29-145 (4) PERMIT APPLICATION CHECK LIST
PAGE 29 PLOT l t-� ZONE (-iF?A / w's F' YES NO DATE
1 . ZONING FORM APPLICATION '70 c ()ruCe J-- tl l Avg Fio. /i- 1 - 114-73
2 . P ERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LICA IF NOT t�
4 . 3 SETS OF PLANS OT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 SIGN / AWNING
e-Ac tr 2 G 7 6
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER -,v /-�O O c
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR
212 Main Street ' Municipal Building
Northampton, Mass. 01000
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE 14" ;;
JOB LOCATION:
(Maps (Parcel) (Subdivision)
HOMEOWNER:
(Name Address) _
(Home Phone) (-Wark 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.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
ti
NORTHAMPTON, MASS. 19— Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name
Address
3. Builder's name Address
Mass.Construction Supeirvisor'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 above statements are true to the best of his, her
knowledge and belief.
Signature of responsible applicant
Remarks
V ate�- Filed Q- - q
File No, Q_91- 14//4 �5_
0006 .
ZJxZ0G PERMIT APPLICATION (§10^ 2) v r
P
1. Name of Applicant:-
Address :
2 , Owner of Property:~
Address: Telephone:
~~
3 . Status of Applicant: oer Contract �urolzaoe�
I,eosee Otbar (explain:`-- )
4 . Parcel Identification: Zon
Zoning District (s) (include overlays)
Street Address— Hi,ll &V&_
Required
5. Existing Proposed _by Zoning
Use of Structure/Property
(if project is only interior work, skip o #6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- 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 i i
if necessary)
�~
7 , Attached Plans: S}ca�ob �I�o Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
Date: Applicant" s Signature:
THIS SECTION FOR OFFICIAL USE ONLY:
X' Approved as presented/based on information presented JAN 1 2 1'7-3
Denied as presented--Reason:
Special Permit and/or Site Plan Required: 1 utr!"ut ou'LlIM16 lf`!�FILCTIONS
F nd g e 7q /e Variance Required:
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 eno,d of Health, Conservation uamm|ovivn, Department o,Public Works and other applicable permit granting uvmpmkiow.
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