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DEPARTMENT OF BUILDING INSPECTIONS =
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEEMPTION
I ��� (Please Print)
DATE: rT
JOB LOCATION:
(P rce ) // (S division)
HOMEOWNER- �C
( ame Add ess)
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1 )or two (2) fami lies 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, oft 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 persons) 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 SIGNATURE
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
aNORTHAMPTON, MASS. 19 Additions
- APPLICATION FOR PERMIT TO ALTER Repair
/)/)1 Garage
1. Location S� l �) / 0 / Lot No.
2. Owner's nam Address l
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration T f�1 �z° 22 Y r`DDe��
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
Siding house
14. Estimated cost-
The undersigned certifie that the above statements are true to the best of his, her
. ( knowle e and belief.
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ignature of respon ble app icani
Remarks
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00226 _i
Date Filed
File No.
ZONING PERMIT APPLICATION
1 Name of A ican
Address: Telephone:
2 . Owner of Pr rt ^d ,rte
Address: lephone:
3 . Status of Applicant: G/Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# OSA Parcel# ,
Zoning District(s) (include ove lays) &,
Street Address ,
Required
5. Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
tB1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
• Lot size
Frontage
Floor Area Ratio { .
Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume location)
6 . Narrative Descr ' tion,o P °p d Work/Project: (Use ad itional heets
i s arY) / �s D /7/ ^f'i�� ��' i
14 TX6/Z
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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: Applicant s Signature
THIS SECTION FOR OFFICIAL SE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
Special" Pert and/or Site Plan Required:
7n�=gReq,74i� ed• Variance Required: _
gnatur Building Inspec ��` to
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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PERMIT APPLICATION CHECK LIST
PA G E L)-` P- PLOT ZONE a x-7 �
YES NO DA'►'
1 . ZONING FORM APPLICATION
2 . PE MI I -
3 . OWN NOT �-
3 SET S PLAN
NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELING
9 . ADDITION
0 . ACCESSORY
11 , SIGN / AWNING
1-2 . PERMIT FEE - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED--IF APPLICABLE
14 , UNDER SECTION - CMR 780
15 . FORM A
16 . FILL
COMMENTS :