36-084 (4) 211 WESTHAMPTON RD BP-2020-0323
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-084 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-2020-0323
Proiect# JS-2020-000540
Est. Cost: $3927.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sq. ft.): 117612.00 Owner: WADDILL ANNA
Zoning: Applicant: BEYOND GREEN CONSTRUCTION
AT. 211 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMAO 1027 ISSUED ON.9/11/2019 0:00:00
TO PERFORM THE FOLLOWING WORK.I NSU LATI ON/W EATH ERIZATI ON
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:
FeeType: Date Paid: Amount:
Building 9/11/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
0
M
The Commonwealth of Massachusetts
n Board of Building Regulations and Standards FOR
Massachusetts State Building Code, 780 CMR MUNICIPALITY
USE
o z rn Building Permit Application To Construct, Repair,Renovate Or Demolish a Revised Mar 2011
?o One-or Two-Family Dwelling
D This Section For Official Use Only
o a0 Buil rmit Number: -01 Date Applied:
Z.
mg fficial(Print Name) A Signature I U D to
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers �
l.la Is this an accepted street?yes 1\kAoMap Num r Parcel Number
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:
Public❑ Private❑ Zone: _ Outside Flood Zone?
Check if yes❑ Municipal❑ On site disposal system ❑
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
Pnna Waddilla-
Name(Print) City,State,ZIP
.Q1 I IAI&S4+)a mown Rd
No.and Street ITelephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ I Alteration(s) ❑ Addition ❑
Demolition ❑ Accessory Bldg.❑ I Number of Units Other Sr Specify:
Brief Description of Proposed Work?: _j r 'n
SECTION 4:ESTI TED 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
3.Plumbing $ ❑Total Project Cost'(Item 6)x multiplier x
2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fee 60
6.Total Project Cost: $ 3 q��, (� Check No. Check Amount: Cash Amount:
[i Paid in Full ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) LS—
License
; CJ_
SEAN R 1EFFORDS l� J
License Number Expiration Date
Name of CSL Holder
13 TERRACE VIEW List CSL Type(see below)
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 Masonry
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) j G, j _N
S /�
Sean R leffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View
No.and Street seanluOeyondereen.biz
Easthampton.MA 01027 413-529-0544
Email address
Ci /Town, State,ZIP Telephone
SECTION 6: WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. § 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
to act on my behalf, in all matters relative by elative to work authorized this building permit application
)v t cl Ua)ef�
Print Owners Name(Electronic Signature) kate
SECTION 7b:OWNER' OR AUTHORIZED AGENT DECLARATI N
By entering my name below, I hereby attest er the pains and penalties of perjury that all of the information
contained in this application is true and ac r e to the best of my knowledge and understanding.
_Sean Jeffords
Print Owner's or Authorized Agent's N cc onic 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.gov/oca Information on the Construction Supervisor License can be found at www.ntass.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"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 fnass.gov/dia
* Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): 8c.(.ionrl C1 f eCn Occviruto,ficri
Address: ) CIA(KA(' u \I1 CU, I
City/State/Zip: ECt 1(1 V\A A Phone#: Li 3 5 311 - 14
Are you an employer?Check the appropriate box: Type of project(required):
l.®1 am a employer with _employees(full and/or part-tune)." 7. ❑New construction
2.❑1 am a sole proprietor or partnership and have no employees working for me in g, ❑Remodeling
any capacity.(No workers'comp.insurance required.]
3.❑I am a homeowner doing all work myself.(No workers'comp.insurance required.]i 9. El Demolition
4. 1 am a homeowner and will be hiring contractors to conduct all work on to 10E] Building addition
❑ g y property. 1 will
ensure that all contractors either have workers'compensation insurance or are sole I L❑ Electrical repairs or additions
proprietors with no employees.
12.❑Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet.
These sub-contractors have employees and have workers'comp.insurance. 13.❑Roof repairs
6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other (1,1k C6
152,§1(4),and we have no employees.(No workers'comp.insurance required.)
"Any applicant that checks box#1 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.
,Contractors 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,the},must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. p 1
Insurance Company Name: t V C)ruuar6 106u,ran CP
Policy#or Self-ins.Lic.#: )��(� (�(�zJ l Expiration Date: Q d
Job Site Address: a3 \�ju I b(7 w otl-jr1 0A City/State/Zip: N U ream `� b
, vw ,
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,§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 arrrl n !ties of pe!jruy that the information provided abo a is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area,to be completed by city or town official. S
t
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
6. Other l
Contact Person: Phone#:
k
t
Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Construction Supervisor
CS-074539 F Aires: 11128/2020
4
SEAN R JEFFORDS
13 TERRACE VIEW
EASTHAMPTON MA 01027;x' L�
KIN
Commissioner Commissioner
`;Jk, i�� i J�2C�ii� %!G i? (✓Y��fI l. J L�ik
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Type: Corporation
Registration: 191746
BEYOND GREEN CONSTRUCTION INC. Expiration: 05(0912020
13 TERRACE VIEV'J
EASTHAMPTON,100 01027
Update Addreas and Rctum cera.
SC.41 2041-05117
;rr`�t•ur/ix:+ar.���ri%��/�r.•at:;•w.:r/G
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. it found return to:
Registration Expiration Office of Consumer Affairs and Business Regulation
191746 05,109120220 One Ashburton Place-Suite 1301
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02108
SEAN JEFFORDS �Z =Gt -
13 TERRACE VIEW Not vatic" Signature
EASTHAMPTON,MA 01027 Undersecretary
AFFIDaAVI7
Hope irnaro-vemeut C.cmtmctor i a�A
supplement to Permit Appiicatior-
SUUk%XC3 OL TFdav4 c:Hua—C iMP1QV--"'Ut CMM--lo.-?=Mil ypt iiasiu•:
For Office Use C_nom-
Pern3k.No.:
atlL: l-.i Lig r`.'.t�iILP3b that Lat. i'yconsf1Z1C T' a;tsration, ren
UT`SCUiiJ re-pair, Uli�(BITiI2SCEa?II C£SL3ti�IS1U«_
imp=ove�eat,ramaval yr aelr�out.=an�the canstrtic^Ii.-c�tial of an edition tc sII �pra-existing t;w�er occupied
buLicling cLntaining at i�st one but no�t?rr tba,i fa�-;r dti�elliuQ unit,or:m strsctures vrhiwl<aTe adjacerst fo ssch
:Y:SeCeiiCe vI'L�Iti�(LL!��f'!S QJi:e��%re�3tei'8Ci�'t}2:t14:•iOJ'`.a.�i'II}','v"erC8lra LXCBRi.20T155 aiaiig'VVILti gtE2CX'xC•3'�I]ii.J7iCri�S.
ve ofWork- Weatherization Est.Last:
Owner.,'ti acne:
Date of Pere I Application:
?13ereby cedify that-
e-gistrat on is net aeqpired far the following reamn(s
iVork vxciuded by law
job uDder S 500.00
Bulli'tin aaut owner occupied
er;Specif?7)
Notice is h=by given that. €�
4 04Psit'RS PULLING TffF'+IR ONKN PE1RMI S OR DBAiJii�
i FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAS.ACCESS TO THE
F BI Re rr01\1 PROGRAM OR GUARAI iY FUND UNDER MG7_.C.
- f
sigwd under penalties of pejury:
I hereby apply fc?-a permit as lite agent of the owner:
Bate: Con-rartor: BEYOND}GREEN CONSTBUCTICi%: r:_131279
OR SEAN! R JEFT=OADS
`_�:ot withs`sar-ding l e above notice,I hereby apply;or a-timmit as , o;vuc:o�the*drop l
Date: Owner: Te:• l
BEYOND GREEN
CONST UCTI ON
bEj3p-TS DISPOSAL AFFIDAVIT
TN AC LORDA.NCE WITH TME ^OMNfr,?NWEALTH OF
MA,SSACLiUSETTS DEBRIS
DISPOSAL PRO SI OF
MASSACHUSETTS GENERAL AW CHJ"%P T ER 40, SE 1?0N
54, A CONDITION OF BU-I..DiNC PFR-MIT NUMBF7
FOR DEMOL I'ON WORK IS T KAT T. DEBRIS
RESUL-nNG FPOM THi5 WORK SHALL 3E REMOVED FROM
SITE AND DISPOSED OF IN A PROPERLY +ICENSED SOLID
WASTE DISPOSAL FACiLI;Y AS DEFINED BY MGL Cill,
31.50A.
t 11`iWL�Y-
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
-..r iSTPUL-7 "�iTF II4 vr�nr•-
"J E DISPOSED AND TRANSPORTEu W
3EYOND GREEN CONSTRUCTION or
;kLTERN A.TIVE RECYCLING
S?:-7NA` URE _.-
DATE _ --
Permit Authorization
mass save Form
�lYr'K1 r�I9Y[}1 r~r,r�A'MHi}
Slte ID: 3872835 Customer: ANNA WADDILL
owner of the property located at:
(Owner's Name,printed)
211 Westhampton Rd Northampton MA 01062
(Property Street Address) (0ty)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a b ilding permit to perform insulation and/or weatherization
work on my property.
Owner's Signature: `
Date:
CttCtGL^C6C0440q^€tOhCL�*�;'!�t3AAC0eRCLQ�3dEBOrS�tgr;U^�e.^.:>n;:oaJ,sga.c.r.�sloat�n
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: 800-480-7472
Email:
Page 1 of 1
Rev.20201S For Office Use Only
Scanned by CarnScanner
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232 Atza street Q trei- :..,
Budding :r'�•' -'' r
S`C• •`'=` tit
Northampton, Da 01060
Pc OPeF�v Address:
Blame: �'� r le n
Address:
City, State:
Phone: Lf f 2j" a7,�qq
1.ro11e4 b Owner
(Mame:
Address:
city;state: - 1�1 f�Ya-_V 1Q m 1� r\
i, S c
{} • '{' (conirsc*or) attest and affirm that the building I intend to
insulate does not have any open air(Icnob ants tube)Uviring in the speces to be insulated and that I have
provided'the propetb►owner with a copy of this affidavit.
Contractor signature �✓�T
i
i=
Date b 1
a3 /1
Adk 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!
Nicolejeffords
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.Beyond Green.biz
Easthampton, MA 01027 CSL#74539