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�PERMIT APPLICATION CHECK LIST
PAGE e PLOT T ZONE (5�6 -5 ;y � ZD YES NO f
DATE
1 . ZONING FORM APPLICATION �O
2 . PERMIT APPLICATION
3 . 0 NER OCCUPA STATEMENT LIC . # 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 / AWNI
12 . PERMI FE - H C NLY - MONEY ORDER (V D D
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS ;
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01000
HOMEOWNER LICENSE EXEMPTION
r- (Please Print)
DATE:
JOB LOCATION: 3,
Map) (Parcel) (Subdivision)
HOMEOWNER: tr/1 X il,
(Name & Address )
(Home Phone) (Woek 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
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. Alterations
a NORTHAMPTON, MASS. v`t /,V -19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location t� ���� �%� Lot No.
2. Owner's name T f ll l r' &?--e e 4v r<'?_ Address
3. Builder's name �� ' I Address
Mass.Construction Supervisor's License No. d 3 7 03 I _Expiration Date 4 3
4. Addition
5. Alteration C g Svfa�'a + shee-1 r-6c 4 W a 1/S
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 �r
11. Distance to lot lines
12. Type of roof
13. Siding house �/Vc
14. Estimated cost:- (1 o.
The undersigned certifies that the above statements are true to the best of his, her
/ knowledge and belief.
ignature of re onsible app�icant
Remarks
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Date Filed
t File No.
ZONING PERMIT APPLICATION (910 , 2)
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I . Name of Applicant:_ P
Address : u d� s
-- _Telephone. 5-F x,
2 . Owner of Property; �r/f 1,y , .- ,���,, ,, 5 V93
Address : c f%uc ., s°r Telephone : se`s - .
3 . Status of Applicant: k'60wner Contract Purchaser
Lessee Other (explain ; )
4 . Parcel Identification : zoning Map Sheet# . ate Parcel# /E ,
zoning District (s) (include ,9,yerla
Street Address
jZ (� ; ,
Required
5. Exi s t incr Proposed by Zoning
Use of Structure/Property b ;-
(if project is only interior work, skip o #6)
Building height
tB1dg. Coverage (Footprint)
Setbacks - front _
- side L: 2: L; R:, --
- rear --
Lot size
Frontage R
Floor Area Ratio°
%Open Space (Lot area minus
building and parking) _
Parking Spaces _
Loading
Signs
Fill (volume & location)
6 , Narrative Descript,1?n ,o Proposed Work/Project : (Use additional sheets
if neeessar ) v( t -- oc, 6�c 1 �� r
ZU It 04,07 51,
oa
7 . Attached Plans : e-' Sketch Plan Site Plan
8 , Certification : I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
Date : � Applicant' s Signature :
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as`presented--Reason :
pecial' Permit and/or Site Plan Required :
ng R ui d: _ Varia e Require
�0'
gnatu of Building Inspector Date
NOTE: Issuance of a zoning permit does not roliove an applicant's burdon to comply with all zoning requirements and obtain all required permits
from tho Board of Noolth, Conservation Commission, Dopaitrnonl of Public Works and other npplicnblo pormit granting nuihorilios.
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