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22B-031 (2) 3.eptatement == tnbobu Vropo a t Page No. (of (' Pages 1` Main Office: THE JUBB CO. INC. d.b.a. Northampton, MA: 7 Devens Street • P.O. Box 429 (413) 584 - 3716 Greenfield, MA 01302 LARRY JUBB'S (413) 772 -6217 Brattleboro, VT & Keene, NH q 1-888-639-JUBB P.O. Box 51 IMPROVE-.A-HOME� Email: JubbCompanyinc @aol.com Hatfield, MA 01038 PROPOSAL SUBMITTE ` PHONE DATE T-e 4b 1vo a /v S? ti - 5;20 #/0/II STREET JOB NAME CITY, STATE AN ,� ti v� at ' JOB LOCATION R , r1C \ C 0 I660 TENTATIVE JOB SCHEDULE (Weather Permitting) MA Registration 100001 Approximately 6 weeks from date of signed proposal received by Jubb Co., Inc. MA Cons. Sup. Lic. 055333 Supply & Install National Vinyl Destiny 2 Series Vinyl Replacement Windows • 1/2 Screens (double hung only). • Interlock meeting rail. • Locking Screens (double hung only). • Welded sash & frame. • Tilt -in Sashes (double hung only). rs • Five degree sloped sill. • Health Smart Super Spacer Glass EUE1VED MAR 1 2 !il • Seven - eights thermo glass. • Block & Tackle Balances (double hung only). • Insulated padded frame. • Twin locks on double hung units 32" or wider. • Energy Star approved. • Twenty year manufacturer guarantee on glass seal failure. • Virgin vinyl. • Lifetime transferable manufacturer g antee on vinyl window frame. • Labor guarantee as required by CT, , NH, VT contractor regulations. * Owner to paint or stain any necessary new wood or trims used during installation. * Installers must have clear access to window areas. Color: ❑ Linen White ( *extra charges apply for colors) ❑ Almond* ❑ Brown* !Other* TOTAL UNITS REPLACED: vu,\OVe... .U..I.It S ❑ Grids N® ❑ Aluminum Clad Exterior Castings (❑ Full ❑ Partial) glow "E" Glass yes ctZtr ,Insulation (into weight pockets) yES 6 Storm Window Removal DES OTHER /NOTE: °WW 7 £o G [°rIa NQ �C�r<O S t N 7 - t t= 1 (3 c 'P/-�r ci( �? -, S,CtEE -t ©R- t o 6e t N N V/ rv 9y c-- 57o b c0aA i t '-S b- e.e.Ai Deeit e c( lit) Ptl Woo/ 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.] We ropooe hereby to furnish A l_ material and labor Q — co fete in accordance with above specifications, fort thesum of: f Lk i �` v l tl,�, r f < r" 1" q""''teLik e k "t` -0-61 - '/ArP1e, dollars (s / 179 45 ). Payment to be made as follows: 1/3 DOWN PAYMENT UPON ACCEPTANCE Make checks payable to: The Jubb Co., Inc. (Our installers will collect final balance upon completion). 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 attorney's fees, incurred in collecting any sums owed. All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above specifications /„ ��[ involving extra costs will be executed only upon written orders, and will become an extra Signature __ — \ 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 propo I ma e workers are fully covered by Workman's Compensation Insurance. withdrawn by us . not accepted within THIRTY days. Rtceptante Of Propo�at - The above prices, specifications and r conditions are satisfactory and are hereby accepted. You are authorized to do the Signature AIL/4 _ work as specified. Payments will be made as outlined above. 1p 4 (' `` Date of Acceptancee3 l ` r' ( Signature . WHITE - Remittance Copy YELLOW - Customer Copy • • ... • . 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. ' ' • Date • Signature of Permit Applicant • • ' (Print or type the following information) • . • • y '' i 1 /»kC 3 J ( , . Name of Permit Applicant i• C ig ' Finn Name, if any • • r . . . . f • ti . .. • • •- ,,, —2,(c— . . s._ „,„ 4 i Address . , . :11 ' :'`dbrig:`wi•1I •b e'` di of•: ::'': . ... .. ...... • • .. . • (Location of Facility) • • 7 (L „ 7) Y ••.. : ..,..... . :.,.1 . • • W‘./44(4U11 1L. 7=: 41ZiObJ.JbOld AH HIST INSURANCE PAGE 01/ 01 , ,,04.4 1 I r _ 'NCO i C RT1FICA E OF LIABILITY INSURANCE DATE(MWDDIIYYY) f....... 1 2/22/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF I;' FORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR N =•ATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DO:;- NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERT - .MATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITI • AL INSURED, the pollcy(Ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policft • may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In I(eu of such endorsement(s). PRODUCER CONTACT Tracey Kuklewicz A.H. Rist Insurance Agency, Inc . (, PHONE {413 }863 ^4373 PAX IALC ,,No,_Extl: � {AlC No }: (413)1163 -5555 __ 159 Avenue A E -MAIL ADDRESS: P.O, Box 391 PRODUCER 00002625 Turners Falls tvIA. 01376 _INSURERIE) AFFORDING COVERAGE; NAIL if INSURED .INSURERA :Peerless Insurance Company 2419$ INSURE The Tubb Company', Inc, ' C -- INSURER: : —. P.O. BOX 429 I . INSURER D • INSURER E : __J GREENFIELD MA, 01302 INSURER P : _ _ — -_ I COVERAGES CERTIFICATE NU11,- 4ER :CL111300070 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCI; LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, T:;. OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE I SURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMI 1' SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSA 1 ADDL'SUSS ; POLICY EPF I - Rh,ICY EXP - — lT I TYPE INSUR OP A NCE (Nqa yyi poLLCY NUMBER I IMM /DD/YYYYt __ T I ' -{�M�M/DD JJ IYY __ YY ti, LIMITS _ GENERAL LIABILITY f- I � EACH OCCURRENCE 1,000,000 I X COMMERCIAL GENERAL i 1° "OT'MAGF 10 ROTTED -- 100 000 _ T � 1- MgMAEB_(Ee- oenurren_c�1 r , _...... A ; ; j CLAIMS - MADE ( .. x ...: OCCUR CHT+8 1 .174 9 5/9/2910 5/3/201 MED EXP (Any one person) , 15,000 j __.•., - I. I PERSONAL & AO's INJURY 1$ 1,000,000 - J I I GENERAL AGGRI GATE 1 $ 2,000,000 ' GEN'L AGGREGATE LIMIT APPL., - - ..•,IES PER: ; I ' PRODUCTS - COMP /OP AGG Is 2,000,000 Ti PRO- I... POLICY 1 1 JBCT 1 L OC ! I- i _ i S AUTOMOBILE LIABILITY ! 1 I I COMBINED SING .E LIMIT 1 $ I--I I (Ea accident) ANY AUTO 1 EObILY INJURY (ow pnr' I $ 1,000,020 A ALLONMEDAUTOS MAS6 5/3/2010 S/3/203.1 � .M BOOILY INJURY erACCidrnt)IS 1,000,000 X SCHEDULED AUTOS 1 PROPERTY DAMAGE i X 11 HIRED AUTOS ' I (Per otoidont) $ 1, 000 000 I X I NON-OWNED AUTOS 1 PIP•Besic $ 8,000 i .1 OCCUR 1 � ._.e_.. . i EACH OCCURR1NC Unlit 20 000 UMBRELLA LIAR 1 ( I 3 , ` EXCESS LIAR 1 CLAIM$.MAOE'r I . AGGREGATE, ' $ I i I I DEDUCTIBLE I 1 I. _ ... ,._ 14" 1 1 RETENTION $ 1 $' _ A WORKERS COMPENSATION I , ( x I WC STATU• ! 10TH . AND EMPLOYERS' LIABILITY Y i � -_ ' ANY PROPRIETOR. /PARTNER /EXECUTIVE � - - � ` I E,I„ EACH ACCIDENT I $ _1_00,000 OFFICER/MEMBER EXCLUDND? I N N/ A 1 (Mandatory In NH) N , C86 - 947 1 5/3/2010 15/3/201,1• E. DISEASE - F!, EMPLOYE �� 100, OOD if e9 deetribn undoc -� 0.E;S�RLP7IO OPERATIONS below E.L. DISE=ASE - POLICY LIMIT I $ 500,000 I all DESCRIPTION OP OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD I +1, Addlttennl Remarks Schedule, If mere spate Is rnqulri d) C1acsG£iCiationt Siding installation I CERTIFICATE HOLDER } CANCELLATION _ ('." `) 772-•2 3ry - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED G °_F'br2t I THE EXPIRATION DATE THEREOF, NOTICE. VIE..'_ DE C; L T7 7 1 1 - POLICY ACCORDANCE WITH TWw. PR' , re Div, "s. .$ .. ._ ( . Tr iacz r iti . ,i.errit. / TON. r .,-..:.T.'. —.- S'. "i'.._,.'._. s I 'N.!;1:1;!:, •'_......,., M.._ ..... ..,........«........._ .... -.,.. (6)19'39-200n ACORI,) f.`1,1RPORAT':?N, /MI ri" .. i , . `y. I , ..i ,: _.., '' ACC; itpL -'.fi ,< ._. :t .. :; ,ll'' ,rhr:?. , .i : Fu: Pty of . .. -..+ • • The Commonwealth of Massachusetts Department of Industrial Accidents 5.1 i.,= Office of Investigations _ �� 600 Washington.S'treet ' . — =Iv= Boston, MA 02111 S/01.0 muss.got' /dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly Name ( Business /Organization/Individual): L I i I 1 `� `J � I� � Y7�at1 / �1� ►'� C Address: t . 0. g U IN C] City /State /Zip: ( e► � � L a Phone #: 1 7 c CP a/ 7 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ 1 am a employer with 4. ❑ I ant a general contractor and I 6. ❑ 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 shoot. x 0 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 arc a corporation and its required.] officers have exercised their MO 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. I No workers' 13.0 Other comp. insurance required.] 'Any applicant that checks box N l 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. 1 Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. 