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PERMIT APPLICATION CHECK LIST
�G PLOTI� 3 ZONE Mff/o5p YES NO DATE
ZONING FORM APPLICATION C/
PERMIT APPLICATION
OWNER OCCUPANT STATEMENT LIC A IF NOT C/
3 SETS OF PLANS /PLOT PLAN
NEW CONSTRUCTION
CURB CUT
WATER AVAILABILITY FORMS
REMODELING INTERIOR
ADDITIO
) , ACCESSORY STRUCTURE
I . SIGN AWNING
? . PERMIT FEE - CHECK ONLY - MONEY ORDER e
3 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
1 . UNDER SECTION 127 - CMR 780
i . FORM A
i , FILL
)MMENTS :
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zti DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '>o
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE• Al,
V,-/ � �TT
JOB LOCATION:
(Map) (Pa cel) ( Subdivision)
HOMEOWNER
(Name & ddress
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of six ( 6 ) units or less and to allow such
homeowner to engage an individual for hire who does not possess a
license, provided that the owner acts as supervisor.
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 to six 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 ,�
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. ( � 19 Additions
Repair
a e APPLICATION FOR PERMIT TO ALTER
Garage
1. Location Lot No.
2. Owner's name–1-12 6 � � Address y , a./ LAG. b r
3. Builder's name _ ,�_ d7i� Address'f/4 _
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch ,-� Y L
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
13. Siding house
14. Estimated cosiol 11
` T The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
f responsible o Signature applicant
Remarks
PNINUSHOP
W
i i
Date Filed File No.
ZONING PERMIT APPLICATION (510.2)
1. Name of Applicant:
Address: Te hone:
2 . Owner of Property: `4
Address: Telephone: 1>0
3 . Status of Applicant: yOwner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoni g Map Parcel# 1A3 ,
Zoning Districts) (include over ys}
Street Address ! C
Required
5. Existina Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)_
Setbacks - front
- side 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 Descriptio of Proposed Work/Project: (Use addi Tonal sheets
if nec ssary)
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. p
Date: Applicant' s Signature:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
D ied as presented
n for nial: ' I
ignat re of Bui Inspector ate
NOTE: Issuance of a zoning permit 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 Worlcs and other applicable permit granting authorities.
7/92 FXAS
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