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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION-
�� I (Map) r()?arcel) (Subdivision)
HOMEOWNER: P/ , 7
/ (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 1 ies 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
y 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 m_ ay be' liable for person(ns) 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 SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT "
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
a APPLICATION FOR PERMIT TO ALTER Repair
Garage
1.1. Location 1S Lot No.
2. Owner's name Address �� V,.
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
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
iding house
14. stimated cost:- �
The undersigned certifies that the above statements are true to the best of his, her
f knowledge and belief.
SignaED of responsible app,icant
Remarks
701
V
` 00334
Date Filed File No.
ZONING PERMIT APPLICATION (910. 2)
I . Name of Applic nt: r-
Address: Telephone: 5-rg— 9-7 5 5'
2 . Owner of Property: j d 144 o
Address: Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 3S Parcel# / 7C
Zoning District(s) (include overlays) S R
Street Address awe
Required
5. ExistincT Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #(5)
Building height
!.-'Bldg. Coverage (Footprint)
Setbacks - front
- side L: R: L• R:
- rear
Lot size
Frontage.
Floor Area Ratio
oopen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Descriptio of Proposed Work/Project: (Use additional sheets
if necessary) /h s�. 11 a.
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:_� ���� App 1 icant' s S ignatur -
THIS SECTION FOR OFFICIAL S ONLY:
1/Approved as presented/based on information presented
Denied as presented--Reason:
Special /or Site Plan Required:
F' din Requir Varianc Required
natur o ui ding Ins - (quir to
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning ments and obtain all required permits
from tho Board of Health,conservation Commission,Mpaitmont o!Public Works and othor appiicabi it granting authoritos.
PERMIT APPLICATION CHECK LIST
P *ES NO DATE
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NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 , REMODELING
9 . ADDITIO
0 , ACCESSORY C
11 . SIGN / AWNING
2 ERMIT FEE - - MONEY ORDER
Now-
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
4 . UNDER SECTION - C R 780
15 . FORM A
6 . FILL
COMMENTS:
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