38A-065 (12) 188 EARLE ST BP-2018-1187
GIs#- COMMONWEALTH OF MASSACHUSETTS
MarrBlock: 38A-065 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
CateuorY: Deck BUILDING PERMIT
Permit# BP-2018-1187
Proiect# JS-2018-002127
Est.Cost: $7800.00
Fee:$65.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor. License.
Use Group: BRIAN JIMMO 074769
Lot Size(sp.ft.): 10802.88 Owner. YOURGA JONATHAN&PAULINE PARKER
zoninw SI(97)/URC(3)/ Annlicant: BRIAN JIMMO
AT. 188 EARLE ST
AnnlicantAddress: Phone: Insurance:
37 CRESCENT ST (413) 237-6475 WC
GRANBYMA01033 ISSUED ON.511712018 0:00:00
TO PERFORM THE FOLLOWING WORK 10X24 DECK ON REAR OF HOME
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 5/17/20180:00:00 $65.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2018-1187
APPLICANT/CONTACT PERSON 3RIAN 11MM?I
ADDRESS/PHONE 37 CRESCENT ST GRANBY (413)217-647,
PROPERTY LOCATION 188 EARL E ST
MAP 38A PARCEL 065 001 ZONE SI(97)/URC(3)/
THISSECTIONFOROFFICIALli4 ONLY:
PERMIT APP![CATION OHECLLIST_
E: 'LOSER REQUIRED DATE
ZONING FORM FILLED OUT _
Fee Paid
Building Permit Filled out
Fee Paid
TvoeofConstructiom !0X24 DECK ON RE OF E
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 074769
3 sets of Plans/Plot Plan
THE YOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
_Approved 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/QR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: § '
Finding Special Permit ( Variance-
Received&
ariance*Received&Recorded at Registry of Deeds P'oofEmlosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
5-/1-7/1 fb 21F
Signature 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.
REC } WYl ham ton trort
..r Building D art lent
MAY 1 d � j�al Str t BeK+ pt1
"IC60m 100
Northampton MA 1060 1Wegepc
OEphortex4d a 413587-1272 .
NONTNAMPTON,MA0109a Gula(
APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Prooetv Address: This section to be completed by officeC
pg E' 4-A C s t - Map -�>/gfi Lot 1)(16- Unit
Zone Overlay District
Elm at Dlabid CB Dlabld
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
S, 1\C'yC'on �l Our'rt,A � g� � ��� 2 S � , IL •4-�c, . -6,Name(Print) Current Mailing Address: — ! L
Id Telephone
Signawr
2. uthori.d Aoent:
S�- C3 n� yMA4133
Name(P�n Current Maili,Address:
4) Lj
Signature Telephone
CONSTRUCTION
Item Estimated Cost(Dollars)to be Oficial 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 Fall D
4. Mechanical(HVAC) O
5. Fire Protection
6. Total=(1 +2+3+4+5) C)o Chack Number
This Section For Official Use Only
Building Permit Number. DateIssued:
Signature:
Building Commissionedinspector of Buildings Data
`j imm o corTlrach�nq�r1 @ 9 �L�I . CQYV�,
EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR)
Section 4. ZONING7 All Information Must Be Completed.Permit Can Be Denied pus To Incomplete Information
Existing Proposed Required by Zoning
This column m be filled in by
Building D,pa,maeat
Lot Size - -
Frontage
Setbacks Front
Side L: R.;_-. L'. _ R:. . _
Rear
Building Height -
Bldg.Square Footage % -
Open Space Footage %
(Lm area minus bldg&paved -
arkni
#of Parking Spaces -
Fill: .... . -..- . _
volume&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO . DONT KNOW O YES O
IF YES, date issued:
IF YES: . Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter BookPage ,�r� and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO Q DONT 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 [citation:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(Gearing,grading,excavation,or filling)over 1 acre or is it pan of a common plan
that will disturb over 1 acre? YES O NO qv
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
SECTION 5-DESCRIPTION OF PROPOSED WORK Icheck all applicablel
New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing ❑
Or Doors O
Accessory Bldg. ❑ DomollUon ❑ New Signs Idl Decks Siding jpj Other IC�
Brief Description of Proposed I r
Work: I D x 2Q EL" IC do
Alteration of existing bedroom_Yes--�o No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Ves No
Plans Attached Roll -Sheet
III&If Now housoandn h e I
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 a0ached?
h. Type of construction
i. Is construction within 100 ft.of wetlands? Yes _No. Is construction within 100 yr. floodplain YesNo
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=
OMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, 7S-1vn a [»1 l G%— Y' as Owner of the subject
property /�'�/� "
hereby authorize 11 `t—' c 1� 1 7 \ W� a
to act on my behalf,in all maw relative to work authorized by this building permit application.
Signature I Date y — / — ZU )
as Owner/Authorized
Agent hereby declarti that state and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed untler thepains and ties
afties of perjury.
C' , r J \W-Nv,
Print Name
Signature of,0wnqfAenl Date
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑ ^r/
—
Name of License Holds : f) T 1 G(� \l 11^ f� d C S
License Number
Atl p Expiation Date
sgmbtur Telephone
9.ReWsfarad Hems Impr nt Coaf oor. Not Applicable ❑
Company Name Registration Number
47 co,n�-
Address Expiration Date
Telephone 4 15-2
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....... No...... ❑
City of Northampton
/ Massachusetts
I � c
,r
l S
DEPART[ffiNT OF BUILDING INSPECTIONS je
212 Win Street *a ici"l building Ce
Rorthav n, W 01060
Debris 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.
The debris from construction work being performed at:
I':�% E & (I - St-
(Please print house number and street name)
Is to be disposed of at:
(Please print name and location of facility)
Orr will be disposed of iinnya ddumpster onsite rented or leased from:
(Company Name and Address)
^ )Z
Sig atn P Iicant or Owner Date
If,for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the
Building Department as to the location where the debris will be disposed.
\ The Commonwealth ofMassaehusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass,gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant If t' Please Print Legibly
Name (Business/Organimtiordlndividual): J r r�Cr C�t r�fL r Y1 C
Address: e`)-? C rcC C,X_tl� <,'?�.
City/State,/Zip: G I Phone#:
Are,...emPlayer?Chea the npproprome box: Type of project(required):
1�I am a employer with Z employees(pill motor pact time) T ❑New construction
2. Iemasoleprop6mrorpamershipmdhavenoemploymsworking Pormein 8. Remodeling
any capacity.[No workers'comp.insurance required]
3.❑l am a homeowner doing all work myself.[No worker comp.insurance required.]t 1 Demolition
4.❑I am a homeowner and will he buin tractors to conduct all work on en twill 10 Building addition
gcon mypmp y.
ensure that all contractors either have wotkcts comprnsanon insurance or an sole 11.[:]Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5 1 am a geneml contractor and 1 have hired the sub-contmMrs listed on OM attached sheet.
1jl,�]3.nRoofrepairs
These sub-comracmrs have employees end have workers'comp.insuinsurance; IJ
6 We are a corporation and its officers have exercised their right of exemption per MGL c. l4. Other -D Other t�
152,§1(4),and we have an employees.[No workers'comp.insurance required]
'Any applicaat that checks box I most also till out the section below showing their worke:s'comprnsation policy information.
s Homeowners who submit this affidavit indicating they are doing all work and men hire outside contractors must submit a new affidavit indicating such.
tConeacrors mat check this box mast attached an additional sheet showing the name of the subconhactors and state whether or not those entries have
employees. If the subcontractors have employees,they most provide their workers romp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information. q ,�
Insurance Company Name:
Policy#or Self-ins.Lia#: IS Q L I �^ qG O Expiration Date:
Job Site Address: ��rd E c e L N•� TYT '�'�'A City/State/Zip: O 1 O
Attach a copy of the workers'compensation policy de ]oration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL a 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year imprisonment ' enalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
day against the violat copy of this statement not be forwarded to the Office of Investigations of the DIA for insurance
coverage verifi
I do hereb cera u of penalties perjury douche information provided above is true and correct
Signatme: Data:
Phone#: [ 3 - 2 3 7 5
Oficial use only. Do not write in this area,to be completed by city or town ofciat.
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#:
�Rm® CERTIFICATE OF LIABILITY INSURANCE DAnosnon8
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.
AM—PORTANT. If the certificate,holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 endorsemends).
PaoOucER CONTACT
NAME: Jenny Murdza
Metros Insurance AgencyPHoxE 413-536-1491 MC No: 413.532-8522
2030 Memorial Drive
Chicopee,MA 01020 AooREss lmurdza@rrletroslnsurance.com
IXSUR SI AFFORDING COVEIUGE NAICtl
INSURERA: Travelers
INSURED INSURERS: NGM Insurance
Jimmo Contracting,Inc. INSURERC:
37 Crosent Street INSURER 0:
Granby,MA 01033
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS
CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IOUCY EXP
IRR TYPE OF INSURANCE POLICY NUMBER MWOOM'W MMIDDWryYLIMITS
X COMMERCIAL GENERAL UAMUTY EACH OCCURRENCE $ 1,000,000
CIAIMSNADE OCCUR PREMISES Ee occu — E 300,000
MEG EXP(Myone $ 5,000
A 68036910044 03/09/18 03/09/19 PERSONAL A ADV INJURY E 1,UOQ000
GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000
X POLICY�J01 FLOC PRODUCTS-COMPIOPAGG $ 2,000,000
G HER $
auTou08aE uaealTY Ep-..rJI INGLE LIMIT $ 1,000,000
ANYAUTO 20DUYINJURYIPer Pewnl s
B OWNED X SCHEDULED M1T2331T 09100/17 09/08/18 soDRY INJURY IPer waann0 S
AUTOSONLY AUTOG
HIRED NON-0WNEO PROPERttDAMAGE $
X AUTOSONLY X AUTOS ONLY Ps ewiEent
s
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS OR, CLAIMSYAGE AGGREGATE S
DEC RETENTION$ S
WORKERS COMPENSATION
AND EMPLOYERS'LIABILIT! STATUTE ER"
A oFfICPOPP ETOPUExc uoeo EcunvE Y� NIA UBB361X660 05/21/17 05121/18 EL.EACHAcaOervT $ 100,000
(ManJnary In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
fj tlewiluuM
GESCRIPTION OF OPERATIONS CeIox EL DISEASEPOLICYLIMIT E 600,000
Tr-
DESCRIPTION OF OPERADONS I LOCATIONS INEUCLES ACORD 1.1,..Id-NI Remnke SeNeEUIa,-1 M...a mon epr<a Ie,n1.1.l
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
City Of Northampton ACCORDANCE WITH THE POLICY PROVISIONS.
Building Department
212 Main Street AUTHORIZED REPRESENTATIVE
Northampton,MA 01060 Jenny Murdza
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
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