29-315 (3) PERMIT APPLICATION CHECK LIST
S NO E
3 WNT LICA IF NOT
4 . 3 SETS
NEW CONSTRUCTION
6 CURB CUT
7 . WATER
8 . REMODELING
9 . ADDITION
0 , ACCESSORY
11 , SIGN / AWNING
2 ERMIT FEE - -.-MONEY ORDEE
3 , SPECIAL PERMIT REQUIRED WITH DEED- IF APPLIC B
4. UNDER - C 80
5 . FORM A
6 . FILL
COMMENTS:
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Rcpair
Garage
Location 35e� .�t tom :`. n c�e'tt t�► -L :1/Lc< Lot No.
Owner's name &Lke LIIL� Address 3� :-c-�• .�. 1�� ._ f� 1��.. �'�"`--
3. Builder's name 1"h-- Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration (q
New Porch
7. existing building to be demolished?
Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
3. Siding house
1 Estimated cosy- Scx>."`'
The undersigned certifies that the a ve statements are true to the best of his, her
wledge and belief.
Signature of responsible app,tcant
Remarks
`00St�/MA�O'1
Cr r oaf Nart4aill 1 fan
B r r
� �tlacsaachusrtta
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
n i (Please Print)
DATE:
JOB LOCATION:
HOMEOWNER, i (W) ) (parcel) (Subdivision)
�yvG� 4r(i�
(Name & Address)
(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 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 La s, and State of Massachusetts
General Laws An ed AND SHALL BE ON E JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT # "
M -
" ` 00482
Date Filed File No.
ZONING PERMIT APPLICATION (910 fl
l Name of Applicant:
Address: Telephone: cS�G
Owner of Property: .
v Address Telephone:
U status -of Applicant: 1/6wner Contract Purchaser
v Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# _Iq Parcel# S
Zoning District(s) (include ov rla s) v�
Street Address
Required
5.
Exis-tincr Pro nosed by Zonin
Use of Structure/Property
(if project is only interior wo k, ski ' to #6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side L: R: L:
- rear
Lot size I LP
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)
7. Attached Plans: Sketch Plan site Plan
8 . Certification: I hereby certify that the information containe herein
is true and accurate to the best of my kno edge.
Date: Applicant' s Signature:
— -- THIS SECTION FOR OFFICIAL U_E Y. — — — — — — —
Y Approved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
Finding Re wired• Variance Required:
s gnature of Building Inspector
NOTE: fssuanoo of a zoning permit does not rcilave an applicant's burden to comply Willi all zoning requirements and obtain all required permits
from the board of Health,Conservation Commission, Dopaitmont of Public Works and oUior applicable permit granting outhoritios.
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