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: PERMIT APPLICATION QHE-CJKLIST
PAGE PLOT L�WZQNE tC A- YES NO DAT
1 . ZONING FORM APPLICATION l
2 , PERMIT APPLIQATION
3 WNER OCCUPANT STAT T I LIC . # IF NOT
S LOT PLAN
5 NEW CONSTRUCTION
6 CURB CUT
7 , WATER AVAILABILITY FORMS
B . REMODELING INTERIOR
9 ADDITION
10 . ACCESSORY STRUCTURE
11 SIGN / AWNING
2 ER I T FEE - C ONLY - MONEY 0 DER
14A"S*PEQIA4ERMIJ REQUIRED WITH DEED IF APPLICABLE
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15 . FORM A
16 , F I L L
COMMENTS : _
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.,S 4, _133 5/ Alterations
a rNORTHAMPTON, MASS. 'J 4 A3 e, / 7 1973 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /► Lot No.
2. Owner's name (; � �4 r i 0 0 j.,e r Address %S� 4U54,y C" r, /`/p r PN e /y!}J
3. Builders name � C'h Arj 5�1/i ' AA.` Address { 4 01
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration C�, ► m ry e Y
6. New Porch
7. Is existing building to be demolished? AJ 6
8. Repair after the fire N 1)
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- ' q0 010 U
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
cj:��4 6'7;4t
Signature of responsible appicant
Remarks UU JII
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DEPARTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION-
(Map) (Parcel) ( Subdivision)
0MEOWNER- /,'go r,4 4. o 0
_ (Name & Address )
/J 6s7L1,u Ci r- -ID Yekl cle 1X4 S /3.3 �f 6-R, &97d Zae3k>
(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 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 S I GNA �V 71 }
BUILDING PERMIT #
(Iwmi) I 0 01 Date Filed S uNc i 7 / �3 File No.
ONING PERMIT APPLICATION (§10 .2 )
1 . Name of! Applicant: Cl, �f orJ ,,,4 4/0 6 V-,y
Address :, �,s` L�.s7'iw C;r f7o,(e4 wee ,°niJ Telephone :
2 . Owner of Property: C1,5�ro,-d r=/. //o a v c r
Address :1,5 / Telephone : SSG 133.9
3 . Status of Applicant: ✓Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# _ Parcel# 3'71 ,
Zoning District (s) (include verlays
Street Address
Required
5 . Existinct Proposed by Zonin
Use of Structure/Property
(if project is only interior wor sk p to #
Building height
%B1dg. Coverage (Foot nt)
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)
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification : I hereby certify that the information contained herein
is truett and accurate to the best of my knowledge .
Date : ( Applicant' s Signati. _
THIS SECTION FOR OFFICIAL USE NLY: r
Zpproved as presented/based on information presented
Denied as presented--Reason :
S ecial' Permit and/or Site Plan Required :
I ' n=ui _ variance Required :
o guild ' ns ector D'ate
gna u p '�
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with nil zoning roquiromonls and obtain all required pormfts
from tho Board of Health, Consorvation Commission, Depnilmonl of Pubilc Works rind other npplicabia permit granting nuthorilios.
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