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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 ,
HOMEOWNER LICENSE MCEMPTION
(Please Print)
DATE:
JOB LOCATION:
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Pap) (parcel) r (Subdivision)
xoMEOwNER: t �� i f �
(Name & A ddress) 3a- a 9 G c;
L)U-41 j'r! l - 4 -�Y4 Cv tilt, - 1Y G
(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 at
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 Annotated.
HOMEOWNER SIGNA
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
k Garage
/ l f Location I I 0 1 M t. ° R E%)CC= Lot No.
COwner's name b - C' Address , L ✓y,af
3. Builder's name — ddress___c � ��i �/ . g6O 6✓a �7
Mass.Construction Supervisor's License No. Q Expiration Date
1
Addition (f--o e _r�Q,1V rauAlf) �`? 1 #�e7Gt N 0 P061
5. Alteration
6. New Porch
7. Is existing building to be demolished?
S. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
1 } Siding house
14. Estimated cost-
/ The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
S1g lure of esponsible -pp"'..,
Remarks
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Date Filed File No.
ZONING PERMIT APPLICATION (§i6. 2)
Name of Applicant: Ve-
V Address : Telephone:
Owner of
Address : Telephone:
3 . Status of Applicant: . Owner contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcelf-2--3p
Zoning District(s) (include overlays) ?�
Street Address t l
Required
5• Existin Pro osed by Zo in
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg, Covera Footprint)
Setbacks - front 15
Lrear de L: R: , — 01
.-r 0,
Lot size
Frontage
Floor Area Ratio
Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
(6) Narrative Descriptio of Proposed Work/Project: (Use, additional sheets
if necessary)„ I0000 a1 ' 'oo c+ o ti a '1lPr2fQ
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 knowledge.
Date: Cz �� �R Applicant's Signatur
ZApproved TH23 SECTION FOR OFFICIAL USE ONLY as ese pr nted/based on information presented
Denied as presented--Reason.,
Special" Permit and/or Site Plan Required:
igLind ' g Re a Varianceequired:
natu f Buy ld --- ate
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, Departmont of Public Works and other applicable permit granting authorities.
PERMIT APPLICATION CHE K LIS
P4GE �
S NO DATE
2
3 . OWNER OCCUPANT O
4 . 3 SET S PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER
8 . REMODELING
9 . ADDITION
0 . ACCESSORY
11 . SIGN / AWNING
2 ER -
MONEY ORD&I-
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - C R 780
15 . FORM A
6 , FILL
COMMENTS :
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