29-553 (8) Q O
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DEPARTMENT OF BUILDING INSPECTIONS '
INSPECTOR 212 Main Street ' Municipal Building '
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Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
C� (Please Print)
DATE: 7
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JOB LOCATION: �y (uvt
(Map) tVa Fcel) (Subdivision)
HOMEOWNER:
(Nam , Address ) r -�
( Home Phone ) (work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( I )or two (2) fami 1 ies and to allow such .
homeowner to engage an individual for hire who does not possess a '
license, provided the owner acts as supervisor . DIR780 Section 109. 1 . 1
DEFINITION OF HOMEOWNER: Person( s) who own a parcel of land on
which he/she resided 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
conside-red a homeo«ner. Such "homeowner" shall submit to the Buildina
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 AnnotatedA A W SHALL BE ON THF JOB AS SUPS VISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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/ ' 0 Zoning
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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 3 -S D Alterations
NORTHAMPTON, MASS. D' ( n, 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location (�4 OW I Lot No.
2. Owner's name li Address
3. Builder's name c A_l Address
Mass.Construction Supervisor's License o d Expiration Date
4. Addition L'n . 0ff 1 r7'r � �L/`
5. 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 � ('Lw
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature o responsib! a icant
Remarks t-�lh l �t" �ff � � ( 0-,,J tpA S L
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0. Do an signs exist on the roe YES NO-X
1 y g property?S
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property'?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be Pilled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space: iZ tom"
(Lot area minus bldg
&paved parking)
of Parking Spaces
fof Loading Docks
Fill:
Avo1-itme--& location)
13 . Certification: I hereby certify that the information contained herein
�f is true and accurate to the best of my k o ledge.
DATE.-
APPLICANT'S SIGNATURE Ju V
NOTE: lasudno4e of 6 zoning permit does not relieve an applioant's burden to cWomply th all
zoning requirements and obtain all required permits from the Board of Health, Con ation
Commission, Department of Pubiio Works and other appiioable permit granting authorities.
FILE ,�`
File
n r,
ZONING PERMIT APPLICATION ( 10 . 2)
PLEASE TYPE OR PRINT ALL (INFORMATION
1. Name of Applicant: �ie"3' �� t
Address: CW Telephone:
2. Owner of Property: Oa)(V\ -
Address: _ j �A� Telephone: ( 4
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: � R cvk A —0, RG av ct AAk .
Parcel Id: Zoning Map# Parcel# �� ` District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
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6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO__X DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
�a.
FILE # 0 f' (A
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE: i
PROPERTY LOCATION: ;, `
MAPS _ PARCEL: �_ ZONE
THIS SECTION FORJDFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM VULED OUT
Fee Paid
Riii1ding Permit Filled nlit-
Ft f. pnid 96
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THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from Con rvation o missio
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Signature of Building or Da(e
NOTE:issumnoe of a zoning permit does not relieve an appiloants burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Pubiio Works and other applioabie permit granting authorities.
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