29-189 PERMIT APPLICATION CHECK LIST
YES NO DATE
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1
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2 . PERMIT APPLICATION
3 . L C . # IF NOT
4 . 3 SETS OF PLANS OT PL '
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 , SIGN AWNING
12 , PERMIT FEE , . ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED W[TH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 7130
15 . FORM A
16 . FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS -
INSPGCTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE:
Z� r .� (Please Print)
JOB LOCATION:
[map) (Parcel) (Subdivision)
HOMEOWNER: rci' t�i ' CZ 'L
(Na e' '& 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 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 Zo Laws, and State of Massachusetts
General Laws Annotated. 2
HOMEOWNER SIGNATURE �1l�
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. T No.v� l �/ �7 3 Alterations���' .t°✓ '
a NORTHAMPTON, MASS. 19 Additions
APPLICA ION FOR PERMIT TO ALTER Repair
Garage
1. Location , ' //.( /� Lot No.
2. Owner's name ��.Q�� E .�/.G ?/✓ Address_ /y9 Aa4KI E llw
3. Builder's name 161il 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 five r�
9. Garage No.of cars Size
10. Method of heating ZZ/ 7 4 Ile
11. Distance to lot lines
12. Type of roof
13. Siding house 0
14. Estimated cost � 'j�
The undersigned certifies that the ve statements are true to the best of his, her
knowledge and belief.
{
Signature ofres Bible pp,ican!
Remarks
Voli
Date Filed ' �•-i
File No.
ZONING PERMIT APPLICATION (510 . 2)
I . Name of Applicant: AJ pedl-tic-Z11-
Address : eer t � ,, h Telephone :
2 . Owner of Property: <j�� Ce Ql�o✓-�
Address : Telephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#-�� Parcel#
Zoning District (s) (include over ays
Street Address ,� �,� ��✓
Required
S .
Existinq Pro nosed by Zoning
Use of Structure/Property
(if project is only interior wor , skip t /6)
Building height
%Bldg. Coverage (Footprint)
Setbacks 10 - front _
side L: .2 p R: _� L: R:
-rear,,
Lot size 00 5� �
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6 . Narrative Description of, Proposed Wor Proj t : (Use additional sheets
if necessary) J c�cv,?� � .
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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 : �&q 63 Applicant' s Signature :
THIS SECT:3-6N FOR OFFICIAL USE ONLY:
Approved as presented/basE:d on information presented
Denied as presented--Reason:
Special Pe it and/or Site Plan Required :
an"Fi ing ui ed: variance Required :
o Buildin spect. �, 111 ate
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 Board of Health, Conservation Commission, Department of Public Works and oilier applicable permit granting authorities.
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