35-203 (7) B �4lago ad)11setts
' DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass, 01060
a
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: l
JOB LOCATION•
(Map)a ,(Parcel) (S divis ' )
HOMEOWNER:
�
(Name & Address
(Home Phone) (Work Pho e)
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 ing Laws, nd State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE
BUILDING PERMIT #
t;ac�c,tirirl�nra!t� ,;
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Qi'ifjl 14
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ltlurur;lpal IiuiidinE;
INSPECTOR I\�ortitairrpto�t, :1'[rGSS. 01060
1301.1f) FUEL BURNING APPLIANC : F< <CHIMNrYhPPHCATION PERMIT NUMBER
Owner or Lesser/ �-�✓_ _ �i�l�___ ___ __ _ � U�'7�
(Name) (M ,I) .i ng Addi-ess) (Ti Le. No. )
Con t rac.toe'
(Na (A(Idr s:;) (Tale, No, }
RESIDENTIAI, NON-RESIDENTIAL.
- X One rnrni.ly Hoal(e - Business
Two or More Other
r Nrnnber of Units Spari.fy
Stories i11 Buildlnl;
Type of Applianr.e
New ,�� Wood buy:ning
Used Coal.
LabeLiA _ Combination
Date of Purchase Other
Specify
i°Iode+l or Type �r
M:hnufactorer
Purchased From �'�'t' % rt'•
(Narne of Fl rm) f� Cr; ff, / ^�+
(Address)
Cost - Co-nstructi.on & Appliance
Chimney New .._. Metal Best:os
Existing _W Tnterior chimney
Separate Flue _ Exterior chimney
Other Appliance att.achr:(l to fine
Masonary Lined
Unlined
Notes & Da t.m;
IF
Signature of App ant:
(Address)
Approved By
Title: Da to: 1,4 �y
u
psn�+rr
• BVLY Y),M
000360
Date Filed File No./� '
ZONING PERMIT APPLICATION (§10 .2)
1 . Name of Applicant ; rf!�
Address : i / t Telephone:
2 . Owner of Propert ' ' nl
Address : elep one:
3 . Status of Applicant:_owner Contract Purchaser
Lessee Other (explain: )
4 . • Parcel Identification: Zoning Map Sheet#-� Parcel#1_D3r
Zoning District(s) (include over ys)
Street Address_ /XA
Required
5 • Existinq Pro Dosed by Zoning
Use of Structure/Property
(if project is only interio - work, skip t o 6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side 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)
JL4 01
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information c ntained herein
is true and accurate to the best of my knowledge.
Date: { 14&2— Applicant ' s Signature:
, � ^THIS SECTION FOR OFFICIAL USE ONLY: T ^
Approved as presented/based on information presented
4ignaas pre ented
or D ial
of Build.i for Date
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required pormhs
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit grunting authorities.
7/92 FXAS
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