17C-191 (4) CO IVINION1•VEAL'I'I I O I1•IASSACII.USL'1.'TS
1)EVAIt'1MLeN'1' OL INDUS'1-RIAL AC:C IDLeN'1'S
600 NVAS111NG'1'ON
BOSTON, MASS/1 CHUS1 1"1'S 02111
WOItI�.LItS' COMPENSATION ION INSURANCE AIt F IDAVI'I'
The Jubb Co, Inc. d.b.a. Larry Jubb's Improve-A-Home
(licensee/peru►ittce)
With a principal place or business/residence at:
7 Deverts Street P.O. Box 429 Greenfield, I-Li. 01302-0,(129
Cily/siaie/'Lill
du hereby Certify, Under the pains and penalties ul' perjury, ll►at:
(X) 1 tout an cnlptuyer t►ruvidil►g lite fulluwint, workers, Cu►►►I►ells"►tiun Covulage I'ur Illy elliployces
working oat this job.
GUNK!) J UWC90`_i191
Insurance Cunlplilly I'ulicy Nulnl►cr
1 alit a sole proprietor .old have nu one wurkil►g fur ine.
L ant a sine pruprietur, general culnL actur u►• hunleowllcr (circle one) aild lunve llived Lite cuntracturs
listed below who have tits l'ulluwing workers' cun►penratiun hisuran►ce policies:
f'
Maine of Contractor insurance Cultlpauy/l'ulicy Number
Name of Contractor Insurance Cuntpany/Policy Number
Naine of Contractor Insurance Culupauy/Pulley Number
( )
111111 a holneowner performing all U'le work myself.
NOTE: please be aware that while houncowncrs who culploy persons to do tnaintcuaace, construction or repair work
on a dwelling of not wore than three uults In which t►e houlcowncr also resides or on the grounds appurtenant thereto are not
generally considered to be employers under tic Workers' Compensation Act (OL C. 152, sect. 1(5), application by a
ltoneowner for a Ilceuse or perniit may evideuce the legal status of all employer Wider the Worker's Couipctnsatlott Act.
1 understand that a copy of this statcuicut will be forwarded to the Deparin►cltt of ludustrial Accidents' Office of lusurauce for
coverage verification and that failure to secure coverage as required under Sectiuit 25A of MGL 152 can lead to cite hnpusition
of'crIndual penalties consisting of a fiuc of up to$15W.W and/or imprisouucl►t of up to one year Lund civil penalties In the form
of a Stop Work Order and a [Mine of MUM a day agaMnst mc.
Sighed LWS - rd clay of •Zn o
�L
LicenseeMennittee Licensor/p . 11iit r
�/ !(iG UllLIILUJLCUG<.LGC/C U q--///Ga'jj'
--/ /Ga'jj' ac 6ejefflj
Board ol' BUildillg RCgUlatlons and Standards
One Aslibl,111011 PLICC - ROOM 1 301
BOS1.011. MaSSacilUscttS 02108
1-lomc Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
Expiration: 0/8/04
The Jubb Company, Inc.
Larry Jubb, Jr.
PO Box 429/ 7 DEVENS ST - - ----
Greenfield, MA 01302 - - -- - -- --
Update Address and return card. Mark rcasun for change.
I I Address I Renewal I I Employment l a Lust Card
Board of Buildin Regulations
One Ashburton ('face, Rm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/21/1961
Number: CS 055333 Expires:05/21/2004 Restricted To: 00
LAWRENCE A JUBB JR
110 BOX 429
GREENf7ELD, MA 01302
Tr.no: .22343
Keep top for receipt and change of address notification.
ti
` Aeptart gent Winbobi Vropozat Page No. of Pages
Win Office:
7 Devens Street• P.O. Box 429 THE JUBB CO., INC. d.b.a. Northampton, MA:
Greenfield, MA 01302 LARRY J U B B�� (413) 584-3716
(413) 772-6217 Brattleboro, VT& Keene, NH
18 North Hatfield Road IMPROVE-A-H O M ESM 1-888-639-JUBB
Hatfield, MA 01038 Email: JubbCompanyinc@aol.com
PROPOSAL SUBMI320 TO PHONE DATE
a 9i+4 t Nrz, s o
STREET JOBNAME
W I (_D L
CITY,STATE AND ZIP JOB LOCATION
V:10 945IN Cr-- 174A C 6 6oZ / ,3 0!7 6�2
TENTATIVE JOB SCHEDULE(Weather Permitting) MA Registration 100001
Approximately J —b 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 RoV4,e 2Ua,taioid Vinyl Replacement Windows
• 1/2 Screens (double hung only). • Interlock meeting rail.
