29-299 (2) i
PERMIT APPLICATION CHECK LIST * . .,
PAGE PLOT •-) 77 ZONE « RA YES NO DATE
ZONING APPLICATION
2 . PERMIT P IC IO v
3 . OWNER OCCUPANT STATEMENT LICA IF NOT �` '=r ✓ C•1--
4 . 3 SETS OF PLANS /PLOT PL Sf� �-�- h �°`=
5 . NEW 0 S 0
6 . CURB CU
7 WATER I IT FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY UC
11 . SIGN / AWNING
2 . PERMIT FEE - CHECK ONLY - MONEY ORDER r)
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
4 . UNDER SECTION 127 - C R 780
15 . FORM A
16 FILL
1
COMMENTS : G7 CL C-
6iff of 'Nar llalltptalt z
�e WasoadlIlarHo n
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
�1 (Please Print)
DATE: ZJ J
JOB LOCATION:
(Map) (P 1) (Subdivision)
HOMEOWNER:
`� �
(Na & Address
IAA r/$ � °1✓Cc:
(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
hermit.
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 Annota
HOMEOWNER SIGNA
BUILDING PERMIT #
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c Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.,,:I z V 7 3 S� Alterations
a NORTHAMPTON, MASS. �/� 193 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location � /.S� /Ye o�'e�'. Vd^1- odW Lot No.
2. Owner's name ' E- Address ?/.E.E A'C�l �Q//���'"� ZW,
3. Builder's name Address '�� itQY1 �f�`ged.�_!d
Mass.Construction Supervisor's License No. Expiration Date
4. Addition j66jA11 l/e- cqu..e S&r11 wx
5. Alteration � .. d P t cy STfr►r eb v D n e= �T �, h� C
o.r r es rT
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
14. Estimated cost:- c�
The undersigned certifies that the above statements are true to the best of his, her
e r2,1.2, I knowledge ar0 belief.
Signature of respons le apps an[
Remarks
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bate Filed 93 " 000709 File No. e�-. x`39
ZONING PERMIT APPLICATION (§10 . 2) �� A
1. Name of Applicant: 7-116�0 90Z`G PFC— e '
Address: / C,�� ,tea p,{ -Telephone:
�l�yz�ir C e
2 . Owner of Property: T. �®/DoZe
Address :3JS' �C�clac�k D� jla���t Telephone: S,p4/ 9
3 . Status of Applicant: I/10"wner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# q Parcel#
Zoning District (s) (include overlays) U 17 A
Street Address
Required
5 . Proposed -by Zoning
Use of St
(if projc t0 #6)
Buildir
%Bldg. 0 r- --��
Setback
r` L: i o 5"' R: VV.1.
Lot s i z
'J `
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) ,Cf/Z 4114z c®14 7 .e 14I
e2 &,-,e gy'a> yz- q- I_Y:15-u a t -rl r1 e —c'n Dncr Y-
- � �n�r T
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 e.
Date:��f�� _ Applicant's Signature: '
_ t9
THIS SECTION FOR OFFICIAL USE ONLY:
FEB 12
k-`Approved as presented/based on information presented ,.
Denied as presented--Reason:
Sp ial Permit and/or Site Plan Required:
Z_-nd'n g Re i ed: Variance Required zgnat _ _o - Building--I pector Date
NOTE: issuance of a zoning 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.
/071-
QN 33
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