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DEPARTMENT OP BUILDMC INSPECTIONS
INSPECTOR 212 Main Strcct ' Municipal Building
Xorthainpton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE
JOB LOCATION: 1,172 .D
map) (pa rcel ( ( Subdivirsi—on )
HOMEOWN : o CM
L' - �-:__ E 1 ] s !tz,
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--�� (Name & Address ) _
( Ho e Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied awellinc;s 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 . U,iR7g0 Section 109. 1 . 1
DEFINITION OF HOMEOWNER: Person( s) who own a parcel of land on
which he/she resides or intends to reside, on w —_ch 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 Buildina
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
i 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 SIGNATUF2E -�Cc
BUILDING PERMIT
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.��y^ ,��� Alterations
NORTHAMPTON, MASS. JU vt.C-. 3 19_ Additions .'-
APPLICATION FOR PERMIT TO ALTER Repair
T Garage
1. Location '7�/ �a y.. �d T o,-�h c e— Lot No.
2. Owner's name 0,0 f"e_ Address-
3. Builder's name �l;'_ A`� Address_
Mass.Construction Supervisor'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 heating2s� rr
11. Distance to lot lines � �! �� ` 15;- ! �S4We-
12. Type of roof S�+i tic 1
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 app icant
s
Remarksl�,es
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
1
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION_
Tbi_s col— to be filled in
by .the Bsi.ldinq Department
Required
Existing Proposed By Zoning
Lot size` 0. :)IS C _—C�
d
Frontage "44241
Setbacks -frnnt
- side L: R:, . L: R: / 9-
- rear �G 4 � ��6)
Building height f3 i
Bldg Square footage
%Open Space:
Lot area minus bldg
&paved parking) 1 - -�C)VkA
# 0`4 -Parking Spaces 2y x i
_. rof Loading Docks
Fill.. �3CrU - Ord°,eo f Cv �,ic c�t
-{vol-time--& location) tZ73 st
13 . Certification: I hereby- certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: - APPLICANT'S SIGNATURE
't?n_ NOTE: uanoe of a zoning permit does not relieve an nppiioant's burden to o�orm with all
zoning requirements and obtaln all required permits from tho Board of Health, Conservation ..
iCommisslon, Department of Publio Works and other npplioabie permit granting outhorities.
zi!,'." FILE #
Y.
{ r
1991
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:, 6:6 �A'6—'I :Ec
Address: ��f�fi / T�n �ri.r�„�.� _Telephone:
2. Owner of Property:,
Address: 9}�' Telephone:_ ;-ft— -Sc,6s'
3. Status of Applicant: Owner Contract Purchaser_ Lessee
Other(explain):
4. Job Location: ��y� `-���, R'L
Parcel Id: Zoning Map#_ _ Parcel#_ `? District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property kk .ez -- 1C — " /
If
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
d'
7. Attached Plans: �_Sketch Plan —Site Plan _ Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW_ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page_ and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO �_ DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ;date issued:
(FORM CONTINUES ON OTHER SIDE)
•a FILE #
APPLICANTICONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP �� PARCEL: / 43 _ ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FTT,T.FT) OITT t�
Fee, PAid
Fee, pnid
✓^
f�` f
L-
Remndeli g Tnterinr
Addition to Fzictinv
Acc"sna Strnrture
Bnildinv Plans Tnchided-
a
Owner/Orrnnnnt StntemPnt nr T,irpme f#
3 gets of Plans /Pint Plan
THE,FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION-.
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: § _
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
/
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
Permit fro Conservation Co Im n
Signature of Building Inspector: D e
NOTE:Issuanoe of a zoning permit does not relieve an applicant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commiasion, Department of Publio Works and other applicable permit granting authorities. —
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