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24D-302 • -• • . 1 . 1 •• • .. ,., • • • • . ..... • . ...- • • . . " • . ' .. . • • -. • . . . . . . • . • . . .'' ' • . . • • '. . . . . • . . — . . . .., .. . .. • . . • • • • . .. - .: • . . . - • • • " • ' .. • • AFFIDAVIT • • • • • . ... . . . .• • • • • . . • . . „ . .• As a result of the provisions of MGL c 40, 554, I acknowledge that as a condition of Building Permit • ' .., . 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 MGT..; . • •• ' . c Ili, S 150A. • . 1 • . . . . • . - • . . . • . -. ' • . .. . ' . .,. .. • . . . • • I certify that t will notify the Bttilding Official by • : . .. . . • • • . (Two months maximum) of the location of the solid waste disposal facility where_the debris •resulting from • t • ,. . the said construction activity shall be disposed of, and I shall. submit. the .appropriate form:for attachment • • ... to the Building Permit - • • • .. • ,. . •.... .. . • • • • . , • . .• . . . . . . . . . .• • • .. . . • • • ' ,- . . . • • . . . • . •' • . • . . . . .• . . . .. • . • .. . • • • ' . I , - .. ... e I • . . -- , 1 ( .. / T • . • • • Date • •• • • tgnature of Applicant . • . . . .. . • . . • • . . • . . . . • . . • • • • ... • . • . . . . • . . . . ' ... . _.., • • • • ' . (Print or type the following information) . • ' ation) • . • • . . .. -, .. • • • . • . • . ' • . . ' . . • • • • • • . ' ' . . . ) ' . ', • • • :- Th - C, ‘12/17 COmpalY4 i---*/)c,. • .., • _ . . • • • • • ., Vame of Permit Applicant . . .. • • . . . • . . . . • ' ' • , • • • .. • • • - • — • . p ( Ll• 6dx q07q• • ...• ...•• .••:. . . • . . ... . .... ..... Firm Name, ifany • . . .. . . • . . . . . . . . • . , • • • • • . . , . . , . .. . . .. • • • . .. . . . . ... • • • • • • . 6 I 0/30 "*." '' ::: : ' •i''' ' '' . '" • • . . . • . • • Address ' .. • . • " . • • . . ,,. , • • . . . 40 • e I • • • • . ... • • . . •. 0 .. W. • . • . . . • 4 • . :: ''''v''ill"be'dipcidifo.r.::: .. %'''''''''''''"?".'' _ 77 conJp..,,i, .. . . . • Location of Faciliti) ° • . . • • . .• . • . • . . . . .. - • • . • • . .• • - • , ;' . ' • • �� Propotat Page No. t Pages Main Office: LL Dli 7 Devens Street THE JUBB CO., INC. d.b.a. P.O. Box 429 LARRY JUBB' S Northampton, MA: Greenfield, MA 01302 (413) 584 -3716 (413) panyin 772-6217 IMPROVE —A —HOME® Brattleboro, VT & Keene, NH Email: JubbCompanyincC�3aol.com 1- 888 - 639 -JUB PROPOSAL SUBMITTED TO , DATE uc z i rao l -57y -1 ? 16 8/75 ii STREET JOB NAME ?9 1/r / /NV(, 5 / CITY, STATE AND ZIP JOB LOCATION /L1)2<�/fM /a,>1/ !1/9. iIYY•-� EMAIL '- JOB PHONE MA Registration 100001 / -W -- 7? 757/ 7 MA Cons. Sup. Lic. 055333 We hereby submit specifications and estimates for: Xe 0nc Of — Ste, 'c 19-ND - " -_ /Wk.,/ _ � " t-) ,oi-�u�rnN� i•-1 G- so ,v , C'72,i „0,a,(2_1" «r1i £ ®,/P4/ /7 s.. 0 /2.y Ail Ir'rvi3v PC. OAR g M 60&- 44 a 7Y FL SI7e ,34( 8 3 v 0 s,z2,E , r r ,0a0>e f. M0066 02 7 / i r S /ze r L % a „ Q 6/t7? , /3'60ae r / F /1a0 G 7/ 77 5:z5 . ??4 `x ir-e_ .ISY kr,i J i Al Ci-ii I) S' 11/4..4 M P iff / 41'_-5' - l ff,Y' P S' •f- Let—f6/e_ 'f p, Si o: /%C d du) CA-xii 0004x SERVICE FEE: $ (includes permit and disposal of all job related refuse.) [service fee not inclu ' total amount below, and will be billed separately.] CONTRACT SERVICE CHARGE: An interest charge of 2% per month (24% per annum) will be added to outstanding balances over 30 days, plus all costs, including reasonable attomey's fees, incurred in collecting any sums owed. tiro: ¢ Pr po9c hereby to furnish material and labor — complete in accordance with above specifications, for the sum of: O rr _�kC"ZLOCtMLI Fcsw.. (41.4/ tG l f10 et � V r"71Z14._ dollars ($ i , Y 51 Bt5 ). Payment to be made as follows: 1/3 DOWN PAYMENT UPON AC "TANCE Make checks payable to: The Jubb Co., Inc. (Our installers will collect final balance upon completion). F9 E 1,01' All material is guaranteed to be as specified. A •rk to be completed in a workmanlike '�I manner according to standard practices. Any alteration or deviation from above specifiea- Authorized I. p 44, !/.�' tions involving extra costs will be executed only upon written orders, and will become an extra Signature wi7.� mac... 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 pr osal ay be workers are fully covered by Workmen's Compensation Insurance. withdrawn by s if not accepted within THIRTY days. // -� \\ X e�Ce Of �rOpOgOe above specifications and 1� � � J r� J v ! v conditions are satisfactory and are hereby by accepted. You are authorized to to do o Signature the work as specified. Payment will be made as outlined above. het lt 13 s'i" — ' - 1 - ; f " Date of Acceptant \ Signature 3 // Z0 / L2 f7 8I ?1�1 .`C WHITE - Office Copy YELLOW - Customer Copy f 7 {( Replacement tXiubot Propofsril Page No. / of ( Pages Main Office: 7 Devens Street • P.O. Box 429 THE JUBB CO., INC. d.b.a. Northampton, MA: Greenfield, MA 01302 (413) 584 -3716 (413) 772 -6217 LARRY JUBB'S Brattleboro, VT & Keene, NH I MPROVE•A' •HOMETM 1- 888 - 639 -JUBB Email: JubbCompanyinc@aol.com PROPOSAL TED � S t UUBB r ( MIT TO PHONE DATE T �t^� (y- ,/�/` /" /3 - ,J� �j ty�. -- / J/� , '] STREET `iJ 4( 8, forks JO ' ✓ G t/ e) ��'S I t�'� CITY, STATE AND Zli s JOB LOCATION ore -rhfi) N Mg. SA971V TENTATIVE JOB SCHEDULE (Weather Permit g) MA Registration 100001 Approximately A - g weeks from date of signed proposal received by Jubb Co„ Inc. MA Cons. Sup. Lic. 055333 We hereby submit specifications and estimates for: lI ( Supply & Install Mastic Reujae Z'at� d Vinyl Replacement Windows .��SCAOC 1/2 Screens (double hung only). • Interlock meeting rail. — Th. ACC- • Locking Screens (double hung only). • Welded sash & frame. -- ---" • Tilt -in Sashes (double hung only). • Five degree sloped sill. • Non - conductive intercept glass system. • Seven - eights thermo glass. • Continuous Balances (double hung only). • Insulated padded frame. • Sun Shield Vinyl Compound (Mastic exclusive). • Energy Star approved. • Twin locks on double hung units 32" or wider. • Virgin vin I. • Twenty year manufacture guarantee on glass seal failure. F� 5 5 - 11/ �5 7 1 - N1.05'1 , 2. • Lifetime transferable manufacture guarantee on vinyl window rf arm. fi2 yney' • Labor guarantee as required by CTI&NH, VT contractor regulations. o p Color: A Linen White ❑ Almond* ( *extra charges apply for this colors) o F �y�� tn 64RrhE.S TOTAL UNITS REPLACED: ..C) t/..b \e ri 7 �,, Wef(v] .Grids 10p Sts 1 � ©:q(y 6 T`ds 1-° � ' CKce,�r Off ° si` G rids ar/ d))�/d (Note: Grl ds are beveled) Low "E" GlassyeC) VArgon)/44 Insulation (into weight pockets) y -S XStorm Window Removal CI Aluminum Clad Exte�or Castings (❑ Full CI V Partial) I o I St F-(ocva OTHER / NOTE: S-fii- ca.,,:4 f Wt &OO W --rt. 3.s c c'3r tVeri 7 ff Dc>u.t ' fh /iys � G SERVICE FEE: $125.00 (includes permit and disposal of all job related refuse.) [service fee not included in total amount below, and will be billed separately.] CONTRACT SERVICE CHARGE: An interest charge of 2% per month (24% per annum) will be added to outstanding balances over 30 days, plus all costs, including reasonable attorney's fees, incurred in collecting any sums owed. / / e n a f3C0po hereby to furnish m erial and labor - complete in accordance with above specifications, for the sum of: 46 1f'� LtM e f pelf 2 F1 dollar ( 75 66 )• Payment to be made as follows: 1/3 DOWN PAYMENT UPON ACC • r NCE ake checks payable to: The Jubb Co., Inc. (Our installers will collect final balance upon completion). ?r . 2-S 1) E1■C1 (7 r {`I / / 1 � I { / � � All material rguaranteed be as specified. All work • completed in a workmanlike g p� � y! ik" v /`-r'� mannrter er according to standard to standaa rd practicis es. . AnyAny d alteration or devviation tion from above specifics- Authorized ff / bons involving extra costs will be executed only upon written orders, and will become an extra Si nature F - `< - a — charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and other necessary insurance. Our Note: This pr pot ay be \\y workers are fully covered by Workmen's Compensation Insurance. withdrawn b us if not accepted within THIRTY days. // r gttcptanee of Propooat- The above prices, specifications and . , , . , _ 2i conditions are satisfactory and are hereby accepted. You are authorized to do Signature r f the work as specified. Payment will be made as outlined above. i ; . lr'(c t ( ''! Date of Acceptan 2U Al /2 Signature : t . ) ) , ' -J WHITE - Remittance Copy YELLOW - Customer Copy PINK - Office Copy _ Department of Industrial , Accidents . - ' — ft Office of Investigations a. : . 600 Washington: Street Boston MA 02111 www.mass. /dia Workers' Compensation Insurance Affidavit Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): r " ,$ , �� p _ � Address: p�� • li� l City /State /Zip : k f\-% a Phone #: 700 Are you an employer? Check the appropriate box: Type of project (required): 1. I am: a employer with 4. 0 I am`a general contractor and I 6 New construction employees (full and/or part- time).* have hired the sub - contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet r 1. ❑ Remodelin ship and have no employees These sub- contractors have 8. 0Demolition working for me in any capacity. workers' comp. insurance. 9. 0 Building addition [No workers' comp. insurance 5.: 0 We are a corporation and its required.] officers have exercised their 10.[] Electrical repairs or additions 3.0 I am a homeowner: doing: all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'.` comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are 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 ofthe 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. Insurance Company Name: 0 • Policy # or Self: ins.. Lic. #: (/L g6 6q 99q Expiration Date: 0 t V 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 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 uniter-thapsin,s..."11 penalty, of rjury that the information provided above true d' correct. Signature: -,� �.,� Date: r � Phone #: 0 1 (( / 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 #: • SECTION 8 - CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : Z Li r re /9 U 7,tJ/1 U r License Number Pc 60x M q 6 // 1-?') Address J // Expiration Date , See Con'faC;7' ( 4/l / `7707 tor? / 9 Signature Telephone • 9. Registered Home Improvement Contractor. Not Applicable ❑ the 'em b� Cornpa',i ,. is Cs - -a5 5 3 Company Name Registration Number P &)X -J9 Grrer /J I-111 Q1,3() � Address f Expiration Date Telephone NI V779?' / j r 6 ic.20/y - SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, g 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 lB' No ❑ 11. - Home Owner Exemption The current exemption for "homeowners" was extended to include Owner -occupied Dwellituts 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 ❑ Addition El Replacement Alteration(s) ED Roofing n Or Doors �� Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks [0 Siding [0] Other [0] Brief Description of Promised Work: re p cq o o u /t° q Vi 1 i?e pi /ee/n /nria Alteration of existing bedroom 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. 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 6 reo J , as Owner of the subject property ,-�� / 7 hereby authorize r /1C �LC�1(� C (� /77 to act on my behalf, in all matters relative to work au oriz y this building permit application. 5-e e Con 1-/'a e /- yJl -- Signature of Owner Date E / &ei/ , 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 Signature of Owner /Agent 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 Building Department Lot Size Frontage Setbacks Front Side L: • R: L: R: Rear Building Height Bldg. Square Footage % i Open Space Footage % (Lot area minus bldg & paved , i parking) # of Parking Spaces Fill: (volume & Location) A. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO r/ i DONT KNOW O YES IF YES, date issued:' IF YES: Was the permit recorded at the Registry of Deeds? NO ft DONT KNOW 0 YES IF YES: enter Book Page, i and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DONT KNOW © YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained O 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 0 NO fit IF YES, describe size, type and location:: ! E. WII 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 © NO • IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Department use only City of Northampton Status of Permit Building Department Curb Cut/Driveway Permit q 212 Main Street Sewer /Septic Availability atJ 2 �� ��L Room 100 WaterNVell Availability orthampton, MA 01060 Two Sets of Structural Plans DE, .; BU '_ bile 4 3-587 -1240 Fax 413- 587 -1272 Plot/Site Plans NORTHAM dA01 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 39 Jj /13l(e Road Map Lot Unit Wo r ha m/' 7 Zone Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 3r c-e - 8roo1fs ,3 ? 14/ /Ls, de IQ&Jad Name (Print) / / Current Mailin ddre�s Telephone Signature 2.2 Authorized Agent; 4 ()Lorenee u 6A o '30X 9 6 / /i6-4/ 9 iJa Name (Print) Current Mailing Address: e (1 i3J '7'M -6 i ? Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS 1 Item Estimated Cost (Dollars) to be Official Use Only completed by permit 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 /1 oliq V -- 6. Total = (1 +2 +3 +4 +5) Check Number 43 94$ This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner/Inspector of Buildings Date 39 HILLSIDE RD BP- 2013 -0239 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 24D - 302 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: window replaced BUILDING PERMIT Permit # BP- 2013 -0239 Project # JS- 2013 - 000390 Est. Cost: $11224.00 Fee: $35.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: THE JUBB CO INC 55333 Lot Size(sq. ft.): 5183.64 Owner: BROOKS E BRUCE & A TAEKO Zoning: URA(100)/ Applicant: THE JUBB C O INC AT: 39 HILLSIDE RD Applicant Address: Phone: Insurance: P 0 Box 429 (413) 772 -6217 Workers Compensation GREENFIELDMA01302 ISSUED ON:8/31/2012 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 8/31/2012 0:00:00 $35.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner