29-524 (5) s
PERMIT APPLICATION CHECK LIS h � + *
ES NO DATE
ZONING F0 RM APPLICATI
2 . PERMIT APPLI �-'
3 . OW O
3' SETS OF 2LAN� /PLOT PLAN
NEW CONSTRUCTION
6 . CURB CUT
7 WATER
8, REMODELING
9 , ADDITION
o . ACCESSORY
11 . SIGN
2 . PERMIT FEE — CHECK ONLY — MONEY ORDER
3 . SPECIAL PERMIT REQUIRED WITH DEED IF APPUCABLE
4 . UNDER SECTION 127 QMR 780
15 . FORM A
6 . FILL
COMMENTS : a.,: .
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 '
HOMEOWNER LICENSE EX 14PTION
DATE-
(Please Print)
!�
JOB LOCATION: Z 7
y (Map) (Parcel)
f X3 (Subdivision)
HOMEOWNER:
1-U. ! o g-Lai
(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 AND SHA BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE / 4zzz, 1
BUILDING PERMIT /
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p Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 2, 19_L Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 13 Lot No.
2. Owner's name 5�°-/T Address 13 6)r au LJ°
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration b040 57z0yeF f efft w"i t-
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage /& i/ No.of cars Size
10. Method of heating 6AJ fN� �
11. Distance to lot lines /Z-
12. Type of roof /./,It 10
013. Siding house WOD0
Estimated
cos-
t
The undersigned certifies th he above statements are true to the best of his, her
knowled e jand belief.
Signature of responsible appicant
Remarks
0 0 V 5')
Date Filed File No.
ZONING PERMIT APPLICATION (510 , 2)
1 .
Name of Applicant:
Address : 113 t'=mac►° wj, roc(Ltpj(_� Telephone:
�. owner of Property: ->c o17__ f C1J� i'' Lac.iS
lJ Address : 1-U. Telephone: S - e 2
3 . Status of Applicant:: L,�t5wner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: ZoninA Map Sheeti Parcel#,
Zoning District(s) (incl ide over s) ---
street Address tS
Required
5. Exis h ncf Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
tBldg. Coverage (Footprint)
Setbacks - front
- side L: L: R:
- rear
Lot size
Frontage.
Floor Area Ratio
%open Space (Lot area minus
building and parking) ~'
Parking Spaces
Loading
Signs
Fill (volume & location)
C) 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 true and accurate to the best of my knowledge. -
-
Date: l�_ �T Applicant's Signature.
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
S ecial' Permit and/or Site Plan Required:
in Ong i d: Variance Requ red'
gnat re -of Bulld nspector ate
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply With all zoning roquiroments and obtain all required permits
from the Board of Hoalth,Conservation commission,Dopattmont of Public Works and other applicable permit granting authoritios.
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