24A-030 (12) 78 RIDGEWOOD TER BP-2019-1393
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A-030 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-2019-1393
Praiect# JS-2019-002237
Est.Cost,$3636.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot size(sa.R.): 7535.88 Owner: GONSKI 2009 IRREVOCABLE TRUST
Zoning: URA(100y Applicant. BEYOND GREEN CONSTRUCTION
AT: 78 RIDGEWOOD TER
Applicant Address. Phone: Insurance.,
13 TERRACE VIEW (413) 529-0544 0 WC
EASTHAMPTONMA01027 ISSUED ON.61512019 0:00:00
TO PERFORM THE FOLLOWING WORIKWEATHERIZE WALLS, INTERIOR DRILL AND
PLUG
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:
FeeTyoe: Date Paid: Amount:
Building 6/520190:00:00 $65.00
212 Main Street,Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
gP I�1� 13y� RECEIVED
The Covunonwealtlr of Massach ,JUN
n$ Board of Building Regulations and S daid FOR
c Massachusetts State Building Code,78 CM cn ALITY
O DE PT OF BUILDING INSP Cnous UE
g
[NI.
ing Permit Application To Construct,Repeiq R ovate Oi0@a48e�IROFara r IO/1
One-or 7ko-Fami DwellinFR
Tbis Section For Official Use Onlymber: to Applied:
�g
N � 6Vrt-I c y"Z�l
m (Nim Name) Sigosnue Date
SECTION 1:SITE INFORMATION
1.1 Pro a Addrpe: ,2 Aeageo_ry leap&Parcel Numbers O
iN r iq
Lla Is this an acs ted steet7 es no t0(p0 Map Number PvceI .
1.3 Zoning Information: 1.4 Property Dimensions:
Tnoing Dmuia Proposed Use 1,01 (Sq ft) Frontage(it)
IS Building Setbacks(1111)
Front Yard Side Yards Ran Yard
Required Provided Required Provided Requv d Provided
1.6 Water Supply:(M.G.L c.40,454) 1.7 Food Zone Information: 1.8 Sewage Disposal System:
Public o Private a Zone: _ Onnide Flood Zone? Municipal o On site disposal system o
Check if yeso
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Jexo n paXw Cuy.pNavas,(Prino
Gi 4 V10�� L) M{4 h)fJIPO
79 Rtdc#.amcd I rr y 13- 5148-0375
No.and Suess � Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction o Existing Building o Owner-Occupied o Repairs(s) o I Alteration(s) o Addition o
Demolition o Accessory Bldg.a Number of Units Other Specify: GN r{44D,P1 L6,112)r\
Brief Description of Proposed Wod2: of
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: 09IcW Use Only
Labor and Materials
1.Building E 1. Building Permit Fee:E Indicate how fee is determined:
2.Electrical E n Standard City/To"Application Fee
o Total Project Cost'(Item 6)x multiplier_x
3.Plumbing $ 2. Other Fxa: S
4.Mechanical (HVAC) S List:
5.Mechanical (Fire
Suppress ion S lbtal All Fees'
Check No. _Check Amount: Cash Amount._
6.Total Project Cost: S 3(X3�0 o Paid in Ft o Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTIONS: CONSTRUC ON.SERVICFS
5.1 Construction Supervisor License(CSL) �) �'�(,'SJ7 Q
' SEAN R IEFFORDS I
License Number Exp"n dion Dene - -
Name of CSL Holder -
List CSL Type(see below)
13 TERRACE VIEW
Type Dexxiption
No.and Strut U Unrestricted(Buildings to 35,000 an.fL
EASTHAMPTON MA 01027 R Restricted I&Z Family Dwelling
Cilyrr.wn,State,ZIP M Mem
ory
RC Roofin Coverin
WS Window and Siding
SF Solid Fuel Burning Appliances
413-529-0544 SEAN(o1BEYONDGRP.EN.BIZ I insulation
Tei one Email address,; D Demolition
5.2 Registered Home Improvement Contractor(HIC) 'C„ —7I , I S�C,
Seen R leBbrds-Bcmml Green Co,seunion MC Registration Number Expiration Dns
HIC Company Name or HIC Rcgisnant Nana
13Terrace View sem0bevoadareen iz
No.and Street Email address
Easthampton.MA 01027 411-529-0544
Ci ?own,State ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.1 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...........O
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
to act on my behalf,in all matters relative to work authorized by this building permit application
ye( o.ktached
Print Owner's Name(Elecwnic Signature)
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATIC N
By entering my name below,I hereby attest and pains and penalties ofperjury that all ofthe information
contained in this application is true and acct a best of my knowledge and understanding,l,
Sea,Jeffards l (es
Print Owner's or Authorized Agent's Name Ito his Signature) Dene
