29-122 (2) PERMIT APPLICATION CHECK LIST
;s` YES NO * DATE
4 . 3 SET S PLAN
5 NEW CONSTRUCTION
6 . CURB CUT
7 . WATER V S
8 . REMODELING INTERI
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 SIGN / AWNING
2 . PERMIT E — °� —ONLY — MONEY -ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 27 — CMR 780
15 . FORM A
16 . FILL
COMMENTS:
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. ��`�S'�� Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
Location �' Lot No.
2. Owner's names Address
3. Builder's name �j Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition 1, bau,
5. Alteration --
6. New Porch
7. Is existing building to be demolished? LI.AO
8. Repair after the fire ir /f2d�
9. Garage ( ) -1." No.of cars l Size, f
10. Method of heating C4,-o
11. Distance to lot lines
12. Type of roof
Siding house
4.)Estimated cost:- (i
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
d-. ,Z,k
Signature of responsible ap ant
Remarks
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPT'ION
71 f y,�: (Please Print)
DATE:
JOB LOCATION:
(Map) (parcel) (Subdivision)
HOMEOWNER:
(Name-& A l /,
/ r s)�4 G
o �-3
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
owner-occupied Dwellings -of one (1)or two (2) fami 1 ies 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, 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 Annotated.
HOMEOWNER SIGNATURE !�
J
BUILDING PERMIT 1#
Date Filed 3 - ' j r 00237 0
File No.
ZONING PERMIT APPLICATION (§ib'. 2)
Name of Applicant- -,_ .�1ti - G%�
tl-
Address: 5�j -- elephone:
A
Owner of Property:
Address: �'-�/ /7 � . �C; 174 -Telephone: S 6
3 . Status of Applicant: l,6wner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# elf Parcel# l), ,
Zoning District(s) (include overlays) �
Street Address
Required
5 • Existin Pro osed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%Bldg.Coverage (Footprint)'
Setbacks - front C^ D =5 r
- side L: <; R: S L: + R --�
- rear
Lot size
Frontage.
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & Zocationr
6. Narrative Descripti n of Proposed Work/Project: (Use additional sheets
if necessary)
G
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.
Date: "' % Applicant s Signature
- - - - - - - - - / _ --
THIS SECTION FOR OFFICIAL UE S ONLY: _ _ _
/Approved as presented/based on information presented
Denied as presented--Reason:
S ecial Per 't and/or Site Plan Required:
Ing R it Variance Required:
P� - `
SignatuW of Bull Jrsp ctor to
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning roquiromonts and obtain all required permits
from tho Board of Health,Consorvalion commission, Dopartmont of Public Works and other applicable pormit granting authoritlos.
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