• Locking Screens (double hung only). • Welded sash & frame. IGI
• Tilt-in Sashes (double hung only). Five degree sloped sill. I Jj
• Non-conductive intercept glass system. Seven-eights thermo glass'
• Continuous Balances (double hung only). Insulated padded frame. „ r
• Sun Shield Vinyl Compound (Mastic exclusive). • Energy Star approved. (,1`
• Twin locks on double hung units 32" or wider. • Virgin vinyl. `1
• Twenty year manufacture guarantee on glass seal failure.
• Lifetime transferable manufacture guarantee on vinyl window frame.
• Labor guarantee as required by CT,0NH, VT contractor regulations.
Color: Linen White ❑ Almond* (*extra charges apply for this colors)
TOTAL UNITS REPLACED: 15 1D�o,ble u�r4S �-f-
Grids rPs UP.Ir+ICR 1 RIG 8N ALL lofe r��SESf��S(Note: Grids are beveled)
Low "E" Glass ❑ Argon Insulation (into weight pockets) 'gs P(Storm Window Removal
❑ Aluminum Clad Exterior Castings ( ❑ Full ❑ Partial ) f�0
OTHER / NOTE: /V01W6:
�t,�S T �3,G � t✓��erer� G/i4ss �
v AJ 0.1--
A#
SECTION$ �C NSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : t1CLi.tt v ("L t,C C /t. J ( c L��j. "� 'Y C
License Number
u,j AkA E5bu lo+
Address Expiration Date
Signature Telephone
Rgg e m rnprovemenf Not Applicable❑
Company Name Registration Number
Address Expiration Date
Telephone '7 2 �' 1
SECTION 10.WORKERS` COMPENSATIONINSURANCEAFFI(DAVIT(M.G.L. c. 152, §25C(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 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
x5yws� �a x^ Y ',. ��
SECTIONyr DESCRPTION�bFPROPOSEDWORK ctickall a licabte M '
�s> .ww, aw•rrn .:zxn. ,e. � -TI
�s r 9M�d ;:t.„' � �.:.�',',.„s..•,gab: ,i' .;..�” k6c w' a _ :a: i afca�,. 3.,'�btsn.:,„a. -
^x. s' .;...r";k ...
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors �(
Accessory Bldg. ❑ Demolition❑ New Signs [ ] Decks [ ] Siding( ] Other( ]
Brief Description of Proposed Work: ✓ -[ OT W( 4 L-)
Alteration of existing bedroom—`Yes No Adding new bedroom Yes No
Attached Narrative❑ Renovating unfinished basement Yes No
Plans Attached Roll ❑• Sheet❑
6 If'New hou a 0"r d�it,an to�e�ista`n, sln camia`1 —#he�foll w.ln :
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 .
I. Septic Tank City Sewer Private well City water Supply
:SECTION 7a OWNER4.AUTF10RiZ4TI6N :TO BE COMPLETED WHEN
;OWNERS AGENT OR CONTRACTOR APPLI,c53FpI2 i3UILDING PtrRMi i
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
.J as Owner/Authorized Agent
hereby declare that the statemdnts 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.
Print Name
Signature of Owner/Agent Date
s
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:
iy of Northampton
i ding Department !t
2 2 Main Street S to a
+ voorn 100 e
�aa ort pton, MA 01060
C�4� ash0 587.1240 Fax 413-587-.1272 P,a IStte P
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1-SfTE INFORMATION
t 1.1 Property Address: This section o 15164 ompl tec offr161 ,
MR
M �a ni#
r� Zone a.0�er P H ct � f h-
Elm Sebistrict CB°Distr�ct
SECTION 2-.PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
�f (4 t r t C 1. s ( (/J
Name(Print) Current Mailing Address: i
Telephone
Signature
2.2 Authorized Agent-
A. TLLAa b PO eaX 2n i e cl Ak A
Name( � Current Mailing Address:
-1`7 2---
Signature Telephone
SECTION I-'ESTIMATED CONSTRUCTIOWCOSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
�?o
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) 1 2S- OCR Check Number
This Section For Official Use Ohl
Building Permit Number: Date Issued:
Signature
Building Commissioner%Inspector ofBu�,ldings Date,e,
WILT3E1t PL "` BP-2004-0384
GIS#: COMMONWEALTH OF MASSACHUSETTS
1�C >t9`1 CITY OF NORTHAMPTON
Lot:-001
Permit: BUiidinQ
Category: BUILDING PERMIT
Permit# BP-2004-0384
Project# JS-2004-0564
Est. Cost: $4125.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Groin: THE JUBB CO INC 100001
Lot Size(sq. ft.): 5096.52 Owner: HINRICHS JEFF
Zoning:URB Applicant: THE JUBB CO INC
AT. 11 WILDER PL
Applicant Address: Phone: Insurance:
P 0 Box 429 413)772-6217 Workers
Compensation
GREEN FIELDMA01302 ISSUED ON:1017103 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: Receipt No: Date Paid: Check No: Amount:
Building 10/7/03 0:00:00 6755 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo