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PERMIT APPLICATION CHECK LIST
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PAGE PLOT S77ZONE U/LA-/ws o �l� S NO DATE
1 . ZONTNG FORM APPLICATION
2 . PERMIT (�
3 . � 0 C�
4 , 3 SETS OF PLAN� /PLOT PLAN
5 . NEW CONSTRUCTION
6 CURB CUT
WATER
8 . REMODELING INTERIOR
9 . ADDITIQN
0 . ACCESSORY
11 . SIGN / AWNING
12 , PERMIT FEE - CHECK ONLY - MONEY ORDER OLO4
3 , SPECIAL IF APPLICABLE
4 . UNDER - CMR 780
FORM A
6 , FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 V
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: � -
JOB LOC TION-
( . p) (� rcel) (Subdivision)
HOMEOWNER: 62, C
(Name, & Address)
6- 6 >a s T
(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
conside-red 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 #
• ; w .> 2
3
Z
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
4 r
Garage
1. Location
Lot No.
2. Owners name JCS Yl Address IJ r—OC,-! RUC a Or l U
3. Builder's name bwn e—C Address
Mass.Construction Supervisor's License No. Expirati n Date
4, Addition Q -
5. Alteration
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:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belie .
Signature of responsible app icam
Remarks
Date Filed 00 0 3 0 03 -, File No.
ZONING PERMIT APPLICATION (910. 2)
1 . Name of A tic nt:
Address: , Telephone:
2 . owner of Property: 4 - 4-t-) e
Address : Telephone:
3 . Status of Applicant:zwner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# fir. Pa cel# 3�,
Zoning District(s) (include_- overlays) Lzf�'
Street Address `T r
Required
5. Existin ,---- Pro nosed by Zonin
Use of Structure/Property - r1r C
(if project is only interior work, skip to 6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front q 15--
- side )4+L: R: L: R: `f
- 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 Pro osed Work/Project: (Us additional s Bets
if necessary) &A O e - i - Gc� S
'r
7 . Attached Plans: Sketch Plan Site Plan
s . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: S Applicant's Signature:
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
S cial. Permit and/or Site Plan Required:
ing Re d: Variance Required:
r� a c
Inspector to S 5 rat oT Building
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, Dopartmont of Public Works and other applicable permit granting authorities.
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