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DEPARTMENT OP BUILDFNC INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Macs. 01060
HOMEOWNER LICENSE P_}ZMPTION
(Please Print)
DATE_
JOB LOCATION :
(Map) (parcel ) ( Subdivision )
HOMEOWNER:`( ;'_L-� 't t.6a %-( ��,r� rxt'r�
( Name & Addr ss )
( Home Phone ) Nork. Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( I )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. t . 1
DEFINITION OF Person( s ) who own a parcel or land on
which he/she resides or intends to reside , on there is , or is
intended to be , a one or two family dwelling , attached or detached
structures accessor}f 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 Buildino
Official , on a corm acceptable to the Building -0 =icial , 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 1S2 (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
,I for compliance with the State Building Code , City of Northampton
Ordinances , State and ocal Zoning Laws and State of Massachusetts
General Laws Annotate AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PF.RMTT
Now
V
2 0
42
Now&
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_Z
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col== to be filled in
by the Baildiag Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: 3 ' R: .3C> �f
- rear ��-
Building heightT
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking) �J
of -Parking Spaces
# rof Loading Docks
Fill:
4vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
�j is true and accurate to the best of my kno edge
DATE: �� % APPLICANT's SIGNATURE 7',
NOTE: lasuanoe of a zoning permit does not relieve an applioan s burde to comply with all
zoning requirements and obtain all required permits f m the Board of Health, Conservation .
Commission, Department of Pubtio works and other applicable permit granting authorities.
FILE #
File No
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address:_ 1 ft G QL,4 ofA J-p-v k 'j-/d t,7LC Telephone:
G'
2. Owner of Property:
li
Address: Telephone:
/
3. Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain): y
4. Job Location: `� Gee COY v� L,:>n� a-8-el( e,
Parcel Id: Zoning Map# -2?!2- Parcel#'� _ 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):
-� L io k} k cl.Yt �y�_ Ui r(,-,,l r,n( a)_O1)1
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 Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW `� 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 Document#
9. Does the site contain a brook, body of water or wetlands? NO ✓ 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)
961143 ``
w i'�
FILE #
.. , 2 01996
APPLICANT/CONTACT PERSON: 3
ADDRESS/PHONE: ILI
A
PROPERTY L,Q CATION:
MAP ��� PARCEL: ,� �� ZONE eZ
THIS SECTION FOR.-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM Fn,I,FD OITT
Fee PAid
Rnilding Permit Filled ny&t
xzp/
Addition M Existing C% :.11
tementnrLirprigeft
� .
TIC LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented based on information presented
Denied as presented:
'ompty with all
r7CA+th, Conservation
Commission, Department of Publio Works and other applionbie permit granting authortties.
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70 'C
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.y rS .�-�� �. Alterations
NORTHAMPTON, MASS. It 1 —194(, Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location I q Greq onf �P Y k AA(Nyf�lc-e, Lot No.
2. Owner's name ,-V r.rvt i a-k ,Q, (-2.ts-4-}e,—j Address lel clvr o m-�'t P-
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition Pu-1 .1 A-)',l)4,( Crrb--d &01
5. Alteration
6. New Porch Y10
7. Is existing building to be demolished? 110
8. Repair after the fire h O
9. Garage AO No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:- ;_ 7)
The ndersigned certifies that the above statements are true to the best of his, her
kn ledge and belief.
Signat re of responsible appucant
Remarks
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