23A-275 17 MIDDLE ST BP-2019-1471
GIS 4: COMMONWEALTH OF MASSACHUSETTS
MigxBlmk:23A-275 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildina DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: INSULATION BUILDING PERMIT
Permit 4 BP-2019-1471
Protect 4 JS-2019-002383
Est.Cost 56772.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License.
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sa.R.): 7971.48 Owner. EKUS SALLY
zoning: URB(97VGB(3)/ Applicant. BEYOND GREEN CONSTRUCTION
AT. 17 MIDDLE ST
ApplicantAddress: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON:6/25/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSULATIONNVEATHERIZATION
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 4 Foundation:
Driveway Finnl:
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 Occuoancv Signature
FeeTvpe: Date Paid: Amount:
Building 625/20190:00:00 $65M
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
f — The Commonwealth of Massachusetts
Board of Building Regulations and Standards FOR
UN 2 2019 Massachusetts State Building Code,780 CMR MUNICIPALITY
USE
Builth g Pc mit Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
- _ One-or 71vo-Fami D"I in
This Section For Official Use Only
Buil PermitNumber. — f A lied:
_UIw1 '
Building Official(Print Name) Sigoanve Dale
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors nap&Panel Nu
I ) m drtle .er. Notc(I yva Dl 1 SWT �-/S
Lla D this an ac street? es no Map Number Parcel Number
1.3 Zoning Information: IA Property Dimensions:
Zoning District Proposed Use Lot Ams(sa a) Frontage(R)
is Building Setbacks(R)
From Yard Side Yards Rear Yard
Required Provided Required Provided Required I Provided
1.6 Water Supply:(M.G.L c.40,4 54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public o Private o zone: — Outside Flood Zom7 Municipal o On she disposal systern o
Check ifyear
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
C/71iU Ekhls Eire feral M.6 01 OCDa
Name(Primil City,stare,ZIP
b raidolle 6+- 1,113- 515-15100
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORM(check all that apply)
New Construction o Existing Building o Owner-Occupied o Repairs(s) o I Alteration(s) o I Addition o
Demolition o Accessory Bldg.o I Number of Units I Oliver Specify:
Brief Description of Proposed WorN: r - l nj," 1*1
f- Kajt,, K
Jeu� a..
dUCI
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Caste: Official Use Only
Labor and Materials
1.Building S 1. Building Permit Fee:Ste_Indicate how fee is determined:
2.Electrical S o Standard City/fowu Application Fee
o Total Project Cost'(Item 6)x multiplier x
3.Plumbing S 2. Other Fees: S
4.Mechanical (HVAC) S List:
5.Mechanical (Fire .
Suppression S ToteIARP (O
6.Total Projsu:t Cost: Check No. Check Amount_Cash Amount-
6. � 0LJ o Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTIONS: CONSTRUCTION SERVICES
5.1 Comstructioa Supervisor IAcemse(CSL) �r b,(,153q I I o�S I I$
SEAN R IEFFORDS
License Number Expansion Dam
Name of CSL Holder
Liu CSL Type(see below)
13 TERRACE VIEW
Type Description
No.and Street U Unrestricted(Building m 35,000 ac R
EASfHAMPT'ON.MA 01027 R Restricted 1A2 Family Dwelling
City/Town State,ZIP M
masom
RC flooding Covering
WS Window and Sidin
SF Solid Fuel Burning Applianm
413-529.0 SEAN(dBEYONDOREEN.BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(RIC)
1
9
" .7Uto
Sem R leffards-Bevmd Grmn Construction MC Registration Nomber Expiration Dere
HIC Company Name or HIC Registrant Name
13 Terrace View seanAbevondeeen iz
No.and Street Emeil address
E64hamnWn.MA 01027 413-529,0544
City/Town,State,ZIP Telephone
SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.S 2SC(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
1,as Owner of the subject property,hereby authorize
to act on my behalf,in all matters relative to work anlhoriud lythis building permit application
J e e aA-+6LGh eC1 U 5 I
Print Owner's Name(Elecbonic Signature) Dam
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATI N