9 -- - -- Insurance Company Name: , C r } ���5 _�_.p1,�c t' 1 ( Q Policy # or Self -ins. Lic. #: C 7“-.0 L{ / 7 Expiration Date: 5/3 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. re z- .�. :mss. <. 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 #: ?72e -c t./ It ._ff„.7i.„ iit► Office of Consumer Affairs and usi ness Regulation -`'` % 10 Park Plaza - Suite 5170 ' Boston, Massachusetts 02116 Home Improvement Cqr tractor Registration = Registration: 100001 • • _ ;. 1+r Type: Private Corporation _:,. : Pa -- - ' _ Expiration: 6/8/2012 Tr# 297762 The Jubb Company, Inc.: - = ~` ' , Larry Jubb _ - - - : _ - P. 0. Box 429 - _ Greenfield, MA 01302 T 1 ",,. �.> , Update Address and return card. Mark reason for change. __ 0 Address 0 Renewal El Employment 0 Lost Card OPS•CA1 0 50M- 04/04•(101216 • ' illassachoselIs - Deparllocnt of Public safch `- Board of Buildin Utt nl:uions and stantiartis `JJJ` Construction Suln•r+n or I.ic:en License: CS 55333 Restricted to 00 , •r t" t 41 LAWRENCE A JUBB JR }.* PO BOX 429 71: i ttitkli;; :.. GREENFIELD, MA 01302 f. s _ .•;.t ., �1 Expiration: 5/21/2012 ( '''n Trtt: 24599 SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9. Registered Home ItnprovementContractor. Not Applicable ❑ Company Name Registration Number Address ^ Expiration Da ^ 0-1 A _ s 1 ( \ t 1 C A 2 1;;) - - Telephone - ),..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 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 Massa husetts General Laws Annotated. Homeowner Signature SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable) New House ❑ Addition ❑ Replacement Wi ows Alteration(s) ❑ Roofing El Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [D] Decks {0 Siding [D] Other [C1] Brief Description of Proposed Work: (12 (� t . V11 1.\t \ki,1 d d„C !� C1. \ f (;V'lii >Q Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll - Sheet 6a. If New house and or addition to existing housing complete the foilowinq: 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 . 1. 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 , 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 Section 4. ZONING Alt Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information 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 e - r been issued for /on the site? NO 0 DONT KNOW le YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page and /or Document # B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW 0 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO i IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. r 4"84"1.../; friffl ` ''''f 4../ Ivor rot P I #- 1 wit , \t, � Department use only Cit of Northampton st o f P e r m it: i �� Building Department Curb Curiveway Perm SZ 212 Main Street Sewer/Septic Availability ' ROOM 100 Water/Well Av blility Northampton, MA 01060 Two sets of Structural' Plans _ dF ,,` . hone 413-587-1240 Fax 413 -587 -1272 net/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 i rt Map Lot Unit �,(�`k I N � V�'6(,)f Zone Overlay District Elm St District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) - -- _ _- Current Mail! ddr —� .., , : ' Telephone `� ' / Signs rt(i a ..... _ / it 2.2 Authorized Anent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building c721/79.-- (a) Building Permit Fee 2. Electrical / (b) Estimated Total Cost of Construction from (8) 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 +2+3+4+5) ' 11 6 (J' CKJ Check Number /_°f // /(Y`-) This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Comm Buildings Date • 153 PINE ST BP- 2011 -0784 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 22B - 031 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: windows replaced BUILDING PERMIT Permit # BP- 2011 -0784 Project # JS-2011-001289 Est. Cost: $2479.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THE JUBB CO INC 055333 Lot Size(sq. ft.): 22869.00 Owner: HOLMAN JEFFREY A & TINA M Zoning: URBU100)/ Applicant: THE JUBB CO INC AT: 153 PINE ST Applicant Address: Phone: Insurance: P O Box 429 (413) 772 -6217 Workers Compensation GREENFIELDMA01302 ISSUED ON:3/30/2011 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 3/30/2011 0:00:00 $60.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner