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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No 5 Alterations
ti NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMI TO ALTER Repair
Garage
1. Location t Lot No.
2. Owner's name Address)
3. Builder's name 4,<J7;1(-&1 Address * �.
Mass.Construction Supervisor's License N . Expiration Date IF
4. Addition -4'z
5. Alteration /wC
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 cosL-
The undersigned certifies that the above statements are true to the best of his. her
knowledge and belief. /
Signature of resp nsible appicanl
Remarks
0
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 "
HOMEOWNER LICENSE EY 14PTlON
(Please Print)
DATE: c� 9 :1—
JOB LOCAT N:
(Map) parcel) (Subdivision)
HOMEOWNER- , 11'
(Name- & A dr s) 1
(H 6r66 Ph ne) / (Work Phone)
The current exemption for "homeowners" was extended to include
owner-occupied Dwellings 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 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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATUIE
BUILDING PERMIT "
10. Do any signs exist on the property? YES NO
IF YES, describe size,type and location:
r the o t/
Are there any proposed changes to or additions of signs intended fo pr 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 cols to be f177 in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks front
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of Parking spaces
# of Loading Docks
Fill:
(volume & location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: c/3 APPLICANT'S SIGNATURE i �r
NOTE: u e of a zoning permit does not relieve an applioant's burden to oo ply with all
zoning i ements and obtain all required permits from the Board of Health, Conservation
Commission. Department of Publio Works and other applioable permit granting authorities.
FILE #
n
� a
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address ( Telephone: &I
2. Owner of Prope '
Address:3 G elephone�{/�)
3. Status of Applicant: r Owner 4--' Contr Purchaser Lessee
Other(explain):
4. Street Address:
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property .F '
6. Description of roposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 Permit/Variance/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)
FILE #
APPLICANT/CONTACT PERSON: `/ -�'C G` � tC :� '
ADDRESS/PHONE:
PROPERTY LOCA ON: �- �' e-l-
MAP , PARCEL: G ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7,nM[NC.FORM ITTILT-ED 0111
We , n „ -
r2 G�� r Z
if
T OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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 fro onservation Commission
ignature o uilding In
NOTE:Issuance of a zoning permit does not relieve an pii nt's burden to comply with all
zoning requirements and obtain all required permits rom the Board of Health, Conservation
Commission, Department of Public Works and other applicable permit granting authorities.
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