35-077 (4):;:,���� ✓lZG' ��i�Il?i�>'L<YJ'LCf1G'<,�LGII- U , �/G'�,<XiJJr',rt�l2CGQ�%!�
�:. Board of Buildin g I�e ulations
One Ashburton Place, m 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/21/1961
Number: CS 055333 Expires: 05/21/2006 Restricted To: 00
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 01302
Tr. no: 21956
Keep top for receipt and change of address notification.
i
uirci+ru�rrucall/c r/;;/��,r,�rrc'IIriJCLIJ (
BOARD OF BUILDING REGULATIONS
f License: CONSTRUCTION SUPERVISOR
Nurnbor: CS 055333 I
Blrthdate: 05/21/1961 I
'nnal•rrnrtnn.r•c Explres: 05/21/2006 Tr.no: 21956
I
Rostrlctod: 00
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD. MA 01302
kciing C unit onor
R tie -�
Bea � � - ,,��. '�
o uil >n�,�'e Tula`/"ons and
b ��anda
One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
Tile Jubb Company, Inc. Expiration: 6/8/2006
Larry Jubb Jr. _ _._.._ .... ..
O BOX 429/ 7 DEVENS ST
Greenfield, MA 01302
llltd:tle Address and reltu•u card. Murk rer►sou for change.
1 Address 1 .1 Renewal 13 L;rnployureut ._I Lost Card
COIF mONNVUALI'll O IVIASSAC:IIUSL'I'•L'S
DU'A1CV1Y1LeN'l' QF 1NDUS'I'It1AL ACCIDL"N'I'S
600 VVAS111NC'MN
IIVS'1'UN, IVIASSACIIUSI I"I'S 02111
WOItIMItS' COMI'I NSA'I'ION INSURANCE AFFIDAVIT
The Jubb Co, Inc d.b.a. Larry Jubb's Improve-h-home
(liccuscc/pertniltcc)
with a I?riticipal place of bushiess/residence at:
7 Deveris SL-reeL 1'.0. Box 1129 Greenfield, hi<I. 01302-0,129
City/5lule/'Lill
do licreby eerlify, mider [lie pains and IIe11alticS Of Marjory, dolt:
M 1 11111 11n empluyec providing thu followinL, worker;;' CmIlj)cii:;;Itiun cuveral;e Cur Illy etnitlUyceti
working un this job.
GUAM _ JUWC905194
Insurance Cump11r►y Pulley Number
( ) I am at sule proprietur and have tit) one wurking I'm- Inc.
( ) I a111 a sole pruprietur, general wnll•,uctulr ur, lluilleowner (circle one) and have hired U1e cunU•acturs
listed below who have the l'olluwing workers' c>ompenratiun insur-mice pulicies:
Naiiie of Contractor Insurance Cumpauy/Policy Number
Naine of Contractor Insurance Cumpany/Policy Number
Name of Contractor lllsurance Cunlpany/Pulley Number
( ) I am a homeowner performing all the work myself.
NOTE: Please be aware that while 1loutcowncrs who cmploy persons to du maiutenaucc, construction or repair work
on a dwelllug of not more thaw three wilts in wlilch ilia homeowner also resides or oil (lie grounds appurtenant thereto are not
generally considered to be employers under (lie Workers' Compcusatiun Act (OL C. 152, sect. 1(5), applicallon by a
homeowner for a license or pernilt may evidcuce ilia legal status of an cmpluycr under ilia Worker's Coutpcusailon Act.
I widerstaad that a copy of this statemci t will be forwarded to the Department of Itdusirlal Accidents' Office of lusurauce for
coverage verification and that failure to secure coverage as requlrcd wider Section 25A of MOL 152 call lead to ilia Inlpusitiort
of crin►hial penalties consisting of a flue of up to$15UU.W and/or imtprisum emit of up to one year and civil penalties lm ilia form
of a Stop Work Order lord a Chic of$IUU.UU a day against Inc.
