35-099 79 DREWSEN OR BP-2019-0040
GIS#: COMMONWEALTH OF MASSACHUSETTS
MU.Block: 35-099 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-2019-0040
Project# JS-2019-000054
Est Cost:$3263.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group BEYOND GREEN CONSTRUCTION 074539
Lot Size(sa ft.): 9016.92 Owner: MCPARTLAN DEBORAH
zo_nine. Applicant: BEYOND GREEN CONSTRUCTION
AT: 79 DREWSEN DR
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAMPTONMA01027 ISSUED ON.-7/W2018 0:00:00
TO PERFORM THE FOLLOWING WORK.AIR SEALING, WEATHER STRIPPING,ATTIC
FLOOR, HATCH, BATH FAN
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: Home Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: M 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 Occupancy Slenature:
FeeType: Date Paid: Amount:
Building 7!9/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
ECENED
jTh Commonwealth of Massachusetts
B and f Building Regulations and Standards FOR
'. JUL M ssac usetts State Building Code, 780 CMR MUNICIPALITY
USE
Bttdlfpli tion To Construct, Repair, Renovate Or Demolish a Remed Mar 1011
NRTNPMPTON.MA010fi0
bEP1.OF BUIL a-or Two-Family Dwelling
O
This Section For Official Use Only
Building it umberOV-11- Yo Date Applied:
/ t
ORrci Pr t e) Sig-lme Dam
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessor"ap&Parcel Numbe
-1L.P4�f. NOf-11'1 m per+-'�^ -�-�-
I.I a Is this an accepted street?yes_ ne OI Oto cel D, Map Number ParumbN er�9
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I.ot Area(sq ft) Frontage(ft)
1.5 Building Setbacks(D)
Front Yard Side Yards Rear Yard
Required Provided Required Provided RI-4oned Provided
1.6 Water Supply:(M.G.I,a 40,454) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public❑ Private❑ /one: —,_ Oucide Flood Zoae9
M
Check if yes❑ unici 1❑ On site dis aal system Of
SECTION 2: PROPERTYOWNERSHIF'
2.1 Owner of Record: a
hra MCna�l n NOq�i lv r} 61 d�
Name(Print) �� City,Slate,ZIP
—1 CL_0rC,�,0.SJ11_ C Ufl�-(a95-C_70 —
Nt,mad Street Telephone Limit
SECTION 3: DESCRIPTION OF PROPOSED WORK'(check a6 that apply)
New Construction E3 Existing Building 13 Owner-0ecupied ❑ Repairs(s) 13Allemtion(s) 13Addition ❑
Demolition ❑ J Accessory Bldg.❑ Number of Units Other HSpccuy:WeCA4-0er,'7QJ4f
Brief Description of Proposed Work: ( -O&L_n 4X FM!_o tX _ Itor tJ Wr
SFc'a DD.� O
'fhofM l tiesLia. M. Qom_-�[� _O 4li 0D AXAY.Zk-F
r
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ 1. Building Permit Fee:$ _Indicate how fee is determined:
❑Standard City/Town Application Fee
2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier_x
3. Plumbing $ 2. Other Fees: $
4. Mechanical (HVAC) $ List:
5. Mechanical (Fire $ Total All Fees:rj —
Su ression) �f
/ q Check No.�_Chec�k Amount JX Cash Amount
6.Total Project Cost: Is 3 193 - ( ❑paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CIS
_C� C) C�A•^„ 1 r' a 0 rI"$
SEAN R 11- TFORDS J O-
License Numbr Expiration Date
NamCSLTI.Ider _
List CSL 7 ype(scc Isblbw7
13 TERRACE VIEW Type Description
No.and Street U Unrestricted Buildin m 35,000 cu.R.
EASTHAMPTON.MA 01027 R Resvicted I&2 Famil Dwellin
City/Tuwn.State,ZIP M Masov
RC Roolina Ccvcrin
WS Window and Sidin
SF Solid Fuel Burning Appliances
4I3-529-0544 SEANnJ3EYONDGREEN BIL I Insulation
Tel one Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I -1 I l f LV 5 .a
Sean R lelfords-Bevond Crcen QmsyucCon HIC Regislmtion Number Expirmi n Date
JIIC Company Name or HIC Registrant Name
13 Terrace View M itke ade Pn.lo,
No.and Street Email address
Easthampton MA01027______ 413-529-0544 _
Ci /Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. 6 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 ofthebuilding permit.
Signed Affidavit Attached? Yes ..........X No ..........❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT,, I
I,as Owner of the subject property,hereby amhorize 0 nd C -Ifn CO r),5hiLQ1 -l'O n
to act on my behalf, in all matters relative to work author:. by this building permit application.
�eP cc �hfc/ . --
^�a g
FYint Owner's Name(Eleclmnic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATION
By entering my name below,l hereby artFcs,
pains and penalties o(perjury that all of the information —
contained in this application is true anbest of my knowledge and understanding.
Sean Jeffords _ 4 1 ) )8
Prim Owver's or Authorized Agent's Name(Elature) Daze
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
wwy.mass.gov/qca Information on the Construction Supervisor License can be found at www.mass eov/dos
2. Wben 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.fl.) Habitable room count
Number of fireplaces_ Number 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"
iLll
The Commonwealth of Massachusetts
Department of ludustrial Accidents
I Congress Street,Suite 100
Boston, MA 02114-2017
www.massgowdia
VW.rkera'Compcnsution Insurance Affidavit Builders/ContractorstRil t,icia.Mumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A,,Iica.t Information Please Print Leeibly
Name lHudves=,orP�aaatloa�laaivia�ap:_��Q_n�. Ell'{fl'1�O_r�3 t3uCk'lO'�
Address: of I ck
City/state/zip: �(\ Phone
Are too as emplover•Check she apprapri.0 boa: Type of project(required):
r PqAanaoVk,,crwim_aanPwyea(rwlawor Pervaime4" T ❑New construction
2.❑lam wlepmpne urpansnipandhaeomemployces waning tbnrcin 8. ❑Remodeling
awcaPca, INowvrkeri rmcomp,es., r itarodl
9.3.❑lamaM1omcwner doing allwork myself(No swrkms'mmp.buamixe rtgvircd.)'
