36-132 (5) PERMIT APPLICATION CHECK LIST
PAGE PLOT 1 ZONE LZ YES NO AD TE
1 . ZONING FORM APPLICATION
2 , PERMIT APPLICATION r/
3 , OWNER OCCUPANT STATEMENT LIC A IF NOT
4 . 3 SETS OF ELANS LOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
12 PERMIT FEE - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. O` Alterations
a NORTHAMPTON, MASS. �TJ f' 19� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location kQL)K5iJ e .,Ct L - e X cle_ � ii-_ n l(*d Lot No.
i'
2. Owner's name � Address --q//--u
3. Builder's name Address S
Mass.Construction Supervisor's Li nse 1,36 a;_70 f Expiration Date
4. Addition J
5. Alteration
6. New Porch
7. Is existing building to be demolished? :Z2�
8. Repair after the fire �?9�
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
j ed - and belief.
g
Signature of sponsible applicant
Remarks
PHINTySHSOP
•Y7- ,
�. ae JM assad?list If0
d DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 '
HOMEOWNER LICENSE EXEMPTION
_ (Please Print)
DATE: �l r 22
JOB LOCATION:
(Map) _(Parcel) ( Subdivision)
HOMEOWNER / o C
( ame & Address )
e-qGCAG
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of six ( 6 ) units or less and to allow such
homeowner to engage an individual for hire who does not possess a
license, Provided that the owner acts as supervisor.
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 to six 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 Annot e .
HOMEOWNER SIGNA �
BUILDING PERMIT #
o-t rr
d'C2� y
Date Filed ` v.. �' t O 0 O ��� ,i
File No. -�36
ZO ING PERMIT APPLICAT N (§10 . 2) U R P1
1 . Name of Applican
Address : Telephone: ,
2 . Owner of Prope ty. �X-4 4't Z
Address :, - Telephone: d
3 . Status of Applican t: Owner Contract Purchaser
Lessee Ot7ier (explain: )
4 . Parcel Identification: Zoning Map Sheet# 06 Parcel# 13.-.,
Zoning District (s) (include overlays) R A
Street Address
Required
5 . Existing Pro nosed zonincr
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side L R
- rear
Lot size
Frontage
Floor Area Ratio
oopen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume 4 location)
6 . Narrative Description of reposed Work/ o ' t: (U Use additional she s
if ne ssary) v i
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is tr e and accurate to the best of my kno e.
2
Date: Applicant ' s Signature.
THIS SECTION FOR OFFICIAL USE ONLY:
4 SE 2
Approved as presented/based on information presented 1
DAnied as presented
eason f Depial:
ignatit~re of Buildin 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 permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.
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