29-419 PERMIT APPLICATION CHECK LIST �0 ' *
PAGE PLOT Yl q ZONE UAA YES NO DATE
ZONING FORM APPLICATION
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2 . -PERMIT APPLICATION t-'
3 . LICA IF NOT
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12 , PERMIT FEE - CHECK ONLY - MQNEY 0 DER
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
4 . UNDER SECTION 127 - CMR 780
15 . FORM A
6 . FILL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 3 -j Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location / / GjPs .C�,�rtd �•'��`c AIC1,1,7-1,11 Lot No.
2. Owner's name Address X-3-
3. Builder's name " Address `f
Mass.Construction Supervisor's License No. Expiration Date
4. Addition '
5. Alteration �n
6. New Porch A/P
7. Is existing building to be demolished?
8. Repair after the fire Z►r O
9. Garage /=S No.of cars �- Size Z 1� X S
10. Method of heating nn
11. Distance to lot lines 4 e
12. Type of roof /��hp/y
13. Siding house
14. Estimated cost-
The undersigned certifies that the above statements are we to the best of his, her
knowledge and belief. �//
Signature of responsible app!cant
Remarks r-5- VA','-Y /V IY V /V,
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a;Cl> massac4asrUs
DEPARTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 v
HOMEOWNER LICENSE EXEMPTION
` / (Please Print)
DATE: �/✓�';L a.5
JOB LOCATION:
(Map) (Parcel) (Subdivision)
HOMEOWNER: e""gz?,/�7 _�- /x/417,5-
(Name & Address)
/s" �csrM.,: /?.��rl' �Lnrr-��%�f�r-�.-� ✓`�,9 -Sf6 --.��<�3 ��'l--6';�a�
(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
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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE ' _
BUILDING PERMIT
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004014'
Date Filed Q04 Ul 4 File No.
ZONING PERMIT APPLICATION (§10 . 2)
I . Name of Applicant:
Address :l5- �,�,, rim-,i4 /3�,��, Telephone: .
2 . Owner of Property:
Address : �_5 �r'a�j�r�✓ i>,z., Telephone:
3 . Status of Applicant: o ner Contract Purchaser
Lessee other (explain )
4 . Parcel Identification: Zoning Map Sheetf 91 Parcel#
Zoning District(s) (include _9verla ) MA_
_
Street Address S �� ,
Required
5 . Existinq Proposed bV Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
- %Bldg . Coverage (Footprint)
Setbacks - front 70 r
- side L: 2 R _L: 761 R:
- rear ' r 312, ,
size
Frontage.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of Proposed work/Project: ,(XJse additional sheets
if necessary) 7'. r;
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 knowledge. /l
Date: Applicant's Signature: , �LF-
ZApproved THIS SECTION FOR OFFICIAL USE ONLY:
as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/o Site Plan Required:
Finding Re fired• Variance Required:
S. gnature of Building Inspector �� Date
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning roqulroments and obtain all required permits
from tho Board of Hoolth,conservation Commission, Dopartmont of Public Works and olhar applicabta permit granting authorides.
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