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PERMIT APPLICATION CHECK LIST
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE: (Please Print)
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JOB LOCATION: c� ,Z
(Ma ) (parcel) (Subdivision)
HOMEOWNER:— W�/ yore , . /�N ta�y-
(Name Address ) _
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1 )or 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, 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 Laws, and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE r' J
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 &ddtions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. �Cb2° ic�y/� !,'r ! lor�r,c /Lot No.
2. Owner's name ' fiel aa Address
___)zi Lo e)"
3. Builder's name Address
Mass.Construction Supervisor's License No. —Expiration Date
4. Addition
5. Alteration /
6. New Porch nt_'✓6 N ceY' o12 yr4
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating /1 >
11. Distance to lot lines )3 '1.1-,,7' 'Yd ' 1ellI C 4 E AQ ),,Ari e�_ U'2
12. Type of roof _S ; f)� -�
13. Siding house
14. Estimated cost:- 41006
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
S nature of responsible app,icanl
Remarks __
Date Filed File No.
ZONING PERMIT APPLICATION (910 . 2)
I. Name of Applicant: o
Address : ,Q�y@ Fo e„ee Telephone:
2 . Owner of Property: /4/,6tiW , e�,�1
Address : �f,� Ac���ir �, l.r.
_Telephone : -,��/ 7
3 . Status of Applicant: VlOwner Contract Purchaser
Lessee Other (explain: p )
4 . Parcel Identification: Zoning Map Sheet// j Parcel# �Z
Zoning District (s) (inclu e over ays) �
Street Address
Required
5 . Existing Proposed —by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B dg. Coverage (Footprint)
Setbacks - front r
- side L: R: `?o L: R:
- rear
Lot size
t7: f�tJ
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description o Proposedork/Project : (Use additional sheets
if necessary)_ � � v / 'd1 e' j- d
J e e n e �N O�C> h
7 . Attached Plans : G' Sketch Plan Site Plan
8 . Certification : I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
Date: Applicant's Signature: ® 2
THIS SECTION FOR OFFICIAL USE ONLY:
” Approved as presented/based on information presented
Denied as presented--Reason:
Special* Permit and/or Site Plan Required:
in ng Re r d: variance Required:
� 3
S atur f ector NOTE: Issuance of a 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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PERMIT APPLICATION CHECK LIST
PAGE - YEAS NO DATE
"WS
2 . RMW
3 • LIC . # IF NOT
4 . 3 SETS OF PL6NS ZPLOI PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER VAI B T FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNI
12 . PERMIT FEE � 0 LY - MONEY ORD R
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM
16 . FILL
COMMENTS :
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