38C-006 156 GROVE ST BP-2020-0435
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38C-006 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-2020-0435
Project# JS-2020-000741
Est.Cost: $5987.00
Fee: $65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: BEYOND GREEN CONSTRUCTION 074539
Lot Size(sg. ft.): 16988.40 Owner: BAKER KRISTINE
Zoning: URB(100)/ Applicant. BEYOND GREEN CONSTRUCTION
AT. 156 GROVE ST
Applicant Address: Phone: Insurance:
13 TERRACE VIEW (413) 529-0544 O WC
EASTHAMPTONMA01027 ISSUED ON.101912019 0:00:00
TO PERFORM THE FOLLOWING WORK.INSULATIONMEATHERIZATION
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 10/9/2019 0:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
The Commonwealth of Massachusetts
oard of Building Regulations and Standards FOR
�(•/ assachusetts State Building Code, 780 CMR MUNICIPALITY
USE
oFa Aldi Pe it Application To Construct,Repair,Renovate Or Demolish a Revised Mar 2011
Ivo One-or Two-Famil Dwegin
7 Ai
, P 'Phis Section For Official Use Only
Building ° ub 'Z 2-7 Date Applied:
Buil g Official(Print Name) Signature e
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Ass ors Map&Parcel Num r rn
15Sa C- ruy`e S} N Or G.�m Pt1� � w
1.1a Is this an accepted street?yes no bk 0UcD Map Num r Parcel umber
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use I 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 Recrd•
Name(Print) City,State,ZIP
I ao G fo f ,- Q 3- 3a&-5c13
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORKZ(check all that apply)
New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) o I Addition ❑
Demolition ❑ Accessory Bldg.❑ Number of Units . Other J Specify:UUP Q-('j'1C,1 Ilgb`O r1
Brief Description of Proposed WorkZ:W Rt`!1 ' ' CSA a-5 M&c) Qcr 'v O r
SECTION 4:ESTIMATED CONSTRUCTION COSTS 1 f;J
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
o Total Project Cost'(Item 6)x multiplier x
3.Plumbing $ 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $$ Total All Fees 5
Q Check No. Check Amount: Cash Amount:
6.Total Project Cost: ❑Paid in Fu 1 ❑Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
SEAN R JEFFORDS l.J lJ �/1 C_ 1-,-'11"1 5�
Name of CSL Holder License Number Expiration Date
13 TERRACE VIEW List CSL Type(see below)
Type Description
No.and Street U Unrestricted(Buildings up to 35,000 cu.ft.
EASIHAMPTON.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 SEANCa BEYONDGREEN BIZ I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor(HIC) G, .7 S
Sean R Jeffords-Beyond Green Construction HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
13 Terrace View sean@hVondffeqn.biz
No.and Street
asth t 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 to work authorized b this building permit application
Print Owner's Name(Electronic Signature) Date
SECTION 7b:OWNEW OR AUTHORIZED AGENT DECLARATIO N
By entering my name below,I hereby attest un"re pains and penalties of perjury that all of the information
contained in this application is true a e best of my knowledge and understanding
_Sean Jeffords ,� 3
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
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.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.mass.gov/mss
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
w Department of Industrial Accidents
- 1 Congress Street, Suite 100
0
Boston,MA 02114-2017
.'y www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): V-2)IAC)r)(2S Cir CC CC) \
Address: �,C ( �l(`Q \J �ao
City/State/Zip: - Phone#: l�\zj -5 a C '0 u
Are you an employer?Check the appropriate box: 0\0 Type of project(required):
LDI am a employer with _employees(full and/or part-tune).* 7. 0 New construction
2.0 I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling
any capacity.[No workers'comp.insurance required.]
9. F-1 Demolition
3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]'
10 0 Building addition
4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I 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
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c.
14. Other LJJ e (�,4 Cr i ZC4 tC)
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. t
: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,they 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.
Insurance Company Name:
Policy#or Self-ins.Lic. -7 0a) Expiration Date: 1 1y
Job Site Address: ) CD-u- (1 5+- City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expirati n 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.
!do hereby certify under the pains and penalties of p 'ttr that the information provided above is true and correct.
Signature: Date:
Phone#:
Official use only. Do not write in this area, to be completed by city or town official.
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
Contact Person: Phone#:
®_ Commonwealth of Massachusetts
Division of Professional Licensure
Board of Building Regulations and Standards
Const`gtfiort Supervisor
CS-074539 Expires: 11/28/2020
SEAN R JEFFORDS
13 TERRACE VIEW9
EASTHAMPTON MA 01027
�. a
Commissioner
Office of Consumer Affairs and Business Regulation
One Ashburton Place - Suite 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registratior,
1 ype: Corporation
Registration: 191746
BEYOND GREEN CONSTRUCTION INC. Expiration: 05109/2020
13 TERRACE VIE:N
EASTHAMPTON,MA 01027/
update Addream and Return card.
201,1-05/17
:r
�Nr�rv;;�nr:+rr+r•rI�r�-� J,
office
office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Repigtratlon Expiration Office of Consumer Affairs and Business Regulation
191746 05/0912020 One Ashburton Place-Suite 130;
BEYOND GREEN CONSTRUCTION INC. Boston,MA 02106
SEAN JEFFORDS Z �
13 TERRACE VIEW C` ° Not valid Without signature
EASTHAMPTON,MA 01027 Undersecretary
AFr—,IDAVj-;
Home I-mDrkyve-metit
SUPPIenient to Permit Apuhcanol,
Su"&Ztcl
For OfEce Use Onl-
Penuit No.:
-'` vw i42 A, P'-,quiras thwt ftlu -1!7-2canstructfioi-,, a.tC7&Ljun, reu(YF�ou, repair, muderrization, zonversion,
MnRrOvement,removal or denm1ii'M or the constructional of an addition to any pre-existing owner occupied
buflding contuning at least unc but-no mo-re than four du,,-Cj--g unit,or to strzicturcs villuch are adjacent to SUCb
wdence b�,
crit
s.
'r'vpe of Work- Weatherization
,ddms of Work- 15( (-
-1 �j Ytf\(J-
C
r C) _VY)
Jwmm Name:
Date of-Permit i Application:
T 1-jer-'
oy Caffify that
ZStmtIon is no-c miTaired for the fbIW,-,A'rg reason(s
%Vork-excilude-,by law
Job WAcr S 500.00
Building not mvymer occupied
Owner pulling ov.1n permit
',ether(ipecify)
Nlet ce is herebv gives that:
Li 9i
OWNERS PULLP14G THEIR ONAt"N PEP IT OR DEALINU WITH UTI%RCISTERED CONTI RACTORS, I
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HA."rF A(,.IrRSS TO THIE
.e-RBI-TRATION PROGPLUM OR GI_AR-AIqT--Y--77�,"Nrj UNDER Mol.. ..7. 142A-
Signed'ander PeRaNe's Of Perjury:
I lic-,eby apply for a permit as ibe agent oftiie owaer:
Date: Contra-0tor: M:YOND GREEN CONSTRICTION Reg.4:-13"'.279
OR SEM qJEFFOPW
Not withstanding the above notice, !hemby apply for a permit a-sthecm,'-ner of the property.
Date: Tel.#:
BEYOND GREEN
C0NSTRLCT10N
DEBRIS DISPOSAL AFFIDAM
fps ACCORDANCE 1I:ITH T'iE C0!-4M0NWEALTH OF
MASSACHUSE7TS DEBRIS DISPOSAL ►ROVISIONS OF
MASSACHUSETTS GENERAL LAW CHAPTER 40, SEMON
54, A CONDITION CF BUILDING PEP.'M.TT NUMBE .
FOR DEMOLITION WORK IS Ti AT THP DEBRIS
RES:JLTfiNG Fp
,'Y T HSS WAM ?t - ' F� :— l � F
SITE AND DISPOSED OF IN A PROPERI`f 1 ICENSE0 S01 ID
WASTE DISPOSAL FACILITY AS DEFINED BY MGL 011.3,
..-:5 }A.
FA%- T T Y—
ALTERNATIVE RECYCLING, NORTHAMPTON, MA
7-' STR.UC ION SITE AF.DDRtSS-
_` BE DISPOSED AND TRANSPORTED BY-
3EYOND GREEN CONSTRUCTION or
.kLTERNATI1fiE RECVCL
SIGNATURE
DocuSign Envelope ID:C5C8B52F-7628-4898-A4FE-5640C9B6E638
Irl
Permit Authorization
mass save Form
5firtnrgs thrbu¢h rner��"`•`-+.cnry
Site ID: 3353215 Customer: KRISTINE BAKER
I� Kristine M Baker , owner of the property located at:
(Owner's Name,printed)
156 Grove St Northampton, MA 01060
(Property Street Address) (city)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
DocuSigned by:
Owner's Signature: 5qvx h l ,kw
"--264250620EI 14D4,
Date: 9/12/2019 19:20 AM PDT
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 For Office Use Only
Rev. 10201S
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JFF1Kfl 9
,,,-., 'T/;�f �.L'� T•�r. F�� G :i_.t`.13it5a ?'.tTSE'LC1.iOs"t�5 I}�- '`` :+ ,f
'moi'; 2Main
� � ��0106E}'�.1.ding 'r��sk
Property jAddress:
C ontractcr J
Name: u 3 !
Address: . re V
City, State: J
Pr ope" Ornnl a:'
Name:
Address:
City, State:
(conir actor) attest and a i•;rm that the building I intend to
insulate does not have any open air(knob and tube) inilring in the Spaces to he insulated and that ( have
provided the properiL! Ovmer inllth a cops!Oi-this aiiidalfk.
Contractor signature
i
L
Date
AdkN
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!
Nicolejef fords
Beyond Green Construction I Project Coordinator
Cell:413.539.1728 1 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