17C-250 ' �' otat tnbobn Vropozat Page No. of Pages
Main Office:
7 Devens Street • P.O. Box 429 THE JUBB CO., INC. d.b.a. Northampton, MA:
Greenfield, MA 01302 (413) 584 -3716
(413) 772 -6217 LARRY JUBB'S Brattleboro, VT & Keene, NH
18 North Hatfield Road I MPROVENNA- H OMETM 1- 888 - 639 -JUBB
Hatfield, MA 01038 Email: JubbCompanyinc@aol.com
PROPOSAL SUBMITTED TO PHONE DATE
A-14n0Y Ghcu20 -( v/3 - f - 0 7/ 0�a
STREET • JOB NAME / S7 �leO.0 / c j -
/11 V S fr1'VD Si - .57 AhNe l 41i9 LS -
CITY, STATE AND ZIP JOB LOCATION
Ftb Jca 014 . 6 0 /2 e c /11.93
TENTATIVE JOB SCHEDULE (Weather Permitting) MA Registration 100001
Approximately weeks from date of signed proposal received by Jubb Co., Inc. MA Cons. Sup. Lic. 055333
We hereby submit specifications and estimates for: -KI / n yl 8
Supply & Install Mastic Rae/4,i ?'ateitiond Vinyl Replacement Windows • 1/2 Screens (double hung only). • Interlock meeting rail. qki4 • Locking Screens (double hung only). • Welded sash & frame. • Tilt -in Sashes (double hung only). • Five degree sloped sill.
• Non - conductive intercept glass system. • Seven - eights thermo glas
• Continuous Balances (double hung only). • Insulated padded frame. ifiltA6*
• Sun Shield Vinyl Compound (Mastic exclusive). • Energy Star approved.
• Twin locks on double hung units 32" or wider. • Virgin vinyl.
• Twenty year manufacture guarantee on glass seal failure. ° ARGeN 64S
• Lifetime transferable manufacture gu tee on vinyl window frame. ikl tr JOpWS nacey
• Labor guarantee as required by CT A, NH, VT contractor regulations. redergt„„u if :r
Color: Linen White ❑ Almond* ( *extra charges apply for this colors) gee'
TOTAL UNITS REPLACED: t'( OouBL-e- a-tw Nk5
Grids q( Rba("" ca Dhukl . kt, ts ON L'' (FLAT) (Note: Grids are beveled)
X Low "E" Glass VAS lyt Argon y ' pkInsulation (into weight pockets) ( Storm Window Removay/s
❑ Aluminum Clad Exterior Castings (❑ Full ❑ O / _ Partial) N
OTHER / NOTE: 80 0m SA- St-(E,.S 7 K44 UG 1 e z6b G //}34 6E1Avg• 1 /ad,e
LEt/Et- ON Pgow R.J orv\ Ca F tArk 0.k o,,,,
No iE 1 New fia * .Ova.ble Nury c -to be P)oc4,u7E0 IN CiNfi,C 4 .x1S77rv- 6P M/Vg.s N6
S� Ps 4- lac; A olo' d dill ,Ex7 e1a,e s- i�%E/L/dR _ otAhver /bA�.f'1 a�t.e. . oiyiip/" oe. Stnav
1
1 SERVICE FEE: $125.00 (includes permit and disposal of all job _ related refuse.)
[service fee not included in total amount below, and will be billed separately.]
CONTRACT SERVICE CHARGE: An interest charge of 2% per month (24% per annum) will be added to outstanding balances over 30 days,
plus all costs, including reasonable attorneys fees, incurred in collecting any sums owed.
, to 311rnna c hereby to furnisty material and labor — complete in accordance with above specifications, for the sum of: 1
The Commonwealth of Massachusetts
Department of Industrial Accidents
10' . Office of Investigations
_ai 600 Washington Street
INK I• Boston, MA 02111
`
Ile
1 www . mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
r ,., —.
Name (Business/Organization/individual): I `J C_! t I� L-Qi VIOCei1 . v1
p Address: 0. 1D O )L L/ ce C]
City /State /Zip: � -� c. C km )L M Phone #: l l (2 /
Arc you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I G. New construction
employees (full and /or part - time).* have hired the sub - contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 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. ❑ I am a homeowner doing all work right of exemption per MGL 11.0 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 workers' 13.0 Other
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 arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContraclors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information.
