17A-019 (5) 120 BRIDGE RD BP-2019-1161
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-019 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: , Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Cet9gur : INSULATION BUILDING PERMIT
Permit k BP-2019-1161
Proiect4 JS-2019-001882
Est.Cost,S3175.00
Fe : 6 .00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sp.ft.): 14984.64 Owner: PEREZ HANNAH
Zoning: RI(l00)/URA(l00 Applicant. BEYOND GREEN CONSTRUCTION
AT: 120 BRIDGE RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON:4/19/2019 0:00:00
TO PERFORM THE FOLLOWING WORK:W EATHERIZATION AND INSULATION DOOR
AND ATTIC
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:
Wno..y Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: 01i: 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 Slanalure:
FeeTvac: Date Paid: Amount:
Building 4/19/20190:00:00 $65.00
212 Main Street,Phone(413)587.1240,Fax:(413)587-1272
Louis Hasbrouck-Building Commissioner
yr/�UG -�TiaW
WB.Idmg
The Cotttmonwealth of Massachusetts
Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUSELITY
uilding Permit Application To Construct, Repair, Renovate Or Demolish a RewdMar2011
One-or Twa-Famil DwellinThis Section For Official Use Onl Nu/m� '�� 'Date Applied:
vl 1 YceS // /Cl— q-Iq-zo
Building Oficial(Print Name) I Signorine Date
SECTION 1: SITE INFORMATION
1.1 Property Address: 1.2 Assessor p&Parcel Numbe
1.Is Is this an acce ted street?yes no 01 Map Nirraber Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq ft) Frontage(R)
1.5 Building Setbacks(R)
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:
Zona Outside Flood Zone?
Publico Private o Check if yes. Municipal o On site disposal system .
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'ofRecord:
Name(Print) Ciry,State,ZB
L2.o nci� Ra �-f 13- da i- 71 a�1
No.and Street V Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check an that apply)
New Construction o Existing Building. Owner-Occupied o Repairs(s) . Altemtion(s) . Addition .
Demolition o Accessory Bldg.o I Number of Units_ I Other Specify: l l/P724ir2n
Brief Description of Proposed Wort: r mcd I $b ✓ 00/c$ C
fV,. Cft-
ct[ri ,,u ION4:E5 DC014$tR IONCOSTs 'C Or– "greel
Item Estimated Costs: Official Use Only
Labor and Materials) �l l u 10$�
1.Building $ 1. Building Permit Fee:$ (n5 Indicate how fee is determined:
2. Electrical $ o Standard City/Town Application Fee
o Taal Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
5 ession $ Total All Fees'
eM Cost:
6.Total Proj $ 1 f Check No. 1 I Check Amount: Cash Amount:_
3 1 J.—\ .Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTIONS: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) /1 es_ b�I 1"1cJ? ( 1 a 3110-
SEAN R IEFFORDS EJ
License Number Expiation Date
Name of CSL Holder
13TERMCE VFW List CSL Type(m below)
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 ce.ft.
EASTHAMPTON.MA01027 R Restricted 1&2 Farnfly Dwelling
Cityrrown,State,ZIP M Maso '
RC goofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN(r1BEYONDGREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) 19 f .7 q S/ /
Seen R Jeff d -Beyond QMn Conalmodo HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View scmQbevondveen 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.S 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 .Funny Circ C(7) �'D)�57'yVC,}Ylll1
to act on my behalf,in all matters relative to work authorized Wthis building permit application, l
Sce ami ntC II
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATI N
By entering my name below,I hereby attest under the pains and penalties of perjury that all oftl>e information
contained in this application is true and accurate n the est of my knowledge and mdersmndiaglJ , q
Sean Jeffords `I f
Print Owner's or Authorized Agents Name(EI i ) Date
NOTES:
1. An Owner who obtains a building permitl(F-do'Niaber own work,or nn owner who hires nn unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will npI 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 m
www.mass go Wave 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 floor area(sq.ft.) (including garage,finished basemeta/anics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of hal9baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
F3. '"Total Project Square Footage"may be substituted for"Total Project Cost"
JZI
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgow'dia
Wiltyrkers'Compensation Insurance Affidavit:Builders/ContractorsMeetricians/Plumbers.
TO HE FILED WITH THE PERMITTING AUTHORITY.
A Ifcant Information Please Print L ibl
Nave (BusinesNOrgmimtioWindividmi): n 6wn 0or-w "(9jun,
Address: ) -j Tc, rcka VII^o-o / /
City/State/Zip: L�J-rr C(M rv� Phone#: LI J S- J�)q —05(-1 Lj
Arc you an employer!Check*a appropriate box: o103-1 Type of project(required):
1.�lamaempbya with�anpioyee(ran•nNm pn-time).• 7. ❑New construction
2.�Iaoatole ptopriemra pam'msbip and havemcmplayw workivg fwmeN g. [3 Remodeling
any rapecity.(No workers'comp.an. requhd.7
3.E]Iemu hank.doing all work my,elf[No worker'comp,iacrence r1quired Demolition
4.❑lams hamrownmad will ha hbing common ro cadua ail work on my taolanV )will ]O E]Building addition
enaureds'.11 con.one elthahave workman'compensdioniwnrceoruesole IL[]Electrical repairs or additions
propnamn w'u m eow'aaa 12.Q Plumbing repairs or additions
5.F-1Ian. etad conmctored l hove hued the subupuactostial an the attechd sheet 13.�Roof repairs
Thea subcontrmarhave employers ad love workers'come-Imunmea
b.�We ere acoryoreM1m ed ib otHcers have esemisd thcurightafesemption perMGL c. 14.00lheI IAJ U�
152,11(0),and we have no anpioyees.[No worker'compinsum'ce mquimd.l
*Any awlkam that checks box#I now also 511 out the mom below slmwng their worker'conancoa lm'policy incarnation.
t Hornowws who submit this affideva indicating they arc dome all work and then hot ontude coarectors moa submit a new affidavit md"ung such.
rConow.thatcheck this boxmwa amcland an additions)shcetsMwi"g the Dame ofth subcmtan.and seta whMm or rat 6. ftia,have
ennPloyem. Ifthe tubmnmcmrs have wn,da ces,day mutt provide their wurkarr comp.miicy number.
I am an employer thatisproviding workers'compensation lessursncefor my employees. Below is thepolky andjob sire
information. (-�
Insurance Company Name ((' r Q Y / Ie5�i�-rCL/7 eQ r�, (� _
Policy#or Self-ins.Lia#: Juie e 7 �E� Expiration Date /1 / ''-1 - Vim-"'
Job Site Address: I �� CJr I('ICLP �U C(ty/Staze/Zip: l"Ur'� I .YVI.l}�71
Attach a copy of the worker'comb atlon policy d<daratim page(showingthe policy number and ezplratloTda[e). _
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 farm 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 underthe palm and penal9es jury that the information providedabove is true and correct.
Signature, D t '
Ph #
Oficial ase only. Do not write in this area,m be completed by city or town offrelat
City or Town: Permit/Licewse#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing lmpeetor
6.Other
Contact Person: Phone#:
i
i
i
t Conon of Prof of Massachusetts
Division of Reguaiontl and Standards Board of auiltling Regulations and Standards i
Conataliltr5d�dp�rviadr �
CS-074539 «. Ewes: 11/2812020 I
SEAN R JEFf^f1R06
13TERRACE W J
EASTHAMPT01A 0 7
Commissioner CL !
/ i 1
�7k (fJP�YII7//?ZOOZC{/2L{a/tiZ- OCL �� C12CC68t it
Office of Consumer Affairs and/Business Regulation
One Ashburton Place- Suite 1301
Boston, Massachusetts 02105
Home Improvement Contractor Registration
Type: Corporation
BEYOND GREEN CONSTRUCTION INC. Registration: 197748
13 TERRACE VIEW OS/OB/2020
EASTHAMPTON,MA 01027
t� upu.teadd�eae ena fteNm Caea.
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On1u MCoream
NONEd V8ME TC0NTRRpuleaon
TYPEMom
Camrim OR •✓ balbRegistration
h.OVIretbn d" It found realm W.-
F2yVgybn office of Comumar stadia and aualnesa RegrEation
191]46 0509/2020 QIIaAMbuftbn Place-Salta 1301
BEYOND WEEN CONSTRUCTION INC. Soafdn,MA 02108
SERRAC-0RDS
E MEW
13 STTH�TON.Ma D102T UndersecrWalY Not valid without signature
IFF Lill .=-
Floinc iTniov=effi i
Slippiu'Ilic^IIl Tu��:;n(t AOISIICYn�.
