17A-035 Y O BP- 2010 -0958
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- 2010 -0958
Project # JS- 2010- 001420
Est. Cost: $4263.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 055333
Lot Size(sa. ft.): 15246.00 Owner: DIEMAND MICHAEL E & DEBRA
Zoning: URA(100) //RI/WSP Applicant: THE JUBB CO INC
AT: 244 NORTH MAPLE ST
Applicant Address: Phone: Insurance:
P O Box 429 (41 - Al 772 -6217 Workers
Compensation
GREENFIELDMA01302 ISSUED ON :412912010 0 :00 :00
TO PERFORM THE FOLLOWING WORK. VINYL SIDING & REPLACEMENT
WINDOWS ON GARAGE
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 Si
FeeType: Date Paid: Amount:
Building 4/29/2010 0:00:00 $35.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
cu Street ',J 212 Main Stt Sewer/Se tic Availabil'
P • dY
Room 100 Water/Well Availability
Northampton` MA 01060 Two Sets of Structural Plans
phone 413 =$� - 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 by office
A o , Q I 1 ( � Map Lot Unit
"14 G i a Zone Overlay District
Elm St. District CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record
Name (Print) Current Mailing Address: /
Telephone J`7
Signature
2.2 Authorized Agent:
6 ty)( e PC) P)w� c
Name (Print) Current Mailing Address
S�gre Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by rmit applicant
1. Building (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 = (1 +2 + 3 + 4 + 5) Check Number
This Section For Official Use Onl
Building Permit Number. Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New House ❑ Addition ❑ Repiacement_ Wiyd6vs Alteration(s) ❑ Roofing ❑
Or Doors Er
Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [[] Siding 10J Other [CA
Brief Work: ascription of Proposed
►'1 u 1 A , C r� dJ �i' f C'n� i t'1A f` L
Alteration of ebsting 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.
1. 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.
Signature of Owner Date
as Owner uthorized
Agent ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my o ge
elief,
Signed under the pains and penalties of perjury.
Print Name
Sig re of Owner /Agent
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor Not Applicable ❑
Name of License Holder: �Ci l <k f n e l ih /'— (5 �_i •�
License Number
k)_
Address ( I Expiration Date
Signature Telephone
S. Re is tered Home Imorov ement Contra r: Not Applicable ❑
Com nv Na Registration Num r
1�
Address Expiration ate
Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit m be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the buildin ermit
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
�� �fu - �ry» l/l >Lfyl'Lt:l/G'C� o� ✓�/��.�:�u�cuse��i
Board of Building Regulations and Standards
0 - ic .Ashburton Place - Room l 301
Boston. Massachusetts 02108
Construction Supervisor License
License CS: 55333
RwAlictiun: 00
Expiration: 512112010 TO 25290
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 0
Update Address -wid returia card. Mark i 101• 01211j;C.
Address J-J Itusicival Lost CnrU
aJ 1 2G' � co ?Y Buil W10�ZM1
y . 11, j 9ula C, kndard oar Ing e/01&1
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
home Improvement Contractor Registration
Repistrallon: 100001
Type: Private corporation
Expiration: 0/8/2010 TO 267161
The Jubb Company, Inc.
Larry Jubb
P. O. Box 429
Greenfield, MA 01302
Update Address and return card. Mark reasuit fur change.
60M•07107-pco4go Address [ Renewal C] Employincut Lost Card
AFFCD A V l .
As a result of the provisions of MGL c 40, S54, I acknowledge that as a condition of Building Pe :mit
Number 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 ISOA_
I certify that I will 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 forte.. for attachment
to the Building Permit
L 4
Date Signature of Permit Applicant
(Print or type the following information)
Name of Permit Applicant
L i
Y .
• . • Firm Name, if any
P
: .. j
Address
Tlr�' debris : "' ispo?'b
ocation Facilit
ACORD DATE (MMIDO(YYYY}
� n� CERTIFICATE OF LIABILITY INSURANCE 06 13012009
PRODUCER Pheno: 413 GG3.4273 Fw! 413 - 883.0658 THIS CERTIFICATE IS ISSUED AS A MATTER Of INFORMATION
A.H. RIST INSURANCE AGENCY, INC ONLY AND CONFER$ NO RIGHTS UPON THE CERTIFICATE
159 AVENUE A HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
P.O. BOX 391 ALTS THE C GE AFFORDED BYTE OL!CI S 13 LOW
TURNERS FALLS MA 01376
INSURERS AFFORDING COVERAGE NAIL #
INSURED INSURER A; PEERLESS INSU COMPAN
THE JUBB COMPANY, INC. INSURER D;
P.O. BOX 429 INSURER C-
GREENFIELD MA 01302 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REOUAVENT, TERM OR CONDITION OF ANY CONTRACT OR DTNER DOCUMENT WTH RESPECT TO VAAICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PL•RTAIN, THE IN9URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES, AGGREGATC LIMITS SHOWN MAY HAVF 9GFN REDUCED 9Y PAID CLAIMS.