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered cmbactur
(not registered in the Home Improvement Contmctur(HIC)Program),will#of 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 m=.eov/oca Information on the Construction Supervisor License can be found m www.mass.eov/dos
2. When substantial work is planned,provide the information below:
Total Boor area(sq.R) (including garage,finished basement/attics,decks or porch)
Gross living area(sq.ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number ofbathrooms Number of half/baths
Type of heating system Number,f decks/porches
Type of cooling system Enclosed Open
3. 'Total Project Square Footage,maybe substituted for'Total Project Cosr
The Commonwealth ofMassaehuseds
TDeparnnenl of Industrial Accidents
I Congress Street Suite 100
Boston,MA 02114-1017
wwtumassgov/dia
R orken'Compensation Insurance Affidavit:Builders/Contractom/Elmwicians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
A licant Information Please Print Le 'bl
Name(easiness/Orgenimdot✓IMiviawp: � 'l r Ct/� O n --J
Address: J,-� JU r Ck CjZ 'V l ek')/�,,
City/Statelzip:
Are yea u mabyer!Clerk me appropdce hos: Ir^��I Type of project(required):
Ilan.tummy«conn enployeu fan vad/«pamlimel' `l 7. El Net,construction
x.❑Iwavk Pmaiem«prmashipW have to emdorw screech 8. ❑Remodeling
any aspchy INoamrken'comp iruumnee reap iced)
3.❑Ianalameowrvdomgdlw«kmyclf lNowakers comp.inmmcanquied]' 9. ❑Demolition
a.❑luno hmocorm ata wiu be hums commors mcmtl«tallwmkmmr wovmr lain 10❑Building addition
insure"ran contrcmmeither have workers comprentiunimutaue or are sole II.❑Electrical repairs or additions
pmpriemra with w or le eta. 12.0 Plumbing repairs or additions
5.❑I am a erred aaooecmrew I have hirci ala aubeommemss listN on do amchdi de..
Thane subwmractors have emplgecs and have wohmm
eri enp.uisc er.1 13.❑ROnf repelR
Th
h.❑ rt we aa corporation and in omnis have n«cicd then richt of exemption p«MGL c.
14.®OtherUQO ipC✓t LCLft J.9
153,41(a),mid we have m emPlq«s.IN.woken'com,.imumnce required.l
'Any ap,h,ent that eMcks box CI mustalso fill out the nation below showing to.,,workers'comPensnion polwy Information.
t Ifnmeownm'who submit this affidavit indicating they are doina sll work and Nen hire outside conaaton amt submit a new amdevit mday.,.mch.
$l.ntmtprs thea cheek 0.bon must anaehed nn odditioml sheet showing the mnm of the.so�oiarvr.end come.bane,or nm thnee engin«have
enmloy«s. Ifthesubaoatmcton loveemployees,they must provide their work srump.poicynumber.
lamanemplayerthatisprovfdingworkem'wmpemadoninsurmmfarmyempbymL Below6ehrpeBryandjob she
Information.
Insurance Company Name: plw�YgaLlr
Policy M or Self-ire.Liia N:: J W eC-7nati)7I Expiration Data:
lob Site Address: 70 PCWOM -re.(' City/Stuamp: N0I (�T1 �a
.Y/ V
1 -/.
Attach a copy of the workers'co pensation policy declaration page(showing the policy number and expiration date).
). 0�0 L1U
Failure to secure coverage as required coder MGL c. 152,§25A is a criminal violation punishable by a fine up to S1,500.00
and/or me-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 maybe forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1 do hereby cerdfy under dee pains and p/enaal ot'5s gfperjury that the information provided above is nue and correct.
Signature, Date
Phone k
Oficial use only. Do not write in this area,to be completed by city or fawn orB:ciall
City or Town: PeresitUcense M
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone M:
i
Cornrnonweatth of Mas
sacnusetts
®. Division of Professional Lmensure
eoam of Building Regulations and Standards
Conctr�n'Sup¢rvisor
CS-074539 E;Pires: 11/2812020
SEAN R JEFFORDS
13 TERRACE VIEW
EASTHAMPTONMA 01027
Commissioner V'^"
- lammw,-/uIfGLIARAG vy' �QiC'GLL:Lfi000i
Office of Consumer Affairs and///Business Regulation
One Ashburton Place - Suite 1301
Boston. Massachusetts 0210E
Home Improvement Contractor Registration
Type: Corporation,
91746
BEYOND GREEN CONSTRUCTION INC. Registration:
13 TERRACE VIEW Expiration: OW0912Sl09/2020
EASTHAMPTON.MA 01027
llptlelC AOtlre»antl flctum GW.
