29-269 (3) w
PERMIT LTC IO CHECK IS
I4E "rP L 0 T Z 0 N Ek#k YES NO DATE
ZONING FORM APPLICATION
_PERMIT APPLICATION C/
OWNER OCCUPANT STATEMENT LIC A IF NOT
3 SETS OF PLANS /PLOI PLAN
i CONSTRUCTION
i CURB CU
WATER AVAILABUITY FORMS
3 , REMODELING INTERIOR
ADDITION
i0 ACCESSORY STRUCTURE
J . SIG N / AWNING
2 . n
PERMIT E - E 0 - MO E ORDE -k q5l
13 , SPECIAL ERMIT REQUIRED WITH DEED IF APPLICABLE
UNDER S - CMR 78Q
15 . FORM A
ILL
IM,M E tJ T S
S
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" DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR
212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print) U
DATE: gCA
JOB LOCATION:� �'��-I
(Ma ) (Parcel) (subdivision)
HOMEOWNER: 7N�nn le R L a (;Y)
(Name & Address'
v I eu i t i ye FGw r- r)e E.• - 51
(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 buildinq
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. el.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location A S Lo r 2, V t Pew h r 1 le. l-erl e e, Lot No.
2. Owner's name'QC n nq, RV-P-Aj Q3(161" 5 R\I Address '5 4-onRf/j'eto T orkn eel
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
l
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
13. Siding house
14. Estimated cost:-
Sw e"f,o��- ' ���00 The undersigned certil:ies that the above statements are true to the best of his, her
��.� �r�/ � knowledge and belief.
,,.C;,o 10 hive, �"YT'° R— T6
Signature of AespSaible applicant
Remarks
PHINTaSHOP
y:
a� ti
000 ��06
Date Filed File No.
ZONING PERMIT APPLICATION (§10 . 2 )
1 . Name of A licant: TbanrlQ, I�� ct ��� ph5�l
Address : L e ; Telephone: 5 u-5a S
2 . Owner of Property: -,')�pnne Rrei-f- C6 Ifr)SKV
Address : 41S Lon4i1,',&v D': FIarcf1Pe- Telepho e: 5 y- S y
J
3 . Status of Applicant: Jv Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet T Parcel# 02-(�
Zoning District(s) (in ude ove ays)_ (,(oc
Street Address
Required
5 . Existinq_ Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint) l5'
Setbacks - front
- side a(jf
- rear t
of 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: CJUse additional sheets
if necessary) i � �fi � �
y
Q qrodyNof S W tiIfyN Yk.�,X`<� _
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: ate � � ��1q� Applicant ' s Signature: ,tivyup�l'1 - ��
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
ZApproved as presented/based on information presented
Denied as presented
Reason for Denial: Af
Signature of lding Inspector Date
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 Heafth, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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