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Board of Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Construction Supervisor License
License CS: 55333
Restriction: 00
Expiration: 5/21/2010 Tr# 25298
LAWRENCE A JUBB JR
PO BOX 429 — - - -- -- -- — _ .__ ._. - . —...
GREENFIELD, MA 01302 — — — —
Update Address and return card. Mark reason for change.
:Al a 50M- 07/07- PC0490 171 Address El Renewal J Lost Card
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Board o = uil• ing egula ons an tan• ar• s
.i- One Ashburton Place Room 1301
Boston. Massachusetts 02108
IIome Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
Expiration: 6/8/2010 Tr# 267161
The Jubb Company, Inc.
Larry Jubb
P. 0. Box 429 — ��- - - - -'— •
• Greenfield, MA 01302 - - -- - - - - --
Update Address and return card. Mark reason for change.
[) Address I —I Renewal C7 Employment 11 Lost Card
Al 0 60M- 07/07- PC8490
•
The Commonwealth of Massachusetts
— Department of Industrial Accidents •
►r 1i'1.� Office of Investigations
';�- 600 Washington Street
! = ' ? Boston, MA 02111
•-s,;to ivww.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Liformation � Please Print Legibly
Name 1 -y
Nae ( Business /Organization/Individual): .-1 J t, /� 1, ( 4 A ,r_ .
P i
Address: I'. O . , -4-_,.9
City /State /Zip: e_e t e_icl y MA 0 13°2 Phone #: - 7 - 72- - (7__-t'1
Are ou an employer? Checkl.he appropriate box: Type of project (required):
1. I am a employer with 4. ❑ I am a general contractor and I ❑New construction
employees (full and/or part-time).* have hired the sub - contractors 6.
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. 1 7 • ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition
No workers' comp. insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work right of exemption per MGL 110 Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs
insurance required.] t employees. [No workcrs'
comp. insurance required.) 13.gf Other 0-er( iN t t- lc
I dar—
*Any applicant that checks box ill 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 their workcrs' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Peet---( v- 2 S . c, — S.r r ,tin .c-Q--
Policy # or Self -ins. Lic. #: i,) - g (v (o 4 9 4-9 Expiration Date: O5 /o 3/ g_c ) i U
Job Site Address: (0v ' e I (4 i, U . City /State /Zip: t �t O _ NA 6 t 0 6 .Z
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 pain nd enalties of perjury that the information provided above is true and correct.
Signature: . Date: g 71 c l / O 1
Phone #: 77 - '2-
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 #:
• PROPOSAL
,,,-. -Jubb Co., Inc. d.b.a.
LARRY JUBB'S MA Registration 100001 Page 2 of 2
MA Cons. Sup. Lic. 055333
IMPROVE- A- HOMETM
7 Devens Street P.O. Box 51
P.O. Box 429 Hatfield, MA 01038
Greenfield, MA 01302 -0429 Northampton, MA
(413) 772 -6217 (413) 584 -3716
TO: Larareo, Mr. & Mrs. PHONE
586 -5731 6/11/
60 Sheffield Lane JOB NAME /LOCATION
Florence, Ma. 01062
JOB NUMBER JOB PHONE
We hereby submit specifications and estimates for:
7). install a vinyl sliding patio door INTERIOR COLOR: Sand... white EXTERIOR with screen. to reframe window opening and center in
wall and eliminate entry door. owner to have electric switches and outlet re- located and heat vent. rear wall to be sided witH white
vinyl shingle siding. interior to be sheet rocked and made paint ready. all trims to match exisitng. right side door panel as facing
from inisde will operate.
8). owner responsible to paint walls and wood trims used in window and door installation.
9). to install a Larson white clad strom door at lower rear entry.
WINDOW GRIDS AND DESCRIPTION AS FOLLOWS:
- dinning room awning window = no grids.
- living room casement windows to be change to double hung windows which will have 8 grids at top and 8 grids at bottom.
- kitchen sink twin casement will have 6 grids to each glass.
- office, front corner room, back corner room double hung units to have 8 top and 8 bottom grids.
-twin mulled double hjng units @ second floor rear wall of back corner room. 6 grids to each glass.
- bathroom double hung to have 6 top and 6 bottom grids.
-lower level den double hung to have 6 top and 6 bottom grids and will be white inside and out.
-lower level bathroom and laundry area awning windows will not have grids and they will be white inside and out.
sliding patio door to have grids to both galss panels.
All materials guaranteed as per manufacturer.
service fee: $250.00 (includes permit and disposal of all job related refuse)
service fee not included in sum below and will be added to final invoice.
We Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of:
Thirteen Thousand Twenty and 00/100 Dollars 13,020.00
dollars ($ ).
Payment to be made as follows:
1/3 deposit upon acceptance, invoices are due upon receipt. an interest charge of 2% per month (24% per annum) on past due
balances, plus all costs, including reasonable attorney's fees, incurred in 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 Signatures ./ :Ver
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. Note: This proposal y be
Our workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within 30 days.
Acceptance of Proposal — The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are authorized to do the work Signature
as specified. Payment will be made as outlined above.
Signature
Date of Acceptance:
PRODUCT 13171 FOLD AT (,) TO FIT COMPANION 771 W -D-VUE ENVELOPE. NEBS To Reorder: 1- 800- 225 -6380 or www.nebs.com PRINTED IM U.S.A. B
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PROPOSAL
The Jubb Co., Inc. d.b.a.
