32C-239 (6) 4-'itVW PT
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DEPARTMENT OF BUILDDT G INSPECTIONS _-
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 ' v
HOMEOWNER LICENSE EXEMPTION
l (Please Print)
DATE: L,C_, , r
JOB LOCATION: �JZ C a�
(Maps parcel) (Subdivision)
HOMEOWNER: , 1 C)Q 4 0 y
(NF'Wne & Address
( ome Phone) (Work hone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1 )or two (2) fami 1 ies. 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 SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 9 Additions
a —APPLICATION FOR PERMIT TO ALTER Repair
Garage
1 Location - e- Lot No.
Owner's name ,JU' Address e-
Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration 1
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. stimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge an 1 ef.
Signature of responsible appucant
Remarks
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Date Filed File No.
ZONING PERMIT APPLICATION (910. 2)
1 ,t Name of Applicant: G
Address: - ephone:
21 owner of Property: . c -�-
Address: - Telephone:
3 . Status of Applicant:__�LOwner Contract Purchaser
Lessee other (explain )
4 . Parcel Identification: Zoning Map Sheet# 2 _� Parcel# c�3q ,
Zorting District(s) (include overl ys)
Street Address / L3
Required
5. Existing Proposed by Zoning
Use of Structure/Property -
(if project is only interior work, s 'p 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 Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowlea
Date: Applicant's Signature:
THIS SECTION FOR OFFICIAL U8 NLY'
'Approved as presented/based on information esented
Denied as presented--Reason:
S ecial' Permit and/or Site Plan Required:
i ing R qu -red: variance_ Required:
Ile
gna rdr of Bu , 1 Inspector 1Y�'� a e
NOTE: issuance of a zoning permit does not refiove an applicant's burden to comply VKh all zoning requirements and obtain all required permits
from tho Board of Hoolth,Consomation Commission,Dopartmont of Public Works and other appticablo permit granting authorities.
IC9'�-
PERMIT APPLICATION CHECK LIST
LOT a39 ZONE 9&4t- A3 �� S NO DATE
APPLICATION 1 . ZONTNG FORM = `
2 �.--
3 . , "OW IF NO
3 SET S PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELTNG
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
2 , PERMIT FEE - CHECK ONLY - MONEY
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABL
14 . UNDER SECTION 7 - C R 780
15 , FORM
16 , FILL
COMMENTS :
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