Cr Of`"Ce uSe On7.
m vaans[rucnor. alteration, renovation, rcpaic, mrdw-nization. :ut a
mprovE�mt,removal or detr an o.the CronSbLCnv'neI of an addition to art Fre=.xisang owner occupied i�
v.tov_a �n'am-�S
eL'east onc out ao mocthat four dw hung unit,or to s.ractures winch arc adiaccr o s c
^ce:r but!mn_3 b:&re re„atemi�e,...�c'a.s. xrh certam=x MLions,aIo g-,"th nzhe. ra'ui:cracris. I!
^.e J. `.Neafner2aon Est. .Cost:
-acslab _ D;� Dn .Y � biotca_
=7.Name ._�Q�L14-� �P X'fZ ---.—.-
Oaie of Pernl:t I APPlioation:
- _-_ e=rtiip that;
--urk- xcludecby law
'ob under�5010.
-='ser -n�eift;} •
:c•.:cas lte,=h»gi'sL that
+7ivl'ERS PLILLNG THEIR OWN} F?1v! * .._4 i t `
t
FOR APPLICABLE HOME MPRMMSNT'. OFZK Df I NOT H Mil An t' S°-0 THS �
RBI:�ZA't10A PROt1TLfvRi✓P.G��R?\_: :_tiII BEu7d(3L t.- !-2A
.,Uena-_u°afPe7aieage�w,
i i� eby apply fv-a permit ao£tbe owner. j
3'27$
Data:
%antTact,,n 3EYOK GRE=X^GUSH CTIOiv Reg,k:___
- �._«~ze'!ce sb,.e nctmc , t vercU=apply b. ofthe pmpeny.
BEYOND EEN
C0N5TRLTti
DEBRIS DISPOSAL AFFIDAVIT
In: ,.CCORDANC% -. MC2Mli%�1+E
.Mfi.�C.',..C" '4TH f.... -1� --'' L?::Ji npaC i
MASSACHUSETS GENERAL LAW CHAPTER 40,
54, A. CONDITION ,OF BUIL D'_NG PERM_T NU"R7
FOR DEMOL:-T_ON ti10""K .. AT ;I= DF84`T_:-.
RESUL'n'NG -PQM TtiiS VVORK 5H4..L-. 5F ?,EMQVZD FR...
SITE AND DLSPOSE^ GF IN ,A ?y CFERI:Y -JCE-HSEC SOLID
WAS T= DISPOSAL FACi7-77' AS
3151Ai
"RCI!^!-
ALTERNATIVE RECYC!.ING, NOW-HAMPTON, MA
--'"':-'-"PU_lT.CN SITE ADDRFE:
H= DISPOSED AND TRANSPORTED S"-
'`EVONO GREEN CONSTRUCTION or
.LTERNRTWE RECYCLING
SIGNATURE_,_
DATe _ _=(
rmGyn r+e^wla m �ta5a>por]COeI
Permit Authorization
mass save Form
Site ID: 1609212 Customer- Hannah Perez
Hannah Perez
I. ,owner of the prop"located at:
lOwsr's venae enne.g
120 Bridge Rd Ha ti angaim.MA 0106:
Orga+r s+�wr a/b7 Ic+d
hereby aeahodre the Mass Saw Home EnergySsnd program assigned Participating ComraGrn Wed
below toact on my hdW}and obtain a Ma7uq permit to perform mudabon and/or weatheriveion
work on MY property.
e•oFW�+r
OWINNOWasiowturci ------
412/201912
---412/2 019 1 2 30 PM EDT
FOR OFFKE USE ONLY
i We have assigned the 4aBow6g Man Saw Home EneW Services Participating Cnmractor to the
alww referenced project:
PWtKipatolg Contractor Date
Norm CLEARcsult
IMsase:8W-480-74]1
rm;ul
ME&`f_ OlOGD
ropwty Add.as$: RO & Ckcw- nv
Nof4a -�O(\,V\,�2 .0(-0
Con ci:ow
Name: Are v 5-- YS C 4, C)
Address:
Clty, Srstv.
Phone: C3L4 U,
F-
Name: CW Ina h PC rt!
Address:
CRY, state: UO(44. c-)lIoLoa
1, (contractor) attest and affirm that the building I intend to
insulata does no,,have any open air(icnah and tube)miring in the spaces-to be insulated and that I have
provided the property owner meth a copy of ibis affildaifft.
Contractor signature
D @Qe
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
Thank you!
Nicolejeffards
Beyond Green Construction I Project Coordinator
Cell:413.539.17291 Office:413.529.0544
13 Terrace View,Easthampton I www.beyondirreen.biz
Beyond Green Construction "Leadere in Energy Efficiency" Phone:413.529.0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539