29-162 (2) PERMIT APPLICATION CHECK LIST
PAGE �% PLOT �(� ZONE C�`� /'1',- - YES NO DATE
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1 . ZONING FOR APPLICATION �' 717
2 . PERMIT APPLICATION
3 . -- NER QCC UP STATEMENT LIC. # IF NOT
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER VAIL BI T FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIG AWNING
12 . PERMIT FEE — — MONEY 0 D
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
—, Garage
1. Location Lot No.
2. Owner's name Address
3. Builder's name Lj Address
Mass.Construction Su isor's License No. Expiration Date
4. Addition
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 abov temcnts are true to the best of his, her
knowledge and belief.
ignaiure of responsible app icane
Remarks
•e �ixssadlasetts _
DEPARTMENT OF BUILDNG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE PMUIPTION
(Please Print)
DATE:
` ^
JOB LOCATION. -P woo C/ {' y[ C--� �a SS
Map ,�arc6l) (Subdivision)
HOMEOWNER:
ame, Address)
(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 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, oft 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 Annotat d.
HOMEOWNER SIGNATURE Q
BUILDING PERMIT
Date Filed File No.
/ ONIN PERMIT APPLICATION (§10.2)
1. Name of Ap licant:
Address: A elephone:
2 . Owner of Property: ,� _�•
Address: Telephone:
3 . Status of Applicant: L-15-w-ner Contract Purchaser
Lessee Other (explain:
4 . Parcel Identification: Zoning Map Sheet#. Parcel#
Zoning District(s) (include overlays) Z h ei�E-i
Street Address —
Required
5•
Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior wo k, sk p o #6)
Building height
%B1dg.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 knowledge.
jD
Date: ,� Applicants Signature:
THIS SECTION FOR OFFICIAL U8E — — —
_.... .__
Approved as presented/based on information presented
Denied as presented--Reason:
4ao ial" Perm it d/or Site Plan Required:Ci Requ' a Variance Requ red:u ding Inspect ate
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply witli all zoning requirements and obtain all required permits
from tho Board of Hoallh,Conservation Commission, Department of Public Works and otlror applicable permit granting authorities.
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