35-175 (7) PeRMIT APPLIUATIUN UHkQK LIS'I
J ES NO ATE
k F'
U LICA IF NOT
3 SETS 0 F PLANS ZPLOT PLAN
5 . NEW CONSTEUCTION
6 CURB CUT
7 WATER I I IT 0 S
8 , REMODELING INTERIOR
9 , ADDITIO
10 . ACCESSORY STRUCTURE
11 , SIGN AWNING
F3 79 O%N LICI
12 . PERMIT FEE - CHECK ONLY
13 , SPECIAL PEBMTT REQUI ED W IF APPLICABLE
14 , UNDER SECTION 127 - CMR 780
15 , FORM
16 , FILL
COMMENTS ;
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLI ATION FO PERMIT TO ALTER Repair
11 Garage
Location 'vim e( Lot No.
2. ,Owner's name Address_ ,� �`�Z�`z��� �% ,P 2
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 J_
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
wledge and belief.
4o7 .
q f onsibl 'Signature o res a
8 P PP icant
Remarks —__
+�O�StiAlyplO
° ° .�Aiancllusetia
DEPARTMENT OF BUILDING INSPECTIONS _
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
G> ; (Please Print)
DATE:
JOB LOCATION:
(Map), (Par;c6l (S bdd v' ion
HOMEOWNER:/ � �f
(Nam,E�__& Address
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1 )or two (2) fami 1 ies and to allow such .
homeowner to engage an individual for hire who does not possess at
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 #
a �^
eitYn, rY
r 0016 ,( (.)
Date Filed �" File No.
ZONING PERMIT APPLICATION (510 . 2)
I . Name of Applica
Address : .1' , Telephone:
2 . Owner of Property:
Address : Telephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
`l
4 . Parcel Identification: Zoning Map Sheet# " 4� Parcel//
Zoning District (s) (inc de ter ys)
Street Address
Required
5. Existing Proposed - by Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Covera e tpri t)
Setbacks - front 1518
sidegd 0L:tJ0 R: L: R: 5D to 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)
R
7
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 knowledge .
q �
Date : I Applicant' s Signatur ,'
THIS SECTION FOR OFFICIAL USE ONLY:
y Approved as presented/based on information P resented
Denied as presented--Reason:
S cial' Permit and/or Site Plan Required :
i ng i d: _ Variance Required:_
ignat e o B -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 permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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