By entering my name below,I hereby attest under pains and penalties of perjury that all of the information
contained in this application is true and acuate beat of my knowledge and understanding. /� 1
Sao]effords cO I pr
Print Owner's or Authonzed Agmt'sName(EI goature) Dem
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.a 142A.Other important information on the HIC Program can be found at
www.mass.gov/nca Information on the Construction Supervisor License can be found at 1nnc.mMs-.gov/dm
2. When substantial work is planned,provide the information below:
Total Boor area(sq.it) (including Smile,finished basement/attics,decks or porch)
Gross living area(sq.R) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/bmhs
Type of heating system Number of deduct/porches
Type of cooling system Enclosed Open
3. 'Total Project Square Footage"may be substituted for"Total Project Cost"
The Commonwealth of Massachusetts
Department of Industrial Accidents -
I Congress Street,Suite 100
Boston,MA 02114-2017
www.massgov/dia
Wil.rkers'Compernatiou Insurance Affidavit:Builders/Contractora/Electrfdms/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Apaot Information Please Print Leeibly
Name(BusinesYOrganimdoMMrr�L�� (�ividual): I- 4nd V✓C C/) COlL5-t-tu h Q(o
Address: Te fro Co V i e'W
City/Statdzsp: Ea m Phone#: 43 - 59q-O54 LI
Areyaadaimplinrl Ce«ktjgj_apereptsnelova: 01UaI Type of project(required):
1.®f.m.em. , wish : anpinna(fnumlNorfan-lune)." 7. ❑New constmction
2.❑lamawlepmpr worpetmmhipaod wooemplyceswo iM fwmein S. E]Remodeling
an,opacity.(No woken'comp.humanee retorted.]
9. ❑
10
3.E]l am a homeowner doing ell xww
lr myself akeriimrec
comp umMuired.l' 0 Building additionDemolition
4.❑lamahmneownaandwili chiingcmtmclmw mtanwm mmywopera. India10
ensure that all mntrsama tither have woken compensation nmrneve or arc sole Il.❑Electrical repairs or additions
pmpnemn with no employees. 12.❑Plumbing repairs or additions
3.❑l an a Benenl conarctmrd I have hid the subconenctoa lined on the reacbd Yves
7hxsub-tonus<mnheve cmplgcsad bout wokai came-insunocet I5.❑Raofrepeirs
e.❑We tie ocotp,mtion andvofr�cm have exacird thnr rightofacre urger MGL c. 14. Other
152,4110),and we Mvc to cmPlona:INo wok<ri comp.inswencetryuvd.7
'Arty tillkmt Nat checks box#1 mum els,511 out the vection below showing their wmkeri conryenwion policy infonsition.
Horreownem who submit thisamde.it htdlcating thq tic&ina.11 work and then hire outside contmaors must submit a new affidavit mdiestiry auch.
tContmclom thin check this to.must....hdenadditi,nal sheetshowing the come of rite auburn...... and sen¢whether or the throe entities have
anployar. Ifthe submmnnors Mvc employees,they mint provide their workers'comp.policy number
I am an employer that is providing workers'compensation tmarancefor It employees. Below is the polley and job site
information.
Insurance Company Name: O r Y K1 Akran
Policy#or Self-ire.Lic.#: 3w1e I Expiration Date: '_ 1— ,20
Job Site Address: I1 Middle ,5f' City/Stasizip: -Fib(ul) Q.ZI tvlA l) IOCoa
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,tf25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-yea imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 al
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 herebycertify vender thepains an Ides ofperjury that the information provided above is true and correct
Signature, Dam: (P lot
Phone#'
Official use only. Do not wife in this area,to be completed by city or town ofjlcial.
City or Town: Permit/Lieense#
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#:
�- �
�,y,.
Conenonweaefl of Massaomiaaus
®, Division of Professional Licensure
Board of Building Regulations and Standards
Constra/clton Supervisor
CS-0765391P it": 11/2812020
SEAN R JEFFORDs �. P r
13 TERRACE VJEW
EASTHAMPTON�IA�0
///11>lvS4iL� -
Commissioner
���///}�—/� JJ,,
<J )WYiViiW/K�
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Cwpora w
748
BEYOND GREEN CONSTRUCTION INC. Registration:
13 TERRACE VIEW ExppiraExpiration:on: W05l091209YL020
EASTHAMPTON,MA 0102
UPEne Aatl,veeM flNum GSN.
