25C-089 (2) ,,r
COMMONWEAL'1'I-I OF MASSACHUSETTS
DEPAR'TMEN'T' OTC' INDUSTRIAL ACCIDENTS
600 WASHINGTON STREET
BOSTON, MASSACHUSETTS 02111
WORIM,RS' COMPENSA'T'ION INSURANCE AFFIDAVIT
1 The Jubb Co, Inc. d.b.a. Larry Jubb's Im rove-A-Home
(licensee/permittee)
with a principal place of business/residence at:
7 Devens Street P.O. Box 429 Greenfield, Ma. 01302-0429
City/State/Zip
do hereby certify, under the pains and penalties of perjury, that:
M ll am all eniployer providing (lie following workers' compensation coverage 1'or illy employees
working on this job.
GUARD JUWC905794
Insurance Company Policy Number
O I ant a sole proprietor and have no one working for me.
O I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors
listed below who have the following workers' compensation insurance policies:
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
Name of Contractor Insurance Company/Policy Number
( ) I am a homeowner performing all the work thyself.
NOTE: Please be aware that while homeowners who employ persons to do maintenance, construction or repair work
on a dwelling of not more than three units In which the homeowner also resides or on the grounds appurtenant thereto are not
generally considered to be employers under the Workers' Compensation Act (01,C. 152, sect. 1(5), application by a
homeowner for a license or permit may evidence the legal status of an employer under the Worker's Compensation Act.
i understand that a copy of this statement will be forwarded to the Department of Industrial Accidents' Office of Insurance for
coverage verification and that failure to secure coverage as required under Section 25A of MGL 152 can lead to the Imposition
of criminal penalties consisting of a fine of up to$1500.00 and/or imprisonment of up to one year and civil penalties in the form
of a Stop Work Order and a fine of$100.00 a day against me.
Signed this day of Oc. Le-i— 3H 2n s
'441 Llid
Licensee'Nermittee Licensor/P Init r
"�ll Iy JYL(YJ (IleatI6 1, 0
Board of Building equlations
4.' One Ashburton Prace, fpm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPE=RVISOR LICENSE Birtlidate: 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.
uiiciiruirrucul</c r��.lf�.uu�ridell� I
BOARD OF BUILDING REGULATIONS
I cl License: CONSTRUCTION SUPERVISOR
Number: CS 055333
Birthdate: 05/21/19(31 I
'nno►•91^l1^n_ec Expires: 05/21/200(3 Tr,no: 21956
! Rostricted: 00
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 01302 4Cj,'-j'jI Actin g s onor
Zltte
B a ull inela�fitoii
� b sand an ar s
jV One Ashburton Place - Room 1301
Boston, Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
The Jubb Company, Inc. Expiration: 6/8/2006
Larry Jubb Jr.
O Box 429/ 7 DEVENS ST
Greenfield, MA 01302
tlpdnte Address will return au tl.M►u•I(reason fur change,
I Address 1 .1 Itenewal 1=1 Employment I"'� Lust lge.
Replacement obn 3p opo5ar Page No. of Pages
me `nb
Main Office: L L- [, (!
7 Devens Street• P.O. Box 429 THE JUBB CO., INC. d.b.a. Northampton, MA:
Itield, MA 01302 LARRY J U B B (413) 584-3716
(413) 772-6217 Brattleboro, VT& Keene, NH
18 North Hatfield Road IMPROVE-A-HOMEsM 1-888-639-JUBB
Hatfield, MA 01038 Email: JubbCompanyinc @aol.com
PROPOSAL SUBMITTED TO PHONE DATE
STREET JOB NAME
3 Z. /V e i✓ _
CITY,STATE AND ZIP JOB LOCATION r
lko Ayu S (aJ
TENTATIVE JOB SCHEDULE( eathe ermitting) MA Registration 100001
Approximately weeks from date of signed proposal received by Jubb Co., Inc. MA Cons. Su . Lic. 055333
We hereby submit specifications and estimates for:
Supply & Install Mastic ;;Zayae T&4ZazAvcd 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 guar ntee on vinyl window frame.
• Labor guarantee as required by CTQ NH, VT contractor regulations.
Color: Linen White ❑ Almond` (*extra charges apply for this colors)
TOTAL UNITS REPLACED: �c7u(3L,� -lltllS��-
❑ Grids (Note: Grids are beveled)
Low "E" Glass�JL ❑ Arg0 insulation (into weight pockets) (;V-Storm Window Removal fZ
❑ Aluminum Clad/Exterior Castin s ( ❑ Full ❑ Partial )
OTHER / NOTE: J 1�
o�
y
Ecp SION4SERVICES
8.1 licensed Construction Supervisor: Not Applicable ❑
Name of License Holder A • '-J "6 �) ► i�r-�S �`mss 3 � 3
�T License Number
Address / Expiration Date
Signature Telephone
Not Applicable-J3
I 0 0 0 0 1
Company Name Registration-Number
P a x 4�� e nk a 0 z (0/�-
Address Expiration IYate
Telephone 7-7 2-
0ON ' ORKERS' COMPENSATION�INSU ANCE_A.FFIUAVIT.(M.GL. 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...... ❑
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
Wl' lQ P +I .3p f • li
New House ❑ Addition ❑ Replaceme t Windows Alterations) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other[ ]
Brief Description of Proposed Work: C Ui O <�
Alteration of existing bedroom Yes No Adding new bedroom Yes o
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll O. Sheet❑
Ml`fiN.. ho se nd Wdtli'.t°to"n toTexxig-i-n-L-7tho singe, comptetelb-eTfollow:ing:
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
L 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
ya
S (34TH N7a 0 E UF�OtZA tON" OBE 0 P�tE7 ED W,iiEN
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, f-- ^% ��-e— J a,� b, J 1' ►�� 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.
l.rGu,v .J t.l�la J v^
Print Name
Signature of Owner/Agent Date
`I � = i`ty of Northampton
, Oildin De artment
il' ' g P'212 Main Street
Room 100.
