36-261 (8) MAY 1 6 1 0'
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DEPARTMENT OF BUILDING INSPECTIONS
212 Moin Street ' Municipal Building '
INSPECTOR
Northampton, Mass, 01060
HOMEOWNER LICENSE RXF16P`TION
� (Please Print)
DATE: c
JOB LOCATION: �a-��Z -3 ( > R,
Map (Parcel) ( Subdivision )
HOMEOWNER:- C
(Name & Address )
y( �-- SS , .7�
( Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwelli nGs of one ( 1 )or two (2) fami 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 . CMR780 Section 109 . 1 . 1
DEFINITION OF HOM?OWN-3R= Person( s ) who own a parcel of land on
which he/she resides 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 Buildino
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 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 AND SHAL BE ON THE JOB AS SUPERV OR.
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HOMEOWNER SIGNATURE
BUILDING PERMIT �
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.!5� -75`7 5 Alterations
NORTHAMPTON, MASS.
'tf�7 19 cl Additions
APPLICATION FOR PERMIT TO ALTER Repair
�, rt Garage
1. Location �'C�`� �� Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. �r Expiration Date
4. Addition -e� lD-o-� ►x r
5. Alteration
6. New Porch
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 st of his, her
knowledge d lief.
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Signature of responsible appicanl
Remarks
NNNOW
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10. Do any signs exist on the property? YES NO
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:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This —7— to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - '"'-
a
- side L: R: L: `�g` R: - v
- rear ry .,�.
Building heightS�
Bldg Square footage
3d 6
%Open Space:
(Lot area minus bldg _
&paved parking) ) Q %
# .of Parking Spaces I
# rof Loading Docks
Fill:
(volume--& location)
13 . Certification: I hereby certify that the information contained herein
- re is true and accurate to the best of my knowledgel, r'
ri DATE: �1 APPLICANT's SIGNATURE
NOTE: Issunnoe of a zoning permit does not relieve an npplioants burden to oo iy with ail
zoning requirements and obtain all required permits from the Board of Health, Vonservation
Commission. Department of Publio Works and other npplionble permit granting authorities.
:`. FILE
MAY 6W File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: A(� 3 Mr:A e_-_44"e' Q Telephone: 546 - 7117S
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: 3
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Parcel Id: Zoning Map# � Parcel# � District(s): j /(
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property —
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): /
49 x
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UV 1
7. Attached Plans: Sketch Plan _�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 Peermit/Vadance/Finding ever been issued for/on the site?
NO 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)
a FILE
i-„96
APPLICANT/CONTNCT PERSON:
, S/PHONE:
ADORES
PROPERTY LOCATION:
MAP CG PARCEL• ZONE�.:i 1le
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7QNTNG Fngm FITTED OUT
Fee Pnid
IRvii1ding Permit MUM nvit
Fee Pairl C
Tvne of C'nnctrnrtinn- ,
RPrnnd lino TntPrinr
Additipn to Existing 11-&
Arreccnry S rnrtnre
$nilding Plane Tnrhidt-d-
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�Q�” rcll�gntt—,—tntPment nr T.ireme #
3 .Sete of Plans P�[ int flan
THE OLLOWING 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 ssion
Signature of Building Insp r Date ".
NOTE:lssuanoe of a zoning permit does not relieve an appiioants burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioable permit granting authorities.
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