31B-105 (4) 33 BRIGHT ST BP-2019-0769
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 B- 105 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categojy: INSULATION BUILDING PERMIT
Permit# BP-2019-0769
Project# JS-2019-001269
Est. Cost: $6000.00
Fee: $104.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Groun: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq.ft.): 7492.32 Owner: LEWIS BENJAMIN
Zoning:URC(l00)/ Applicant: BEYOND GREEN CONSTRUCTION
AT. 33 BRIGHT ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 WC
EASTHAMPTONMAO 1027 ISSUED ON:1/7/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-AIR SEALING, EXTERIOR WALL, THERMAX
RIGID BOARD INSULATION AND WEATHER STRIPPING ON ATTIC ACCESS DOORS
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 Occupancy Signature:
FeeTyne: Date Paid: Amount:
Building 1/7/2019 0:00:00 $104.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
0
m
I
m The Commonwealth of Massachusetts
D p Board of Building Regulations and Standards FOR
MUNICIPALITY
o m Massachusetts State Building Code, 780 CMR USE
?" �' uilding Permit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
om One-or Two-Family Dwelling
o °D This Section For Official Use Only
U) it Number: -11 Date Applied:
1�J '1<05s / l-y-Iq
Building Official(Print Name) Signature Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assess o Map&Parcel Numbers_
jPh+ St. NQf4+l �,YVl �} b�l� ►, ����
1.1a Is this an accepted street?yes no O 10C9-0 Map Number Parcel Nu`m er
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?
Municipal❑ On site disposal system ❑
Public❑ Private❑ Check if yes[]
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Yli(z,min
Name'(Print) City,State,ZIP
�3 6��jhl-
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) ❑ Addition ❑
Demolition ❑ Accessory Bldg. ❑ Number of Units Other ❑ Specify:(A i-41)t°,(d'?Q-i 1 r)rA
Brief Description of Proposed Work2: 1 f SeaA (;1 &r Q>5 `` }.L( CSX
CLL - 1 l :9 ' 'T�'Ut fmL h
L �. cc 7
`
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:
2.Electrical $
❑Standard City/Town Application Fee
s
❑Total Project Cost (Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire $
Suppression) Total All Fees:$ MA 64
Check No. Check Amount.�oq Cash Amount:
6.Total Project Cost: $ 6000 0 Paid in Full 13 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) _
SEAN R JEFFORDS l
License Number Expiration 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(a,BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) I C, 1—)( U Gt I ac)
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View seanabeyondgreen.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.152.4 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 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize I,Woro (l C1 Y 2-e-(� C.o n cj-i Y-\
to act on my behalf,in all matters relative to work authorizedby this building permit application.
S(e QA-fachCd
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNERI OR AUTHORIZED AGENT DECLARATION
By entering my name below,I hereby attest under the s and penalties of perjury that all of the information
contained in this application is true and ac c o st of my knowledge and understanding.
_Sean Jeffords
Print Owner's or Authorized Agent's Name(Electro Signature) Date
NOTES:
I. 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 y/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"maybe 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 Leaibl
Name (Business/Organization/Individual):
T
Address: ' r(GC e \,4\ f-LO
City/State/Zip: r" n Phone#:
Are you as employer?Check the appropriate box: Type of project(required):
1.[31 an a employer with _employees(full and/or part-time).* 7. ❑New construction
2.❑I am a sole proprietor or partnership and have no employees working for me in 8. (]Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.Q 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]' .
10[]Building addition
4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will
ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
5.r-1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insumme.t
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other w Q Cl ctrl Z(il r I
152,§1(4),and we have no employees.[No workers'comp.insurance required]
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy 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.
tContractors 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 sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: S w e C, Z 0 CO Expiration Date: I l
Job Site Address: 33 BCity/State/Zip: t U 0 f`r ► )CL YY1 tdr\ i
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). \�lQ
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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
I do hereby certify under the pains and penal s o that the information provided above is true and correct
Si nature: Date:
Phone#:
1
Official use only. Do not write in this area,to be completed by city or town official.
f
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 3
6.Other
Contact Person: Phone#:
4
7
7
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
ConstqjoM^itrvisor
CS-074539 ;
� ires: 11/28/2020
SEAN R JEFFf0RDS E
13 TERRACE;W.
EASTHAMPTON A.lwv
• «J�'.S•t:lLl
Commissioner
I
Office of Consumer Affairs and Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
BEYOND GREEN CONSTRUCTION INC. Registration: 5M/2s
13 TERRACE VIEW Expiration05/fKJ/2020
EASTHAMPTON,MA 01027
Update Address and Katum Cara.