Signed this clay of ONE.70
LicenseelPerinittee Licelnsor/P - roil 1'
Page No. of Pages.
1 1
THE JUBB CO,, INC.d.b.a.
LARRY JUBB'S
IMPROVE-A-HOME 7 Devens Street 18 North Hatfield Road PROPOSAL
P.O.Box 429 Hatfield,MA 01038 MA Registration 100001
Greenfield, 0429
77 2-6217 Northampton,MA MA Cons. Sup. Lic. 055333
(413)77 6217 (413)584-3716
PHONE DATE
TO Hayden.Diana
Road JOB NAME/LOCATION
842 Ryan
Florence,W.01082 �2-� UPPER REAR DORMER ROOF (only)
842 Ryan Road
Florence,tuts. 01082
JOB NUMBER JOB PHONE
We hereby submit specifications and estimates for:
-SUPPLY & INSTALL ELK PRESTIQUE 1 SERIES 30 YEAR ROOF SHINGLES-
-choice of color: 115 IW In
-remove and dispose of *existing shingle layers. (*up to 2 layers.) a�
-replace up to 3 @ 4' x B' x 1/2" cdx plywood as necessary. i ,
-*supply a install 3' width of ice and water membrane at roof bottom. '
-supply & install 15 lb. felt to remaining exposed wood. Cy
-supply & install 5" aluminum drip edge to all fascias. color: (�L, ) •
-supply & install 01 vent stack boots. same d-S 1 -trerz 0
-rake and broom clean job site daily at and of each working day.
-30 year limited shingle guarantee from manufacture. (see separate copy of manufactures
warranty) .
-labor guarantee as required by MA building regulations and standards.
-any work not described herein will be executed only upon a mutually agreeable written chant
order.
-lower rear fiberglass sun porch roof may sustain damage while upper roof work is performed.
Jubb will protect roof as best possible from debris but Jubb does not assume liability for
leaks present or future as a result of existing conditions or of said work performed as
described herein.
-upper rear fiberglass door canopy to be removed by homeowner prior to roof work start.
-roof work is only to upper rear dormer roof.
-gutter and gutter helmet to be removed and reinstalled by Jubb.
SERVICE FEE: $375.00 (includes permit & disposal of all job related refuse) .
[service fee not included in total at bottom & in to be billed as separate] .
W(9 1PIP®1P®Z(9 hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of:
Three Thousand Fft Six and 00/100 Dollars dollars Is 3,058.00 >.
Payment to be made as follows:
$1,000.00 DEPOSIT UPON ACCEPTANCE, INVOICES ARE DUE UPON RECEIPT!An Interest charge of 2%per month
(24%per annum) on past due balances,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 professional
manner according to standard practices. Any alteration or deviation from above specifiea- Authorized -
tions involving extra costs will be executed only upon written orders,and will become an Signature V
extra 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 may be
workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within 30 days.:,
�cG10 6l�Q�11II1�G 9! r(y ' �II'��)itll�X1)1
—The above prices, specifications / ��
and conditions are satisfactory and are hereby accepted. You are authorized signature i
to do the work as specified. Payment will be made as outlined above.
� .� Signature
Date of Acceptance:
4.tti/tNp�O
8 � w
B 6 �asascknactia'
DEPARTMENT OF 13UILDWG INSPECTIONS
212 Main Street ' Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I,
(Iicensee/permittee)
with a principal place of business/residence at:
(street/city/statr/ap)
do hereby certify, under the pains and penalties of perjury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
(Insurance Company) (Policy Number) 01xpiration Date)
( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date)
(Name of Contractor) (Insurance Compauy/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Compaay/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(artads additiocul:bed ifneocniry to include informs ioa pertaining to all ooatraaors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that vihile homeowners who ernplGy pazotu w do m iTltM l f„C wustvction or tcpair work on a dwelling of
not mere than throe units is which the homeowner rides or oa tbo grounds appurtens thacto arc not gsacraily oowidered to be
cmployrta under the%Ym er's compeas4oa Act(GL152,ss 1(5)),application by a homeowner far a Gecase or penn2 nay evidence the
legal ctvtu of en employer under the Wockeet C*oVaxmtioa AcL
I undcrslaad that a copy of this wlemmi may be forwarded to the Dcpaitmcai of Industrial Acdd=&Offioo of fasur+oeo for the
eov=ge verification and that failure to secure covecngo under section 25A of MGL 152 can lead to the imposition of aimi pcaaWl:s
o0au ding of a floe-of up to S1,500.00 anNoe imptisotm ent of tip to one yew and civil pemlties in the form of a stop Work Ord--and a
firm 0(5100.00 a day against mc.
