06-022 (15) BP-2009-0691
GIS#: COMMONWEALTH OF MASSACHUSETTS
rogno •14.022 CITY OF NORTHAMPTON
Lot: -020 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2009-0691
Project# JS-2009-001011
Est.Cost: $2254.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq. ft.): Owner: HEAFEY BRIAN J&VIRGINIA B
Zoning: URA Applicant THE JUBB CO INC
AT: 44 EVERGREEN RD #109
Applicant Address: Phone: Insurance:
P O Box 429 (413)772-6217 Workers
Compensation
GRE ENF I ELDMA01302 ISSUED ON:2/12/2009 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 2/12/2009 0:00:00 $35.0011344
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo
11,5 00
s Department use only
City of Northampton Status of Permit
Building Department Curb Cut/Driveway Pamtit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-5874240 Fax 413-587-1272 Plot/Site Plans ‘.
Other Specify
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH AQNE OR( fttg FAMILY-DWELLING.
, l49 C-. I�
SECTION 1 -SITE INFORMATION
This section
torLU pL
ULotpce,1.1 Property Address:
\Qykte 1-'j-I1f Con 405 <v)i-� )0?Map n4 ' Lot Un
it
-ve+ /t en Qa. Zone a 0 eOaYDlstrict
-Si _...:
-ee„C51 ti 14- Elm SI District CS mistrial
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
g.1 Owner of Record:f.) (Th 1 .
Bftar, Vice. -el "ico i" iceK r1 Gni
Name(Print) J Current Mailing Address: Cas
� //
tel" 3 / "" /
Signature
Telephone
$.2 Authorized Anent:
---1—kr‘.e,----t....0-1 o. r . PO a6 ti aq cYricl, MfJGI?c�
Name(Print) ^ Current Mailing Address:
jf<'1h( dp-rd `4 -1 -7.)- cpai .1
S ,� // Telephone
SECTION 3-ESIRMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. 8uik ng (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from(6)
3. Plumbing Building Permit Fee 7
4. Mechanical(HVAC)
5.Fire Protection !/
S. Total=(1 +2+3+4+5) ra. QSC1. Check Number AC4(4"
155--
This
:7 —'.This Section For Official Use Only
Building Permit Number: Date
Issued:
Signature:
Building Commisslanerllrepector of Buildings Date
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House n Addition ❑ Replaceme ndows Alteration(s) ❑ Roofing n
Or Doors
Accessory Bldg. ❑ Demolition ❑ New Signs 101 Decks III Siding(cal Other[Of
Brief Description of Proposed
Work: l_(}.11 Gnci ins-ISI ! -7 ✓ cid/creme/v-1- wlnc
Alteration of existing beroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll -Sheet
sa.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. lathers 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
t- , . ,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.
Signature of Owner Date
t
I, �Q t.cJ(e✓l� e_ t"nn 7 �J L� ,..) l ,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.` _
knw rCn(P i4 J jab" J•
Print Name 9m
21(4 ay
nature of Owner/Agent Date
• SECTIONS-CONSTRUCTION SERVICES 1
8,1 Licensed Construction SgpervlSpr: Not Applicable ❑
�♦♦—
Name of t.taesaryoider LL. '.s > G l/♦ 3 a ...__
license Number
00 (2)n - lj ag 5161_t iQpi fl
Address cc'� h /�- /� 'fir+ ^-� (a)_/-7�� }Expiration Date
C r "e
cid d . Pr C/i Y l {GtXI'/
Signature elephone
1
tlsv •d Horne u •rocs eat •ntrac.•r. Not Applicable ❑
a. elt/ V1C dot
Company Name t Registration Nu ».r
nX ct 7 .. , • . 0
�(/,yy,•.'.Ss� (L/ tel /�--`� ((Qr.
"lam Expire ion Date
l`�✓ � n 1 ` �"- • Telephone '7 7C 'G 2//
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)I
Workers Compensation Insurance affidavit st be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildin ennit
Signed Affidavit Attached Yes No 0
11. — Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(I) 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
ps supervisor.CMR 180. 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
N,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 hvo-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,ona Conn ar tptable to the Building Official.that hetshe shall be
responsible for alt 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 Ordhmnces,State mid J weal Zoning Laws mid State of Massachusetts Gteerul Laws Atuxstatral.
