29-068 (5) PERMIT APPLICATION- CHECK LIST
PAGE gq PLOT 61 ZONE t. S NO DATE
1 . ZONING 0
i
2 . PERMIT
3 . OWNER OCCUPANT STATEOEAT LICA IF NOT
3 SETS OF -PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 CURB CUT
WATER 7 .
8 . REMODELING INTERIOR
9 , ADDITION
i
0 . ACCESSORY STRUCTURE I
I
11 . SIGN / AWNING
12 , PERMIT FEE - CHECK ONLY - MONEY--ORD,ER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
4 . UNDER SECTION - C R 780
5 FORM A
6 , FILL
COMMENTS :
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�iassucllasetts
DEPARTMENT OF BUILDING INSPECrIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE MMMnTION
DATE:
(Please Print)
� C�
JOB LOCATION: U G�
(map) (Par `1) (Subdivision)
HOMEOWNER: K K ,
(Name* & A dress)
f (Home Phone) (Work Ph ne)
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
r 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 Ann otat d
HOMEOWNER SIGN r �-�-
BUILDING PERMIT
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ZO
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.1'w3 "51 ��?�I Alterations
NORTHAMPTON, MASS. 19 Additions
91 APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Lot No.
2. Owner's name =Y Address o r
3. Builder's name v Address
Mass.Construction Supervisor's License o. Expiration Date
4. Addition II
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
knowl a and belief.
U, E 'er t --
ignatare of i ponsible app icant
Remarks
4
► • ; Fa�1,
4
Date Filed File No.
ZONING PERMIT APPLICATION (§10.2)
I . Name of Applicant:
,5 v _ Telephone:
Address:
2 . Owner of Property:
Address : S - _ Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Ot er (explain )
4 . Parcel Identification: Zoning Map Sheet# �� Parcel# fog ,
Zoning District(s) (include ovyTlay s
Street Address '3S ,
Required
5 Exist 1n Pro osed by Zoning
)r work, skip to #6)
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S1
R: L: 104 R: ID 4- <
us
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73V 7
6 . Narrative Description of P op sed Work/Pr- ' ect : Use a dit' onal 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 know le
Date: Applicant's Signature.,
i,4 - - - /_�,� - -
THIS SECTION FOR OFFICIAL USE ONLY: — _
Approved as presented/based on information presented
Denied as presented--Reason:
Sp ial' Permit and/or Site Plan Required:
di Req Variance Required,_
gnatur lding I spec or j�� Date
NOTE: issuance of a zo in does not relieve 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 applicable permit granting authorities.
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