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Board of Building Regula Xons and Stwidards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License License CS: 55333 Restriction: 00 Expiration: 5/21/2010 Tr# 25298 LAWRENCE A JUBB JR - PO BOX 429 GREENFIELD, MA 01302 Update Address and return card.Mark reason for change. 'Al a'3 50M-07/07-PC 8490 Address Renewal Lost Card Boar o uil in tlao/onts�/an g t One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100001 Type: Private Corporation Expiration: 6/8/2010 Tr# 267161 The Jubb Company, Inc. Larry Jubb P. O. Box 429 --- ----- - ----- - -- -- - - - ---- Greenfield, MA 01302 ---- — __ Update Address and return card. Mark reason for change. 50M-07/07-PC8490 F]:At ti ( ] Address [—] Renewal � Employment i-1 Lost Card The C;ontmoitiveulllt of 11/ussac/tt►selfs -r Uc1x►rintcnf r f fit rlusfri(i!Accidents Ojjice oj•1►lvesligalions 600 Mislt►n/,ion Streel _ 13os/on, AM 02111 lvww.nu►ss.govIdia Workers' Cotupeusation Insurance Affidavit: 13uiILIers/Contractors/l lectricians/Plumbers Aimlicant Itirormation Please I'I•int 1,egibly Nat11C (Busincss/organnizatiou/ludividual): Address: City/State/Zip: �t,�-��l MA 0130.)_ 11110lle it: `1�� —�z►`7 Are u an employer?Check the appropriate box: Type of project(required): 1.19 1 ant it euployer with_ 6 ❑ 1 ant .1 general contractor and 1 6. ❑ New consU ucliott eutployces(full and/or part-Bute).* have hired the sub-contractors 2.❑ 1 aul a sole proprietor or partner- listed on the attached sheet. 1 7. ❑ Remodeling ship and have uo eutployees 'These sub-contractors hove 8. ❑ Demolition working for me in ally capacity. workers' comp. insurance. J. ❑ Building addition [No workers' comp, hlsurance 5. U We are a corporation uud its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I our a homeowner doing all work right of exemption per MGL 1 I.❑1'lurnbing repairs or additions Myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.)t employees. [No workers' 13.EvrOther h e�s o-1'6" S comp. insurance required.] *Any applicant(lint checks box#1 must also fill out the section below showing their workers'compensation policy information. t llonrcowners who submit(Iris affidavit indicating they are doing all work and Inca hire outside contractors must submit anew affidavit indicating such. iContraclors that check llris box nmst attached au additional sheet showing flit name of the sub-coidractors and tlicir workers'comp.policy information. lam art employer that is providing workers'compensation insurance for►ny enTloyees. Belo►v is the policy and job site iirfurmation. Insurance Company Policy 11 or Self-ins.Lie.It: ( ,W L 03 9_41_1 g Expiration Date: 5/ 3 /0 9 Job Site Address: 14-9 G O�S Uc-� City/State/Zip: �0 M A Ut Attach a copy of the workers' compensation 1 olicy declaration page(slrolving the policy utuubcr and.expi • 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 imprisomnent,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 cerlyy underlhe pains d pe Ifies of perjury that the i►fornmliat provided above is true and correct. Signature: �'y" � ' Bate 1 t /�i J 0 I'llolle il: Official use arty. Do not►price in this area,to be completed by city or town official. City or Town: 1'crmil/Liccusc ll Issuing Authority(circle out): 1. Board of Health 2. Building Deparlment 3.Cityll'own Cleric 4. Llectricul Inspector 5. Plumbing Inspector 6.Other Contact Person: !'hone il: 'AL Page 2 of 2 Phillips Enterprises, Inc. 586-5860 11/17/08 149 Easthampton Road _ Northampton, MA. 01060-4199 K dl area of manufacturing building i I + in looking for and the clean up of same after roof work is completed and to look for nails l that may present themselves as much as several weeks or month's from job conclusion. Jubb will not assume liability for flat tires. AREA WHERE ROOF TO HE INSTALLED: -rear of manufaturing building where rolled roof material is leaking. approximately 674sf. OTHER: 1 ) . upper roof deck area that intersects this roof is rubber and is folded onto same. Jubb will have to cut back and re-attach with a tie down bar and sealed accordingly. nTJVL:VV j w�n.T: , 1) . up to 12 ::beets of 1/2 cdx (5 ply) plywood are included in price below, a pro-rated adjustment to the final ir:voice will be made if more or less than 12 sheets are used. per j sheet pro-rata cost including labor is $41.00 SERVICE FEE: $625.00 (includes permit & disposal of all job related refuse' . [service fee not included in total at bottom & is to be billed as separate,i . f i i �IYCe 'i .vii it]iiu [�.'✓!: ;.un,.:..�,;. ..�y. ..y ...I,.d anc l)(1/I V6, l '.� )•.�, ,Uff. i � id �' 3,583.00 $i, UC.CC ;;'ZIOSIT JPON ACCEPTANCE. INVOICES ARE DOE UPON RECEIPT! An interest charge of 2% per month (24'd per annum) on past due balances, plus all costs, including reasonable attorney's fees, incurred in collecting any sums owed. -� r 30 ays. 5 11/1.9/2008 14:38 FAX 4135170022 PHILLIPS LNTERPRISES 10 001 7)a SAL w: Page 1 of 2 Phillips Enterprises, Inc. 586-5860 11/17/08 149 Easthampton Road Northampton, MA. 01060-4199 kear area of manufacturing building I -SUPPLY & INSTALL ELK PRESTIQUE 1 SERIES 3D YEAR ROOF SHINGLES- -Choice of color: 9/a e,k ) -Remove & dispose of *existing rolled asphault layer. (*one layer. ) -Replace up to 12 @ 4 ' x 8 ' 112" (5-ply) cdx plywood as necessary. -Supply & install rubberized ice & water membrane to entire roof deck before shingling. -Supply & install 8" aliminum drip edge to all related fascia edges. color; white. -Supply & install aluminum flashing at intersecting area of upper rubber roof. -Rake and broom clean iob site dailv at end of each working day. -30 Year limited shingle guarantee from manufacture. (see separate copy of manufactures warranty. -Labor guarantee as required by MA board of building regulations and standards. -Any work not described herein will be executed only upon a mutually agreeable written change order. NOTICE: 1) . building owner to provide a suitably accessible location for roll off dumpster placement . owner is advised that due to weight of dumpster that damage may possibly occur at location where dumpster is placed. Jubb nor the dumpster company will assume liability for said possible damage. 2) . it is the owners responsibility to cover and protect items stored below roof area where dirt, dust or debris may fall due to nature of roof work, clean up of dust or debris to these areas to be the responsibility of the homeowner. 3) . Jubb will make every effort to protect lawns, sidewalks, exterior walls of building, etc. however some damage to these or other areas of owners property may unfortunately occur due to nature of work herein. 4) . Jubb will. make every effort to clean up nails from ground: (lawns, driveways, etc.) it is also the responsibility of the owner to exercise reasonable dilliger.ce Cont'd — - - ::_i'!''_"'_" 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. r nL, 30 �ays. SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: l)r Per C1tr d t • -) ��_�g J. ��� 1� J'�' ©!51 License Number Address b_ Expiration Date Signature Telephone 9. Registered Home Improvement Contractor: Not Applicable ❑ b I D 0,-3 Compan/y�Na�me �1 q Registration Number P0,.0, &0)( 0�o O? d2U 1 Address (� I qn /� / Expiratio Date Gvee4,_ I ed d M A 4 t 3 V � Telephone7�� _t02-( 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 buildog permit. Signed Affidavit Attached Yes....... d 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.Aperson 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 upou completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers'Compensation) and Cbapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for persons) 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 SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors L] Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [Q Siding[0] Other[� Brief Description of Proposed Work: Q Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet 6a.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. I. 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. ,y, Signature of Owner Date 1, ,)r-2� Q-, "A V". 0,�-e s - ,as Owner/Authorized Agent hereby declare that the statements a d inforniation 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 f Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Availability. Room 100 Water/Well Availability. Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans — t Other Specify i1 APPLICATION TO CONSTRUCT,ALTER,REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 7 1.1 Property Address: This section to be completed by office 14`1 �=�' �` Map Lot Unit (� u-� Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: LL� -F� -cam . ` `ter_ 121 Name(Print) Current Mailing Address: Signature Telephone ct� 2.2 Authorized Aaent: n a,w,--e� A . /lr`�A Name Print f ( ) Current Mailing Address: 4:12��__77" -49 7 -7�z_—6,2j —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 3 583 . O a 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) 3 S�3 . 00 Check Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date ` ' t BP-2009-0573 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 c.142A) Category BUILDING PERMIT Permit# BP-2009-0573 Project# JS-2009-000814 Est. Cost: $3583.00 Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THE JUBB CO INC 055333 Lot Size(sq. ft.): 451717.20 Owner: PHILLIPS WILLIAM L TRUSTEE Zoning: GI(100) Applicant: THE JUBB CO INC AT. 149 EASTHAMPTON RD Applicant Address: Phone: Insurance: P O Box 429 (413)772-6217 Workers Compensation GREEN FIELDMA01302 ISSUED ON.121412008 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP, PLY & SHINGLE 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 12/4/2008 0:00:00 $60.0011155/11165 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo