32C-184 (4) PERMIT APPLICATION CHECK LIST
PAGE ` C PLOT � � ZONES YES NO QATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 OWNER OCCUPANT STATEMENT / LIC # IF NOT
4 3 SETS OF PLANS /PLOT PLAN ��`
5 . NEW CONSTRUCTION - -
6 . CURB CUT
7 . WATER kVAILABILITY FORM
8 . REMODELING INTERIOR
9 . ADDITION -
10 . ACCESSORY STRUCTUBE
11 . SIGN AWNING
12 PERMIT FEE - CHECK ONLY - MONEY ORDER
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 , FILL
COMMENTS : —
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crr DG'PARTMLN7' UN 13UILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01000 "
d
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:
(Map) (Parcel) (Subdivision)
HOMEOWNER: T�r�,Y�orcr �� wD Sri/v;`,y� a
(Name 1 Address) 74;�7
(Home Phone) (Work Phone )
The current exemption for "homeownor,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, not Dossess 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 SIGNATURE �✓
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 0 "' Alterations
a NORTHAMPTON, MASS. �T, e � `' 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location d ` ��t"Q f4 r) " Lot No.
2. Owner's name � 1, a�r , ' ` ' 4 / ' t° '
,,t Address
3. Builder's name 1" a Address f a
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch i � ,� rA d: ,:: ,e,�Qs'�,,c�
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:- 5-0 p-
J
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
° Signa r of responsible ap canl
Remarks
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Date Filed File No. !3:;�G'- 194
ZONING PERMIT APPLICATION (§10 . 2) G13
1 . Name of Applicant: ti V Y !wr
Address : 0 XL's rr/l rr�,'L� 'ed1l Telephone: -q-2,)- 7
S dv Ali p�.,p"`un
2 . Owner of Property: F ft x �-7rt•r
Address : Telephone:
3 . Status of Applicant:Owner Contract Purchaser
Lessee other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 30,Jf, Parcel#�� ,
Zoning District (s) (include overlays)
Street Address ts 0,9�,
Required
5 . Existinct Proposed by Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
Bldg. Coverage (Footprint)
Setbacks - front
- side L ,
- rear _ Q
Lot size
Frontage
Floor Area Ratio
%open Space (Lot area minus
building and parking)
Parking Spaces _
Loading
Signs
Fill (volume & location)
0.6 "
Narrative Description of ProRosed Work/Proje t: sea ditional sheets
if necessary)
;nee 4
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 knowledge.
�� .1 .
Date: A Applicant ' s Signatu?' 4 '
THIS SECTION I'oR OFFICIAL USE ONLY: ~
SEP ` g
Approved as presented/based on information presented
ADe ied as presented
so for Denial :
Signature BaTiding I for ___._.______ ��5 to ~
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with ail zoning requirements and obtain all requirod pormhs
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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