36-162 (2) �r0�l���r Page No. � of Pages
Main .,r •e: THE JUBB CO., INC. d.b.a. 18 North Hatfield Road
7 Devens Street Hatfield, MA 01038
P.O. Box 429 LARRY J U B B'S
Greenfield, MA 01302 Northampton, MA
(413) 772-6217 IMPROVE-A-HOME (413) 584-3716
PROPOSAL SUBMITTED TO PHONE DATE
STREET JOB NAME
CITY,STATE AND ZIP JOB LOCATION
ARCHITECT DATE OF PLANS MA Registration 100001 JOBPHONE
j_jj/6 1 MA Cons. Sup. Lic. 055333
We Hereby submit specifications and estimates for:
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Provisions of MA Law require Contractors to inform purchasers of MA Contractors Aegistration, Regulations, Rig is of Recession, Specific
Warrantees,and other consumer rights. I (We) have received, reviewed,and understand a separate copy of these regulations.
(Signature)
We 3propOle hereby to furnish material and labor—complete in accordance with above specifications, for the sum of:
dollars ($ ).
Payment to be made as follows:
Vs, P,>wty o N A�+-"uc_ 3 altruce_ Due a.A) Cew ele plc-A%
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o >t�
All material is guaranteed to be as specified.All work to be completed in a workmanlike
manner according to standard practices.Any alteration or deviation from above specifica- Authorized
tions involving extra costs will be executed only upon written orders,and will become an extra Signature
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 prop sal ay be AA
workers are fully covered by Workmen's Compensation Insurance. withdrawn by us if not accepted within C, days.
21cceptance of 3propIUVIA—The above prices,specifications and
conditions are satisfactory and are hereby accepted.You are authorized to do Signature
the work as specified.Payment will be made as outlined above.
r f Signature
Date of Acceptance:
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 MGL
c 111, S 150A_
I certify that I will notify the Building Official by
(Two months m wdmum) 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 Dorn-..for attachment
to the Building Permit
6-A-0
�; ...�
ate igua re P rmit Applicant
(Print or type the following information)
Name of Permit Applicant
Firm Name, if any
i
Val,
. kfi_
Address
'be"disposed:.of
cr
01
Location of Facility
f?e
Board of Building Regulations
One Ashburton Place, Rm 1301
Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 05/21/1961
Number: CS 055333 Expires: 05/21/2008 Restricted To: 00
LAWRENCE A JUBB JR
PO BOX 429
GREENFIELD, MA 01302
Tr, no: 23246
Keep top for receipt and change of address notification.
DPS-CAI 0 5OM-04105-PC8698
Board of Building Regula ions and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Registration: 100001
Type: Private Corporation
Expiration: 6/8/2008
The Jubb Company, Inc.
Larry Jubb Jr. ---- - -- --- -- ---P. O. Box 429 - ----- - _ -- - _ -- - -
Greenfield, MA 01302 ---- - ------ -----------_---_---_-__- ----_-_ .--
Update Address and return card. Mark reason for change.
PS-CA1 C, 5DM-04/05-PC8698 i Address Cl Renewal ❑ Employment [ Lost Card
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,111A 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: I/ U• t�C� X 4�—`�
City/State/Zip: Ot3o.)— Phone i1:_
Are u an employer?Check the appropriate box: Type of project(required):
1. " Iam a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. E]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.❑ Electrical repairs or additions
3.❑ 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.❑Roof repairs
insurance required.]t employees. [No workers'
comp. insurance required.] 13.❑ Other
*My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Ilomeowners 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 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.
Insurance Company Name: �ifn
Policy#or Self-ins.Lie. 1Aj C_ 0 g Expiration Date: 5 3 ! O
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 MGI,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 under 1he pains d pe flies of perjury that the information provided above is true and correct.
Signature: Date:
Phone#:
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#:
$tf,1�.5 ;rtN'+Rx r o{i rygY�l9�'l1iKltnli�hFy��1��i I L yi >.C`'P`L��4}
�SEGT�IO,N�8 r�CONSr,R�UCT,IOMISERVICES:I;��
13.1 Licensed Construction Supervisor: Not Applicable O
Nance of License tiolder Ib��
License Number
PU U1 y4
Address Expirati n Date
I U
Signature ••—''"` T 6p ne
Ji' /
J,'�. l ""e ' Not Applicable.❑
/
ComRany Narne Registration'Numb r
a6 G
Expiration to
Address � +J`' — C� l.3
Ir Telephone
+SECTI,ON� OWOIRKERSt
� COMP,ENSATION 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 affid;
will result in the denial of the issuance of the b jMing permit.
Signed Affidavit Attached Yes....... No...... 0 -
:. 'o; ®�wner.L'�xem:pt'io1>t
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 n homeowner.
Such"homeowner"sliall submit to the Building Official,on a form acceptable to the Building Official, that he/she shall he
responsible for all such work performed under the buildine 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
SE ION rx�xf��I'tNI�M,/llf'.t ,�1'�rF �` � tiff 11111 Y, �� r't 4 ',^fi ✓•'Ci. rih'r -f "•/:�y:':'L:.J�7�Y
t ,Fr NMQ 7T 1�7'I►AAGI�r'�i�ti a'441 �t�lli�'1�9r r(11k1•rr k i�Dt I � r).'.ji:;'„1v,.r' .►r,�,,j - :� 1 r,... a �.
CT 5 �DESChiPTION O�PRO�OSEDbWORKI(clieckrall apl�licablc),^ ` d {il
.,r-w,x•.^�rw•,xl u,r.w. „«.�xr, ..,••«.m,•,..-r—.,:i.._ ..-- ' '.
•t.Itr aft. _M1C1.aurklc:,r,►n raunalx V",rlatn'r'ttr,nwvrstiA'.xr.'rxry,�.,.. i.:,,�.•-.Ir,.:
..,,.t,o.xtro, eKnl�¢,driitl.Ml a^.hKr rY?'a.inx;:wx•vtinerm rr.a.F°Ir!:na�r�,..,,,,,.x'+yer,;,pix•,:«,.•.:1T:r,.y�1a•19•e'-... .., .,
New House 13 Addition ❑ Replacement idows Alteration(s) ❑ Roofing ❑
Or Doors
Accessory Bldg. ❑ Demolition[] New Signs [ ] Decks [ ] Siding[ ] Other [ ]
C-r
Brief Description of Proposed Work: CGc t'
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative o Renovating unfinished basement Yes No
Plans Attached Roll O - Sheet O
Wa1I1YNi vW-HOUT06fi— €o—M- diti Ktinh�liou'sing-co iii plbtb4tlierfollowin •
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?
I. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Mascheck Energy Compliance form attached?
h. Type of construction
L 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
x M1l'i���! �i"y?[I�,p�dE ��jl'��11t1..+�kC1Ul h�i�p i�1�Nirrvl q:l� a,if I 124�1�„ - ��l� I I �, i I ��.• ...,I .....
�SECTjI,QNaT„�0*„NERA,11THrOrRIZA7fON� iTOBE�COMPL'ETED''WHEN ; 1r
Q�W,N RNS A�,GCE( TjaOI� ICO�twT�,tAC��OR�gPPIrIES ,OR!BgILD1NG;PERMIT:'
as Owner of the subject grope
hereby,authorize to ac
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
r'1(' % t�� _ ` �'� , 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 °r
7V�
— Sl nature of Owner/A ent Data
of Northampton rs a r
T `<< Building Department e /"
�; 212 Main Street
'doom 100, a e e
r . " W etso a a Pa
PQ� w,Nc��tharr�pton; MA•01060 ,
phoq*r ,,6,, -�240 Fax 413.587.1272 ' She P
Othe, 'pe0{V
APP4 I ITION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
.SECTI0 Nx1�'u�SITEINFORrMQT,ION
1.1 Pro ert Address: � `';,��R. ,:y;y�T�il s,,sectio 'to be':dbdip eted by officer
P y -� � +•t�'il�` °'�
'I .tt :� 00.
CJ/C (G .Ov}erlayDistrict
t iI IJ? X I,'tdxJ ipiJ!° 7 I 1+` l 1 Pi4j 1},':31 • "l1*r}1f
!'! ' FiTi,�,....-{f �! �i, i!"I L ti'F.t;�;'���,1•::�•�. J 'i
+Elm'St. District ��'r. x i�CB�D,istr(ct ,?
`.SECflO(►�2 �PIF�OPERTY1QI(YN, R$,HIP%AUTHORIZED;AGENT.
'I{�' "IXiI'/ .1• ,M'.. I'tl rM1.,I:�H,: , „It �: ,:'P'I' .
2.1 Owner of,Record: 7i )
Name(Print) Current Mailing Address:
Telephone
Signature
2.2 Authorized Agent,
--.._
me(Print) Current Mailing Address:
Signature Telephone
�:..r,. rN!;'t"��.rl h1*.�RINF�1'+'t xh! i' 1Ni,llr�h�,nidy I,II{'f.jl-'jl,!Iprl. ,r I�+.lr, a 111?!I•'.'I l n. i
hSECT�OW31 "E�STIMAT RUCTION,9O5T5
Item Estimated Cost(Dollars) to be �I ;,p;,�'q((w9al;UejOPly
completed b permit applicant
it
„yd,II 1 1 ,•
1. Building (a)'Building'Permit1Flee rl , �r �,•
.. ,�tl..' r' ;RIB 'I '� i ' I•! +:
2.• Electrical (b) Estimated Total';Cost;of '
Construction?frorJ 6
3. Plumbing Building .F.ermit;}Fee•''r''
,..
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(I + 2 + 3 +4 + 5) G Check Number . �
°.,��+. ' i,: .� 1'In�.i 'S ry;lh�t '.�'•1 �i .'. ,I ', ..., ` .:1:1 I � ',,t'}.1, '
', 4 �„,d„ , „h • r :fihis'Sectlon For Official UselOnl r
It. + °:: I h N'' r�,. 1 h I I I , :. , �iI�;I , plk I," ll, '1'ti •k ,
Bt1Jld ngil?Sefrllt� Umf�etGdicll �rlli:,l,,,ll ,1 l' ].Date Issued,
ICI IF�tr rJJ I +,I .} ix
n• I x .M 11 4, } ,
•11 uiR�16'�1y!F rh lyr" I? X`I'tf ,�,
•iP,U'.,rat
i:}Sgnatt) ei'��+ �Iv ,i,Yl�d`°I/ii�Nl141� ` 1•��4;4M-„i�.��'r�'�rn�l}f,M�x;,j4:.R:,,j I f. ''11��.4 , I,I � "•',. A it ..
.k
,li ; Bulllilig CommJssloger(I�spector o1 BulJdlggs.l; r, Date;;v "'';°
I I
�x -0851
BP-2008
CIS#: 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-2008-0851
Project# JS-2008-001298
I:st. Cost: $7155.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: THE JUBB CO INC 100001
Lot Size(sq. ft.): 11543.40 Owner: WAMSLEY MARK
Zoning: SR Applicant: THE JUBB CO INC
AT. 1086 BURTS PIT RD
Applicant Address: Phone: Insurance:
P O Box 429 (413) 772-6217 Workers
Compensation
GREENFIELDMA01302 ISSUED ON:41212008 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 4/2/2008 0:00:00 $25.0010568
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo