32C-276 (21) COMMONWEAUI'l.•1, Or' MASSA.CHUS1l.1. 1.S
DEPAl<i.'Jl'IY ENT Or, INDUST MAL ACCIDENTS
600 WASHINGTON 5'I RUE"I'
BOSTON, MASSACHUSL'1TS 02111
WOR1M1 RS' COM)l BNSA'I'1<ON 1NSURANCI✓ AFFIDAY]<r
The Jubb Co, Inc. d.b.a. Larry Jubb's Improve-A-Home -
(Ilcensee/perniluea) , .
WWI a principal place or busluess/residence ut:
7 Devens Sbreeb P.O. Box 429 Greenfield, Ma. 01302-0429
City/static/Zip
do hereby certify, under the pules aiid penttilics of het}ury, dart:
M I um an umpluyur providing thu runuwing wurkers' compunatttiun uuvcrttau l'ur,t»y employees
working, uri tlils,lob.
u_u_t C_W 0-1 D39 A-+)j? I o.
lnsuratice Cutupany horsey Number
O I am it sole proprietor and have no ouc working rut• nic.
O I ani a sole proprietor, general contractor ur honicuwncr (ch'cle ouc) and have hired the cuntructors
listed below who have the following workers' coin pensittion insurance policies:
Natne of Contractor Insurance Cumpany/Pollcy Number _
Name of Contractor Insurance Company/Policy Number
Natne of Contractor Insurance Company/Policy Number
( ) I ain a horneowner perrorining all the work inyseif. '
NOTE: Please be aware that while lionicownars who employ parsons to du nialmonatico, cointructlon or repair work
on a dwelling of not more than three units In which the hoinaowner also resides or on the grounds appurtenant thereto are-not
generally considered to be employers under the Workers' Compensation Act (G..L C. 152, sect. 1(5), application by a
homeowner for a license or permit may evidence ilia legal status or all employer under ilia Worker's Componsatloii Act.
i understand that a copy of hits statatneut will be forwarded to ilia Department or ludustrlal Accidauts' Office of JiisGrancd for
coverage verlfieatton and that failure to secure coverage as required under 5ectlun 25A of MOL 152 can,lead to tiro Imposition
Of crlminal penalties consisting of a tine of up to$1500.00 and/or iinprisotiment or up to one year and clvll penalties In die forth
of a Stop Work Order and a tine of$100.00 a day against me.
Signed this i $ day of Msn
r
LicenseelPermittee Licensor/P tnit r
Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 100001
Type: Private Corporation
Expiration: 6/8/2008
The Jubb Company, Inc.
Larry Jubb Jr.
P. O. Box 429
Greenfield, MA 01302
Update Address and return card.Mark reason for change.
)PS-CA1 Cr 5OM-04/05-PC8698 Address [:] Renewal Employment Lost Card
Board of Building eqqulations
One Ashburton Place, fpm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/21/1961
Number: CS 055333 Expires:05/21/2008 Restricted To: 00
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 01302
Tr. no: 23246
Keep top for receipt and change of address notification.
DPS-CA1 0 5OM-04/05-PC8698
Propont
Page No. of ! Pa es
Main Office: THE JUBB CO., INC. d.b.a. 18 North Hatfield Road
• 7 Devens Street LARRY J U B B�S Hatfield, MA 01038
P.O. Box 429
Greenfield, MA 01302 Northampton, MA
(413) 772-6217 IMPROVE-A-HOME (413) 584-3716
PROPOSAL SUBMITTED TO PHONE DATE
,54etlenlr Caeely dcgivs rxllv 013
STREET JOB NAME
$a td h +. 4pt 1
CITY,STATE AND ZIP JOB LOCATION f
ARCHITECT DATE OF PLANS MA Registration 100001 JOB PHONE
6- 7 MA Cons. Sup. Lic. 055333 77�'6d�7
We Hereby submit specifications and estimates for:
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ARDIVAIVIIJ& w fNPOw RLp kC.E mevt-,
a OWNCr Wiu.- IVES-0 To P&qN-T Ex-n5g/op. t dio GAXW4S Whist oc.Q
��attr� WItgooLos were— -A- ht_"Em (Vcf)✓ NL1N1N►iAL)
r
4r,'E T OWN 8M't CONS RIJiCsTION4$,ERVICES'�
8.1 Licensed Construction Supervisor: n Not Applicable ❑
Name of License Holder QT
License Number
� log
Expiration Date
Address
-?-7 Z-G2-t-7
Signature Telephone
g e om marov"°�eme"ntontracto _, Not Applicable .❑
JAX I DOOC)
Company Name Registration Number
P O &)( `-t-�-�i cp/c o B
Address Expirat on Date
J MA V 1 3L9 2-- Telephone —7 —7 2 —�C'2— -
,SEC,T��ION 10 WORKERS',COM PEN SATION: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 affidz
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... No...... ❑
om ®own30M, M i , n
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)famili
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner act:
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(
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
r s� t �a�yAy Cti y diwk X,, v ,
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:mPxtk$! �'k?! X'��€r• p7iS4d.#`�FF'x`Ui".k'"''�W"Ntl(9f!iW.45°!Si!MBK. ?IC '�!6?�' a + .,,�:,':: ,tYrx'xF,�!�'i��z
t�'a2ary?so��,;;�'sf'�'r�;c�nlvi.h;m�.�"-r�tsa 'e�r�nga�� *F?!:e!tu r�-�w,!?�psrr?;RaA�.ti+i"ins�+ictws._:x,;,. . : , +.....;a , ;;;,�;ei•;,+
New House ❑ Addition ❑ Replace"Windows Alteration(s) ❑ Roofing ❑
Or Doors 1;*J
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ]
Brief Description of Proposed Work: w e KAOw N
Alteration of existing bedroom Yes No A ding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll❑. Sheet❑
w s fe the foloin 60iffNhou drdrn-oexi i it `ff
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.. Mascheck 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
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
SECT1017a �OVfNERAUYfORIZATfON OBECOMPLERTED WHEN
�C1NI� RS,4GEN1'�Of2CQITRACTOR"AI�f�LiES�FO�R ¢UILDING,PERMIT, r r
F. r}Ik°vV: r
I, as Owner of the subject prope
hereby authorize to ac
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
-J � as Owner/Authorized Agent
hereby declare that the statements and info ation 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 A
Signature of Owner/Agent Dat
t
City of Northampton
Building Department
SCE' Q 2006 ,212 Main Street S
Room 100. a e
$Northampton, MA 01060 ets
phoe 413-587-1240 Fax 413-587-1272 0 e P
Omer - 3
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION11 SITE INFORMATION
1.1 Property Address: yam, �nThis ect""` to tie=co p eted�by office -' K ���
r I i.�l.vv� s �`f" • 3apzy Y . -,:, Lo
'''. 'r�a1 �• 1��`!,;� �'� ,�,ri^ �.{�,��rnx ., i�, �r,�'�y i r'�s^..
