29-496 (3) PERMIT CATIO CHECK LIST
YES NO
x
2Olk- ,
3 LICA IF NO
A . T --- P LAN
5 NEW CONSTRUCTION
6 . CURB QUT
7 WATER S
8 . REMODELING
9 . ADDITION
10 , ACCES ORY STRUCTURE
11 . SIGN / AWNING
12 . PERMIT E ONLY MONEY 41116
13 . SPECI UI ED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. / Tel.No. 5 �a� �0l�a Alterations
NORTHAMPTON, MASS. X3/2-3 19 l Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location tUrtty° /"/f r`Ft Lot No.
2. Owner's name Ah g 4,2 eT ,p� Address
3. Builder's name /t�eiT s6��y"" )Pagl 4- Cdt�, ddress a&, _�i► �,-1t'1 t Asa+ S err
Mass.Construction Supervisor's License No. Expiration Date
4. Addition .YV
S. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- 000
t
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,icanl
Remarks
� �l.:st�c!)asrllr
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR'' 212 Main Street ' Municipal Building
Northampton, Mass. 01060 ' v
i
I -
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: T/U—Y,CGL
JOB LOCATION-
. (Map) (parcel) (Subdivision)
HOMEOWNER: �i l �7� P S C-).S & 0-91
(Name• & Address)
(Home Phone)--IWork Phone)
L077 - 2330
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings -of one Mor 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. CMR780 Section 109.1 .1
DEFINITION OF HOMEOWNER: Person(s) who own a parcel of land on
which he/she resided or intends to reside, oft 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
BUILDING PERMIT #
u
Date Filed 3 -�) File No.
ZONING PERMIT APPLICATION (510 . 2 )
1. Name of Applicant: /C
Address :. Telephone : 51'. G/,5--�
2 . Owner of Property:
Address :- Telephone :
3 . Status of Applicant: V*�Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# q ,7(�
Zoning District (s) (include overlays) / i"
Street Address t;�
- Required
5. Existina Proposed -by Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks } - front 30/
I - side L: ?-C R: L: _R:
I - rear '
Lot size --
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed Work/Project : (Use additional sheets
if necessary) eve Zk
'r
7 . Attached Plans : Sketch Plan _Site Plan
8 . Certification : I hereby certify that the information contained herein
is true a nd accurate to the best of my knowledge .
Date: 3 �3/7/ Applicant' s Signatur
- - - - - y - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
proved as presented/based on information presented
Denied as presented--Reason :
Special' Pe it and/or Site Plan Required:
n i'ng q i ed : Variance Required'
3 zj j
Signat o Building Ins o — t� Date
NOTE: issuance of a zonin rmit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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