LARRY JUBB'S MA Registration 100001 page 1 of 2
MA Cons. Sup. Lic. 055333
IMPROVE- A- HOMETM
7 Devens Street P.O. Box 51
P.O. Box 429 Hatfield, MA 01038
Greenfield, MA 01302 -0429 Northampton, MA
(413) 772-6217
(413) 584-3716
PHONE
TO: Larareo, Mr. & Mrs. 586 -5731 6
60 Sheffield Lane JOB NAME / LOCATION
Florence, Ma. 01062
JOB NUMBER JOB PHONE
We hereby submit specifications and estimates for:
SUPPLY & INSTALL NATIONAL DESTINY 2 series VINYL REPLACEMENT WINDOWS
4J
- Health Smart Super spacer glass 7/8 ". .U� • b
- Interlocking meeting rail.
- Welded sash and frame.
- Locking 1/2 screen.
-Tilt in sahses (double hung units)
-Twin locks on double hung window units made 32" or wider.
- Twenty year manufacture guarantee on glass seal failure.
- Lifetime transferable manufacture guarantee on vinyl window frame.
-Labor guarantee as required by MA Board of Building Regulations and Standards.
- INTERIOR COLOR: Desert Sand = main level and second floor windows. (basement windows to be white on the interior.
- EXTERIOR COLOR: White to all windows replaced.
Description of work:
1). to remove existing windows and frames along with replacement of interior *wood trim. *new to match existing and owner to
paint or stain.
2). dining room install awning window without grids.
3). living room eliminate twin casements and install single double hung units with 8/8 grids.
4). install a twin casment window at the kitchen sink with 6/6 grids.
5). install double hungs to the office, *back corner room *(one window not to be replaced), bathroom. 8/8 girds to all except
bathroom where 6/6 grids to be installed.
6) I cover level 01 double hung and 03 awning style windows.
C �� Propose hereby to furnish material and labor — complete in accordance with the above specifications, for the sum of Cont'd
dollars ($ ).
Payment to be made as follows:
1/3 deposit upon acceptance, invoices are due upon receipt. an interest charge of 2% per month (24% per annum) on past due
balances, plus all costs, including reasonable attorney's fees, incurred in 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 Signature r� (/2+-
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tomado, and other necessary insurance. Note: Thi roposal ay be
Our workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted withi 30 days.
Acceptance of
Proposal — The above prices, specifications and
conditions are satisfactory and are hereby accepted. You are authorized to do the work Si ature
as specified. Payment will be made as ou ined bove.
Date of Acceptance: ?f
re000CT 13128 FOLD AT 0.) 10 FIT COMPANION 771 De -0-VUE ENVELOPE. NEBS To Reorder: 1 - 225 - 6380 or www.nebs.com PRINTED IN U.S.A. 8
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SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : i— 1� i�2til C-C • (Job V. - 3
License Number
PO Q315 q OS - Z I /20
Address Expiration to
Oreet, -Cel /VA 0(3
Signature / Telephone
7' 7 2-- — (a "Z 1 - 7
9. Realstered Home Improvement Contractor. Not Applicable ❑
• 0 . . 00001
Company Name Registration Number
PO @ x 4)..1 06 : 7 l�
Address 1 /� {� / Expirati Date
Vt f d / k I\ O 1 3 O Z- Telephone 7 2-- - 6 , 2.-t 7
SECTION 10- 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 No ❑
11. - Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner- occupied Dwellinii of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5,1.
Definition of Homeowner: Person (s) who on a parcel of land on which he/she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official. that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacemenndows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [O] Other [a]
Brief Despiption of Proposed
Work: �-�t.� l V i 1 it k.e4J IA)
v1 wS o �v
i
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
sa. If New house and or addition to existing housing, complete the following:
a. Use of building : One Family Two Family Other
b. Number of rooms in each family unit Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS 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 budding permit application.
60 Q4 ,A. p U d_-f ((
Signature of Owner 1 Date
I, i eot -e-e A . J u _0( 0 , . , as Owner /Authorized
Agent hereby declare that the statements aid inform'tion on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
v-e4 - P . 00� J r . �►- �5 .
Print Name
‘ qiq° C. /
Signature of Owner /Agent Date
Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212 Main Street Sesver/Septic Availability
Room 100 Wateh Well Availability
W,G 2 \ MA 01060 Two Sets of Structural Plans
phone 413 - 587 -1240 Fax 413 - 587 -1272 Piot/Site Plans
Other Specify
I APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
1.1 Property Address: This section to be completed by office
(;2o e l d Map Lot Unit
Zone Overlay District
±-t_ 0 V
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
AVAA a e�G'�. l6t_ Coo .e 16e i d. L -�.. �� o ► �
Name (Print) Current Mailing Address: : s 7
Telephone
Signature
2.2 Authorized Anent:
Liu) ire 4 . -J b J . Pvve-s • Po 3o x 4» k f�J
Name (Print) ' / Current Mailing Address: OI 3 ��
4112=0
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Budding (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
( I i � 5 C‘ 6. Total = (1 +2 +3+4+5) 1 3 U , � a • 0 CJ _ Check Number
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
BP- 2010 -0208
GIS #: COMMONWEALTH OF MASSACHUSETTS
Ne ` :Rioqk: 17C , 123 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Pennnt: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2010 -0208
Project # JS- 2010- 000256
Est. Cost: $13020.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 055333
Lot Size(sq. ft.): 24785.64 Owner: LARAREO JOHN M & CYNTHIA L
Zoning: URB(100)/ Applicant: THE JUBB CO INC
AT: 60 SHEFFIELD LN
Applicant Address: Phone: Insurance:
P O Box 429 (413) 772 -6217 Workers
Compensation
GREENFIELDMA01302 ISSUED ON :8/24/2009 0 :00 :00
TO PERFORM THE FOLLOWING WORK :INSTALL REPLACEMENT WINDOWS /DOOR
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 8/24/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo