35-083 (6) PERMIT APPLICATION CHECK LIST
PAGE PLOT 007) ZONE Sri / ' Wc_��e t " YES NO DATE
1 . ZONING FORM APPLICATION /1i
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT
4 — 3 SETS OF PLANS T PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIG N / AWNI
12 . PERMIT FEE — CHECK ONLY —'MO EY ORDER '
13 . SPECIA PERMI REQUIRED IT F APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.NoAty r^7 3J-9 Alterations
NORTHAMPTON, MASS. 199Y Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /2— qS— u-fO r T 12afb — Lt W +l Lot No.
2. Owner's name P 014 tf T,6 -VK(eV1 Address f.I1 s—90 5 P,T 0*)
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: �N
The undersigned certifies that the above statements are true to the best of his, her
✓� Q knowledge and lief.
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Signature of responsible appicani
Remarks gmtep �2w u-,Lo +/1(ey e6cceg equg,44 p&w Ifet,J iqr
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
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DATE: / JUrd P
JOB LOCATION: - m'
(Map) ()?arcel) (Subdivision)
HOMEOWNER: h;W"r-i T, Q Vze erl
Name & Address)
t�tl�.r 13u.t ISI-e Y_
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellincxs of one (1 )or two (2) fami 1 ies and to allow such .
homeowner to engage an individual for hire who does not possess as
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 #
Date Filed �'17 , - File No.
ZON NG PERMIT APPLICATION
1 . Name of Applicant: P ttvlirl w oerm
Address : ,- u. t 772am Telephone:
2 . Owner of Property:
Address : L s c,ntl �t` �tln Telephone: 4-fV,13J`9
3 . Status of Applicant:-K-Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel# ,
Zoning District(s) (include verla ) n S
Street Address IL S r ,L� Y ,
Required
5• Existin 'Proposed by Zonin
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 —T
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 Pro osed Work/Project: (Use additional sheets
if necessary) e K � i-o e f,Md / K� dae
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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 knowledg
Date: 1U0_t*_ Applicant's Signature:
"
�� THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
S cial' Permit and/or Site Plan Required:
,i d' g Re e : Variance Required:
S�
5 gnatu of=pennft actor �� at
NOTE: Issuance of a 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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