10 Building addition
❑DemOhn
tia
a❑Iamahomevwveranawalbemtingmtit :wrsmcoMu anwmkonmypmpem [will
we dun abl wnvacmm ddsr have wohers'rompcimuon inmrwrewme sole 11.❑Electrical repairs or additions
P` 'ncto"with m'""Pl"yCeS'- 12.❑Plumbing repairs or additions
sIanageneml cmmacm.anal nave n�dme.ase�mua<m.li:ad on mr arwonm:nrn. -
iksesub-commcmrs ha.eemvloyecsand be.e worker,'anmp.is mmrcc 13.❑Roof repo,[rs
6 E We are a corsaitain and iu officers have exereoci]their right ofexemplim,per MGL<. 14�Orh¢rt�"'v-z/-`J'1vs✓y� v'—v
lir,§ (a),andwebavenocmplwees.INoworkers camp Inarciewcus kroll
'Ar,a,,1a,mt da checks Iron ab muu atm llb om the v.<tion belay showing tnmr workers'mmpenmlion pnlirY infnmmtion.
'llm who sulanil this attidevir mdicasing mey arc doing all whh and then hire ounkle vonmxnrs mon zubmitaruw effdavit idical gsma.
:("cmtmctors
mnPloYenNhecsbuilkerozrancatowrsmMwe,vcmcNmcphlendyrev,dthey catutshpootvsdheowdwinigr Ure deme ofmtM srils, "uamcmbersr end sten wh nr nm those¢mitt¢:M1vvc
I an,an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy h or Self-ins.Lic.#: k.J yw�� `���.�\/.L ty _. Expiration Date: ((.,�� f
Job Site Address. -)9 C(Ci A.S , ®Y' _City'Smte/Zip:_Lv_o (+v)�.�����'rp�`
Attach ao
copy ofthewrkers'compensation policy declaration page(showing the policy number and expiration date).t� IVv '
Failure to secure coverage as required under MGL a L52,§25A is a criminal violation punishable by a fine up to 51,500.00
and/or ane-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine crop to$250.00 a
day against the violator.A copy ofthis statement b arded to the Office of Investigations of the DIA for insurance
coverage verifcation.
I do hereby certify under the pains and per at the information provided oboe¢is true and correct.
Signature__
Phone#
Official use only. Do not write in this area,to be completed by city or town official.
City or Town' PermittLieense# _._
Issuing Authority(circle one):
1. Board of Health 2.Building Department J.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone q:
i
Massachusetts Department ofnd S't Safety
Board of Building Reguia[ions and tandartls 1
GnU,License: CS-0T4539 `
5.na90n Slly'2:FISp:
SEAN R JEFFOROS
13 TERRACE VIEW
EASTNAMPTON MA 01021
Commissio^.er- 111201201s
I
P✓ //YG
B Wr7�at d'f2��1(Ir Ct lL�j `�/�..���f'.11'it t;I'r•�C./-P��T
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
BEYOND GREEN CONSTRUCTION INC. Regietration: 191746
20
13 TERRACE VIEW Expiration. 05/09/20
EASTHAMPTON,MA 01027
..... .........fieNm GON.
011ka M GMW Tttnr.✓/l
Al(alrs A We
HOME IMPROVEMENT ,�..,FT Registration valid for lMlviduel use only
TYPE: a11f' before Me expkation date. Ntound retum to:
ROgja(ra[IgnOffice at Co...,Attar.antl Business Regulation
191748 OY0g2 One Ashburton Plats-Softs 1301
BEYOND GREEN CONSTRUCTION INC. @oeton•MA 02108
SEAN JEFFORDS
13TERRACEVIE'N NOL VBIId without signature
EASTHAM�iON,MA p1027 Undersecretary 9
I
_ ,� e 1'
e.�oiC. d bL
City of Northampton
Kassachusetts
' Jr, � ■( 3
D6PAND OF NrrILNING INSpY TXMG
212 Hain St eet a a ioipal a ild np vj. pC
(� Northam n, M 01060 37\
Property Address: 1 ` bA)S('O �-f,
Contractor
Name: IEL4o- d C ( eeo Cona- )C-I or,
Address: 1 �J �'(-'(1Q("2 V i CW
City, State: C�CG4� Y4C11�'�](jV\ l O\0"T�'
Phone: ,( 0\ - 0SLAL1
Property Owner
Name:
C�* (A �(�rYbC+1ClY�
Address:
City, State: �! _
1, 500,0 Jed-Fo�c� (contractor) attest and affirm that the budding 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 I I
t
k
s
''4>.���
Permit Authorization
mass save Form
Site ID:
I, 3413%3Customer: DEBRA MCPAULAN
QrUS, yda /'ev-)
,owner of the property located at:.
YYY��• (Ow.eN.M.Dfi�dl
79 Drewsen Dr Northampton, MA 01062
(napes U.dAdd.l IUM
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 onmy property. �® ❑((L�y(�-�y �n
owner's Signature:
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: 800ABO-7412
Email:
so.oRa W.0M,
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!
McolejefJords
Beyond Green Co ut' o,to l i Protect Coordinator
Cell:413.539.1728!Office:413.529.0544
13 Terrace View,Faathamplan I www.beyondg'eea.biz
Beyond Green Construction "leaden:in Energy Efficiency" Phone:413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539