28-063 all fir T
eplatement Vtnbo U 10ropmW Page No. / of Pages
(wain 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 Brattleboro, VT & Keene, NH
(413) 772-6217 1-888-639-JUBB
P.O. Box 51 IMPROVE-A-HOMED Efnail: JubbCompanyinc @aol.com
Hatfield, MA 01038
PROPOSAL SUBMITTED TO PHONE DATE
Elt� S'z L ilkgAAA_..< Sy `/ - - » 13 � F-
STREET JOB NAME
CITY,STATtAND ZIP JOB LOCATION
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
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). • Five degree sloped sill.
• Health Smart Super Spacer Glass. • 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. -PastT
• Lifetime transferable manufacturer guarantee on vinyl window frame. t gtso ��
• Labor guarantee as required by CTi01 NH, VT contractor regulations. ve
• Owner to paint or stain any necessary new wood or trims used during installation. 3 (
• Installers must have clear access to window areas.
Color: ❑ Linen White (*extra charges apply for colors ❑ Almond* ❑ Brown* ❑ Other*
TOTAL UNITS REPLACED: I r S d-- ( Pt c, tt/tnrn0W
❑ Grids ND ❑ Aluminum Clad Exterior Castings (❑ Full ❑ Partial)
; Low "E" Glass S ❑ Argon Q�Insulation (into weight pockets) wL 14 Storm Window Removal.tES
OTHER /NOTE:
ERVICE FEE: $125.00 (inud s permit and disposal of all job related refuse.)
[service fee not included Cl' tal amount below,and will be billed separately.]
Vt roposie her by t furnish material and labo —complete in accordance with above specifications, for the sum of:
oC
1 dollars($_ ).
Payment to be made as ollows:
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 i collecting any sums ed.
All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized J
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 pro Sal y be
workers are fully covered by Workman's Compensation Insurance. withdrawn by S If not accepted within THIRTY days.
?P 1XI I - �i
ZfCCetltance Of Pr0P00ai[ — The above prices,specifications and
conditions are satisfactory and are hereby accepted.You are authorized to do the Signature
work as specified.�Payments will be made as outlined above.
Date of AcceptanL.: 3 Signature
WHITE-Remittance Copy YELLOW-Customer Copy
The C'olmnonlveollh oj'Massuchuseffy
IDelmrimertt of Indttstriut Accidents
Qjjlce ojlnvestigaf olis
600 lVushington .S'tree't
13oston, 111/1 02111
►v►v IV.III uss.goIMia
Workers' Compensation Llsur:ulce Affidavit: 13uildcrs/Cul►lral:tors/l,�leclrici:uls/l'lunlbers
Annlic.tnt Information Please Print Legibly
Name (Business/Orgaiiizuliotr/iiidividual): �z-
Address: '/ O• Y,
City/State/Zip: -t-�t-�(�l MA Ol3v� Phone !l: ?:� —61�--►_7
Are ydu an employer? Check the appropriate hox: Type of project(required):
1.!`J' l ant a employer with 5 4. ❑ 1 ant a general conlractur and 1 G. ❑ New construction
c llployces(lull and/or part-time).* have hired the sub-contracture
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. E] Remodeling
strip and have no employees 'These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. y. F-1 Building addition
[No workers' comp, insurance 5. U We are a corporation and its
required.] officers have exercised thcit 10.E] Electrical repairs or additions
3.❑ 1 our a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ toof repairs
insurance required.]i employees. [No workers'
comp. insurance required.] 13. Other c v��a w v G
•Arty applicant(hat cheeks box f!I must also fill out the section below showing(heir workers'compensation policy information.
t I lomeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
lContraclors that check this box roust attached an additional sheet showing the name of the sub-coutraclors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance fur my employees. Belo iv is the policy and job site
information.
Insurance Company Name: 7— Expiration Policy# or Self-ins.Lic.0: C–V/C, 03 4 g Dale: 3 I 9
Job Site Address: .3(01 VaK+(?I/ 162-c's . City/State/Zip: ' --(C)re4^"C- I AAA 0 CCUiv2
Attach a copy of the workers' co 1 pensatiun policy declaration page(showing the policy number aud.expiration date).
.Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crunulal 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 Ile pansy d pet It' of perjury that the information provided above is true and correct.
Si nature: ����'��`'�`% �_`' Date: t 1 D�
Pholle It:
Official use only. Do not write in this area, to be completed by city or toiwl official.
City or Town- Ile rmit/Licerise di
Issuing;Authority(circle one):
1. Board of Ilealth 2. Building;Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
G.Other
Contact Person: Phone Ih
SECTION 8-CONSTRUCTION SERVICES
8.1 licensed Construction__Supervisor: Not Applicable ❑
Name of License Holder: l��-OLIV.1 e c � A-
license Number
QD o x u 5 5 3 3 3
Address Expiration Date
gyee -C AA_A 013 02- -7 `7 2—la 2(-7 / l
Signature Telephone C) O
9.Registered Home Improvement Contractor: Not Applicable ❑
Company Name Registration Number
Po 210 x / o v o� I
Address � Expiration Date /
t7i 3O� Telephone '77)--`(PZ1 —] c]6 O�'��01 (3
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 buildi g 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 lure 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 wilt be required frvhn tone to lime,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers'Compensation) grid 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 asstanes 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
MW
SECTION b-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement ndows Alteratlon(s) Roofing E]
Or Doors [�
Accessory Bldg. ❑ Demolition ❑ New Signs [Cl) Decks [Q Siding[lam] Other[Q
Brief Description of Proposed_
Work: t'
i S n p r � �-f-
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
8a.If New house and or addition to existinq 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
1' 4' J J �,-e S as Owner/Authorized
Agent hereby declare that the statements and r(iformati on on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
1 it,c�tl r-P�.C,Z A , J t�'-bL' -j-y% �re S
Print Name ;4*
o
Signature of Owner/Agent Date
s Department use only
C ity of Northampton Status of Permit
ullding Department Curb Cut/Driveway Permit
1212 Main Street Sewer/Septic Availability,
} Room 100 Water/Well Availability
orth mpton, MA 01060 Two Sets of Structural Plans
phone-581240 Fax 413-587-1272 Plot/Site Plans `
; ��OS10 Other Specify
t4 � �Q _Ai1� ONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLI NG
SECTION 1 -SITE INFORMATION
1.1 Property Address: This section to be completed by office
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 Mailing 11dress:
Telephone
Signature
2.2 Authorized Anent: n
��Y-e r.,c e� j,,� :J t.- ��e �� 0 ox �d2`'1 �v'���-�e C /V�A
Name(Print) + _.. Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS -7
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building -7 (a)Building Permit Fee
} ov. v�
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) '.5 `7 D 0, 00 Check Number ( c `
This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commissioner/lnspector of Buildings Date
I ; , BP-2009-0553
GIS#: COMMONWEALTH OF MASSACHUSETTS
t"I &l _ 1 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-2009-0553
Proiect# JS-2009-000789
Est.Cost: $5700.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq.ft.): 42340.32 Owner: SZYMANSKI STEPHEN S&IRENE
Zoning:RR(100)//WP/WSP II Applicant: THE JUBB CO INC
AT. 361 SYLVESTER RD
Applicant Address: Phone: Insurance:
P_O Box 429 (413) 772-6217 Workers
CoLnpensation
GREENFIELDMA01302 ISSUED ON:121112008 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 12/1/2008 0:00:00 $35.0011158
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
MW