32C-234 (6) w
fie -V 11nv z cvmveaeYz 0 1-�JaclwZefd
Board of Building Regula coils and Standards
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Construction Supervisor License
License CS: 55333
Restriction: 00
Expiration: 5/21/2010 TO 25298
LAWRENCE A JUBB JR _ _ _—_-
PO BOX 429
GREENFIELD, MA 01302 Update Address Address and return card. Mark rcason for change.
Is-CAI it 5OM-07/07-PCO490 Address (—) Renewal Lost Card
lug 9 ec Boa l egula andar
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
The Jubb Company, Inc. Expiration: 6/8/2010 TO 267161
Larry Jubb
P. O. Box 429
Greenfield, MA 01302
Update Address and return card. Mark reason for change.
IS-CAI p 50M-07107•PC9490
�_] Address ❑ Renewal ❑ Employment I.1 Lost Card
The 67onin1oitirealth oJ'Alas. ach(1sefty
� Department rJ'1►rclrrstriu/ilccirlenls
— _ (>JJicc� of I►lnc�s•tigations
_ — 600 IVu,vhington .''treat
Boston, 111/1 02111
' IVIVIV.111ass.govI(lia
Workers' Compeusation Lrsurauce Affidavit: 13uilders/Conlr actors/Electricinus/1'lunihef•s
Applicant Information —7-- Please Print Legibly
Name (Business/Organizatiot/Individual):
Address: lam- 0. K +-�--q
City/State/Zip: ��et-rC�e—1 cl M/}
Arc ydu an employer?Check the appropriate box: Type of project(required):
1. 1 am a employer with L;) 4. ❑ i ant a general contractur and 1 G. ❑ New construction
cutployees(full and/or part-tithe).* have hired the sub-contractors
2.❑ 1 ani a sole proprietor or partner- listed on the attached sheet. I 7. ❑ Rcnrodcling
slip and have no employees These sub-contractors have 8. ❑ Detrtolitioh
working for me in any capacity. workers' comp. insurance. 9. E] Building addition
[No workers' comp, insurance 5. 0 We are a corporation and its
required.] officers have exercised their ]0.❑ Electrical repairs or additions
3.0 I am a honneowner doing all work right of exemption per MGL 11.❑ Plunibing 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.❑ Other
'Any applicant that checks box III must also till out the section below slowing their workers'compcnsatiou policy information.
t homeowners wlto submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infonnation.
I am an employer that is providing;Porkers'compensation insurance for my employees. Belo PP is the policy and job site
information.
Insurance Company Name: O- ..et-�j
Policy 11 or Self-ins.Lie.11: (✓t W L OZ 94 g Expiration Date:
Job Site Address: C� 4– City/State/Zip: �–Vb -.y..;� '+ ► A%- /A
Attach a copy of the workers' compensation ji. icy declaration page(showing the policy nwnber aud.expir Lion 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 forin 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 play be forwarded to the Office of
Investigations of file DIA for insurance coverage verification.
I(lo/hereby certify under be pains d penallies of perjury that the information provided above is true and correct.
Signature. 0-' Date:
Phone/h
Ofjicial use only. Do not write in this area, to be completed by city or tolvn official.
City or Town: Permit/License 11
Issuing Authority(circle one):
1. Board of Health 2.Building Departnieut 3.City1fown Cleric 4. Electrical Ltspcctor 5.Plumbing Inspector
6.Other
Contact Person: Phone It:
Replacement inboW PrOPO5ar Page No. of Pages
�,� Main Office:
Replacement ll [ l 1 Northampton, MA:
7 Devens Street• P.O. Box 429 THE JUBB CO., INC. d.b.a. P
Greenfield, MA 01302 (413) 584-3716
(413) 772-6217 LARRY JUBB'S Brattleboro, VT& Keene, NH
18 North Hatfield Road I MPROV E-A-H OM ETM 1-888-639-JUBB
Hatfield, MA 01038 Email: JubbCompanyinc@aol.com
PROPOSALSUBMITT TO PHONE DATE
Jr- /0 r 6 i ir
STREET JOB NAME
CITY,STATE AND ZIP JOB LOCATION
TENTATIVE JOB SCHEDULE(Wea er 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:
Supply & Install Mastic Rmpd Wlatmr mrcd 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). • Five degree sloped sill.
• Non-conductive intercept glass system. • Seven-eights thermo glass.
• Continuous Balances (double hung only). • Insulated padded frame.
• 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.
• Lifetime transferable manufacture gu ntee on vinyl window frame.
• Labor guarantee as required by C , MA NH, VT contractor regulations.
Color: 1&d Linen White ❑ Almond' (*extra charges apply for this colors)
TOTAL UNITS REPLACED: '�) iU6L Nt.INL-S
❑ Grids K1 (Note: Grids are beveled)
XLow "E" Glass ❑ Argon N A 10 Insulation onto weight pockets) , Storm Window Removal'
❑ Aluminum Clad Exterior Castings ( ❑ Full ❑ Partial ) �d
OTHER/ NOTE:
;e��
r��� �tA
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:L'.— i- U, -J IP rC S d �5 a � 3
v' License Number
Address F +� ,� Expiration Dale
Signature Telephone
9.Registered Home Improvement Contractor: Not Applicable ❑
Coompany�Nlame Registration Number
P L, ct-zc,S L.�4_ C 1 0
Address Expiration Date
M A 0 t G Z- Telephone -Cv I
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 hvo-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
i
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement ypndows Alteration(s) O Roofing
Or Doors 1[ 1
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [I] Siding[O] Other[o]
Brief Description of Proposed i
Work: -"-S'f'ZL.-{ 1 �.'
Alteration of ebsting bedroom Yes No dding 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.
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
1, 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
I, 0.-t )Y�G�.�.0-(t— 1 j r• -GS , 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
\F5 Department use only
Cdy,of Northampton Status of Permit:
Buttdlrig Department Curb Cut/Driveway Permit
2fi2 ain Street Sewer/Septic Availability,
�p R00 11100 Water/Well Availability
QC� NofA mpto , MA 01060 Two Sets of Structural Plans
phOl �t48 40 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
91 + Map Lot Unit
Zone Overlay District
Elm St District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) Current Mail' Address:
Telephone
Signature 4—
2.2 Authorized Ascent:
Name(Print) Current Mailing Address: J 1 . O 2
-7-7 2 —(o,:2-i -7
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit 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=0 +2+3+4+5) -7 , 0 0 Check Number
This Section For Official Use Only
Building ermit Number: Date
g Issued:
Signature:
Building Commissioner/inspectorof Buildings Date
BP-2009-0428
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 042A)
Category BUILDING PERMIT
Permit# BP-2009-0428
Project# JS-2009-000578
Est. Cost: $2475.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq. ft.): 32582.88 Owner: DUVAL PAUL H
Zonings URC(100)/ Applicant: THE JUBB CO INC
AT. 94 HAWLEY ST
Applicant Address: Phone: Insurance:
P O Box 429 (413)772-6217 Workers
Compensation
GREEN FIELDMA01302 ISSUED ON:1011612008 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:
TUTS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
Fee'Type: Date Paid: Amount:
Building 10/16/2008 0:00:00 $35.0011032
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo