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DEPARTMENT OF BUILDFNC INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE; /}ao,- 1 ,17- . 1 9l o/(o
JOB LOCATION: "� S
(Map) (parcel ) ( Subdivision )
HOMEOWNER: 4, 11015 �. 7-4 �y s3� u,e,-5
(Name & Address )
( Hon-�e Phone ) (work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied wellings of one ( 1 )or two (2) fami 1 ins and to allow such .
homeowner to engage an individual for hire who does not possess a '
license , provided that the owner acts as superviso__ . CNfZ780 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 ch 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 ueriod shall not be
considered a homeo�'rner . Such "homeowner" shall submit to the Buildina
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 auvised 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 maybe" liable for person(s) you hire to perform work for
You under this permit .
t 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
1 NORTHAMPTON, MASS. API /-� 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
,^ Garage
1. Location 3 c G 5 f(-c 'n 0 71e' ,2d : �e,r irr) 0 lerzi fx--cc Lot No.
2. Owner's name -F- A Address art j'� ,tor l�ixrrrPrLtr
3. Builder's name Address
Mass.Construction Supervisor's License No. t ? rz Expiration Date
4. Addition
5. Alteration rc. 0"2 ���k( j`d4•i K;F� -.1-- 50 f'i'r s
6. New Porch
7. Is existing building to be demolished? 'y O
8. Repair after the fire A2/tq
9. Garage A''/4 1 No.of cars Size
10. Method of heating /
11. Distance to lot lines
12. Type of roof X14
13. Siding house X4141 1oi-N c-;' ck-) U'r C-
14. Estimated cost:- J 0 chi 0
The undersigned certifies that the above statements are true to the best of his, her
knowled and belief.
Signature If r sponsible appicani
Remarks
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10. Do any signs exist on the property/? YES NO ✓
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property/? YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —7— to be filled in
by the Balding Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
'/60pen Space:
(Lot area minus bldg
&paved parking)
# pf Parking spaces
j¢` of Loading Docks
Fill:
(vol-lime--& location)
13 . Certification: I hereby certify that the information contained herein
is tru a d accurate t9 the best of my kno edge.
DIffE: - (r -APPLICANT's SIGNATU
NOTE: kga a e wit to zoning permit does not relieve-H-FrlipplloanlVs buy-den to mply with all
zoning req rem nts and obtain aH required permits from the Board of Healt , Conservation
Commission De artment of Publio Works and other applioable permit granting authorities.
FILE if
9 996 'lf/(�Y
• /
File No �)
PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: �Qj1A, d . Telephone: 76
2. Owner of Property:_ s
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain): f�
4. Job Location: � ,P � � AY
Parcel Id: Zoning Map# Parcel# � �1 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property .
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermiWariance/Finding ever been issued for/on the site?
NO DON'T KNOW t--� YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or D�oc-°ument#
9. Does the site contain a brook, body of water or wetlands? NO L— -
DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued: _
(FORM CONTINUES ON OTHER SIDE)
FILE 4 = �
APPLICANT/CONTACT PERSON: f ���
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP - PARCEL:— ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7,0XING FORM M.1211 OUT
Fee Pa*d
"Rnilding Permit Filled ovit
f � —
of Pinn-s I Plot Plan
✓'
TBj5E,F6LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit from onservat' mmissio
Signature of Building ector 16ate
NOTE:lssuanoe of a zoning permit does not relieve en applioanYs burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
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