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PERMIT APPLICATION CHECK LIST
PAGE 35 PLOT 174 ZONE SP j6 I a il'1N \/CLIIC Rcj_ YES NO DATE
,1 . ZONING FORM APPLICATIONIt- ta-q
2 PERM1T APPLICATION V
3 . OWNER OCCUPANT aTATEMENT STATEMENT LIC A IF NO
4 . s SETS OF PLANS /PLOT PLAN S N«h "4- PIOT P►a, Y '
5 , NEW CONSTRUCTION —
6 CURB OUT
7 . WATER AVAILABILITY FO MS
8 REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 , SIGN AWNING
2 , -PERMIT FEE - CHECK ONLY MONEY ORDER
13 , -SPECIAL—PERMIT E UIRED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 - CMR 780
15 . FORM
6 , ILL
COMMENTS ;
6 .
SOCO E
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DEPARTMENT OF BUILDINQ INSPECTIONS - ?
INSPECTOR 212 hfain Street ' Municipal Building
Northampton, lYtass. 01000 ,
HOMEOWNER LICENSE EXEMPTION
�, ` (Please Print)
DATE: 'V t�'�I ' �, I��( ,=�
JOB LOCATION:_ '3S 17 X 2,i 2
(map, (Parcelb C (Subdiv�}sio
HOMEOWNER: c �, � V C "r
l (Name & Address) r- , - r'—
Home Phone) (Work Phone-)
The current exemption for 11homeownpr,s11 .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 doe.q not Dossess a
license, provided that the owner acts as supervisor.' CMR780 Section 109.1 .1
DEFINITION OF HOMEOWNER: Persons ) 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,�� Gif- . ',
BUILDING PERMIT ##_ �� �_
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. � Alterations
NORTHAMPTON, MASS. i .z t' 19 Additions
' ~•
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �; N c _ �� Lot No.
2. Owner's name z ��, "��E.`^, ��i;1 y Address
1
3. Builder's name_;�a ) C�� �. � � i" c r Address
Mass.Construction Supervisor's License No. Expiration Date
C le
4. Addition
5. Alteration
6. New Porch
j
7. Is existing building to be demolished?
8. Repair after the fire
9. Garages dC No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost-.
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks t <=' VU C
�F -! -
TV
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1 �
Date Filed //- I a- 9 U 00A. J File No. �35- i,7y-
ZONING PERMIT APPLICATION (§10.2)
R
I. Name of A pl ' ant: � �'r • ' at"
Address: ' / �., � n; Telephone: — — ,�
2 . Owner of Property:
Address: Telephone:
3 . Status of Applicant: Vzowner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# tom` - -��
Zoning District(s) (include overlays)
Street Address 41Ln Piy-) e_ �1c i i e ,i R d
Required
5. Existing Proposed bv Zoning
Use of Structure/Property ^
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front ;c` f
- s ide R L• ' L R
- rear r
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description o Proposed Work/Project: (Use additional sheets
if necessary) ��� A c_L`C .L I r-
t� t52�s �-
C' C, y i�
7 . Attach_d Plans: s ketch Plan ite Plan j
a ( '`t � ii�c`
S . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
( �' Applicant' s Signature:
Date: c"? 1, s� ��1 P`j g
THIS SECTION FOR OFFICIAL USE ONLY: MW 21y�L
PoeApproved as presented/based on information presented
Denied as Len nted
ea n fo l:
i natu e of Buildin ns ector D to
g P
MOTE: 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 Works and other applicable permit granting authorities.
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