1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. _
Insurance Company Name: � C �� "35
- -1 -�C �C? ✓�
Policy # or Self -ins. Lic. #: L + (' Expiration Date: 5 / 3 /)
Job Site Address: City /State /Zip:
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 pains and penalties of perjury that the information provided above is true and correct.
Si nature: — Date:
Phone #: 02( 7
Official use only. Do not write in this area, to he 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 #:
1
AFFIDAVIT • • .
. As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Permit •
. Number • all debris resulting from the construction activity governed by this
. • Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL .
• • • c 111, S 150A. . - -
I certify that I will notify the Building Official by .
. (Two months maximum) of the location of the solid waste disposal facility where the debris resulting from ,
. the said construction activity shall be disposed of, and I shall submit the appropriate form. for attachment
to the Building Permit. • . . •
•
.
• . ' • P ate • • Sig*.iature of Permit Applicant
• . (Print or type the following information) • .
• . . . . 1 0 Ut-)re 0 .. . `---( ( — I ) ' 6 7-7 - - -- 7- ; '.
• Name of Permit Applicant
. —--.--------76 . . .
�� ,,A , q i- ..
• • • . .. Firm Name, if any • • •
- Nil
Address
'•' • . lre•. :debris' igi.l•I •be'' d i s pos d •b .... . i . . • . .... .. . .: ..
7- •-::: ) e .c______, • •
Location of Facil ty
•
•
•
•
1
R .
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : k _ ► ' r* L—f _ �' J I') 1 55 33 3
License Number
d Hd i //
Address Expiration Date
Signature Te
9. Registered Home Improvement Contractor. Not Applicable ❑
.dub la( I b /
Company Name Registration Number
PC) EC) 9 Col /2___
Address Expiration Date
Telephone) 7 7
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, g 25C(6))
Workers Compensation Insurance affidavit must be leted and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building pe
Signed Affidavit Attached Yes No ❑
11. — Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner - occupied Dwellings 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 own 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
.
s
.
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replacemen lndows Alteration(s) ❑ Roofing ❑
O r Doors
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [C] Siding [0] Other [0]
Brief Description of Prop¢sed
Work: `7r, ]1 f ir,5) a I I4 0 H wires doGL,,S
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
ea. 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 building permit application.
Signature of Owner Date
1O►+r( , as OwnerMuthorized
• _ hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
• • _ ief.
Signed under the pains and penalties of perjury.
Print Name
Signatfirexiftiwner /Agerrt Date
i
•
Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Permit
212� ain Street Sewer/Septic Availability
Rom 100 Water/Well Availability
North amp on, MA 01060 Two Sets of Structural Plans
`ti3
phone 413- 587 -1240 Fax 413 - 587 -1272 Plot/Site Plans
Other Specify
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
5 i n U (' - 1 4, r1 Map Lot Unit
Ch E r m C (a , �` 1 i Zone Overlay District
Elm St District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
a C � lcl�( 1 I c4 S o o r encC Ni
Name (Print) Current Mailing Address:
�1
4 1 S
Telephone
Signature
2.2 Authorized Agent: �-� Boy, I /y
InC�LtJ'�nC� i-t �1•�J i Po Bo o�q �lCfn , -id` rid
Name (Print) Current Mailing Address:
4 i 3
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (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
6. Total = (1 +2 +3+4+5) � � (� C GC1 Check Number i i (Q (1 $3c
This Section For Official Use Only
Date
Building Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
.
51 NORTH MAIN ST BP- 2011 -0145
GIS #: COMMONWEALTH OF MASSACHUSETTS
Vap:B1ock: 17C - 250 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP-2011-0145
Project # JS- 2011- 000240
Est. Cost: $4364.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 055333
Lot Size(sq. ft.): 21780.00 Owner: CHURCH ANDREW A
Zoning: URB(100)/ Applicant: THE JUBB CO INC
AT: 51 NORTH MAIN ST
Applicant Address: Phone: Insurance:
P O Box 429 (413) 772 -6217 Workers
Compensation
GREENFI ELDMA01302 ISSUED ON:8/20/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REPLACEMENT WINDOWS
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 8/20/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner