29-166 (5) PERMIT APPLICATION CHECK LIST
J-LO C c11 V
Yes No Date
1 . Zoning Form Application
2. Permit Application
3. Homeowner statement if applicableZLic . # if not
I c, N C I h(I ID-r-(Y I G 1 -y I C.
4. 2 sets of
_
Curb cut
6. Water- Department
7.. Permit fee - check only
x 9
Special Permit =uIred with deed if applicable
9. Under section 127 - MR 7RO
10. Form A
♦ PERMIT APPLICATION CHECK LIST
u RA
PAGE PLOT IGCo ZONE WS 114 o Dr. YES NO DATE
J . ZONING FORM APPLICATION Flo--e-n `' CL `f" aG
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC .# IF NOT
4 . 3 SETS OF PLANS OT PLAN e -CG �tQ� '
5 . NEW CONSTRUCTION
6 . CURB CUT
7 , WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR L�
9 . ADDITIO
10 , ACCESSORY STRUCTURE
1 , SIGN / AWNING
1 2 , PERMIT FEE - CHECK ONLY - MONEY ORDER )` Q...0/
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM
16 , FILL
COMMENTS :
Move Pole. From i L.ocaztc ��cChev-
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.
��" "� Alterations
U V /,'16 19 f Additions
a NORTHAMPTON, MASS.— -fit/ Repair
APPLICATION FOR PERMIT TO ALTER
r
Garage
1. Location f/L/ t�/ v'c� 0/^r°�'" A Lot No.
2. Owner's namel)kme- V �t 440ttz 1� aj I N Address /
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
I y
5. Alteration ���� l y" U!�/�`Y�HC
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 cjqtifies that the above statements are true to the best of his, her
–,� knowledge and a ef.
��
Signature of responsible appicant
Remarks
�'f1UU1AT
LJ'Tf r of 'Nort1jamp toll
z S
cs DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION: //7 ,3w/'. GC�G��t'
(MM P) (Parcel) ~ (Subdivision)
HOMEOWNER:/ � D� l�" l C�7 Address).1� �W J K A,)
/ (N e & / � 0,t)(00 r0 L JA
(Home Phone) (Work PE-one)
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
arson(s) who own a parcel of land on
whi to reside, on which there is, or is
int mily dwelling, attached or detached
str and/or farm structures . A person who
con in a two-year period shall not be
con neowner" shall submit to the Building
Off the Building Official, that he/she
sha h work performed under the _building
e ri tt1��
l " -visor your presence on the job site
wil. e, during and upon completion of the
wor ued.
I
reference to Chapter 152 (Workers '
Coml ibility of Employers to Employees for
inji of the Massachusetts General Laws
Annotated, you may ze iiab.ie ror 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 L al Zoning Laws , and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
�diyrn, .p
0000 5 31
Date Filed LA, aC14 93 File No.
ZONING PERMIT APPLICATION (§10 . 2) 1 U RA l K/S jO
1. Name of Applicant:j_ e a
Address :�j(yl rC1 P,�C�� �7� , )C1C1,^z!4r Telephone: -
2 . Owner of Prope ty:
Address: /c/ ��r w U/" ck Telephone:
3 . Status of Applicant: /\ Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# ac/ Parcel# ICG, r
Zoning District (s) (include overlays) LIRA / W s p
Street Address r w -
Required
5 • Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #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 Pro ect• Use add ' nal sh ets
p p / 7
i necessary) �40l� ►Y� �1°�`��'
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the infor tion contained herein
is true and accurate to the best of my knowled R
Date : �4�- Applicant's Signature: �-�-
THIS SECTION FOR OFFICIAL USE ONLY:
t- Approved as presented/based on information presented
Denied as presented--Reason:
Special Permit and/or Site Plan Required:
i ing ired: Variance quired;- )�, re
�1-�,r /o Si n =zoning .n nspector at
g
NOTE: Issuan 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 other applicable permit granting authorities.
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