Homeowner Signature
.Jfle eoliI//1T.4�IZ da P7«G�LLXi.L1l.LClladele4
Re
Board of Building gula ions and Standards
7 One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Construction Supervisor License
License CS: 55333
Restriction: 00
Expiration: 512112010 TM 25298
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 01302
Update Address and return card.Mark reason for change.
5 CAI a 50M.m/0700490 ( I Address CI Renewal I I Lost Card
kik -60 arirten
Boar o Lutlaing� egulatdons an tan ad rdst�
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
Expiration: 6/8/2010 Trk 267161
The Jubb Company, inc.
Larry Jubb �.
P. 0. Box 429
Greenfield, MA 01302
Update Address and return card.Mark reason for change.
rl Address ri Renewal Ti Employment f Lost Card
CAI 0 50M-07/07 PC8410
ri
�"� PROPOSAL
�J
The Jubb Co., Inc.d.b.a. / MA Registration 100001
LARRY JUBB'S }AA Cons Sup. 1c.055333 1
/' IMPROVE-A-HOMETM ^n\
7 Devens Street P.O.Box 51 \\�
P.O.Box 429 Hatfield,MA 01038
Greenfield,MA 01302-0429 Northampton,MA
(413)772-6217 (413)584-3716 i
PHONE DATE
T0: Heaney, Brian 413-563-9534 C 01/20/09
76 Blackberry Lane JOB NAME/LOCATION
Northampton, MA. 01060 Yankee Hill Condos(Unit 109)
Evergreen Road
Leeds, MA.01053
JOB I.MBEP ` JOB PHONE
4 fir le
We herebys0mitapa0ra and estimates tor,
-SUPPLY& INSTALL MASTIC'royal waterford"VINYL REPLACEMENT WINDOWS-
-welded
INDOWS-welded sashes&frame. continuous balance system.
-7/8"thermo glasss. -tilt-in seises for easy cleaning.
-locking 1/2 screens(double hung only) -true sloped sill for water run off.
-interlocking meeting rail. -dual night latches.
-twin cam locks on windows a 32"or wider. -energy star rated low-e-glass.
-20 year manufacture guarantee on glass seal. -Sun shield vinyl compound.
-lifetime manufactures guarantee on vinyl window.frame&parts. -tabor guarantee as required by MA.BBRS.
COLOR:White interior and exterior.
NUMBER OF UNITS REPLACED AND STYLE: 07 double hung ,
GRID CONFIGURATION: none.
LOW-E-GLASS: yesd ARGON GLASS: no INSULATION INTO WEIGHT POCKETS: n/a.
STORM WINDOW REMOVAL: yes ALUMINUM CLAD EXTERIOR CASINGS: no.
OTHER/NOTE:
1).windows to have aluminum horizontals to the inner area of the sashes.
2).owner advised wnd casings may be scratched or chipped during installation. Owner responsible to perform any necessary paint
touch up.
3).ail plants,fish tanks,t.v's,etc.to be moved away from windows by owner or tennant prior to new window installation.
4).grids are an extra charge option and are priced at$15.00 per sash.see options below.
OPTIONS:
1).Grids:top&Bottom grids a$30.00 additional per window. yes please add top&bottom grids for$210.00. _
2).Grids:top sash only+$15.00 additional per window. yes please add top grids for$105.00.
SERVICE FEE: $125.00(includes permit&disposal of all job related refuse) -
[service fee amount not included In total below&will be billed with final job invoice) .
We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of:...
Two Thousand Forty Four and 00/100 Dollars dollars($ 2,044.00 ) .
Payment to be made as follows:
1/3 DEPOSIT UPON ACCEPTANCE.ALL INVOICES ARE DUE UPON RECEIPT.An interest charge of 2%per month(24%per
annum)on past due Involves, plus all costs, including reasonable attorney's fees, incurred in collectingany sums owed.
AA malarial 5 guaaaled to be as spanned.M work to be competed N a rydeavonel c"
mem"eovrtg to mandato PradiCes,Any ane abon or deviation from above specifcAuthorized •
tins Invoking extra oaf will be mewled only Won minim coders,a witl benne an Signature O: / •
I / '� ,21/..
arta charge overall above the estimate,AY agreements cotangent upon strikes,acddgts / /'"
or dela»beyond err weal.Owner to cavy fire,tondo,end War necessary knaanca Note:This proposal ..: i7.
Aswat¢rcarsnrymvendbyWorkers CarperseaonPeace, withdrawn by us It not accepted with:- 30 days. •
Acceptance of Proposal—The above prices, specifications and
conditions are satisfactory and are hereby accepted.You are authorized to do as work Sgratwe
as specified.Payment ova be made as outlined above.
Signature
Gate of Acceptance.
•
ii,c Cie nnurrii en lth of a Juts t'lt usntir
Department rf 1rtd:atrial Accidents
!. --1-14--1=--=-7 g6 Office of"lupcstiRat ions
W 600 IVashington Street
_,' .- Boston, IIIA 02111
' ary IVI VIP.rt tss.gu tlrlifr
Workers' Compensation insurance Affidavit: flu ilders/Coit(rac tossiglcctricitutslPluutbers
AnUlicant Information _, NouseI'i int I,cgibiv
Name Uusinessior irnio adividanl : ~i�}- U..i� ` Cl ..1_-
anok.t.. " —..—
Address:...__._._. %�4)-9
r.
City/State/Zip: "✓emsriti.e=! CL MA 0L202. Phone U:T 17:C_ ._C,J--(1
Are man m an employer? Check the approp riate box: Type of project(required):
L(� I am a employer with 4. 0 I ant a general connector and I 6. Ej New construction
et ployces(full audlor part-litur).* lurve hared the sub-contractors
2.0 I aur a sole proprietor or partner- listed on the attached sheet. i 7. !J Remodeling
ship and have no employees 'These sub-contractors have 8. lJ Demolition
working for ere in any capacity. _ wuskers' comp. insurance. 9. u Building addition
lit workers' comp. insurance 5. l .l We are a corporation and its 10.0 Electrical repairs or additions
required.] officers have exercised their
3.0 I aur a homeowner doing ail work right of exemption per MGL I I.0 i'luuthing repairs or additions
myself.[No workers'comp. c. 152, §1(4),and we have no 12.0 Roof repairs
insuraucc required]i employees. (No workers' 13.0 Other
comp_insurtutee required.]
*Any applicant that elseeka box#1 must elm till Out the section blow showhrg their vmkcrs'compensation policy inronuatiun.
t Homeowners who submit this attidavit indicating they arc doing oil oak and Wen hire ours ids coalmines must submit a new affidavit indicating Snell.
tCushadars that check this box oust attached an additional sheet slowing elm IMAM of lha su bmoutrocsms and their workers'comp.policy information, _
J an,an employer that is providing workers'compensation iaseranccf'ur Illy employees. Below is the policy and Job site
information. //�� /t
Insurance Company Haute: C �ti..C'-h'-tu 04 G.CA-.4J`.-t- /
Policy 1i or Self-ins.Lie. /F: l..- 1/i C-• 039 421-23 .tg Expiration Date: 3 10 9
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage us required under Section 25A of MOL c. 152 can lead to the 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 tine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of
Itvostigatiotts of the DIA for insurance coverage verification.
I do hereby certify undohe pr�yaiarallies r f perjury that the information provided above is true and correct
Signature: ,cIls.`4r Dale: —
Photon: '1r/2_ -6,2t`7
Official use only. Do not write in this urea, to be completed by city or/own ojjicial
City or Town: Permit/License U
Issuing Authority(circle one):
1. Board oflledlh 2.Building Department 3.Cityliuwn Clerk J. Electrical Inspector 5.plumbing Inspector
6.Other
Contact Person: Phone Il:
•
•
• AFFIDAVIT •
,
As a result of the provisions of MGL c 40, $54, I acknowledge that as a condition of Building Permit
. Number all debris resulting from the construction activity governed by this
Burldiug Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL
c 111, S 150A
I certify that I wall notify the Building Official by
(Two months maximum) of the location of the solid waste disposal facility where the debris resulting from ,
the. said construction activity shall be disposed of, and I shall submit the appropriate fow.for attachment
to the Building Permit 7
•
t_- 10O A
ate ` ure of Permit Applicant
(Print or type the following information)
Name of Permit Applicant
•
.. Firm Name, if any
Address
: �. . debris will pe'disposed
Lir Ca jpS .
(Location o Facility)