35-178 (2) pro
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DEPARTMENT OP BUILWNG INSPECTIONS '
INSPECTOR 212 Main Strcct ' Municipal Building
Northampton, Macs. 01060
HOMEOWNER LICENSE EXEMPTION
( Please Print)
DATE-
JOB LO ATI ON= O �
(Ma ) (Parcel ) ( Subdivision )
HOMEOWNER.
(Name & Address )
( Horne Phone ) 'Mork Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellinqs of one ( 1 )or two (2) fami I ies and to allow such .
homeowner to engage an individual for hire who does not possess a `
license , provided that the owner acts as supervisor . Cb1R780 Section 109. 1 . 1
DEFINITION OF ROKEOWNER- Person( s ) who own a parcel or land on
which he/she resides or intends to reside , on ch there is , or is
intended to be , a one or two family dwelling, attached or detached
structures accessory to such use and/or farm struc ures . person who
constructs more than one home in a two-year aeriod shalt not be
considered a homeowner . Such "homeowner" shall submit to the Buildirno
Official , on a form acceptable to the Building O_ ici al , that he/she
shall be responsible for all such work performed under the buildinq
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
t for compliance with the State Building Code , City of Northampton
Ordinances, State and Local Zoning Laws and State of Massachusetts
General Laws Annotated AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT
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Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. J Alterations
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NORTHAMPTON, MASS. U `,� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location / Lot No.
2. Owner's name er- M I Address
3. Builder's name � 1.7 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_ p
12. Type of roofs L—S�
13. Siding house
14. Estimated cost- ��
The undersigned certifies that the above statements are true to the best of his, her
knowledge and b—elyief.
Signature of rep nsible app icani
Remarks ` / o,OC-, S'sO Q2 14� JW�4
10. Do any signs exist on the property? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This co?== to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
' &paved parking)
_of `Parking spaces
# of Loading Docks
Pill:
":(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
rf is true nd accurate to the best of my knowledge.
6 DATE: - 9 APPLICANT'S SIGNATURE` S
NOTE: Issuance of as zoning 9 Permit does not relieve a pplioant's burden t mply with all
g requirements and obtain all required permits from the Board of Hen , Conservation _
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
1 File No.9-1/� Ilj_
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: � r
Address: " r l Telephone: 6
2. Owner of Property, . , " z i—4L
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Address:— Telephone:
3. Status of Applicant: /., Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: �-'�L
Parcel Id: Zoning Map# 0 5 Parcel# 7 � District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Des 'ptio of Proposed Use/Work/Project/Occupation: (Use ditional sheets if necessary): t
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7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO t/ DON'T KNOW YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO L/ DON'T KNOW YES
IF YES,has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued: _
(FORM CONTINUES ON OTHER SIDE)
FILE #
APPLICANT/CONTACT PERSON:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP PARCEL: z2z ZONE
THIS SECTION FOR�OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM M LED OITT
Fee Paid
]Riiilding Permit Filled nut
V y�
if.
Striirtnre
ITIded-
THE LOWING ACTION HAS BEEN TAKEN ON THIS AP ICATIOM
Approved as presentedfbased on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received& Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
lPermi Co a ati C is
J
Signature of Building hispectdK Dlate
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authorltles.
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