32C-270 (2) PERMIT APPLICATION CHECK LIST
PAGE 32--(—' PLOT ;�7) ZONE YES NO DATE
ZONINQ FORM APPLICATION
2 .- -PERMIT APPLI 3,1 OWNER OCCUPANT STATEMENT LIC . 0 IF NO
4 . 3 SETS OF S PLAN
NEW CONSTRUCTION
6 . CURB OUT
7 WATER
8 . REMODELING
9 . ADDITION-
10 , ACCESSORY STRUCTURE
11 . SIGN
2 . PERMIT FEE — y 31 a.
3 . SPECIAL PERMIT- REQUIRED DEED IF APPLICABLE
14 . UNDER SECTION 127 — C R 780
15 , FORM
16 . FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 "
HOMEOWNER LICENSE EXEMPTlON
(Please Print)
DATE• (.� / G' � Cl/
JOB LOCATION: -3-.2- c- ®,
(Map) (parcel) (Subdivision)
HOMEOWNER: C?S P !J 5k V Ca L-)A-)/ C. Uf ;'V f T z
(Name & Address)
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
owner-occupied Dwellincxs of one (1 )or two (2) fami I ies. and to allow such .
homeowner to engage an individual for hire who does not possess at
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 buildinq
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 m_ ay 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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATUPI
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. `L' X07 3 Alterations
NORTHAMPTON, MASS. A� ,/ 19-�4 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1^ Location !412 - q2 LC,i //l m YTj c Is f Lot No.
Owner's named T Address y 15, 10`,
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
C5. 1 teration
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-
a 0 The undersigned certifies that the above statements are true to the best of his, her
1� knowledge And belief. � /
\ Signature of responsible app!cant
Remarks
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003 594 Date Filed �Vl 1 I C.C File No.
ZONIN , PERMIT APPLICATION (510. 2)
-. Name of Applicant: Q /S.
Address: ' Telephone:
----�
Owner of Property: -,- S
Address: 't ��, ,��f _ Telephone:
3 . Status of Applicant:"'�Owner Contract Purchaser
Lessee Other (explain j
4 . Parcel Identification: Zoning Map Sheetj,�2Z Parcel# C,
Zoning District(s) (include overla 's). Wit,
Street Address
Required
5. Existing Proposed by Zoning
Use of Structure/Property Si o RQ
(if project is only, interior work, skip to #6)
Building height v o 10 C S o
aBldg. Coverage (Footprint)
Setbacks - front 15
side L: -IF,' R: ' —L:,2 ,7 ' R: q I
- rear 1S 0
Lot size _5D 7 3, 3 5 0 . 3
Frontage.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Descrip ion of Proposed Work/Project: (Use additional sheets
if neces ry)
O a W
7. Attached Plans: r/ Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowled .
Date: r� /�C Applicant's Signature.
T-- ECTxON FOR OFFICIAL U E NLY.
Approved as presented/based on information presented
Den'ed as prese ed--Reason:
ecial' Pe and/or Site Plan Required:
i g Re u' Variantce Required:
gnatur �f .uildi.n ctor Date
NOTE: lssuanoe of a zoning permit does not repave an applicanN burden to comply wiUt all zoning requirements and obtain all required pormits
from the Board of Hoaitf%conservation Commission, Dopaitmont of Public Works and otlior applicable permit aranling authoritios.
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