29-050 PERMIT APPLICATION CHECK LIST ry ,
PAGE PLOT ZONE ..` YES 0 DATE
1 . ZONING FORM APPLICATION
✓ �i z.-
2 . PERMIT APPLICATION
3 WNER OCCUPANT STATEMENT LIC . # IF NOT
4 . 3 SETS OF PLANS /PLOT PLAN 4 , N. ✓
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER V I BI T FORMS
8 . REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIG AWNING
1 2 . M V. FEE - LY - MONEY ORDER, - -
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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DEPARTMENT OF BUILDIN O INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 ,
HOMEOWNER LICENSE EXEMPTION
,f (Please Print)
DATE:
JOB LOCATION: 3 S-0 ell A A.J _
(Map) parcel) (Subdivision)
HOMEOWNER: s . {p mfs ��a�.�/ _
(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 109.11 .1
DEFINITION OF HOMEOWNER: Person(s) who own a parcel of land on
which he/she resided or intends to reside, oft 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. k5l7 3l/J Alterations
NORTHAMPTON, MASS. .JUAf Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 3,-0 P-An/ P.a t7 Lot No..1
2. Owners name S.„IQ.�,�- /1'l. .A/•�t/� Address 3 SAO 2V q� R a)9
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:-7
The undersigned certifies that the above statements are true to the bes. of his, her
knowledge d belief.
Signature of responsible app icow
Remarks U100 h t Asb a jam_pro I tie/f Agx.39!)
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Date Filed ® .00 `'
_ File No.
ZONING PERMIT APPLICATION
?� 1 . Name of Applicant: a141
Address: 3,�'y R�A,o eo g Telephone:
2 . Owner of Property: �„
Address: - Telephone:
3 . Status of Applicant: L_&ner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet` ;Parcel#
Zoning District(s) (include overlays) ,err —
Street Address 3 i ,.,.
4 Required
5. Existin - Pro nosed by Zoning
Use of Structure/Property , ?...-
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front ..5e)
- side L: R: L: R: 73'�'-
- rear
Lot size —
Frontage. —
Floor Area Ratio
. %Open Space (Lot area minus —
building and parking)
Parking Spaces F —
Loading —
Signs —
Fill (volume & location) —
6 . Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary)
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7 . Attached Plans: L Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowled e.
Date: - L - �� Applicant's Signature:
THIS SECTION FOR OFFICIAL USE LY:
pproved as presented/based on information presented
Denied as presented--Reason:
Special'' Permit and/or Site Plan Required: —
d WRe a variance Required:
�5 gnatur in ctor at
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required peini s
from the Board of Noalth,conservation commission,Department of Public Works and other applicable permit granting authorillos.
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