35-105 (4) PERMIT APPLICATION CHECK LIST
P GE : _., S NO DATE
2
ZION k-1,
it I F NOT
SETS OF NS /PLOT PLAN
5 NEW CONSTRUCTION
6 . CURB CU
7 . WATER I I S-
8 REMODELING INTERIOR
9 . ADDITIO
0 , ACCESSORY STRUCTURE
SIGN AWNING
2 , PERMIT FEE - L - 0 E O DE
3 , SPECIAL UI ED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 - CMR 7&O
15 , FORM A
FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01000
HOMEOWNER LICENSE EXEMPTION
/
DATE• (Please Print)
�/�y /�
JOB LOCATION: L� /QZ('�,((
(Map) (Marcel) (Subdivision)
HOMEOWNER
(Name Address )
(Home Phone) (/Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) fami lies, 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.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. �r Alterations
NORTHAMPTON, MASS. /Zie/ 19 ?�� Additions
Repair
APPLICATION FOR PERMIT TO ALTER
r Garage
1. Location Lot No.
2. Owner's name Address ���C� , iJ
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition Lt )
5. Alteration
6. New Porch 110
7. Is existing building to be demolished? �LiC7
8. Repair after the fire
9. Garage 62llD I-- No.of cars Size
10. Method of heating —�
11. Distance to lot lines
12. Type of roof <
13. Siding house
14. Estimated cost� ��,n
JJ��IVJ
The undersigned certifies that the above statements are true to the best of his, her
\\ knowledge and belief.
L�\
Signature of responsible applicant
Remarks
qu
0011-1 0
Date Filed (1,S5 File No.
ZONING PERMIT APPLICATION (510 . 2 )
1. Name of Ap cant:
Address : 4 Telephone:
2 , Owner of Property:
Address : Telephone :
3 . Status of Applicant: �6wner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# ) „ Parcel# 16') ,
Zoning District (s)
(include overlays)
Street Address
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footpri 7L:�Setbacks - front
- side R: 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 Descr ' tion 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 : 7/141 q Applicant's Signatur e • o
/T FIIL THIS SECTION FOR OFCA US ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
Sp is ' Permi and/or Site Plan Required :
F g Requ ' ed : Variance Required :
S nat u o B �ppermft ector �\
�AAty
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NOTE: Issuance zoning oes not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from tho Board of Health, Conservation Commission, Department of Public Works and other applicablo permit granting authorities.
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