35-081 (4) PERMIT APPLICATION C�HEC LIST
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PAGE 3 PLOT ] ZONE
1 ZONING FORM APPLICATION T�(066
2 , PERMIT APPLICATION
3 OWNER OCCUPANT STATEMENT / LIC A IF NOT
g , 3 SETS OF- PLANS /PLOT PLAN
5 NEW CONSTRUCTION
6 , CURB CU
7 , WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 ADDITION
10 , ACCESSORY STRUCTURE
11 SIGN / AWNIjG
2 ER I FEE - CHECK ONLY - MONEY ORDER
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
UfJQER S -C�'IQN f 27 - CMf3 730
15 , FORM A
16 , FILL
COMMENTS ;
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' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
/ (Please Print)
DATE•
JOB LOCATION:
(Map) (Par el) ( Subdivision)
HOMEOWNER:
(Name & 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 Zoning Laws , and State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. �6c i d 1993 Additions
Repair
e
APPLICATION FOR PERMIT TO ALTER
�
, Garage
1. Location P j Lot No.
2. Owner's name d �- l Le nu 1 0 Address
3. Builders name i C:�it a- /,1 l a z- i4 Address t
Mass.Construction Supervisor's License No. Expiration ate
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.
LA/ `
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Signature of resiloWsible appicant
Remarks
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001 �? . f�
Date Filed' / 7
/ �a� File No.
ZONING PERMIT APPLICATION (510 . 2)
I . Name of Applicant:—RaL, LCD n,
Address : ICI 7 / Telephone : -p
2 . owner of Property: '
roperty:_ 'Ezl L cl,� � ? e 2,, ,
Address : Telephone :
3 . Status of Applicant'X owner Contract Purchaser
Lessee Other (explain ,. )
4 . Parcel Identification: Zoning Map Sheet# �y Parcel# ,
Zoning District (s) (include o�lays) S
Street Address
Required
5. Existincr Pro nosed by Zoning
Use of Structure/Property -z-
(if project is only interior work, skit 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/Project : (Use additional sheets
if necessary)
7 . Attached Plans : Sketch P1 n 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 USE ONLY: r —
Approved as presented/based on information presented
Denied as''presented--Reason :
pecial' Permit and/or Site Plan Required :
din 4,- e fired: Variance Required :
gna u e . Inspector Da e
- 1
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 other applicable permit granting nuthoritios.
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