Elm St. District +•;
SECTION 2'- PROP.ERTY OWNERSHIP/AUTHORIZED AGENT
2..1 Owner of Record: /
s1�U vV1- 4- �T�-( l� Z CAJl
Name(Print) Cu rr nt Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
Name(Print Current Mailing Address:
Signature Telephone
SECT fiON 3r ki=S`iIMATRb COiVSMCTION'CbSTS
Item Estimated Cost(Dollars)to be Official Use Oniy
completed by ermit applicant
1. Building (a) Building Permit Fee
(�U
Do
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) O p g, p Check Number
This Section For Official Use Only
Building Perm.t Mmb& Date Issued:
Signature
Building Commissioner%Inspector of Bu,:i�dings, . Date
I A
82 WILLIAMS ST- 1-A BP-2007-0317
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-276 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2007-0317
Project# JS-2007-000479
Est. Cost: $2008.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq. ft.): Owner: BERNSTEIN STEVEN&ELLEN
Zoning: URC Applicant: THE JUBB CO INC
AT: 82 WILLIAMS ST - 1-A
Applicant Address: Phone: Insurance:
P O Box 429 (413) 772-6217 Workers
Compensation
GREENFIELDMA01302 ISSUED ON.912012006 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 9/20/2006 0:00:00 $25.009355
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
L D O nY Page No. of ! Pages
Main Office: THE JUBB CO., INC. d.b.a. 18 North Hatfield Road
7 Devens Street Hatfield, MA 01038
P.O. Box 429 LARRY J U B B'S
Greenfield, MA 01302 Northampton, MA
(413)772-6217 IMPROVE-A-HOME (413) 584-3716
PROPOSAL SUBMITTED TO PHONE DATE
S v ,lv± caze:ito lIV, 013
STREET JOB NAME
CITY,STATE AND ZIP JOB LOCATION
ARCHITECT DATE OF PLANS JOB PHONE
MA Registration 100001
< ,- X I MA Cons. Su . Lic. 055333
We Hereby submit specifications and estimates for:
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p D QS C44 P_ 91,4,5S -£b ALL S/1.fA6 S
Qr�I�j 00 D T2 i W S 727 AS: 7- Z1V71r210R liviiyD d"Ji r dJ1, 1yar
UNIT otyNER 'TO C>671110 fit AI-WFN famiSSlnN CgoM C;ounc) /+SSpu�7ioN
ALMIDAMN& LAj IN0Qc4 9e P ftFC_ meNt,
. OWNU' olio- NU-O To f&iw ' EX-r6,t1o9- jjoeto CA_fi 4S Luhent nto
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ReF 92� ) FSx u i c e Fee. 60T t fi c I tad cd` IN Ate\ N� b e1 ow . My& W i LL 13 F-
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Comhmd S c Ch : N iriAuat-c4tvAge of er r'After)LIJIJI he
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4-fT61NEr.S keS rU C ARA-ed !N t'_Akf_c+tiV,l ANV/ -46(tnS N-Ve1)
61UIN 2
Provisions of MA Law require Contractors to inform purchasers of MA Contractors Registration, Regulations, Rights of Recession, Specific
Warrantees, and other consumer rights.I (We)have received, reviewed,and understand a separate copy of these regulations.
(Signature)
We rope5t hereb to furnish material and labor-complete in accordance with above specifications, for the sum of:
720-D °'°
dollars ($ CZ 0()T )•
;1 ment to be made as follows:
a oow&j PAYMetor wood AcGEejANC6 AAAkC- ORcL: PAXAlk fa i�,e ��6bLo .l�vc.
6 NPA B 141 r4tV C- ,per O N C6m.o I e*7 o N
All material is guaranteed to be as specified.All work to be completed in a workmanlike
manner according to standard practices.Any alteration or deviation from above specifica- Authorized
tions involving extracostswill be executed only upon written orders,and will become an extra Signature t-Ij QyoxJ2
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 proposal By be
r?onditions k flly covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within days.
nce of pr0p05dC-The above prices,specifications and
e satisfactory and are hereby accepted.You are authorized to do Signature te woras sped.Payment will be made as outlined above.
V, Signature
Date of Acceptance: