29-292 (2) PERMIT APPLICATIION CHECK LIST
PAGE a�q PLOT d, r�9�ZONE J I YE'S NO
1 . ZONING FORM APPLICATION
3 . # IF NOT
4 . 3 SE S PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATE ORMS
8 . REMODELING INTERTOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING
12 . PERMIT FEE MONEY ORDER �
13 . SPECIAL PERMIT REQUIBED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 C R 780
15 , FORM A
! 6 . FILL
OMMENTS •
5
i THIS PLAT NOT FOR RECORDING PURPOSES
100 '
Plan Book 74 Page 46
Lot #138
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#53
101 .76 ''
Pencasal Drive
To: The Florence Savings Bank &
The First American Title Insurance Co.
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES,AND BASED ON EXISTING MONUMENTATION,ALL EASEMENTS, ENCROACHMENTS
AND BUILDINGS ARE LOCATED ON THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES. I FURTHER
REPORT THAT THE PROPERTY IS NOT LOCATED IN A FLOOD PRONE AREA AS SHOWN ON FEDERAL INSURANCE MAPS FOR COMMUNITY
NUMBER 250167#
DATED: May 18, 1994 NOTE
THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY AND DOES
SURVEYOR: NOT CONSTITUTE A PROPERTY SURVEY.
MORTGAGE LOAN INSPECTION PLAT
pt�KgF Northampton, Massachusetts
RICHARD Prepared For
J. Diane M. Brawn
LABARG&Sk
#34605 Scale: 1 "=30 '
! 3
4�G S4,IitY `��
Richard J.LaBarge,Sr.,Registered Professional Land Surveyor
110 Fling Street,Northampton, Massachusetts 01060
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 V
HOMEOWNER LICENSE EXEEMPTION
DATE; �
(Please Print)
� � -
JOB LOCATION: U't ,
(Map) (Parcel) (Subdivision)
HOMEOWNER:
ddress)
26-61M
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1)or two (2) fami I ies 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, 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 persons) 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 L ws, and State of Massachusetts
General Laws Annotated N t BE ON JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT
a > ?
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No Alterations
NORTHAMPTON, MASS. 19� Additions
. ! Repair
APPLICATION FOR PERMIT TO ALTER
Garage
��
1 Location 6 1,�/� n VC, Lot No.
Owner's name I Z V l'�' - -B��vt"' Address �3 � ri
3-Builder's name 1 Y Address l7 fie-•
_ Mass.Construction Supervisors License No. Expiration Date
�4. AdditionV dr
5. Alteration
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
Siding house
14. Estimated cost:-- y�
The undersigned cenifi at the above scat ents are true to the best of his, her
knowledge 1
Signature of esponsible app icant
Remarks
_.._--_._
-:i 003270
Date Filed File No.
ZONING PERMIT APPLICATION (910. 2)
1. Name of Applicant:
Address: Telephone:
e ,
2 . Owner of Property: . Kk
Address : � _,, Telephone: !tg.4dLE—
3 . Status of Applicant: -Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# 01-11U-Zoning District(s) (includq1overlays V
Street Address
Required
5. Existin Proposed by Zonin
Use of Structure/Property . . L'i,Z, �&:4 I
(if project is only interior ' wor , kip #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: 1 ' L: R,
-
- 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 Yr.2 osed Work/Project: (U e additional sheets
if necessary)
M Li
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the informatio o tained herein
is true and accurate to the best of my knowledg
Date: 1�' Applicant's Signature:
THIS SECTION FOR OFFICIAL US IN JY:
ZApproved as presented/based on information presented
Denied as presented--Reason:
Special' Permi �nd o-r Site Plan Required:
g ng Requi d: � Variance Required:
o Buildin In or g � a�
NOTE: Issuance of a t�-�_,�orTnh does not relieve an applicant's burden to comply with all zoning requirements and obtain all required. �+^9 Pe PP PiY fl q q permits
from the board of Hoallh,Conservation Commission, Dopartmont of Public Works and other applicable permit granting authorities.
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