18C-114 (6) BP-2024-0410
194 JACKSON ST COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
18C-114-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2024-0410 PERMISSION IS HEREBY GRANTED TO:
Project# DECK 2024 Contractor: License:
Est. Cost: 8513
Const.Class: Exp.Date:
Use Group: Owner: JOSEPH MORSE ALISON &
Lot Size (sq.ft.)
Zoning: URB Applicant: JOSEPH MORSE ALISON &
Applicant Address Phone: Insurance:
194 JACKSON ST
NORTHAMPTON, MA 01060
ISSUED ON: 04/11/2024
TO PERFORM THE FOLLOWING WORK:
BUILD 10X16 DECK OFF REAR OF HOUSE
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
/60_
Fees Paid: $65.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
Z- O ,K' ✓
File #BP-2024-0410
APPLICANT/CONTACT PERSON:MORSE ALISON &JOSEPH
194 JACKSON ST NORTHAMPTON, MA 01060
PROPERTY LOCATION 194 JACKSON ST
MAP:LOT 18C-114-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $65.00
Type of Construction: BUILD 10X16 DECK OFF REAR OF HOUSE
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION
PRESENTED:
Approved Additional permits required(see below) For all projects that need additional reviews ]1.7 c41.7E
e
as checked below,please see the Office of Planning& Sustainability Permit nage or scan here 'at #
PLANNING BOARD PERMIT REQUIRED UNDER:§ �' •
Ercek,N
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
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
//42 8ZzLI
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.
ite ern-AI/116 plans ,..... plei-
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' il4 The ConuiiiiiiwealiIi us Massaciioetib ' 4,09 \.,f--
U Board of Building Regulations and Standard .
ir , .
Massachusetts State Building Code, 780 CliktrA-',, mumapAuTy
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This Section For Official Use Only \--70 'io•4T
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Building Permit Number: i P". - tO , Date Applied: s
7-7
Building Official(Print Name) Signature Date
SECTION 1:SITE INFORMATION
1.1 Property Addrps: 1.2 Assessors Map 4tr Parcel N111.11herg
_ 19 ii j cc,K 54A/‘ StWti. _ / c-
1.1a Is this an accepted street?yes no
1.3 Zoning Information: 1.4 Piopt/oDimensions:t-7 `15
Zg ni..trict pr,...,---,4 1 tse T'1' A f( (1 ft) Pr---4^zr(ft)
1.5
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided
t5 Lio 30C
-10,i.:0 kJ ,."__._:, .:___, ,:__.f._._._.:: .4: ! 1.3 e:,,.: ...1"..‘•!:.i,,,:..si SJ4t:',iin:
Zone: Outside Flood0 Zone?
Public CI Private CI Municipal 0 On site disposal system 0
Check if yes
SECTION 2: PROPERTY OWNERSHIP'
) 1 :'' J 1 .7 All: kip 1,\A milhN f-'1A ma)
Name(Print) i City,StateZIPI Is z crA) /11 ;
/ 9 q j ,..1( )-0i.% S Fre_J- k 1 1/ -g8. 2i4( ktoe,5-6‘. ./Q0e/vf-,c_i
No.and Street Telephone Email Address
. y)
New Construction' Existing Building 0 Owner-Occupied 0 Repairs(s) 0 Alteration(s) 0 Addition El
Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify:
r,,,__., ..: _, r r--;.-F.,:•4 Wofk2: , / n-
at,Jd___,Jo ae/4 &Pc-k 6 it te Ar 0 f liokile...
SECTION 4:ESTIMATED CONSTRUCTION COSTS
s'.: ' ' ': .'
L. ' r. • :--_ '1 ly
1. Building $ S'51 3 - 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $
ri'1,' 1 13"^jr..,7t C,-,*-43(Ttm 6)T"mlitiplier x
---.1 I !...g
4. Mechanical (HVAC) $ List:
5.Mechanical (Fire
Suppression) $ Total All Fees: $
41 L),-
('t _‘ ,k
,
6. 4 t•--;%:•:i .r. i- "
513 . a.)
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
License Number Expiration D. e
Nam of C.S.L.II_'_'-=
List CSL Type(see below)
No.and Stre Type 0 escription
U Unrestri ' (Buildings up to 35,000 cu.ft.)