SGf O xr�n
%/,r�nuumxrcmn�/�n�•.�.✓�"rir�ur/(a
HOME
NPRvAMiE ABwlneea Rapulatlon
HOME MP
TYPE:
Registration
eax,s rfi.n lata.Itual use only
TYPE(.IXaraElar before fheoxpirafionAffairs
air alountlretum to:
Re!9174lon OSM912MOioni,in One sh Consumere-Suite
u ie 13nd auaineas Regulation
191]06 05r09I2020 One AsnbuRon%acs-Sake 1301
BEYOND GREEN CONSTRUCTION wO Beeton,MA 02108
SEAN JEDS
ISTERRACE OE
EASTHAMPTNEW Not valid without Signature
EABTHAMPTON,MA OrtOZi Ung, 9
.i!•r u7w iii i
Home immovement C:ontmctm Laa
Supple meai to Permit Appiioauoc
Sn�d M4�v1:[n.Nma Imppn_•,�t Cacpe:ts P tA�
For Office Use Onl'.
Permit No.:
. Ns i42 A. royuiros that the Aretwnstrmrion, altentien, tenovadoq repair, modernization, eversion
'� iittprovement,rera0val or demolition or the constructional of as adder in any pr -cxistmg owner occupied
y
building containing at least ane but no tore than four dwelling reit,"wattnetat wldeh an 4=0to reek
7 residence arbnldinge be done by regstaredc mtmctom with omturt exception,along Aim other roaummenta.
'ype of Work: Weatherization Est.Cost;
-1i sof Work: -79 R dulkL. XA >er IVQY_ t r,p 11ntia
<)waetsName:��PHP,��t—
Date ofPam'RlApphcabon:
?hereby oartify ihae
esaadoa is not retptited fnr the following reason(s}:
Wodc excluded by law
Job mater S 500.00 I
Hai!d.ng not ow w occupied
Owner palling own permit I
other(specify)
Jeiice;s hereby given that
e
OWNERS PULLING THEIR OPvN PERMIT OR UF,AidNO WIIH UNREGISTERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GLAR.UdTY 9R MGL C. 1424.
Sped under pee allies of pe-1my:
I hemby apply fur a permit as the ag"U ofthe owner.
Date: Contractor. BEYONDCREENCONSTRUCTION Reg.4:-131279
OR: SEAN c JE=FOFOS
r the above notice.I here for a Meemit as 3e owner afthe property.
_,at:¢ihstsrdmg by aAldy pt' P
Date: Owner-. _ Tel.#:
6EY0IND GREEN
C0NSTRIJCT ! () N
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH THE COMMONWEALTH OF
MASSACHUSETTS DEBRIS DISPOSAL PROVISIONS OF
MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT NUMBE
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM THIS WORK SHALT. 9E REMOVED FRQF
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL Cliff,
3150A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
^NSTRUCTION SITE ADDRESS-
llg Ridu0000d -Ta Nocl)aT,Mo-
'C 8E DISPOSED AND TRANSPORTED BY-
Oto(10
3EYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE
DATE
DocuSign Env91 p ID:9780FE9F-A8DD49CF.e1B7-C4D0C855E686
RISE
ENGINEERING'
OWNER AUTHORIZATION FORM
1, Jerelyn Parker
(Owner's Name)
owner of the property located at:
78 Ridgewood Terrace
(Property Address)
Northampton, MA 01060
(Property Address)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
iffiw w
c4.Wilatpre
10/17/2018 1 12:21 FM EDT
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
60 Shawmut Road Unit 2 i Canton, MA 02021 1339-502-6335
www.R ISEengineeri ng.com
.�i` .�
- City of --iffo=th tor_
Ir � � DSessachesette �
� ; cEPd&TMEUT of BiTir.�➢iG Ild988CTIDPS
,.,w"^3?: = N '. street o rmui�z, Bu t
xorcnempt.' m oioeo .
Property Address: -7g R�dqAeWOWTtr �b�}Mnrrnl-nn-� MIA- O\OIaO
Contractor
Name: BeqorrA Arefl tr
Address: _13 �jTf VrVrri re V I z la )
city, state: EaSA-hctrnptYnrNw 010Q61
Phone: L{ f S- JLlu
Property Owner \ -
Name: Jexe'Wr\ 1" Ur
Address: 9 Fl;d�
C)ocl Ye rrir u-
City, State: NOYatno w\�+�r�y ay O\b \yam
I, S e Ctn (contractor)atteat and affirm that the building 1 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 vub a copy of this affidavit.
Contractor signature
Date i ( I15 � 19
AWN
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 jefords
nevmui Gwen Construction I Project Coordinator
Cell:413.539.1729 I Office:413.529.0544
13 Terrace View,Easthampton I www.beyondgreen.bia
Beyond Green Construction "Leaders in Energy Efficiency" Phone: 413529.0544
13 Terrace View Established 1998 www.BeyondGreen.biz
Easthampton, MA 01027 CSL#74539
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