29-204 (2) PERMIT APPLICATION CHECK LIST
i", �,►-• u R/'
PAGE � PLOT ZONE W`mil'
D YES NO DATE
1 . ZONING FORM APPLICATION �`D -n
2 . PERMIT C T 0
3 . OWNER OCCUPANT EMENT LIC # IF NO
4 . 3 SETS OF NS /PLOT PLAN
5 . NEW CO ST UC ION
6 . CURB CU
7 . WATER V BI LITY FORMS-
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCES80 Y STRUCTURE
11 . SIGN AWNING -
12 . PERMIT FEE - CHECK ONLY - MONEY-OR DE -<-_ 2,2 l
13 . SPECIAL --PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION - 127 - CMR 780
15 . FOR
16 , FILL
COMMENTS : �-
�gIIAA/pT
$ +� yLlnssacllusctts
5
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION•
(Map) (Parcel) (Subdivision)
HOMEOWNER: c Nf'i SJ V 7-0�6 1 E 2� c?? b'R rC�c1
(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.
--yin �
HOMEOWNER SIGNATURE f l'/ t.r 1v W,
BUILDING PERMIT #
C n•
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. l Tel.No. Ry_ ?06 Alterations
t oti NORTHAMPTON, MASS. 1�/ } 19 `3 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
s� G2 Garage
r7
1. Location d I 85#i `ryT _ z)fC� E�:cy� F YI:� J`/9/� Lot No.
2. Owner's name M 1 /? � frf Y --r0ejjV Address 2 7 13 bLriz z L�!
3. Builder's name L S AM L Address Ski 6-
Mass.Construction Supervisor's License No. Expiration Date
4. Addition SA/F
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire R.,0
9. Garage No.of cars Size
10. Method of heating t
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
4115-0 The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,ican!
Remarks
cr�anDate Filed Lf �3C71 `-D_ 00o��U t:
File No .
ZONING PERMIT APPLICA'T'ION (910 . 2 ) L A/
1 . Name of Applicant : U
Address : ,�'� - fZ Fti�� Telephone : ,�5 9069
2 . Owner of Property: ,c�is�
Address :__ 1)R c)P —Telephone :
3 . Status of Applicant :-' Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet# Parcel#� ,
Zoning District (s) (include overlays) ?fti� G..' ;
Street Address Q17 —,, -
Required
5 . Existing Proposed
by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6 ) .
Building height /y _
%Bldg . Coverage (Footprint) --
Setbacks - front
- side L: R:
- rear
Lot size i00
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) 3A i�o� y ti$D
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 : y/,C)/17-3 Applicant' s Signature : V o,�� J�,- j
/
THIS SECTION FOR OFI�OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason :
Special' Permit and/or Site Plan Required :
i ling e fired : Variance Required -
1 \ `s Y
gna re �zonflngpornmit inspector \� "� at
NOTE: Issuanc not rolieve an applicant's burdon to comply with all zonin41 roquirernonts and obtain all required porrnils
from tho Board of Hoallh, Consorvalion Commission, Doparlrnonl of Public Works and other applicablo pormit granting authorities.
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