INCR ADD' TYPE OF INSURANCE POLICY HUMBER POLICY FFFECTIVP, POLICY IIXPIRATiON LIA11T$
LTA INBR DAVE M*oDrrY r
GENERAL LIABILITY CDP 8661749 06/03/09 05/03/10 EACH OCCURRENCES a 1,000,000
X COMMERCIAL GENERAL LIABILITY DAMAG@ TO RCNTOO
PRFMIBF (FA OmForo S 1 D0,000
CLAIMS MADE 7,X OCCUR MF,D, EXP (Any pan p?ravn) g 15,000
A PERSONAL & ADV INJURY a 1,000,ODO
GENERAI, AGGREGATE s 2
GENT, AGGREGATE LIMIT APPLIES PER; PRODUCTS- COIdP /OP AOO. F 2,000,000
POLICY PR� LOC
a
i
AUTOMOBILE LIABILITY CA $669247 05/03/09 05/03110 COMBINED SINGLIc LIMIT
ANY AUTO (Eonxldnrl) a 1,000,000
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS (Per person) a
A
X HIRED AUTOS
BODILY INJURY
X NON -OWNED AUTOS (Per accident) Z
PROPERTY DAMAGE a
(Per accident)
QARAGG LIABILITY NIA AUTO ONLY - EA ACCIDENT y
ANY AUTO
OTHER THAN EA ACC
AUTO ONLY; AGO 3
EXCESS I UMBRELLA LIABILITY N/A EACH OCCURREN $
OCCUR 71 CLAIMS MADE AGGREGATE W
$
DEDUCTIBLE S
RETENTION $
R
WORKERS COMPENSATION A WC 8664947 06/03/09 05103!10 X tOgY LI MITS OTH"
EMPLOYERS' LIABILITY
A ANY PROPRIETDRIPARTNRR15M ICUTIVO C. L, EAC14 ACCIDE1 a 100,000
OPPICBRiMP•MAER EXCLUDED?
El DISEA3E•EA EHPLOYEE S 500,000
If yew, dA Ceram un4nr
SPFDIAL PROVISIONS below Fl, DISFASF- POLICY LIMIT $ 100,000
OTHER: N/A
DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PRoVISiONS
CLASSIFICATION. CARPENTRY /SIDING INSTALLATION
WORKERS COMP POLICY INCLUDES COVERAGE FOR CORPORATE OFFICERS
CERTIFICATE H OLDER CANCELLATION
The Jubb Company SHOULD ANY OF THE A80VE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS
PO Box 429 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO
Greenfield MA 01302 DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, IT'S
AGENTS OR REPRESENTATIVES.
AUTYIORI7-F-q REPRESENTATIVE
Attention: Mary 772 -2530
rBCeyd, ►�Uk10wIC2
ACORD 25 (2001/08) Certificate # 21665 i`9 ACORD coszrsneAT -
The Common)vealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
kip Boston, MA 02111
lvtvlt: inass.gov1dla
Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians /Pluinbers
Applicant Information —�—� g
/� Please Print Leibly
Name (Business/ Organization /Individual): ► Vt _) L,L�� 013.
Address:
City /State /Zip: �'�v -t ie( 1\A A v t 302 Phone #: -7 - 1 :L - (v_�Ll
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I arm a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub - contractors
2. E3 am a sole proprietor or partner- listed on the attached sheet. # 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9 ❑ Building addition
[No workers' comp. insurance 5. ❑ 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 MGT 11.❑ Plumbing 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.❑ Other
comp. insurance required.]
•Any applicant that checks box #1 must also fill out the section below showing their workcrs' compensation policy information.
t Homeowners 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 workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site
information. n
Insurance Company Name: 1' L ;ir [ S t _ lit • G , .r ��
Policy # or Self -ins. Lic. #: i.J L 8 (v X0 -� 4 `� Expiration Date: 05 `;t2 r U
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 as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fume 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 lie violator. Be advised that a copy of this statement may be forwarded to die Once of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pair nd enalties ofperjury that the information provided above is true and correct.
Si nature: I`'� Date:
Phone #:
Ofcial 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 #:
PROPOSAL
The Jubb Co., Inc. d.b.a.
LARRY JUBB'S MA Registration 100001 Page 2of2
MA Cons. Sup. Lic. 055333
IMPROVE- A- HOME
7 Devens Street P.O. Box 51
P.O. Box 429 Hatfield, MA 010311
Greenfield, MA 01302 -0429 Northampton, MA
(413) 772 -6217 (413) 504 -3716
Pf IUNE U A7
TO: Diemand, Mike 315 -0467 C 4/5/10
244 North Maple Street JOB NAM-c/ LOCATION
Florence, Ma. 01062 Vinyl Siding installed to:
garage.
Jolt NUMB[H JOB PI ]ONE
W e hereby submit specifications a nd estim for:
SERVICE FEE $150.00: (includes permit & disposal of all job related refuse).
[service fee amount not included in total below & is to be billed at job completion].
We Propose hereby to furnish nlalerial and labor -- colulplule in accohdanco with M0 above specilicallons, for the sum of:
Four Thousand Five Hundred Sixty Eight and 00 /100 Dollars dollars ($ fi8-69'
Payment to be made as follows: )
$250.00 DEPOSIT UPON ACCEPTANCE. INVOICES ARE DUE UPON RECEIPT! An interest charge of 2%
per month (240 per annum) on past due balances, plus all costs, including reasonable
attorney's fees, incurred in collecting any sums owed.
All material is guaranteed to be as specified. All work to be completed in a prolossional
manner according to standard practices. Any alteration or deviation Isom above s ilica- ,
lions involving extra costs will be executed only upon written orders, and will become an Signature
ed
extra charge over and above the estimate. All agreements contingent u Sic
or delays beyond our control. Owner to carry fire, tornado, and other necessary insuranc Note: This proposal may be
Our workers are fully covered by Worker's Compensation insurance.
withdrawn by us if not accepted within 30 days.
Acceptance of Proposal — 1ho above prices, specifications arid
conditions are satisfactory and are hereby accepted. You are authorized to do the work Signature
as specified. Payment will be made as outlined above.
Siynaluhe _. _ - - --
Dale of Acceptance:
PROPOSAL
The Jubb Co., Inc. d.b.a.
LARRY JUBB'S MA Registration 10 Pag 1 oft
MA Cons. Sup. Li 055 333 9
IMPROVE- A- HOME TM
7 Devens Street P.O. Box 51 � --
P.O. Box 429 Hallield, MA 01038
Greenfield. MA 01302 -0429 Northampton, MA
(413) 772 -6217 (413) 5134 -3716
PHONE PATE
TO: Diemand, Mike 315 -0467 C 4/5/10
244 North Maple Street JUUNAMG/UJ61 - 10 - N -
Vinyl Siding installed to:
Florence, Ma. 01062 garage.
S C0
J01I NUM01 i JOO PHONE — --
We hereby submit specifications and estimates for:
- SUPPLY & INSTALL ALCOA /MASTIC BARKWOOD VINY SIDING .048 GAUAGE THICKNESS-
- width: (4 ") r•
- siding color: (1L1 Grey) corner color: ( l Grey)
- *trim color: *all trims to be WHITE unless otherwise specified. *an additional charge may
apply. ( *SPECIFIED TRIM COLOR: ) *trim colors for: soffits, fascias, j- channels,
window & door casings, light blocks, louvers and other accessories.
-no backer beneath siding.
-to nail siding approximately 16" on center & according to manufacture specs.
- install vented vinyl soffit panels on all applicable overhangs.
- install j -block light blocks.
-rake and broom clean job site at end of each working day.
- lifetime manufacture guarantee on Barkwood Vinyl Siding.
-labor guarantee as required by MA building regulations and standards.
NOTE:
1). work is to garage only.
2). owner to remove existing siding and dispose of.
3). Jubb to install Tyvek /Typar or similar wind and weather barrier.
4). Siding brand and color are approximate to existing siding.
5). to install a vertical board between garage doors and clad.
6). to remove 0 windows at rear of garage and board up to allow for siding installation.
7). re- install butters. advise owner to buy new black screws as existing caps will break.
8). owner to buy hooks for clothes line.
9). owner to fix light wire.
10). to replace 0) windows in garage. 01 non funtioning dead -lite. windows
will be National Destiny series. white vinyl with 1/2 screens.
11). nails from siding will poke through into the garage and will show.
T tQ pr ,' Flo mnnnt i nn
---�- r _hlacls- for-hrind._chime...
W e P ro p ose hereby to furnish material and labor — complute in acculdance with the abuvo specifications, for tho surn of: _
Cont 'd
),
Payment to be made as follows: dollars ($
$250.00 DEPOSIT 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.
All material is guaranteed to be as specified. All work to be completed In a professional
rnanner according to standard practices. Any alteration or deviation from above specifica- Authorized
lions Involving extra costs will be executed only upon written orders, arid will become an Signature
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tomado, arid other necessary insurance. Note: This proposal may b
Our workers are fully covered by Worker's Compensation insurance. 3 O
withdrawn by us it not accepted with n days.
Acceptance of Proposal — Tho abovo pricos, specifications arid
conditions are satisfactory and are hereby accepted. You are aulthorized to do the work Signature I
as specified. Payment will be made as outlined abovo.
Dale of Ac;c:eplarx;e:....
c/ �