For d —Ouly
permit Number
wisp# Lot 4
Y k Signature of Licensee/Permit tce
j 1
' 9rk � 3b` s'�'yFba b t .:`"X3'9 A'
SECTION 8CNSTRUCTION SERVICES
J l 1
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
Signature Telephone
Re redmmprov.merit Contracts �• y, � � Not Applicable'.0
Lkru .,,
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10 WORKERS'.COMPENSATION1NSURANCE AFFIDAVIT(M.G.L. c. 152, § 25_G(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affid,
will result in the denial of the issuance of building permit.
Signed Affidavit Attached Yes....... No...... ❑ --�-
. VX
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
SECTIOIV¢3' ft ChMPT101 ;'0 ROPkOSED� CORK`rc ieckeall a hcable „
6'fR':.+,+?��'XF,
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ti-l''.
Or Doors ❑
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ J Siding( J Other[ ]
Brief Description of Proposed Work: � C'1 � ��( � ✓ CSC- � 7� .-,c, F ..,
.13x 'ct' " V120r'� r'T`1 c rl dad .
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll o . Sheet o
aIf Newhouseardodtlitionto existinghoushng,`completefhe 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. 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 .
1. Septic Tank City Sewer Private well City water Supply
SECTION ,' OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS gGENT�OR CONTRACTOR ApP�IES;F'ORfB UILDING PERMIT,
j, 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
I, 1,6,u..;r t -)Le / 1 `..VJ 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.
v Signed under t e pains and penalties� o P er 1 u- ry.
C _
�
i7)
Print Name
Signature of Owner/Agent Date
c
Section 4.
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE
DENIED DUE TO LACK OF 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 ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
r
' f
-Cit ' of.Northampton a
�'Buhdi.ng Department
212 Main Street S
-, .,.� _ Room 100 a
Northampton, MA 01060 o its o
phone 413-587--124q Fax 413.587-1272 Plol.. itez.
i
P
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITI=INFORMATION
1.1 Property Address �Ths section to be completed byoff�ce
.?�
� � y �
its I, 1 a 1 Zone Ouerla Distr
{
Elm Si. Distruf CB Dist �ct
SECTION - PROPERTY;OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: r
Name(Print) Current Mailing AddreS
�r - h
Telephone
Signature
2.2 Authorized Agent:
Name(Print) -, Current Mailing Address:
Signature Telephone
SECTION 3 ESTIMATEb CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
coin' leted buy pen-lit a `lica,
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 =(1 + 2 + 3+ 4+ 5) Check Number
This Section For Official Use Only
Building Permit iNurinb6 r:` Date Issued:
Signature:
Building Commissioner%inspector of Bu�ldtngs Date
842 RYAN Rb BP-2005-0892
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:35 -077 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2005-0892
Project# IS-2005-1238
Est. Cost: $3056.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq.ft.): 19906.92 Owner: HAYDEN ROBERT F&DIANA L
Zoning: SR Applicant: THE JUBB CO INC
AT. 842 RYAN RD
Applicant Address: Phone: Insurance:
P 0 Box 429 (413) 772-6217 Workers
Compensation
GREEN FIELDMAO1302 ISSUED ON:3124105 0:00:00
TO PERFORM THE FOLLOWING WORK.-REPLACE SHINGLES ON UPPER MAIN ROOF
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 3/24/05 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo