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PERMIT APPLICATION CHECK IS
PA l�
G ,, mm' YES NO DATE
2 .
LICA IF NOT
3
3 SETS
5 . NEW S 0
6 , CURB OUT
7 WATER
8 . REMODELING
9 , ADDITION
0 , ACCESSORY STRU
11 , SIGN / AWNING
2 PERMIT E -
3 . SPECIAL D WITH DEED IF APPLICABLE
4 . UNDER SECTION - CMR 780
5 . FORM A
6 . FILL
COMMENTS:
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street 4 Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
- (Please Print)
DATE;
JOB LOCATION: d�l
Ma ) (parcel) (Subdivision)
HOMEOWNER:
(Name & Address)
Y,Z/- l 6'Fr
(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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT # k1
70 �
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
/�� 1/ ''ll Garage
Location r3� (��Jl d er Dr i✓ z J Lot No.
Owner's name M✓ e e 1p Address 7/ 6,6161,11k? Dr I✓f'1
3. Builder's name T,-.n n u P'S-ij r- Pn IJ L Address 't{% Cng-j) - Me 6;71'1',0 12C 192
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
'1
5. Alteration
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
D14stimated iding house
cost- 41%(f, e o
The undersigned certifies that the above statemcnis are true to the best of his, her
knowledge and belief.``'
W
Signature of responsible app,icant
Remarks
``1lr ,
Date Filed - V ` °5 File No.
ZONING PERMIT APPLICATION (§10. 2)
I . Name of Applicant: Mand
Address: 171 Zjen Or,,�,o Telephone:
2 . Owner of Propert� . /1"1aYLt' {.Ghee Lk
Address: Telephone:
3 . Status of Applicant: ✓Owner Contract Purchaser
Lessee Other (explain
4 . Parcel Identification: Zoning Map Sheet#_ Parcel#Ap,
Zoning District(s) (include overlay
Street Address ,
Required
5. Existing Pro osed by Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
. 1dg. Coverage (Footprint)
Setbacks - front y G
- side L: R: /5' L: /V R: 61 4
- rear _3
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)�r �r�11 . �1�n�',v
.f
7. Attached Plans: 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:
ZApproved T E HYS SCTION FOR OFFICIAL fJBE ON
as presented/based on information presented
Denied as presented--Reason:
Special'* Permit and/or Site Plan Required:
' d g Re iced: Variance Required:
S.in net e o-f Bui1din at
NOTE: Issuanco of a zoning permit does not relieve an applicant's burden to comply with all zoning roquiroments and obtain all required pormits
from tho Board of Hoalth,Conservation Commission, Dopartmont of Public Works and otlior applicable permit granting authoritios.
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