29-211 PERMIT APPLICATION CHECK LIST
PAGE f PLOT -:2-11 ZONE c�-, / = ' �" l , YES NO DATE
1 . ZONING FORM APPLICATION
2 . PERM I �-"
3 OW OCCUP IE...NOT �--
4 . 3 SETS OF S PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELING
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN AWNING
12 . PERM T FEE - C - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 27 - C R 780
5 . 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
DATE:
(Please Print)
�e,���
JOB LOCATION:
(Map (parcel) (Subdivision)
HOMEOWNER:
(Name & Addre s)
_5—S'6 oy a y
(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 Zoning Laws, and State of Massachusetts
General Laws Annota ed. 1
HOMEOWNER SIGNA
BUILDING PERMIT
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
1 Garage
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
�^
. Location Q O (3 P u Lot No.
COwner's name a t/)60 C J?P) I t4 Lc Address C213 "71("; e
l;i Builder's name —S )m c Address
Mass.Construction Supervisor's License No. Expiration Date
4, Addition i d�'S`i�.vq�R fora ?C
�5.,�l teration
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
Siding house
14 Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. ,y
Sign re ojresponsible appicant ,
Remarks
0 01(2 6 6
Date Filed v
File No.
ZONING PERMIT APPLICATION (510 . 2)
Name of Applicant: �Q v; (_ P e \n i'o
Address : Sav 6(- Cl 141 nv Telephone:�/_pG - V00 y
j2 + Owner of Property:
Address : L2 , e Ginue Telephone:
3 . Status of Applicant:l__-Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#-2-L Parcel#
Zoning District(s) (include verlays (,{ �
Street Address
Required
5• EXL' sting Pro osed by Zoning
Use of Structure/Property t-, rr y
(if project is only interior work, sk p to )
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L:'\ R: L: R:
- rear
Lot size
Frontage
Floor Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
signs
Fill (volume & location)
Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary)
'r
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:
Lc( Applicant s Signature e�/c ck U
THIS SECTION FOR OFFICIAL USE ONLY: r
ZA'pproved as presented/based on information presented
Denied as presented--Reason:
Special' Permit and/or Site Plan Required:
in 'ng R glir d: Variance Required:
S' gnat re of N (�- A a
NOTE: Issuance of a zoning permit does not reliove an applicant's burden to comply with all zoning roquiroments and obtain all required permits
from tho Board of Health, Conservation Commission, Department of Public Works and other applicabio pormit granting authorities.
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