29-336 (2) PERMIT APPLICATION CHECK LIST
AGE Z9 PLOT � � ZONE
YES N ' *RATE
1 . ZONING FORM APPLICATION 3G Ac: reb
2 . PERMIT APPLICATION l�
3 . OWNER OCCUPANT STATEMENT / LIC A 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 - CHECK ONLY - MONEY ORDER -
13 . SPECIAL PERMIT REQUIRED qITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 FORM A
16 , FILL
COMMENTS :
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tTi DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building '
INSPECTOR .%0
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE:
(Please Print)
�_
JOB LOCATION: ����� �,�, /r� Ct>R�sf f .,,c ref fcs Sec y a,�
(Map) (Parcel) (subdivision)
HOMEOWNER:— Pte' 4AJ ez' C
(Name & Address )
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of six ( 6 ) units or less and to allow such
homeowner to engage an individual for hire who does not possess a
license', provided that the owner acts as supervisor.
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 to six 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 SIGNATURE—
BUILDING PERMIT #