22B-031 (3) •
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, glee - � ° 01&h t_ xis ,j ac /ueae
r i` ` y Board of Building Regula tons and Standards
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One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Construction Supervisor License
License CS: 55333
Restriction: 00
Expiration: 5/21/2010 Tilt 25298
LAWRENCE A JUBB JR
PO BOX 429 - .. - - ---------- ...---------._._..-.-
GREENFIELD, MA 01302 — — -- - --
Update Address and return card. Mark reason for change.
;AI 0 50M- 01 /o7- PC0490 I--I Address I—:1 Renewal I 1 Lost Card
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d. i f Boar. o • guile ing egula o ns an tandar• s
t One Ashburton Place - Room 1301
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7
R•.‘ 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.
0 Address r) Renewal [7 Employment [1 Lost Card
AI 0 60M•07ro7•PC8490
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The Commonwealth of Massachusetts
*�. a Department of Industrial Accidents
_ — = 11— Office of Investigations
_ 600 Washington Street
i Boston, MA 02111
1vww /dia
Workers' Compensation Insurance Affidavit: Builders /Contractors /Electricians /Plumbers
Applicant Liformation Please Print Legibly
Name (Business/Organization/Individual): � J ( J t , � �� . ��, r .
P
Address: 1'. o .
City /State /Zip: vee.v &ict, MA Ot3 Phone #: -7 7 2- - 7-I
Are y u an employer? Check the appropriate box: Type of project (required):
1. am a employer with 'S 4. ❑ I am 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 sheet. z ED 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. ❑ Roof repairs
insurance required.] t employees. [No workers' ('
comp. insurance required.] 13.OQncr�. w t ct t;
Any applicant that checks box N1 must also fill out the section below showing their workcrs' 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.
1 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: i' e_t_ie—t P S _ � t s �a —
Policy # or Self -ins. Lic. #: -cl 4-ct Expiration Date: 06/c, 3/c U
Job Site Address: i G 3 ri City /State /Zip:44 ote44kz/2- / mi l
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 pair nd enalties of perjury that the information provided above is true and correct.
Signature: Date: F/1 f o
Phone #: —71 ti 2-1
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 #:
Replacement L% tubatu Vropossai Page No. / of / Pages
1\
Main Office: THE JUBB NC. d.b.a. Northampton, MA:
7 Devens Street • P.O. Box 429 CO., ' (413) 584 -3716
Greenfield, MA 01302 LARRY JUBB'S Brattleboro, VT & Keene, NH
(413) 772 -6217 1- 888 - 639 -JUBB
P.O. Box 51 IMPROVE -A -ROMEO Email: JubbCompanyinc @aol.com
Hatfield, MA 01038
PROPOSAL SUBMITTE PHONE DATE
t k otrY,ANt 5 — sa67 7/2/40
STREET JOB NAME
1 53 e'iNib " •
CITY, STATE AND ZIP JOB LOCATION 5 J l�
rL tice- IVeA
TENTATIVE JOB SCHEDULE (Weather Permitting) MA Registration 100001
Approximately 6 •-g 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. 1,--(2S
• Locking Screens (double hung only). • Welded sash & frame.
• Tilt -in Sashes (double hung only). • Five degree sloped sill. �
• Health Smart Super Spacer Glass. • Seven - eights thermo glass.
• Block & Tackle Balances (double hung only). • Insulated padded frame. I1
• Twin locks on double hung units 32" or wider. • Energy Star approved. •
• Twenty year manufacturer guarantee on glass seal failure. • Virgin vinyl. 8 11 1 /o ° t
• Lifetime transferable manufacturer g ntee on vinyl window frame. 1 ' 33
• Labor guarantee as required by CT MA NH, VT contractor regulations.
* Owner to paint or stain any necessary new wood or trims used during installation. ((4 6
* Installers must have clear access to window areas.
Color: ❑ Linen White ( *extra charges apply for colors) ❑ Almond* ❑ Brown* "Other*
TOTAL UNITS REPLACED: i 1 QoAt� HuN6j
'Grids 46.5 (JiXC-e_Pr b i s N Oeiv) ❑ Aluminum Clad Exterior Castings (❑ Full ❑ Partial)
aLow "E" Glass j,$ Argon ,/PC OkInsulation (into weight pockets) ' ill Window Removal ,'
OTHER /NOTE: �°
CO.tbR ON C ■TEg--FOR TO GE , S74ND
C 61aR_ 6N mac.- 1e'tot2 ? js6 whit
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: (� Not Applicable ❑
Name of License Holder : I- �./LLAj i"Pit-L!.,P _ f • i. J Y. Pr-e., . Q= -7-, 3
C D to x. 4- � �} , / License Number l CE-Z).. / ( Q Address Expiration e
-r e4... - t e11 M/\ 01302
Signature / Telephone
— ,. 7 `7 z - 6 2I 1
9. Registered Home improvement Contractor: Not Applicable ❑
., 1,L.b b Co ., - .1 -(..,c . 1000c
Company Name 2 Registration Number
4�
P U.. GO)(
� 1 cA.,(0 s /.9.2. 0i O
Address ` �f -17)._,,,2-1-7 Expiratio Date
l-'v &A,--t 1 ' t. J- AA A C7( C) -- Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(8))
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 ❑
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 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
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SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Replaceme ndows Alteration(s) ❑ Roofing ❑
Or Doors ( � ` J
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [p Siding [0] Other [0]
Brief Description of Propo d
Work: trx.G- -171.i ( V i vu Ir (A) t vt- o w S
Alteration of existing bedroom Yes ding
new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
8a. 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?
1. 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 APPUES FOR BUILDING PERMIT
I, , as Owner of the subject
property
hereby authorize
to act on m _ y � ' behalf, in all matters relative to work authorized by this building permit application.
application.
i
Signature of Owner I Date
I, A- . J u b J v' . Pre- - , as Owner /Authorized
Agent hereby declare that the statements and ififormatiori 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
_. /19/09
Signature of Owner /Agert Date
Department use only
City of Northampton Status of Permit:
Building curb Cut/Driveway Permit
c, 12 Main Street Sewer /Septic Availability
��� ° ,Rbom 100 WaterMrell Availability
Northampton, MA 01060 Two Sets of Structural Plans
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 DWELUNG
SECTION 1 - SITE INFORMATION 1
1.1 Property Address: Thls section to be completed by office
I 5 �`� f . Map Lot Unit
"Et U v , - Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record: Pt rC, NYA-- d.4. -‘ t 5 - 2) ) s . F-'� O
Name (Print) Current Mailing Address: 3 . — U _ 7
Telephone v �
Signature
2.2 Authorized Anent:
) rem A e b 5 Pr x 4— a..9 � �_ Ak
Name (Print) / / Current Mailing Address: / Of 30 Z
�, ,__ '772.
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building G (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) It 5 S,GG Check Number i 'L56
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
e �
se �
BP- 2010 -0207
GIS #: COMMONWEALTH OF MASSACHUSETTS
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- 2010 -0207
Project # JS- 2010- 000255
Est. Cost: $5225.00
Fee: $35.00 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: URB(100)/ 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:8/24/2009 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 8/24/2009 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo