29-363 (2) PERMIT APPLICATION CHECK LIST
PAGE �� PLOT '3 ZONE -` �°' " YES NO r t�TE
IO
2 . PERMIT APPLICATION
3 . . IF NOT
3 SETS OF S PL
5 . NEW CONSTRUCTION
6 . CURB CUT
7 W ER AVAILABILITY FORMS
8 . REMODELING
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
12 . ERMIT FEE - 3 ONLY - MONEY
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 2 - CMR 780
5 . FORM A
16 FILL
COMMENTS•
O�.i11AAlPJO ..-r°
Passacllnsells r
DEPARTMENT OF BUILDAQG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 "
HOMEOWNER LICENSE MCEMPTION
DATES Q
(Please Print)
� � .
JOB LOCATION: J a �-t-k
(Map) (IParcel) (Subdivision)
HOMEOWNER-
( ame, & Ad s )
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1)or two (2) fami 1 ies and to allow such .
homeowner to engage an individual for hire who does not possess at
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 "home r'il ertifies and assumes responsibility
for compliance with State uilding Code, City of Northampton
Ordinances, State a Local oning Laws, and St f Massachusetts
General Laws Annota ed.
HOMEOWNER SIGN = G
BUILDING PERMIT #
E A D
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
Location f Lot
2. wner's name Address l-5
3. Builder's na Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
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
11. Distance to lot lines
12. Type of roof
113. Siding house
(14. timated cost-
�� t
The/ufidersigned ce ' ies that the above statements e best of s, her
kno ledge and li .-
Signature of responsible app is
Remarks
Date Filed �w 7 0 0 ?. ;w O.J File No.
20 G T APPLICA 0
Name of Applica - -�� G�J' � � �✓
AddFro Telephone: _0 19
n d
Ownf Propert
Address: el o : d
3 . Status of Applicant: t .-Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheets ol- 1
� arcel# ,
Zoning District(s) (include overlays) �C
Street Address1!
Required
g. Existincr Proposed bv Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side L: R: 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 Proposed Work/Project: (Use additional sheets
if necessary)
.dt.(,RA T ( FZ7�7
7 . Attached Plans: Sketch Plan Site P
8 . Certification: I hereby certify that the infokmati containe e'
is true and accurate to the best of my know edge.
Date: Applicants Signature:
^THIS SECTION FOR OFFICIAL ONLY: — _ — r — — a
Approved as presented/based on information presented
Denied as presented--Reason:
4cgrn�atu�4 ial' Permit and/or Site Plan Required:
ing Requ' 'd: variance Require
f ilda tag ns 4 qtA Date
NOTE: Issuance of a zonin ar oes not reiiove an applicant's burden to comply with all zoning requirements and obtain all requirod permits
from tho Board of Health,Consarvaton Commission,Dopartmant of Public Works and othor applicabia permit granting authorilios.
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