29-430 (2) Page No. 1 of 3 Pages.
' THE JUBB CO., INC.d.b.a.
LARRY JUBB'S
IMPROVE-A-HOME PROPArrly DSAL
7 Devens Street 18 North Hatfield Road
P.O.Box 429 Hatfield,MA 01038
Greenfield,MA 01302-0429 MA Registration 100001
(413)7A 013 7 Northampton,MA MA Cons. Sup. Lic. 055333
(413)584-3716
PHONE DATE
To Yelin Norman Mr . & Mrs . -
16 Golden Ave JOB NAME/LOCATION
Florence , Ma . 01062 ROOF WORK
16 Golden Ave
Florence , Ma . 01062
JOB NUMBER JOB PHONE
We hereby submit specifications and estimates for:
> -SUPPLY & INSTALL IKO CHATEAU �)LTPA SHADOW 30 YEAR ORGANIC ROOF SHINGLES -
--choice of color =( .. Ixe.. ( 0 ) -
-remove and dispose of *existing shingle layers . ( *up to 2 layers . )
-*replace up to 3 @ 4 ' x 8 ' x 1/2" cdx plywood as necessary .
---supply & install 3 ' width of ice & water membrane at roof bottom .
--supply & install 15 lb . felt to remaining exposed wood .
.-supply & install 5" aliminum drip edge to all tasc ' as . c
-supply & install Alcoa Rovar ridge vent . color =( _(' ►►' _) -
--supply & install — vent stack boots .
-supply & install new aluminum step flashing at all intersecting gable wall,,
& chimneys .
--rake and broom clean job site daily at end of each working day .
-shingle guarantee as described above by manufacture .
-labor guarantee as required by MA contractors registration regulation .
,M_�;Oo•00
-* I1-7
-> SERVICE F1"-E- $525 .00 ( includes permit & disposal of all job related refuse )
[service fee not included in total at bottom & is to be billed as separateA .
WY(B 1Pj ([)1Pb M hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of:
f°ol.lY" T• rousand Seven Hundred Fifteen and 00/100 Dollars dollars($ 4715 .00
Payment to be made as follows:
$500 .00 DEPOSIT UPON ACCEPTANCE , INVUICE , ARE OUk. UPON RECEIPT! An interest
charge of 2% per month ( 24% per annum) orl pa ;t due balances , plus all co:st..s
including reasonable attorney 's fees , incurred ill collecting any sums owed .
All material is guaranteed to be as specified. All work to be completed in a professional
manner according to standard practices. Any alteration or deviation from above specifica- Authorized
tions involving extra costs will be executed only upon written orders, and will become an Signat -
extra charge over and above the estimate. All agreements contingent upon strikes,accidents or
delays beyond our control. Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be
workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within 30 day
Amnapllimcs aT 1PT(D1pT)341A —The above prices, specifications rn M
and conditions are satisfactory and are hereby accepted. You are authorized Signature _ lr��"�^^�� ��/ t Z �-
to do the work as specified. Payment will be made as outlined above.
Signature
i
Date of Acceptance:
Board of Building Regulations and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
Expiration: 06/08/2002
The Jubb Co., Inc.
Larry Jubb, Jr. — -- _ ---- ----- --
PO Box 429/ 7 DEVENS ST --- —--
Greenfield, MA 01302
Update Address and return card.Mark reason for change
-� Address ❑ Renewal Employment Lost Card
d Board of Building Regulations
One Ashburton Place, Rm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/21/1961
Number: CS 055333 Expires:05/21/2002 Restricted To: 00
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 01302
Tr.no: 21513
Keep top for receipt and change of address notification.
r
COMMONWEALI'll Ole IVIASSACHUSL'l"l'S
DEPAK'1'MEN'I' O1? INIMSTRIAL ACCIDENTS
600 WASIIINCTON
BOSTON, IVIASSACIIUSE'1"I'S 02111
WOKKLKS, COMPENSA'1'lON INSURANCE AFFIDAVIT
I The Jubb Co, Inc d.b.a. Larry Jubb's Improve-A-Home
(licensee/permittee)
with a principal place of business/residence at:
7 Devens Street: P.O. Box 429 Greenfield, Ma. 01302-0429
City/State/Zip
do hereby certil'y, under Lite pains and penalties of perjury, that:
(X) 1 ant an employer liroviding the following workers' compensation coverage fur lily e►liployces
working on this job.
GUARD J UWC905794
Insurance Company Policy Number.
O 1 ant a sole proprietor and have no one working for me.
O I ant a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors
listed below who have the following workers' compet-ratiun insurance policies:
Nauie of Contractor Insurance Cumpany/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
( ) 1 aln a homeowner performing all the work myself.
NOTE: Please be aware that while homcowncrs who employ persons to do maintenance, construction or repair work
on a dwelling of not more than three units in which the homeowner also resides or on the grounds appurtenant thereto are not
generally considered to be employers under the Workers' Compcttsation Act(GL C. 152, sect. 1(5), application by a
homeowner for a license or permit may evidence the legal status of all employer under the Worker's Compensation Act.
1 understand that a copy of this statement will be forwarded to Lite Dcpartnnent of Industrial Accidents' Office of Insurance for
coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 call lead to the Imposition
of criminal penalties consisting of a fine of up to$l5W.W and/or imprisonment of up to one year and civil penalties in the forte
of a Stop Work Order and a fine of$100.00 a day against me.
Sighed this clay of 20
r ,L
LicenseeMermittee Licensor/P mil r
• 0 4gtiAMp�o •_
a� �$ (rxf ! turf wart 11aillpf all
B B �RSb AC{lttSttta
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
WORKER'S COMPENSATION INSURANCE AFI'AV r
(licenserJpermittee)
with a principal place of business/residence at:
(phonet#)
(&ta=Uci ty/statr/a p)
do hereby certify, under the pain-s and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
4;•
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additionl sheet il'nveeniry to include information pertaining to all ooaimce )
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing alt the work myself.
NOTE:please be aware that while homeowo=who employ parsons to do mkMr�corrzucdoo or repair work oa a dvmllmg of
not mroc o than throe units in which the homeowner resides or on the grvands appurtenaai thereto art not gtncrady oDw6crcd to be
employtra under the worker`s oampcnsatioa Act(GL152,a 1(5)),application by a homeowner for a License cc permit may evidence the
legal rtatua of an employ«under the Wodcoet Contparaalioa AcL
I understand dAi a oopy of this rtatcmmt may be forwarded to the DtpertmmG of Industrial Acci&o&01£00 of[n%AvLnoo for the
coverage v+aificatioa and that failure to secure covcmr under section 25A of MOIL 152 can lead to the 4MOS60a of criminal penalties
oomisiing of a fine of up to S1,500.00 and/or impriso of up to one yrar end civil penalties in the form of a Stop Work Order and a
fum o(5100.00 a day against ax.
For dgnrtm�us0 only
Permit Number
P4 Lot#
Signature of LicenscdPermittee Date
i •
Version 1.7 Commercial Building Permit May 15,2000
,�,s L 3 x z; `1 7 3 t
SOTI 1D,a STR ICTURA 1�f E 7 M,211d
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11 ,OWNER AUTHORIZATION ,TO BE COMPLETED WHEN
OWNERS AGENT OR;CONTRAGTR APPLIES F4R BUILDINGPERMIT
l 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.
Signature of Owner Date
as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Print Name
Signature of Owner/Agent Date
SECTJ0N 12 CI~INtTRUC Ifi?N sERYicES ,
,.�:. »� � . _ to
10.1 Licensed Construction Supervisor: �f Not Applicable ❑
Name of License Holder: �G l e n t�'_- ✓ �- J �' 1/C` iC'f'�l 'S J 33
License Number
ki /c:) c
Address Expiration Date
1JJ/
Signature Teleph e
(v 2
SECTION 13 -WORKERS' COMPENSATION,1 SURANCE',AFFIDAVIT(M.G.L. c 152,§25C(5)}
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....... No...... ❑
Versionl.7 Commercial Building Permit May 15,2000
S C, ON ` ROFESSIONAL DES1G AND CONSTRU TtON SERVICES FOR BUILDINGS�`AND ST.I2UCY I3ES,SUB
SONS R7YlON',CO�NTROL P�RSTJA T 701,71'0NIR I36f�C,,ON I'A'INING MtE TIIAN'3'5'0O.O�C F. OF ENt✓it1;SD3 �AEi .
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
�� (U Not Applicable ❑
Company Name:
ResponsibIpj Charge of Construction
J
Add ess
igna a Telephone
� t �
Versionl.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L. c. 40, §54) 17.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
A. Has a Special Permit/Variance/Finding ver been issued for/on the site?
0
NO DON'T KNOW 1/ YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry,Gf Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
' Version 1.7 Commercial Building Permit May 15,2000
}S1ECT�IAONfrw4�CbNST�UCTION�S�/R4YIC� F� ''I�'1�OJEGTS LESS'THAN X35,000
CU�1G4kll* � £ a��L23�333
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
DESC2�P-7='
SECTION 5 .US'*GROUP'AND CONSTIO CTIOT
�N XPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H Hi Rh Hazard ❑ 3A ❑
Institutional ❑ 1.1 ❑ 1.2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use b Specify:
CO3
IMPLETE THIS SECTION IF EXISTING.BUILDING UNDERGOING RENOVATIONS,;ADDITIONS AN D/0 HANGE IN`USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION.6 BLI'LDING HEIGHT.AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION L�� �
Floor Area per Floor(sf) St /f
1 1RM
2nd
1st
4
2nd 3rd Wit, 3 WIT
4th q
3rdy F j
4th /
q
L�:��.."ii3` 747'i.'•`{:. .!�rvinj, z��i, l i y.
Total Area (sf) Total Proposed New Construction (sf) 3r
................................... ih
Total Height(ft) A,
Total Height ft ...................
Version 1.7 Commercial Building Permit May 1S,2000
itv fi orthampton
119 2 Department
ain Street
o m 100
FRO i 3 1 'CCl No Br p on, MA 01060
phone 413 587P240 Fax 413-587-1272
DEEI DE BUILDINQ INSPECTION
RVIAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
mU
SET101V 1STE f1Ft31VId7tQN
1.1 Property Address: T i5-se is (I6 mp tl f
ve
} y.
Q �
� � r
Elm St�Dlstr ct � =e � •. CB DYstrlctf � �
SECTION 2s; PROPERTY;OWNERSHIP/AUTHORIZED'AGENT
2.1 Owner of Record:
o L/
Name(Print) Current Mailing Address:
S8C� - J
Signature Telephone
2.2 Authorized Agent:
-P0 cc�, t-lc)-q
Name(Print) Current Mailing Address:
i a ure Telephone
SECTION°33' E57'IMATED GO IS7RUCTION'COSTS
Item Estimated Cost(Dollars)to be Of#icia Use Q�ly�1;
completed by ermit applicant
1. Buildingo co (a) Building Permit:Fee
2. Electrical V� (b) Estimated Total Cost of
Construction.fi-om 6
3. Plumbing Building Pgrrnit Fse,
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) 1 Check,:
urnber
This Section F.or Official Use-Oal
BuiCdtng Permit dumber: Date'lssued
Signature
i3�tllding Cornet ssioner/Inspector of"Buildings Date
q ;U BP-2002-0466
GIS#: COMMONWEALTH OF MASSACHUSETTS
: ck,- V-430 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: roofing BUILDING PERMIT
Permit# BP-2002-0466
Project# JS-2002-0707
Est. Cost: $4715.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 055333
Lot Size(sq. ft.): 10541.52 Owner: YELIN NORMAN V&DAWA LHAMO
Zoning. URA Applicant: THE. J U B B CO INC
AT. 16 GOLDEN DR
Applicant Address: Phone: Insurance:
P O Box 429 (413) 772-6217 Workers
Compensation
GREENFI ELDMA01302 ISSUED ON.•10 131101 0:00:00
TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/31/010:00:00 5205 $25.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Building Commissioner-Anthony Patillo