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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. .3 '1 8� Alterations
a XNORTHAMPTON, MASS. QA!S4 19 4ezAAd ditions
APPLICATIO FOR PERMIT TO ALTER Repair
Garage
1. Location—?// �QQ 6 /Ezo L-e_ � ✓ Lot No. /3�
2. Owner's name,,,3 %�'a P �/, (� �..5 Address'4�/T//,���
3. Builder's name �l� Address
Mass.Construction Supervisor's License No. 4A Expiration Date
4. Addition
5. Alteration I f3,p L 6–a O U 4:p
6. New Porch A N
7. Is existing building to be demolished? A/b
8. Repair after the fire 4/Q
9. Garage AIA No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cosL- Cp ^*d
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app scant
Remarks (ACClelkva/ [12DR-/C -1� A6 r>/ 6W 19'P h4 cZ le&
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DEPARTMENT OP BUILDING INSPECTIONS
INSPECTOR 212 Main Strcct ' Municipal Building
Northampton, Macs. 01060
HOMEOWNER LICENSE EXEMPTION
-� r _ ( Please Print)
DATE k� ? L� )
C
JOB LOCATION:�1l /� /�
(Map) l( (Parcel ) ( Subdivision )
HOMEOWNER: `)�A !i,
(Name & Address )
( Ho ni,e ?hone ) (Work. Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one ( 1 )or two (2) Tami 1 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 . '1MR780 Section 109. 1 . 1
DEFINITION OF HOKEOwNBR: Person ( s) who own a parcel of land on
which he/she resides or intends to reside , on wh?cn 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 . person who
constructs more than one home in a two-year period shall not be
considered a homeowner . Such "homeowner" shall submit to ` the 'Buildi no
Official , on a form acceptable to the Building 0=fcial , 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" certifii-s 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 AND SHALL BE ON THE JOBA�S SUPERVISOR.
HOMEOWNER SIGNATUFZE
j' BUILDING PERMIT );
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10. Do any signs exist on the property? YES NO � J
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:
1.1. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUB TO
LACK OF INFORMATION.
This c01=n to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks r7
- side L: R: L:/_R:_ C
- rear
Building height
Bldg Square footage ��-
I`�
%open Space:
'(Lot area minus bldg ()
&paved parking)
_9f -Parking Spaces,
of Loading Docks A
Fill: /V
'4vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DA'L'E: Pj APPLICANT's SIGNATURE '
NOTE: "Ua)noe`of A zoning permit does not relieve an applioant's burden to oompty with all
zoning uirements and obtain till required permits from the Board of Health, conservation
Commission, Department of Publlo Works and other mpplioabla permit granting authorities.
',`„ FILE f
File No.Wf
.ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TY'P;E OR PRINT ALL INFORMATION
1. Name of Applicant:
Address �
2. Owner of Property �4 1 I� t l � /_,, CJ
Addres�.-J,/ �::. �T_> �, .��} I '1\ Telephone: '�// 3
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# -� Parcel# District(s): 'r --
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
SAC U'c'J y �''L' L�' /� fl c2c l ✓ e �//
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7. Attached Plans: Sketch Plan 1 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 PermitA/ariance/Finding ever been issued for/on the site?
NO :�L — 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--�,_ 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 # 4 p � tF
APPLIfCANT/CON; ACT PERSON: C� ' �C Zit —0117
ADDRESS/PHONE:
fl
PROPERTY LOCATION: '� -
MAP 3 ( PARCEL: ° ZONE�l �
THIS SECTION FOR-OFFICIAL USE ONLY:
PERNUT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.0NING FORM M.TFI) ()ITT
Fee PAid
Byyilding Permit Filled nig ,
0
Building Plan-,Trichided-
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: '
Approved as presented/based 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
Permit from Conservation Co mission
Signature of Buil g t '/Date(`
NOTE:Issuano•a of a zoning permit does not relieve an applloant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commlealon■ Department of Pubiio Works and other applloable permit granting authorities.
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