29-533 PERMIT APPLICATION CHECK LIST
PAGE q PLOT 5 3 ZONE �S eGo r y L- R YES NO DATE
1 . ZONING FORM APPLICATION v
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC J 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
1.1 SIGN / AWNING
e�k #r45 l.,
12 PERMIT FEE - CHECK ONLY - MONEY ORDER # Q-0 aQ
13 SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 . FILL
COMMENTS :
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DL'PARTMENT OF BUILDING INSHCTIONS
INSPECTOR 212 Alain Street ' Municipal Building
Northampton, Mass. 01000 M
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: �c � - L�r" I( , t g�ta,_;
JOB LOCATION: �' 094
(Ma,g) (Parcel) (Subdivision)
HOMEOWNER: �%�
Name & ddress )
(Home Phone) (Work Phone )
The current exemption for "homeoWnpr,s" .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 possess 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 S I GNAT�JR E`er
BUILDING PERMIT #
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CA a d
r�_ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.
Miscellaneous 31sgq-q t.� Alterations
NORTHAMPTON, MASS. 19sa Additions Re pair 11
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APPLICATION FOR PERMIT TO ALTER p
Garage
1. Location Gec;-cvt -kw* �c�t C� 1"� Lot No.
2. Owner's name L i SA Address Q-
3. Builder's name Address fop
Mass.Construction License No. Expiration Date
f)e >
4. Addition - X I
5. Alteration
6. New Porch ff
7. Is existing building to be demolished? (1 I
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
14. Estimated cost:- //
The undersigned certifies that the above statements are true to the best of his, her
knowledge. d lief.
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Signat re of responsible app,icant
Remarks
s'CYa 1
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0001 . 0 ,`♦
Date Filed �� I�o, ! File No. a.9- 53
ZONING PERMIT APPLICATION (§10.2) WSP
1. Name of Applicant: LsA h'1. �
Address:_ ( of j Telephone:
2 . Owner of Property: C Q
Address: Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#_2,7 Parcel# ,
Zoning District (s) (include overlays) w a p
Street Address in �,rec-Qr-y Lm-ne-
Required
5 . Existing Pro Dosed
by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side L 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)
i
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: c Applicant' s Signatur -.
— — — — — — — —
ZApproved THIS SECTION FOR OFFICIAL USE ONLY:
as presented/based on information presented OCT 16
D nied as ypsented
eas for i
gignatu Buil D e
NOTE: issuan g 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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