36-158 (2) '�O�'StinMP�o'L
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 "
HOMEOWNER LICENSE EXEMPTION
DATE; (Please Print)
JOB LOCATION: S("" — /,5- n�
(Map) (Parcel) (Subdivision)
HOMEOWNER:
(Name & Address)
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1 )or two (2) fami I 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. 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 Annot ed AND ALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
BUILDING PERMIT # "
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location '1440 4),e S' Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch a.P
7. Is existing building to be demolished?
8. Repair after the fire
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
`,, Q;� knowledge d belief. _
" i' Signature of responsible app ican7
Remarks
• ISM
Date Filed File No.
ZONIN PERMIT APPLICATION
Name of Applicant:
Address: Telephone: G"
2 . Owner of Property:
Address : , Telephone:
3 . Status of Applicant: lj'owner Contract Purchaser
Lessee Other (explain )
4 . Parcel. Identification: Zoning Map Sheetlf 3(0 Parceli
Zoning District(s) (include veil )
Street Address c `~
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
oBldg. Coverage (Footprint)
Setbacks - front
- side L: R: L:
- rear
Lot size
Frontacg3e.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
Narrative Descr'ption of Proposed Work/Project: (Use additional sheets
if necessary)
1 �
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 knowled
Date: ApplicantIsSignature: �"—
/ ^THIS SECTION FOR OFFICIA L iY ONLY:
G' r
Approved as presented/based on information presented
_D.enied as presented--Reason:
S , cial' Perm't and/or Site Plan Required:
in g R 'red: variance Required:
gnatuke� of Buildznc , rispector �` at
IOTE: issuance of a zoning ponnit does not refiove an applicant's burden to comply with all zoning roquiroments and obtain all requirod pormits
om tho Board of Hoalth,consarvation Commission, Dapaitmont of Public Works and other applicablo pormh vranting authorities.
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