neaw
Owner's Signatu kb-C , (.' U91W
BEBFFE..I�.
Dom: 1/24/2019 7:50 PM EST
•e+•+•seseeee+ease•e®u+e+•++ea+•eees•+uo++e++ee+++ee+++++++++sae+es
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 1 of 1 F+F Office Use Only
Rev.102015
------ City Of 2\70--thalkPton
13 C<
OE2nAR�:d1 OF BiTZWM INanrc==s
Propenty Address: LAO
contractor
Name: PjpunnnAretri Ccr)&�-Tuc�ior,
Address: is f'r rn C2 V 1 f a)
City, State: Ea S+i-)cu'n iil M fq 0102:1
Phone: (412�- 15act- 0st-411
I voperq Owner
Name: brf\�r�w I- cn_
�j
Address: � �o V�\VnMnW- Rcl'\
Cky, State: C\0CC)
1, SMn c�P��Y- (contractor)attest and affirm that the building I intend to
insulate does not have any open air(Icnob and tube)wiring in the spaces to be insulated and that I have
provided the propetf owner wlth a copy e Ihis affidavit.
Contractor signature
Date
AON
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
Thank you!
NicolejefforJs
Beyond Green Construction i Project Coordinator
Cell:413.539.1728 i Office:413.529.0544
13 Terrace View,Easthampton i www.beyondgreen.hiz
Beyond Green Construction "Leaders In Energy Efficiency" Phone:413-529A544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539