G005 ,i,' t ampton, MA'01060
OCL " phoje 13 5 7-1240 Fax 413-587-1272
'
I �rn1 I � nc,C
q LlCAjJ � dNST CT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
�ECTIOt4&.'.' ON
1.1 Property Address:
4- 6- 11-� �- A-v e—. a o
Iy y 1,4 ���n� one
t 0 a s
_t
, Elm St ;District
$ECTION'2 PRO PERTY;'�",q ERSNI VAUTHORIZED,�AGENT�
2.1 Owner of Record:
J Pmt 4-- �.u e w A-y 2 .
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent:
(9c> a,r, d AAA
Name(Print) Current Mailing Address: 3G
,t `7 -2 2-1`1
Signature Telephone
E(TbN
3 TIMAT 'CONfft )G'TIONC bSTS
Item Estimated Cost(Dollars)to be ;Qfficial Use Only
completed by ermit applicant
1. Building (a)'Buildmg"PerrnJ '!Fe� �
2. Electrical (b)Estimated TotalCost of
Constrbcti on rfrojn `6
3. Plumbing Building Permit F#e' r
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(I + 2 + 3+4 + 5) -7576), 00 Check Number
This:Section For Official Ilse Oril
�utl'dtngP�erthrxi�lµmf�e ,, Date Issbed, b tta
"
xr , I 4 ��! + a if '
gal.nx.:�hu ,allaltl.u .r nu.1ll7rr4 �,jt Y',
w
Ft f u Y 1 r ¢M17tIA�Y�M 1. 1i l.�
, ,, uiJ ing Corlmissio..tlerll.�.P.gctor
34 LINCOLN AVE BP-2006-0410
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:25C-089 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0410
Proiect# JS-2006-0594
Est. Cost: $750.00
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq.ft.): 16422.12 Owner. BRASWELL JEAN A
Zoning.URB Applicant. THE J U B B CO INC
AT. 34 LINCOLN AVE
Applicant Address: Phone: Insurance:
P O Box 429 (413) 772-6217 Workers
Compensation
GREENFIELDMA01302 ISSUED ON:1011312005 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 10/13/2005 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
3&eptarcmettt Winbobi Propont Page No. of Pages
Main Office:
7 Devens Street• P.O. Box 429 THE JUBB CO., INC. d.b.a. Northampton, MA:
_.;t Itleld, MA 01302 LARRY J U B B�� (413) 584-3716
(413) 772-6217 Brattleboro, VT& Keene, NH
18 North Hatfield Road I M P ROV E-A-H O M ESM 1-888-639-JUBB
Hatfield, MA 01038 Email: JubbCompanyinc@aol.com
PROPOSAL SUBMITTED TO PHONE DATE
STREET JOB NAME
31K /- /c i✓ 4 k�
CITY,STATE AND ZIP JOB LOCATION
IUo 'S
TENTATIVE JOB SCHEDULE( eathe ermitting) 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 ;eeyae 2Wa,tetotd 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 guar ntee on vinyl window frame.
• Labor guarantee as required by CTQ NH, VT contractor regulations.
Color: Linen White ❑ Almond* (*extra charges apply for this colors)
TOTAL UNITS REPLACED: 44IL.11l"
❑ Grids (Note: Grids are beveled)
INA L ow "E" Glass��', ❑ ArgonN insulation (into weight pockets) 1/� (>e-Storm Window Removal 1/ s
❑ Aluminum Clad Exterior Castin s ( ❑ Full ❑ Partial ) / J
OTHER NOTE:
00
t� a5
SERVICE FEE: $125.00 (includes permit and disposal of all job related refuse.)
[service fee not included in total amount below, and will be billed separately.)
CONTRACT SERVICE CHARGE:An interest charge of 2%per month(24%per annum)will be added to outstanding balances over 30 days,
plus all costs,including reasonable attorney's fees,incurred in collecting any sums owed.
We prop05C hereby to furnish material and labor-complete in accordance with above specifications, for the sum of:
J I-e-A �Ait�" �: IV I � D,o C 00
6t dollars ($ -7 J Q ).
Payment to be made as follows: 4t�o
1/3 DOWN PAYMENT UPON ACCEPTANCE Make checks payable to: The Jubb Co., Inc. (Our installers will collect final
balance upon completion).
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 OA fi
tions 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 proposal lay be
workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within THIRTY days.
Z.rceptance of propoga[-The above prices,specifications and
conditions are satisfactory and are hereby accepted.You are authorized to do Signature ZC
the work as specified.Payment will be made as outlined above.
Date of Acceptance: f�/��l Signature
WHITE-Remittance Copy YELLOW-Customer Copy PINK-Office Copy