35-195 (7) asn-
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PERMIT APPLICATION CHECK LIST
PACE_ PLOT 19�5 ZONE '5'R �.�, YE NO DATE!
1 . i�u,--rte � r_ i � d. v ,Q - , �
ZONING FOR APPLICATION - qD-
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LICA IF NO
3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER VAIL BI IT 0 MS
8 . REMODELING INTERIOR
9 . ADDITION -
10 . ACCESSORY STRUCTURE
11 . SIGN WNING
2 . PERMIT FEE - CHECK ONLY - MONEY OR DE ` -W, 00 l�
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780 —
15 . FORM
16 . FILL
COMMENTS :
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j(L / Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.J ® 7 6( V S Alterations
soNORTHAMPTON, MASS. C va� /5- 19-u- Additions
APPLICATION FOR PERMIT TO ALTER Repair
ii ►�J-_i Garage
1. Location l! -t' PI ii- f� Lot No.
2. Owner's name r Ct V\cA b e t- ie Address PCI
3. Builder's name 5G M.e C- CV2 Address Q ►'ti-f-- 6- 5 ci fo
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration r b 1(it CQ Gi SX 9 54oca5c S k e A 0 olA a /ox o-
6. New Porch
7. Is existing building to be demolished? ��e
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating No i\Pe
11. Distance to lot lines—R. S Icy e reo f-
12. Type of roof
13. Siding house
14. Estimated cost- /d,
The undersigned certifies that the above statements are true to the best of his, her
knowledge ael' f.
C
-�— Signatur of responsible app,icant
Remarks
oar ro
(54th of 'Wart4alliptou 4
�sgBRr�t»8rtte T
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass, 01060
a
HOMEOWNER LICENSE EXEMPTION
/ (Please Print)
DATE: —
JOB LOCATION:
( ap) ( cel) (Subdivision)
HOMEOWNER: +'l rA VI
NeAddress)
Shy- 6 a7's- � yj
(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 Loca Zoning Laws, d State of Massachusetts
General Laws Annotated.
HOMEOWNER SIGNATURE..__.
BUILDING PERMIT #(
; . -•�� 0003 .
Date Filed �(� hs- j F ile No.
ZONING PERMIT APPLICATION (§10.2)
I. Name of Applicant ; ] r \,J i e "ka a
Address : O r ,' c , Telephone: - 9 D
2 . Owner of Property: CA hJ �e r- i'l'l ct t-i 4
Address : / _ Telephone: 7
3 . Status of Applicant: V Owner Contract Purchaser
Lessee Other (explain: )
4 . Farcel Identification: Zoning Map Sheet# S Parcel# i , r
Zoning District(s) (include overlays)
Street Address i i g ,7_ j��� ,T Fli-C P d
Required
5 . Existin Pro ose b Zoning
Use of Structure/Property a+orc� ,� ,e 5 ors e See
(if project is only interior work, skip to #6)
Building height /,
%B1dg. Coverage (Footprint)
Setbacks - front
Al-
- side / L /
- rear
Lot size /p
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 a dittional sheets
if necessary) ® re lace +0 6t.c
o r C,9 e e .
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 knowledg
Date: A)X� ,,, -- App l icant ' s S ignature:
f �?
ZApproved~ `THIS SECTION FOR OFFICIAL USE ONLY:
as presented/based on information p resented OCT 15 :
,
Dqnied as presented
n f D nial :
igna e of Bu ' spector Date
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permit
from the Board of Health, Conservation Commission, Department of Public Works and other applicable pormit granting authorities.
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