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17A-045 91le _60w&;W1w1"111ea1w11. 0111-1141jad"w6eff'j. Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 - -v- Construction Supervisor License License CS: 55333 Restriction: 00 Expiration: 5/21/2010 TO 25298 LAWRENCE A JUBB JR PO BOX 429 -- -- - -- GREENFIELD, MA 01302 - - -- - --- Update Address and return card.Mark reason for change. 'S-CAI 0 5OM-07/07-PCO490 Address r lienerval ( I Lost Card ne -� �� Boaw �jjjg egul a ons an �tandars One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100001 Type: Private Corporation Expiration: 6/8/2010 TO 267161 The Jubb Company, Inc. Larry Jubb P. O. Box 429 Greenfield, MA 01302 Update Address and return card. Mark reason for change. s.cAl 0 50MV07/07•PC8490 [) Address ❑ Renewal ❑ EMPloyment Lost Card The C.'onrnron►vealih oJ'1llassachnsetty Department If hulrr.vtrial Aecidenty —_ Office ofltrvesligatiolrs 600 Mishington .S'lreet Boston, JIM 02111 IV)VIP.ma.v.v.go v/clia Workers' Corupensaliou lusurauce Affidavit: 13uilders/Contra cloys/Electr'ici.uts/Pluntuet•s Aimlicant Inrornlation —7-- Please Print Legibly Natne (Business/Org<urizatiort/ladividual): Address: C). City/State/Zip: MA Ot3(D.)_ Phone Ih __7 Are ydu au employer?Check the appropriate box: Type of project(required): 1.Ly 1 am a employer with GD 4. ❑ 1 aril a general contractor and 1 G. ❑ New construction employees(full and/or part-lithe).* have hired the sub-contractors 2.❑ 1 ant a sole proprietor or partner_ listed on the attached street. t �• ❑ Remodeling ship and have no employees "These sub-contractors have 8. ❑ Dcutolitio❑ working for me in any capacity. workers' comp. insurance. I. ❑ Building addition LNo workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions thyself. [No workers'comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13.❑ Other *Any applicant that checks box//I must also tilt out the section below showing their workers'compcnsatiou policy information. I I lorneowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workcrs'comp.policy inrormation. I am an employer that is providing workers'compensation insurance for my employees. Below is III policy and job site information. Insurance Company Name: r �t�� Policy it or Self-ins.Lic.it: (✓t VJ L 03_9 4 g Expiration Datc: Job Site Address: 1 gi7 r-� ��� • City/State/Zip:--f � c'�I o Attach a copy of the workers' compe t number policy declaration page(showing the policy wuber and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to Vie imposition of criminal 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 Ire pains it pet It' of perjury that the information provided above is true and correct. Signature: Date: Phone/h `-7 rl 2 —(v Z•-t'7 Official use only. Do not write in this area, to be completed by city or lo►vn official. City or Town: Permit/License 11 Issuing Authority(circle one): 1. Board of hlealth 2. Building Department 3. Cilyffown Cleric 4. Eluclricul Inspector 5.Plumbing Inspector G.Other Contact Person: Phone Ih 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 p'� DATE NF— M 6 Vv D --e=- t STREET JOB NAME o CITY,STATE AND ZIP JOB LOCATION yd a�-a 1) AS s J B l k lP l ARCHITECT f DATE OF PLANS JOB PHONE MA Registration 100001 Y- S(•t/`�p MA Cons. Su . Lic. 055333 d� We Hereby submit specifications and estimates for: ' 11�_ �Cl�1 � �!� 51/N.►% � u1� c s /Y' /�� W <'l u J '/ Yr Std- c1/ G6JS f o i A/N'{A elt / i- �� ,SP jo'r 86.1- cut;A ('006ffi �M 0,F9 ✓'5;b 1cTrns- A. et Nokc R -� eRUIC�'�`• \1'1(aS IUC;,��c p� CL'!'mo� f �� �loc�sn c- ,F A �[ -rrs,g�rrr,� R�Gus'F� S CkFkP-( N aukereA , c of a AVAW SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Constructi1onS,uaervisor: ii Not Applicable ❑ Name of License Holder: �- ^' A- J Ca b J �• PY e S. 6 s 3 License Number Address Expiration date A Signature Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ J �b Co 'L • . 1 0000 1 Company Name Registration Number Po �°I 0�,Z 0 8 02o I o Address 1 Expirati n Date A A D ( 30 'y Telephone 7 7 2 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 building 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 hire 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 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(s) 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 Q Addition ❑ Replacement vAndows Alteration(s) Q Roofing Q Or Doors (®', Accessory Bldg. ❑ Demolition ❑ New Signs [lam] Decks [[] Siding[O] Other[E1] Brief Description oqf Propose Work: -L tA- 4-A LA) Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet Ga.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. u. t Signature of Owner Date as Owner/Authorized Agent hereby declare that the statements and" ormatio 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 OZ, og Signature of Owner/Agert Dhte Department use only \Q &'Northampton Status of Permit: Building Department Curb CutlDriveway Permit M ain-Street Sewer/Septic Availability 2 Room 100 ` Water/Well Availability, Northampton MA(?1060 Two Sets of Structural Plans phone 415-557-1240 F. -587-1272 Plot/Site Plans . Other Specify APPLIdIPITION i'OrCONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Map Lot Unit o Ak A Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: cd Name(Print) Current Mailing Addr N Q r Telephone p. Signature 7 ? o A 2.2 Authorized Anent: n +--n 1. P_,, e I 1 Name(Print) Current Mailing Address: Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 3 4S0 O (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=0 +2+3+4+5) 3 O Check Number v' This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date BP-2009-0369 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-2009-0369 Proiect# JS-2009-000496 Est.Cost: $3450.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THE JUBB CO INC 100001 Lot Size(sg. ft.): 11238.48 Owner: MONDS DARLENE&CINDY BURCH Zoning:URA Applicant: THE J U B B CO INC AT. 180 BRIDGE RD Applicant Address: Phone: Insurance: P O Box 429 (413) 772-6217 Workers Compensation GREENFIELDMA01302 ISSUED ON:101212008 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 10/2/2008 0:00:00 $25.0011011 212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo 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 ll PROPOSAL SUBMITTED TO PHONE DATE N� 6 VV D STREET JOB NAME o of 0 CITY,STATE AND ZIP JOB LOCATION ►rz t �-a 41AS'5- - ARCHITECT DATE OF PLANS JOB PHONE MA Registration 100001 - St //, MA Cons. Su . Uc. 055333 �a2/ We Hereby submit specifications and estimates for: /l� ' v''Z /V,9 Td i'1/�9'L���Ll,� /7iiU�_ „���ia✓.v !���u�.J� /V doh Y IVO, !' cockilyct-- l cd ►yl F7 4,01e - w Cl Ae;Otl el-(?41 01�1V rz,Ame (.f- MO C1,1/Uo, 61275 - AW,&&f7e 1' Aea4v e , No Gil G�JS i A P A11V'& h tc / Fcrr = 3 ,SD1dd' �rAf��t �yo(�i<i o.�f = ,0.39 ✓l5t61e_-raAS= SEeUa- FEE NMI 1NC.UA09_Q eRUIC��`• `Y1l�S� IUCJ�,p '� ��mi� f c{t �loc�c- c-�F AL.c -rng ,2�u9-rte R�Gu:��/ N (c5 B e v ND�a�C nr� i 9 G1,A A/Afo kekZiVARj- z} _ot2NF$4r a „I,-_UCFO iN r r L e�c_TiN� j4A,k UIR S O Provisions of MA L w require Contractors to in purchasers of MA Contractors Registration, Regulations, Rights of Recession, Specific Warrantees,and other consumer rights.I (We)have received, reviewed,and understand a separate copy of these regulations. (Signature) We COpO�t hereby to furnish material and labor—complete in accordance with above specifications, for the sum of: ,--a L � �6da dollars($ Y.-b }. P ment to be made as follows: ;. �h Lo Ate-� �14 L2 CItu'P c >N lQvi 09 [P!:67a ) All material is guaranteed to be as specifie .All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifica- Authorized , tions involving extra costs will be executed only upon written orders,and will become an extra Signature IN 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 propos may b workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within G days. Otcceptance Of 3propOgat—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do Signature the work as specified.P ment will be made as outlined above. © Signature Date of Acceptance: