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17C-017 (3) DEBRIS AFFIDAVIT As a result of the provisions of MGL c. 40, S 54, I acknowledge that as a condition of this 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. I certify that I will notify the Building Commissioner of any change in the location of the solid waste disposal facility to be used within 72 hours. Date Signa -o Permi t scant _ l Print or type the following information: CSC y/ �'►-�C' ' j'�.G� J Name of Permit Applicant C-JJ-) Firm Name (if applicable) CUB �_ Address The debris will be disposed of: CO Facility Address QC:QRd ----- ----------- ------- � DATF(MrvDD;YY) TIO, CERTIFICATE OF LIABILITY INSURANCE _ mAR408 PROOK1111 iHIS CFR11fICATE IS ISSUED A3 A Mi\'1'IER or INronNIATION A.H. RISi INSURANCE AGENCY, INC. ONLY ANU COWERS NO LtIGHiS UPON THE CEItI It:KATE 169 AVENUE A HOLDER. THIS CERTIFICATE DOES NCT AMEND, EXTEND OR P.O. BOX 391 ALTER THE COVERAGE AFFORUEL) 8•/ THE POLICIES BELOW, TURNERS FALLS MA 01378 PHONE: 413.863-4373 INSURERS AFFURUING COVERAGE NAIC./ INSURED INSURER A GFNERAL CASUALTY E JUBB COMPANY, INC. I(L,IJr?rR n P.O. BOX 479 - - --- ---_ - I - - - GRELNFIELU MA 01302 Ila;vl?I.(2 c 'IPISUI?rR D' 114SURER E' COVERAGES —� TI IC POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS;I,IEf) TO THE IFISUPk;) NAf,!EO ABOVC FOR THE POLICY PCR100 INNCATEC, NpTVv'17HSTANOIfk_: ANY REOUIREFAF,NT, TERM OR (`,ONDITION OF ANY CONTRACT OR OTHCR O^CU1AFEF T `4$1711 RCSPr-QT TO V/HICH THIS CERTIFICATE MAY BE USUEO OR MAY PERTAIN, THE INSURANCE AFFOROCD BY THE POLICIES DESCPIRED HERLItI IS S!eJEr.T TO ALL THE TC11M , EXCLUSIOtJg ANC) C-CN01TiON3 OF S!JC!1 POLICIFB, AGGREGATF LIMITS SHOWN MAY HAVE BEEN REOUCffJ RY PAIO IM.".•I� TYPE pp INSURANCE POLICY NUMBER I r'ol-ICv rrf GCTIve POLICY CXPIPATION i -----4�-- y-TE IrII'�rrYy. t)AfE:I(dGUDDrn'1 LIMITS GENERAL LI.hBIUrY CCX 0394426 I UEC 14 07 DEC 14 08 EncH OCrURRENGr_ 1,000,001 I--..._.— _ _ X COMMCRCIAL GENERnI.I,IABIUTY oA,UarC Tc a N,EU g — 1 OU,OU( CI,AIFASMADE i X I OCCUR ( I iP_RE'AISCG(Ea_�cupgcn). -_, -^_ .- _ I I MED.FXP(AnY One Pr,-.c!,1 A i - t'ERSONM.A ADS'IN_'URY 000 - - I ,OO( IGENFRALAGGRGCATE IT 2,0Uo.00L G[N'1_AGGREGATE LIMIT APPLIEC PER I —" -- - — IPP,ODUCTS.CON�P/OPAGG 2,01)UM01 I POLICY 1 I AUTOMOBILE LIABILITY CgA_U394428 JUN 5 07 W JUN 6 O8 „OMDINFC SI^IGL_LIMY __� ANY AUTO AU rOC --'-1 r 1 � I I ALL OWNF , 9p171LY INJURY -- -- -- --- - q _ X-.I SCFIED(A.EU AUTOS ' I (Par person) I` 250,000 X HIRED AUTOS ,� IBOUILY INJI)NY I� Y. NON-OWPJF,DAUTOS (Pnrnc""lenl) SOU,UUU PROPERTY DAMAI?E �S 100,000 GARAGE LIABILITY N/A I AUTO ONLY-EA Al.CICENT a, ANY AUTO I� I OTI IGR THAN EA ACC II - I (AUTO ONLY nC-G EXCESS I UMBER6LLA LIABILITY ' N/A I I EACH OCCURRENI;E I, OCCUR I I CLAIMS MADE I AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND i CWC 0394428 MAY 3 U7 MAY 3 08 X I r0C 27A�L _ 6MpLOYER$'LIABILITY =F g AF FICF RIETORIPARIMER$EXECLITIVE i El EACI•I ACOIOENT OFFICFR,TrIWBER EXCI,I)Dto7 I __. ..! IF yee,eaucTIDR Dllrinf I "_L.DISEAS&EA F,(,,PLOYEE 500,000 8PECIAL PhoV1810N9 polow + _ I E.L.O$SU SF-POLICY LIMIT It 100,000 OTHER: N/A {I I DESCRIPTION OF 0 PERATIONS/LOCATI0NNEI-IICLES/EXCLUSION$ADDED ENDORSEMENT/SPECIAL PROVISI()NS CLASSIFICATION: CARPENTRY/SIDING INSTALLATION WORKERS COMP POLICY INCLUDE$COVERAGE roR CORPORATE OFI"ICLRS CE Fir-AT HOLD ADDITIONAL INSURCO;INSURER LE1 IER: CANCELLATION _ THE JUBB COMPANY SNOUlO ANY OF THE ABOVE DESCRIBED POLICIFS Bj°_ CANCELLED BEFGR!-THE PO BOX 429 EXPIRATION DATE THEREOF, THE ISSUING COMPANY W!LL ENOEAVOR TO MAII ;n GREENFIELD MA 01302 DAYS WRITTFN NOTIC[ TD THE CEFTIFICATG HQI,oEft NAMFq TO TI'IF I EFT,oUt FAIIJ RE TO DO SO SHALL IMPOSE NO O81-IGATION OR LI,IUILITY OF ANY K¢JO UPON'(HE IN.q IRER,IT'S AGENTS OR REPRESENTATIVES. AU7H0RI7E0 REPRP,9ENTATIVF r=, Attention: MARY 772-2530 ACQRU 25(x001/08) Certlflcete# 9035 — Heidi 14x53 The Commonwealth ofMassachuselts Department of Industrial Accidents 11@ JW Office of Investigations 600 Washington Street Boston, MA 02111 wlvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 2 Address: O• City/State/Zip: MA Ot_3v�Phone#: Are ydu an employer?Check the appropriate box: Type of project(required): 1.ff I am 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.El 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑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' 1311 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'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. ;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: Policy#or Self-ins.Lic.#: G1Jt/ 02S9 Expiration Date: 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 under Ire pains d pe Ities of perjury that the information provided above is true and correct. Signature: • Date: Phone#• -7'j2 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#: __ = ✓f?� �V Q�71/� GGIZ Q `/��,1;1G�GlZGCc1,� 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 Cr 5OM-04/05-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 0 50M-04/05-PC8698 -] Address Ll Renewal 0 Employment L Lost Card PROPOSAL The Jubb Co., Inc. d.b.a. , MA Registration 100001 page 1 of 2 LARRY JUBB S MA Cons. Sup. Lic. 055333 IMPROVE-A-HOME TM 7 Devens Street 18 North Hatfield Road P.O.Box 429 Hatfield,MA 01038 Greenfield,MA 01302-0429 Northampton,MA (413)772-6217 (413)584-3716 ----- 1`1 IONE DATE TO: Jenkins, Mary Ann 586-5508 01/26/08 106 North Maple Street JOB NAME/LOCATION Florence, Ma. 01062 Siding 106 North Maple Street Florence, Ma. 01062 JOB NLJM13FIl JOB PHONE - _ _ J-Z�y 5 We hereby submit specifications and estimates for: -SUPPLY&INSTALL ALCOA/MASTIC VINYL SIDING- -of width: ( 4" ) ' -choice of siding color: ( � 9CRti ) corner color: ((n) X— ) -*trim color: ( *white) [NOTE: other trim o lors slightly extra] *trims:j-channels, soffits, window&door casings, fascias, light blocks, louvers and other accessories. r—CU -customized baked enamel aluminum trim on all window/door casings, &fascias. _ - -*3/8" backer beneath siding. *(substrata/SUBSTRATUM, wall leveler). -nail siding approximately 16"on center&according to manufactures specifications. -replace any minor areas of exterior sheathing wood rot. (replacement of up to 3 @ 7/16"each osb sub sheathing). -vent all soffits where possible to heated areas of main house only. -install center vented soffit panels on all applicable overhangs. -install j-block light blocks&dryer vents as necessary. -rake&broom clean job sight at end of each working day. -lifetime transferable manufacture guarantee on Barkwood vinyl siding. -labor guarantee as required by MA. board of building regulaitons and standards. NOTE: 1). round window casings to be painted by owner. 2).siding installed up to newer wood windows& patio door that are presently clad. 3). upper rear gutter presently has broken hanger brackets. 4).to remove pose-ef•2 of 3 trellaces and to re-install trellace at driveway side. 5). not to cover cellar window frames.suggest replacing cellar windows. 6). upper front gutter at ell has rusted sickle type hooks that will remain. 7). existing gutters will remain. 8).gutter downspouts to be removed and re-installed as necessary. (see line 9.) We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Cont'd dollars($ Cont'd ). Payment to be made as follows: $1,000.00 DEPOSIT UPON ACCEPTANCE.ALL 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 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 Signature extra 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. Note:This proposal may b Our workers are fully covered by Worker's Compensation insurance. withdrawn by us if not accepted within 30 days. 1 'Acceptance of Proposal —The above pries, specifications and C CC ,,L 'editions are satisfactory nd are hereby accepted.You are authorized to do the work Signature Xk ry Y P �cified.Payment will be mad a. outlin attpye. �/ � ,` Signature _---_-___— -__ L ceptance ... ----r - - PROUD, ,3128 FOLD AT I>I TO FITCONIPANION 771 DU-O-VUE ENVELOPE. NEBS To Reorder:1-800- 25-6380 or www.nebs.Cone POINTED IN U.5.11. B PROPOSAL The Jubb Co., Inc. d.b.a. MA Registration 000 age 2 of 2 LARRY JUBB S MA Cons. Sup. Lic 0 5 IMPROVE-A-HOME TM 7 Devens Street 18 North Hatfield Road , 1 �f P.O.Box 429 Hatfield,MA 01038 v �r Greenfield,MA 01302-0429 Northampton,MA (413)772-6217 (413)584-3716 -- PHONE DATE TO: Jenkins, Mary Ann 586-5508 01/26/08 106 North Maple Street JOB NAME LOCATION Siding Florence, Ma. 01062 106 North Maple Street Florence, Ma. 01062 JOB NUMBER JOB PHONE We hereby submit specifications and estimates for: 9).to replace upper left front ell downspout that is rusted through. 10).to install vertical wainscoat siding under main house left side bay window. 11). not to cover front porch posts, railings, lattice areas, door jambs or kick plates.see option to cover porch ceiling and beams. 12).to remove front wood screen door at kitchen ell porch and rework casing, clad and re-install storm door. 13).see option below if you wish to have porch ceilings covered. OPTION: 1).to install a barn red 1"x 4"custom clad wood molding at soffit area where soffit meets house wall. $676.00 yes(add to price below). 2).to upgrade siding panel as outlined above to .048 gauge Barkwood siding. $328.001,yes(add to price below). 3).to cover porch ceilings with non-perferated soffit type panels. $357.00_yes(add to price below). SERVICE FEE: $250.00(includes permit&disposal of all job related refuse) [service fee not included in total at bottom &will be included on your final invoice] We Propose hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: Nine Thousand Seven Hundred Sixty Seven and 00/100 Dollars dollars($ 9,767.00 ) Payment to be made as follows: $1,000.00 DEPOSIT UPON ACCEPTANCE.ALL 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 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 Signature extra 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. Note:This proposal ay Our workers are fully covered by Worker's Compensation insurance withdrawn by us if not accepted within 30 days. Acceptance of Proposal ---me above prices, specifications and conditions are satisfactory and are hereby accepted.You are authorised to do the work Signature _ as specified.Payment will be made as outlined above. Signature Date of Acceptance: PRODUCT13124 FOLD AT(,)TO FIT COMPANION 711 OU-O-VUE ENVELOPE. NEBS to Reorder:1$00-225.6380 or www.net)s,com POINIMINU.S.A, B , SECfiTION 8a'USER.VICES t�"`.< 8 1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: �i Wry n S �h r) r d S 5 License Number 00 Gd-y Htl- s a l Address Expiration Date ,Zighature elephone R a ste ed'f off" lme mpravement Contractor• Not Applicable -❑ oo --�t ComL)any Name, Registration Number „1 co / 3,/ v ) Address �] —7 Expiration Date 1 f 4elephone / 7� SECT1QNa10 WORKERS'.COMPENSATION'INSURAN E AFFIDAVIT(M.G.L. c. 152, § 25C(6)) Workers Compensation Insurance affidavit mu e completed and submitted with this application. Failure to provide this affid� will result in the denial of the issuance of t uilding permit. Signed Affidavit Attached Yes....... No...... ❑ _ �- ome ner. e ptio The current exemption for"homeowners"was extended to include Owner-occupied Dtivellines 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 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( you hire to perform work for you under this pen-nit. 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 I SECTION"5'DESCRIPTIONOFiPROPOSEDIWORKt(check��all applicable) _.r1MY+Y,V+ )cM'C W.i 4.M1 Lf•in IP,,S Ire —1]xh.W F ^ RO.r11,451..,. r +Y+f.,n.1'",.'i�eu,,lY!(�nt1EK+,:i�A�f1'°iD�itk'�R.,rie'i u.S�l'11J'i 4f app„&tk`,''.rr"n l.R.v,vk;.lh.!'••t.1...id('f5J?irfbl:4�IFN".!N1A�N M'.' .'.- .,. ... . .,2..1:'ti:F,!'.:: New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑ Or Doors ❑ Accessory Bldg. ❑ Demolition❑ New Signs [ ) Decks [ ] Siding Other [ ] Brief Description of Proposed Work: �Ly)lj 1 . J Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative❑ Renovating unfinished basement Yes No Plans Attached Roll O. Sheet❑ 57,10Nev�i"house�arid ors "tidition to'existing housing complete*tfie followini7: 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. Mascheck 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 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 SECTtION 7a� OWNER AUT•,HORIZATION ,TO'BE COMPLETED WHEN OWNIxRSYgGENT O�RrtCONTRACTaRYAft, ESt OR�BUILDING PERMIT Ylu rn as Owner of the subject prope hereby authorize to ac my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date as Owner/Authorized Agent he declare that the s a ement nd informati n n 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 CJ Signature of Owner/Agent Date l City,\of Northampton S t s r , G Cuiidl g Department y' ? '21Main Street X S r is a ,� " ' Room 100 a e e v Northampton, MA 01060 > w Sets oe a a r Cv phone 413 587 1240 Fax 413-587-12 172 S e Other pe0,�y A P ATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION:1 SITE INFORMATION 1.1 Property Address: > s� This sectio toatipletedby office ;y ; MQ / �� Maps r a�rw Lot : .+' "�'+' 1i „i �J t>i^ •f v. n e t 4"i `Zone y Overlay District = F �-+l •.a D istrajic.^-t �A n�cV Elm St: ; -SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record:rA Name(Print) Current Mailing Address: Telephone Signature 2.2 Authorized Agent: fo ew� Grid Name(Print) Current Mailing Address: -7--2c;� —Co a i 7 T19-nature Telephone ,'SECTION.3 =ESTIMATE !CONSTRUCTION''COSTS Item Estimated Cost(Dollars)to be Official Use Only. completed by ermit applicant 1. Building (a) Building Permit Fee:: 2. Electrical (b) Estimated Total Cost of Constructionfrorn'' 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4 + 5) (o-7, O Check Number This Section For Official Use Onl Buildmg Permit Numbet' Date Issued: y` . Buildy Coinrn,ssioper/Inspector of Buildlrigs Date 7 f r BP-2008-0781 pis#:I 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: vinyl siding BUILDING PERMIT Permit# BP-2008-0781 Project# JS-2008-001192 list. Cost: $9767.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: THE JUBB CO INC 100001 Lot Size(sq. ft.): 22302.72 Owner: JENKINS MARY ANN zoning: URB Applicant: THE JUBB CO INC AT. 106 NORTH MAPLE ST Applicant Address: Phone: Insurance: P O Box 429 (413)772-6217 Workers Compensation GREENFIELDMA01302 ISSUED ON:311312008 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL VINYL SIDING 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 3/13/2008 0:00:00 $25.0010516 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo