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23A-002 (6) 35 MEADOW ST BP-2017-1305 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma:23A-002 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Bath reno BUILDING PERIVIIT Permit ft BP-2017-1305 Project JS-2017-002162 Est.Cost: $34783.00 Fee:$227,50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Grow: BARRON & JACOBS 60475 Lot Size(sq. ft.): 26745.84 Owner: PERLMUTTER SAUL E& SUSAN R LQNDERMAN zoning- ...9741WP(5)i4.IRA(3Y Applicant: BARRON & JACOBS AT: 35 MEADOW ST Applicant Address: Phone: Insurance: 70 OLD SOUTH ST (413)586-8998 Workers Compensation NORTHAMPTONMA01060 ISSUED ON:5/11/2017 0:00:00 TO PERFORM THE FOLLOWING WORK:REMODEL BATHROOM - CHANGE LOCATION OF WINDOW WILL HAVE 2X8 HEADER 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 5/1120170:00:00 $227.50 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File ri BP-2017-1305 APPLICANT/CONTACT PERSON BARRON &JACOBS ADDRESS/PHONE 70 OLD SOUTH ST NORTHAMPTON (413)586-8998 PROPERTY LOCATION 35 MEADOW ST MAP 23A PARCEl,002 001 ZONE URB(97)/WP(5)/URAf3)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT FeePaid Buildineine Permit Filled out Fee Paid TvoenfConsmuction: REMODEL BATHROOM-CHANGE LOCATION OF WINDOW WILL HAVE 2X8 HEADER New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin' Plans Included: Owner/Statement or License 60475 3 sets of Plans'Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: prfproved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received& Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of I lealth Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Dere itio• f- . Signa ire of Building Official Date Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. *Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planning&Development for more information, _. . _ Department use only City of Northampton Status of Permit MAY I Q Building Department Curb Cut/Driveway Permit 212 Main Street Sewer/Septic Avalmbilily Room 100 Water/Wen Availability Northampton, MA 01060 Two Sats of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 •SITE INFORMATION 1.1 Property Address' "� This section to be completed�( 'eby office TD ns a S-k- Map dl,4 Lot ✓02 Unit JJU oV�i" � Zone Overlay District 'S Elm St District Ca District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: S&)\Rn f\ .&Jt( Y S 'N'S\r\clAn-. ?Y`an.ti/+W, 755 MOcksit+3 c'VV'P, w2 Name(Print) Current Mailing Address: Car • Telephone Signature .a.2 Authorized Agent: 4X\`tY0n k.S0,4, b5 ' (JA '+a cobs v oto 44, S - Name(Print) Current Mailing Address: Sign aTelephone SECTION 3•ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a)Building Permit Fee 2. Electrical `}2-1 2-00 (b)Estimated Total Cost of Construction from(6) 3. Plumbing 7j. kt5 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection �.I Si �y�, w 6. Total =(1 +2+3+4+ 5) n7 1i�`t4Tj Check Number 9jV 60 qpr 25 ) This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissionertmspector of Buildings Date Section 4. ZONING ALL Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by cArAn2pr ol st ./�,,„ Building Department Lot Size .I✓ 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 O DONT KNOW ®t YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO O DON'T KNOW 0 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 O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O Obtained O , Date Issued: C. Do any signs exist on the property? YES O NO ® IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO (i) IF YES, describe size, type and location: 7-Je E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all aoolicable) New House n Addition n Replacement Windows Alteration{s} Lyn Roofing Or Doors Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [q Siding[O] Other[O] Brief Description of Proposed Work: m.rial 4.xt sh rv, tip t\ bah - All coakkz-1 `re v'a wyxx+. it SrtWa 9 wI', deeen,g, \D k't" w`,nan.4,w k‘\ Alteration of existing bedroom Yes X No Adding new bedroom Yes y No �2%y Attached Narrative Renovating unfinished basement es )L" No Plans Attached Roll -Sheet Nkakfial Ba.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,v, 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 I, c \ \ wk"0LY' ; Syw<)\ - UYSfkQxrv'As- .,as Owner of the subject property hereby authorize PJ GIYvyv\ av'yi iy\ E S to act on my behalf, in all matters relative to work authorized by this building permit application. Se 4-, ltYtYt�tYN'(`t � 17\ t r+s U Signature of owDate I, CY`t s S "ilkt&A S ,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. Print Name 2-is Signature of OwneriA Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of license Holder: GVN(s S\O,QVVN "[ctcunS ( S c)6OL License Number oke S Ar St- tockVb'n*,0-\6Y\- "6 /lg Address , Expiration Date 51gb YTMC Sig ature Telephone 9. Registered Home Improvement Contractor: Not Applicable 0 oorrov, \o0�°1 Companv Name Registration Number k C \A S9.- ‘h `st 10( PG h..\eV. /v 2"51 I b Address Expiration Date Telephone '5v6L: %Ct % 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 Ljf1 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 SIGNATURES By signing below,you agree to items A,B and C. DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. A. Alternative Dispute Settlement(Arbitration Clause): The Seller and the Buyer hereby mutually agree,in advance,that in the event of a dispute concerning this Agreement,the parties shall submit such dispute to a professional,state-approved arbitration service(cost,if any,to be paid by the submitter)prior to either party proceeding to legal action in the courts. B. By signing this agreement,you,as the owner of record,are hereby authorizing Barron&Jacobs Associates Inc. to act as your authorized agent in all matters pertaining to the building permit application. C. This is a binding Agreement. You may not cancel it except as stated. This Agreement covers and supersedes all conversations,statements and agreements,expressed or implied,between the parties,their agents or representatives. �. -- 11/2I 1/7 You,the Buyer,may cancel this transaction Buyer Date at any time prior to midnight of the third �t business day after the date of this transaction. / y/y//7 See the attached notice of cancellation formB Date far an explanation of this right. Seller retains an equal right to cancel 2,1 B- n&Jacobs [alive Date Contact Information Office Manager: Sandy Scavotto Office:413-586-8998,x100 ❑ Chris Jacobs,President CT HIS#0554397 Cell phone:413-250-6677 Home phone:413-665-9113 Office phone ext: 103 ❑ Adam Skiba, Senior Designer Cell phone: 413-923-7003 Home phone:413-610-0660 Office phone ext: 106 MA Construction Supervisor License 060475 MA Home Improvement Contractor 100809 CT Home Improvement Conractor 518617 Purchase Agreement Page 24 of 24 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: b ) 'j\\ \v y cX The debris will be transported by: 1cjcxY1W\ k �1cl The debris will be received by: \j(i,Vi �cAirJ Y {avlic Building permit number: J Name of Permit Applicant (,)e 'S •adc cy)S Date Signature of Permit Applicant L \ The Commonwealth of Massachusetts n=—=-=— Department of Industrial Accidents Office of Investigations €= T' 1 Congress Street,Suite 100 Boston,MA 02114-2017 % 47 ims www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): R(AYK?n �'�eTc,D`(�ti 56(aG�LS Address: --RID C.‘ 5-51 SC City/State/Zip: - asks.t ,u A" a 40 Phone#: -'5 1-6' , Are you an employer? Check the appropriate box: contractor and I Type of project(required): L1 gl I am a employer with 4. D I am a general employees(full and/or pan-time).' have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. [Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' insurance.! 9. ❑ Building addition [No workers' comp. insurance comp. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] c. 152,§10),and we have no employees. [No workers' I3.❑ Other comp. insurance required.] *Any applicant that checks box e I must also fill out the section below showing their workers'compensation policy information. Homeowners who submit his affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: N]QXD)Q{ Iq!ryNym2-k\ \'r&C—.per Policy#or Self-ins. Lic.