23C-101 PERMIT APPLICATIO CHECK LIST
°_.4:25_ PLOT I ZONE , ._ F '1 NO DATE
2 . PERMI'T, v -1T; n`
3 . :OWNER,
PZatfA .°V T IOVN / L I C. It IF NOT
4 , 3 SETS OF PLANS /PLOT PLAN
5 , NEW CONSTRUCTION
6 . CURB CUT
7 , WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
12 . PERMIT FEE - HECK-NLY - MONEY ORDER .i 11 °/
13 . SPECIAL PERM QUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS .
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Date Filed File No.
ZONING PERMIT APPLICATION (510. 2)
n -
1 ./ Name of Applicant: C., " -C
, _ Address : 1 t "1 - Telephone: - i
2 . Owner of Property: l4k-c
Address : Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# ( ^Parcel# //'/ ,
Zoning District(s) (include ggerlays) {, (.<.-k.t>
Street Address `5'I 1 1C�u. _x_c t1 `i-'2 ,
Required
5. Existinq Proposed by Zoning
Use of Structure/Property , ;{,,e.„- ,m,.L.,
(if project is only interior work, !_ kii to # )
Building height
%Bldg. Coverage (Footprint).
Setbacks - front
- side L: 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 Description of Proposed Work/Project: (Use additional sheets
if necessary)
- Ui
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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 knowled
Date: Applicant's Signatur 2,, 4 ap
THIS SECTION FOR OFFICIAL USE LY:
Approved as presented/based on information presented
Denied as presented--Reason:
S. -cial' Per ' and/or Site Plan Required:
t incl. Ree c Variance Required:
t)-Sk ,IA/7‘
igna e •f Building I s ector Date
NOTE: Issuance of a zor>fponnit 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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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. S-- --)Ai (L/43 Alterations
%r NORTHAMPTON, MASS.
c i 19�y Additions
kA' APPLICATION FOR PERMIT Repair
TO ALTER
Garage
1. Location S -) t " C L �" Lot No.
2. Owner's name J L R,..51(.. 0 Address / c-'cif /4 o I'c h , of 4. rNA 4 ie 3
3. Builder's name n Q__ Address _.'
s . e,
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
13. Siding house t/
14. Estimated cost=`ig 0-00-
I
The undersigned certifies that the above statements are true to the best of his, her
knowled a and belief. GAAdti i
Ci■vviA_Ad
Signature of responstble appicant
Remarks
oO
O _, 6. (rzf of Northampton , _*
f 43 fr t B ttsaiscfittsatia -� '=
!L]1�cj�•nC
�' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 �r
HOMEOWNER LICENSE EXEMPTION
( (Please Print)
DATE: (7L ) `�
JOB LOCATION:
(Map (Parcel) (Subdivision)
HOMEOWNER: ;\ �,,.; (, ! c- >
(Name & Address)
iPG1 / A 1-1, /e_ c ,G- x/136 -oO
(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 tate of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE Ai / /
BUILDING PERMIT #