R Res r'• d 1&2 Family Dwelling
City/Town,State,ZIP • Iv[ ., 1=nry
RC 'oofing Covering/
----- ` WS Window and Siding
Solid Fuel Burning Appliances
I Insulation
Telephone. D A r
5.2 Registered H e Imp ovemen ontractor
HI 'stration Number Expiration Date
HIC Company Name or HIC Registrant Name
No.and Street ..--Ail:.c3::1r.z-ss
City/Town,State,ZIP Telephone I
SECTION 6:WO'1 1 RS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152. ¢ 25C(6))
f1T Iv.cf,-71-4<.r1 n«ri q''/'' ''"rye iti i f?.771: RtTT p `r.i
Workers CotnrP!±sat��r I,.�,1.�^^P aft___�t m�r^' , ..Wiz__Lh'_ ..,, �nr•. Fa___.._.,to c
:his _I:..it ...!1 ,._.i la '__. `:.iial.>f!.'i,.Issu es. of u1:tui illtig}.cnnit.
Signed Affidavit Attached? Yes No ❑
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNYW S AGENT OR CONTRACTOR<\1FLIES FOR i;J ILDING r'E RMIT
I,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.
• '" 7' ',_ ,- -.;re) ^ate
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
T'• -"--.:13 my name be!ew,I hereby nttcst 7r-'^r`',- : --,4-- -'-i•r,s of per i tb•i. .11 of the information
♦ ,L.._•::. IA.. : :... rr l .- .__ `e.:1.4 k;:S.t4..e4.t. 55_• .. ': - -' ,...c.::.; . '.:. -is c _.- .._ ..._ .._ z,
)05GP4 N\O0-CC s Z
Print Owner's or Authorized Agent's Name ectrontc ignature
NOT1,1'.,
1 A�n.. -1. :1 . . 1 •' r ' . 1. ._ ; ' . V :cr f r 2tt tui
(ilol icgislcic d in the ilurile htipiuveiiieut Coati actor(nil;)rroglau), will nut have access to the arbitration
program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When _ ' ' •.1 1- , . .1 . • 1 '' • r•... '' ' ' 'ow:
Total If; (7; t') _.._ 4l'. . ''. i - .. . '1:___ . :: J 1_- _._1 .
Gross living area(sq. fL) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms , Number of half/baths
Type of heating sr+T.• __ Number of d .1rc ",r"- er
�y ^
T or44t: i_i`; i��:::,�:..i. Pr, -I"
r °' ..__,'.-p.::.
3. "Total Project Square Footage"may be substituted for"Total Project Cost" ��
`= The Commonwealth of Massachusetts
_ i Department of Industrial Accidents
l I Congress Street,Suite IN
Boston. MA02114-2a17
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11 in kers' Compensation Insurance Affidavit:BuilderslContraetorsfEleetricians!Plumhers.
TO BE.FILE!)WITH THE PERMITTING AUTHOkf1'l.
%nolicunt Information Please Print 1.e♦t ibls
Name(Huai mess,Organization;Individual►: J c t. iLloi'se
Address: I G) W J-Ac.loh Si.k
City/State/Zip: j��1' 41- Ok 1 1A 010( Phone#: �.
Are oy y uu an employer?Check the'appropriate box:- l - '4'�'ri b Type of project(required):
1.0 lam a employer with____, employees[full and Of part-time I.* 7. .New construction
21:0 lam a wade proprietor or partnership and have au employees worsting for me in $. a Remodeling
any capacity.[No workers'camp.insurnrax recluinail
30 1 am a liomwwnci doing all work myself.[No wr rkacomp.eo _insurance required.] 9. 0 Demolition
10❑Building addition
4211 am a homeowner and*ill be hiring contraaloes conduit all work on my property. I will
ensure that all contractors either have workers'conmensation insurance or an sole i i.Q Electrical repairs or additions
proprietors with no employees. 12.0 Plumbing repairs or additions
S01 am a,general contractor and 1 has a hired the sob-contractors listed on the attached sheet 130 Roof repairs
These sub-contractors have employees and have workers'comp.insurance.
6.0 We are a curporatiun arid its offreera have exercised their right of exesamtiun per A,ttiL c. 14. Other
132.,flit),and we have no employers.[No waiters'comp.insurance required.]
*Any applicant that checks boa*I must also fill out die section below show ing their workers*compere cation policy information_
f Homeowners who submit this attiadasit indicating they arc doing all work and then hue outside contractors must subunit a new affulas it mdia&tang such.
tCuntractors that cheek this box must atta.-b.t`an.addition I sheet show mg the name of the sub-.ontrutars and.state whether to not those entities have
employees. Ifrbe sub-contractors has employ Ci+.they mum pros isle their workers comp.1!uliey number.
I am an employer that Ls'providing workers'compensation insurance for my employees. Below is the polio•and job site
information.
Insurance Company Name: —
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the wo kere coaipeasi.tii,ui polio declaration page(showiag the policy iwaiber and expiration date).
Failure to secure coverage as required under MGL c. 152,025A is a criminal violation punishable by a tine 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 S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA Tor insurance
coverage verification.
I do hereby rer • der th ins and penalties of perjurt.that the information provided abov is and correct
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St'ndtun: D'te:
Phone#: Ate'-! / _,5 "Z... �. � 2-q c
(odd use oak. Do* in Algeria.to be completed by city or town ol]icii[
City or Tooa: Prrinit+License p
Issuing Aadtartty(circle one):
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_. • _ _ _ _.• _ . .._ .. ... •.___.. _._ _ __ . ...e -_ .r_..
6.Other
Contact Person: Phone#:
City of Northampton
•
y Massachusetts
,,., :.,
,` F • DEPARTMENT OF BUILDING INSPECTIONS
•
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212 Main Street • Municipal Building
ys11 Northampton, MA 01060 3.
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HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT
I, (insert full legal name), bon insert month,
day, year), hereby depose and state the following:
1. I am seeking a building permit pursuant to the homeowners' exemption to the permit requirements of the
Nfas.:rr'n,: :its St:Ite T:iLl.ing Cale, cc {f ci:it 70 C_'.'.l? 11O. 5.1.3.1, in connection _t'itlr a project or work on a
parcel 6 f 1 :2 d:.o :c';i,_h I hold legal title.
2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners' exemption,
does not inr h ti? field et-cc/icy; of n. � . ! . _'. t 'i !' o . . t'- will: 780 CM.R 11O.R3.
t• I Slide i►..'7 I.:.. CALe r .. r,.•- _ "as J,/e r ...�a! 7P �.MP 11V.R.5.L.2:
3. I qualify it;;ut;-the :.sr:i�::.a CA:.L 5 JtY.ii:.: . i�_ tdif� :
Person(s) who owns a parcel of land on which he/she resides or intends to reside,on which there is, or
i` ' ! ' +' : i ... _ `. ' �... `" ._..:i.�....: car L!K.7Lich4::d•;.eruct!crc.S aca.'ssoiy to such use
A th.n Li a . C year pc. iod shall not be
considered a home owner.
4. I do not hold u oa itl N-141;4,..!f?4:;ctts k .: :f±'J;t'J3:un m4q vision ,{::4, except to the extent that I rat*for
and will abide by 11t+`!{ilik-.:.r%•./ijsctts $: :•..'. k c:t;'s Yc<.� ... ,� '.' _._:..: :�r!'.. i : ' or wcul:
on my parcel, I am not engaged in construction supervision in connection with any project or work involving
construction, recoslrgetion, at ira_i;t, re full-, d. : ' '.':: rr - i i g a7•� acirifj regulated by any
provision of the Massachusetts Slate Building Co:!
5. ,`.. .'._c 'tr ._......'.`:rr ;ti ''.ti :..:s:s'::. ;:.,Fo t'ct or work on my
parcel, I uckrunviedde drat I am requited to urul will act as the bupefvisor for said project or work.
Signed under the pains a;n1 penalties<,f per jut y on (h
(Sign tire)
Ci t..y 0 f_ - '',.
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/4''••.S.,A,Z''
Massachusetts
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s. 1,74$0.,f__ .• _iii.m.illamy Lain, INA ir.a.*:.60
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CC'.."c: —
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
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Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
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