#: )61175b-QLO ' OD Idb65 ' 2--021 "Pc Expiration Date: 3\\ \g Job Site Address: 5') ' v421,(.41ka N . City/State/Zip: c`ny"o y.FRa 15Mt 0 \Ob(-) Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa 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 foe 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'� the a s and penalties of perjury that the information provided above is true and correct f Signature: ( " r.2 Date: 1\24" Phone#: -.A\? -SW'ICI e t Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORn CERTIFICATE OF LIABILITY INSURANCE DATE IMWDWYYYYI kam------; 3/3/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the holicy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Adina Edgett Webber S Grinnell INONN.Ern. (413)586-0111 FIS Ndl:(413)586-6481 B North King Street GMAIL58:aedgett@webberandgrinnell.com ADDRE INSURER(SIAFFIXtDlNG COVERAGE NAIC a Northampton MA 01060 INSURERA Main Street America/MSA 129939 INSURED INSURER BN@I/MSA - • Barron S Jacobs Assoc. Inc. INSURER C A.I.M. Mutual/A.LM. . Attn: Cecil R. Jacobs INssRERD: 70 Old South Street INSURER E: _ Northampton MA 01060-3833 INsuRERF: COVERAGES CERTIFICATENUMBER9:1Lp 03/18 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR AUDI.SU R i POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IVSD WYD. POLICY NUMBER IMMIDOPNYYI IMM'DDRWY)I LIMITS X COMMERCIAL GENERAL LABILITY EACH OCCURRENCE IE 1,000,000 A '. CLAIMS-MADE X . OCCUR PREMISES lEaoje RENTED 500,000 MAGETIERENartencel S --_ - !@xe0a9D 13/9/201] • : 3/9/2018 MED EXP(Anyone person) E 10,000 • PERSOAL a ADV INJURY I $ 1,000,000 I GENI AGGREGATE LIMIT APPLIES PER I I ' GENERAL AGGREGATE $ 3,000,000 X '' POLICY T , LOC l ' PRODUCTS-COMP/OPAGG S 3,000,000 _, • ',OTHER: i EPLI „b 10,000 AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT accident) S _ B ANY AUTO IBODILY INJURY(Per person) 'E 1,000,000 I—ALL OWNED SCHEDULED ' '$ -- 1_1AUTOS x IM1T80490 3/9/2017 3/9/2018 BODILYINJURY m a dent $ X HIRED AUTOS % ANON-OUTOSWNEO I/PROEq DAMAGE $ AST'CHOPP} MeE Ipayments 8 5,000 ' UMBRELLA LIAR X OCCUREACH OCCURRENCE IIS 1,000,000 IEXCESS LIAR L S-MADE B 'AGGREGATE 1s 1,000,000 DED I - I RETENTION$ 10,000 CUT8049n 3/9/2017 3/9/2018 r IIE WORKERS COMPENSATORI X 'PER I OTH• I AND EMPLOYERS LIABILITY YIN' ♦5 TUNE ER IEXECUTVE EL EACH ACCIDENT S 500 000_ ANY PE/MEMBER.EXCLUDR C 'Mandatory EXCLUDED' NJ N A If yes debate in and — pg8006365201]A 3/1/2017 3/1/2018 rpIGEAGE-EA EMPLOYEES $00,000 DEOSCRIPTloN OF OPERATIONS belowI I EL DISEASE.POLICY LIMIT $ 500,000 , DESCRIPTOR OF OPERATORS I LOCATORS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if mon space Is repWedi CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NONCE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W Grinnell, cecu, czc 2l-.'l— - - ` - ----v I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onunn C-0°fry oIn mon mica/tl a Clia iac; uieu ckt,V Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100809 Type: Private Corporation Expiration: 6/232018 Till 419291 BARRON & JACOBS ASSOCIATES, INC. Cecil Jacobs 70 OLD SOUTH STREET NORTHAMPTON, MA 01060 Update Address and return card.Mark reason for change. Address - Renewal Employment Lost Card SCA I U mMOYn . t in n/6,,,,w, ,0/"/1.tws,-Aux/6 Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR91 before the expiration date. If found return m: Registration: 100809 Type: Office of Consumer Affairs and Businessto: ion Expiration: 61232016 Private Corporation 10 Park Plaza-Suite 5170 Boston.MA 02116 BARRON&JACOBS ASSOCIATES, INC. Cecil Jacobs 70 OLD SOUTH STREET ___ NORTHAMPTON,MA 01060 undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS6EO473 Construction Supervisor cnWsTONIFRa NOLO satn.st 111 NORTNh01/TDOWA r."1nn CA.— Expiration: Commissioner tVNMII e � _. I "wunroazi ykowIna_ tActakik,„ti -, \ . , . -...„. . . . N. .. 1 Ill 4 I , . i _. _ '\JQM 'f' �i'4 3 7 �'NJ N 11):AA M 1111111, 41 3 . M , 1 1 • HI 1� 1: (� i4.4 r P fi ,w0.i O,�wd 5- /--1 ,--- 2'-8" 2'-8" City of Northampton _ HEADER 2X6 'N pEn Building Department IJ plan Review 11 111 212 Main Street Northampton. MA01060 i I II • 51-7" SCALE:I/2 -I. DRAWING PROJECT: .CCGVT INFO: DRAWING PHASE: Barron & ,Jacobs ,MEET: PE ZONDERMAN RESIDENCE PROPOSED Design . Build . Remodel FLOOR NOLD SOUTH STREET.NGR,NOMTGN,MOD,SfA e 1 PSN BATHROOM REMODEL 35 MEADOW ST D,,,�: a,.,�.,, 1 ,• 1 FLORENCE, MA 01062 DRAWN BY: CAH , ALL DRAWINGS.PLANS.5 DESIGNS ME PROPERTY OF BARRON&JACOBS,INC.