35-141 (2) PERMIT APPLICATION CHECK LIST
p . PE:flT ZONE ��. �/ "��... `.' € NO DATE
ZONING APPLICATION
2'. PIERNIT 6PPLICATION
3 j LICA IF NO
4 . 3 SETS S ZELOT PLAN
NEW C S 0
6 . CURB CUT
7 WATER S
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 SIGN / AWNING
12 . PERMIT FEE — CHECK- ONLY — MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 7 — C R 780
15 . FORM A
16 . FILL
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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 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 Porch2'Y�
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
11, Siding house
4. stimated cosL
The undersigned certifies that the above statements are true to the best of his, her
knowledge belief.
1 `
Signature of res risible appicant
Remarks ��
ti
Grik of Nort 4a1lCptan r
4 8
� �acssselluaetia
' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXY14PTION
L (Please Print)
DATE: 1S—
JOB LOCATION:
M,—I,) ('Parc 1) (Subdivi on)
HOMEOWNER: -;-
( ame & 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 G`'
BUILDING PERMIT # 7
f�
002443
Date Filed r
File No.
ZONING PERMIT APPLICATION (510. 2)
I . Name of Applicant: a-�q /q1S
Telephone:
2 . Owner of Property:
Address : Telephone:
i
'-3 . Status of Applicant: L o0iner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheet# Parcel#
Zoning District (s) (include GV (u y-Vays,)
Street Address
Required
5. Existinq Proposed —by Zoning
Use of Structure/Property
(if project is only interior work, kip o #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)_� � r1Ti�2� 1 -I �^ai r"� �s��rr�U(- %�Zf�l L�✓z�
,IJ
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 knowle ge.
Date: /�� Applicant's Signatur �-
THIS SECTION FOR OFFICIAL U ONLY:
1`'Approved as presented/based on information resented
Denied as presented--Reason:
pecial' Permit and/or Site Plan Required:
finding Re uired: variance Required: -
/v,7F 7�/,
gnat4/e- of Bu iW- fig Inspector to
NOTE: Issuance of a zoning permit does not roliove an applicant's burden to comply with all zoning roquiroments and obtain all required permits
from the Board of Health,Consorvation Commission, Dopailmont of Public Works and other applicablo pormil granting authorilios.
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