SCA 1 0 20ta4sr17
CSI`INIJ7CNllMflflnr'fesuwl.:r/!• -
office of ConsumerAtfeirs&mess Regulation
f I ME tAAPROVEMENT ObUrRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Reoisitration Expiration Office of Consumer Affairs and Business Regulation
191746 05ro9t202D One Ashburton Place-Suite 1301
BEYOND GREEN CONSTRUCTION INC. Boston,AAA 02108
SEAN JEFFOROS �--
13 TERRACE VIEW C--� NOt valid Viljthbtlt S1$TlEtil>t dA
EASTHAMPTON,AAA 01027 Ung
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Homae lmoroveire-at"'(rt=tfjr C-a-'.'
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ovwor, rqmr, mf. --mization, con
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pled
z-mrovemera-L removal or demelit-fon or ihc of an aMtioi any pre-exiSfing7oWner Occupi
acont to sucil-
"m z ciuraiat least o=but ae mm.-.ffian fmur dw_-lling unit,`Jr to stT=W4res wl�'Uch a:--a
Duilaill be donebyroWistered contra,•txrs.whh �- ;li oxcepLions,alozig w-. x othcr r=airenaznt's.
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y fhat.
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RAINTY IFTUND UNEIGRI'vIGL
ARSF-7-RATITON FR: CIR—a-M 0IR GUA fL=__:
Siv,w'd!_'rdk'T Penalties of Pe#-Y,
I he,-eby apfly It-, a permit as.fhe agent of the owner-
Date: convactor.
erg "£` G�RFFIN C-Qo!ST?-,UC_l 10 4 Reg.4: 1'1279
OR: SEAI'-' !:�jEFFORDS
-Ul- says 'rnate, apIV f1; ca -he c--r r ohe er
ty
Date:
BEYOND GREEN
DEBRIS DISPOSAL AFFIDAVIT
T N! ACCORDANCE OF
MASSACHU,"'SETTZS DEE-BRI*S
MASSACHUSETTS GENERAL LAW CHIIIIPTER 40-, SE=10%
54, A CONDITION OF BUILD-ING PEER Ir NLl'f,!=2lZ---
FOP, DEMMLT TIONt WORK !- TtHiAT TEE E)EBR
RESUL77ING FROM THsl%--e !'NORK 51;ill. 5P- aMOVED Fit Zw'),
SITE AND POSEID OF INA PROPERLY !I-C'EWSEED S 7-
WASTDIS
E POSAL FAC-101TY
—15c
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ALTERNATIVE RECYCLING, NORTHAMPTON, KiA
�W(MGN SITE ADDRESS
-
33 f;Cj Ci h 'S, N0 1 KAA PID &O
BE DISPOSED AND TRANSPORT ED B'-"-
3EYOND GREEN CONSTRUCTION or
,.;LTERNATIVE RECYC
SIGNAT1URE
DATE
--- city of moox- h-mApton ,;---
t 1'LJ sDEPA€ZBaW OF BVTX�MG MSl'k.CTSONS �
212 Main Street Q Municipal BuUding S.C, ��•,
Yaort-bampton, be, 01060
Propeli:y Address: �r> qh+ NOY-41hCk rn�'), KA
trdo`=Q6
Name:
Address: '� 4� t St it A V�
fUD
Lv�
Gtfiy, State: Gscufn
T `s
Phone: LI (D E)L4L.
Name: )
Address: e-O CjV—A-
City, State: l� 1 C�
(contractor) attest and affirm that the building i intend to
insulate does not have any open air(Ecnob and tube)wiring in the spaces to be insulated and that l have
provided the property, owner With a copy of,this affidavit.
Contractor signature
t
i
Date
Ad�N.
BEYOND GREEN
CONSTRUCTION
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!
Nicole Jeffords
Beyond Green Construction I Project Coordinator
Cell:413.539.1728 I Office:413.529.0544
13 Terrace View,Easthampton I www.beyondgreen.biz
Beyond Green Construction "Leaders in Energy Efficiency" Phone: 413-529-0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539