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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location D Lot No.
2. Owner's name Address
3. Builder's name �—° 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 heating
11. Distance to lot lines
12. Type of roof
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
Remarks
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DEPARTMENT OF BUILDrNc INSPECT/oNs
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Macs. 010GO
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE;
JOB LOCATION:
(Map) 4i�rcel ) ( Subdivis ' on )
HOMEOWNER: V lyu L , /.�F3��/c r s►-An he
(Name & Address )
C e , �^ l r � 1 MA
/ ( Home ?hone ) (Work Phone )
The current exemption for "homeowners" was e::tended to include
Owner-occupied Dwellings of one ( 1 )or two (2) fami ("'es and to allow such .
homeowner to engage an individual for hire who does not possess a `
license , provided that the owner acts as supervisor . CF1R780 Section 109 . 1 . 1
DEFINITION OF HOtr?OWNER: Person( s) who own a parcel or land on
which he/she resides or intends to reside , on 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 . 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 buildinq
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 1S2 (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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE J
BUILDING PERMIT. #;
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10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NOV
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to b- filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
S
Frontage
Setbacks - frnnt /
- side L: R: L: R:
- rear
Building height
Bldg Square footage 8�O
%Open Space:
Lot area minas bldg
' &paved parking)
pf Parking Spaces
of Loading Docks
Fill:
':(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
a
is true and accurate to the best of my knowledge.
DATE: APPLICANT's SIGNATURE `�— A 144 NOTE: Issu no of a zoning permit does not relieve an ap ant's burden to comply with all
zoning requirements and obtain all required permits from a Board of Health, Conservation _
Commission, Department of Publio Works and other mppiioable permit granting authorities.
'! FILE #
i • • _.�_..._� ____^•-+--..-...+.ter
j Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPrE, OR PRINT ALL INFORMATION
1. Name Qf Applicant: nw ,�
Address:_ As �!'d� �� ( ,It--
Telephone:_1&:h2 f —/p� L
2. Owner of Property: ' VQ/ �, 4r
Address: 's id � Telephone:
3. Status of Applicant: _ZZwner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# 2-1 Parcel# District(s): U R P
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property c.� iG /5_C'F_
6. Description of Proposed UseNllork/Project/Occupation: (Use additional sheets if necessary):
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)
M
' FILE # 961200 ) 1
APPLICANT/CONTACT PERSON: �Vy— rA27
ADDRESS/PHONE:
PROPERTYLPCATION:
MAP PARCEL: ZONE
THIS SECTION FOR�OFFICIAL USE ONLY:
PERNHT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FH,T,FD OUT
Fee Pgid
lRivilding Permit Filled civit
Fee Pnid
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THE OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION- `
// 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
I/
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 m Conservation m' si
9/
Signature of Building InspeqO Dat
NOTE:lasuanoe of a zoning permit does not relieve an appiioant's burden to oomply with all
zoning raquirementa and obtain ail required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable permit granting authorities. —
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