arwt O 1aMdlnl
H
qgof Consumer a ee Re9uleEOn
HONE IMPROVEMEEME NT CONTCOMPACTOR before eeVindfor indiMss.It fond rety
TYPE:CaoaaEm before f eq uation date. If d Bu return to:
Rei91746an One sh urton Msr -Suitandaminesa Regulation
1917A6 OS'09k0e0 One Ashburton Place-sutte lam
8EY01,10 GREEN CONSTRUCTION INC. aostcn,MA 02108
SEANJEFFOROS
13 TERRACE VIEW C °
WTHAMP70N,MA 01OW Underseoretary Not valid without signature
APPIDr.Viri
Home lmmrov V rent(kMhaetw i. ,
Suppleaieat to PermitApphoauoz
a�Bia+ci.4Tiauv:;=¢liemocarc.+mu Cavm:,�mPmekApplicn..
Por Office Use Oul
PenitNo.: _
etc
I Note IQ A, requites that try, Arecopstny�oq alteration, rmtovado. repair,
imProventent,temova[oc demo!idon or the constcl;ctiotsvl of an additi n t am,' gno aeor roccuPied
raniadding e01 bm1IDg�b sone but o more than four dwelling unit,or to strtaprvs which are adjacent to such
tesidaoce orbuxTdin steed contrac� itt
's, certain exceptions,along 'th other mm. erAs
"'ype of Work: WeafharizYlation,,/ �i Est.Com --
Own,,ssofWotk:_ l� Illil.l �c - IctateI1(',�{'�/Im_ oloc9
Owners Name:_ A (I f. k.(A
Deft of PmBh,f AppLCODn:
I hereby eerlify that
'egimfion is not requited far the following reason(s):
Wodr excluded by law
Sob order$500.00
Building not owns*occupied i
Owner nailing own permit
Othe'(specify)
Notice is hereby given that:
OW'NHRS PJLUING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCpCS TO THE
ARS17RATION PROGRAM OR GUARANTY FUND UNDER MGL C. 1424.
Siped under penat9es of petjmy:
1 hereby apply fv-a pernin as Lhe agent oftbe owner.
Date: 0011 attar: BEYOND GREEN CONSTRUCTION R-g,#. 131279
OR: SEAN R:EFFORDS
Nut withsWnding'1c abr e Route.1 hereby apply fora permit as the owner oftbe property.
Dates--- Jlner:__._—._ TeLP:
BEYOND GREEN
CONSTRUCTION
DEBRIS DISPOSAL AFFIDAVIT
IN ACCORDANCE WITH 71HE COMMONWEALTH OF
MASSACHUSETTS DEBRIS DISPOSAL PROVISIONS OF
MASSACHUSETTS GENERAL LAW CHAPTER 40, SECTION
54, A CONDITION OF BUILDING PERMIT NUMBS
FOR DEMOLITION WORK IS THAT THE DEBRIS
RESULTING FROM THIS WORK SHALL BE REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY LICENSED SOLID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL C111,
-3i50A.
FACILITY-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
_CNSTRUCTION SITE ADDRESS-
I-7 (Yldc((eSL DO(coe_,�1O ( a
-3 BE DISPOSED AND TRANSPORTED BY-
3EYOND GREEN CONSTRUCTION or
ALTERNATIVE RECYCLING
SIGNATURE
DATE __� --
Do Sign Envelope ID.663620EB-AB09-a5E7-9F30-FA76DE236B33
RISE
ENGINEERING
OWNER AUTHORIZATION FORM
I, _ Sally Ekus
(Owner's Name)
owner of the property located at:
17 Middle Street
(Property Address)
Florence, MA 01062
(Property Addrfess)/'
hereby authorize -%0(141 (3(wp
(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.
I \Z �u5
%&Rj lure
5/24/2019 1 9:57 AM EDr
Date
RISE Engineering, a Division of Thielsch Engineering,Inc.
60 Shawmut Road Unit 2 1 Canton,MA 020211339-502-6335
www.RISEengineering.com
/W
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!
Vicale)e�ords
Beyond Green Construction I Project Coordinator
Cell:413.539.17281Office:413.529.0544
13 Terrace View,Easthampton I www.beyondgreen.biz
Beyond Green Construction "Leaders in Energy Efficiency" Phone: 413529-0544
13 Terrace View Established 1998 www.BeyondGreembiz
Easthampton, MA 01027 CSL#74539
I _
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