29-363 (4) x
PERMIT APPLICATION CHECK LIST
PAGE Z PLOT iyJZOUE P0 YES No A TjV r
ZONT.NQ FORM L C ATION
2 , PERMIT APPLICATION
3 OWNER OCCUPANT STATEMENT / LIC A Ir NOT
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
CURB CUT
7 . WAIER 6VAILABILTTY S
B . REMODELING INTERIOR
9 . AQDITION
10 ACCFUSORY STRUCTURE
SIGN AWNING
2 , PERMIT FEE - CHECK ONLY - 0 E ORDER
13 . SPECIAL PEBMTT REQUTRED 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, brass. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print)t-4 DATE• 1
JOB LOCATION:
(Map) c l) b ision)
HOMEOWNERt -� _ �'• « /
ame & d Bess ) G"
(Home Phone) (Work Phone)
11%j _ a •3 -- :5,3j
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 su ervisor. 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 an Local Zoning Laws, and Sta of Massachusetts
General Laws Annotate: g
HOMEOWNER S I GNA
BUILDING PERMIT #
i
u
Date Filed �''� File No.
ZONJ�VG RMIT APPLICAT (910 . 2 )
y
1 . Name of Applic4nt :
Address ,
? �lrs
2 . owner of Property:�z-4 l; F
Address :,;ll/ elephone : �LJ ?s
3 . Status of Applicant:_X_Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification : Zoning Map Sheet#�_ Parcel# � ,
Zoning District (s) (include overlays) uf�
Street Address
Required
5 . Existinq Proposed — by Zoning
Use of Structure/Property Zv ,
(if project is only interior work, skip to #6)^
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
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)
7 . Attached Plans : Sketch Plan site n
8 . Certification : I hereby certify that the it - ati i�ontain¢d, here
in
is true and accurate to the best of my knowledge f
Date : 1<> fry Applicant ' s Signatu
THIS SECTION FOR OFFICIAL USB ONLY: �
Approved as presented/based on information presented
Denied as` presented--Reason :
Special• Permit and/or Site Plan Required :
in ing eq ired : _ Variance Required : _
�gigna ure of g Inspector ate
NOTE: Issuance of a zoning permit does not relieve on applicant's burden to comply with nil zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Depaitrnont of Public Works and olhor appiicnblo pormtl granting authorities,
/6,,71_
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. . `= t,- n 1 r'E, Alterations
NORTHAMPTON, MASS. .SZ2_ r, 19 9-L! Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location !l 1., A >-.)") )11 .)r E) r! .�j c,- Lot No.
2. Owner's name 6-1 / Address ' s' ' r r^ Mfr c t
3. Builder's name AddressS`I
Mass.Construction Supervisor's License No. 61(2206, Expiration Date 4z all 2ZIlV4�
4. Addition
5. Alteration S r-4,a -4-gin::.-4,6 Dec k /S- X 2"e3
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:-
Th"u iiersigned,cert' ' s that the above statements are true to tfijbest of his, her
knowledge d 1.
Signature of respo Bible u p,ican!
Remarks
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