25A-138 (3) PERMIT APPLICATION CHECK LIST
PAGE 95A" PACT /39 ZONE �` 1-tut OAe.. . YES NO DATE-
1 . ZONING FORM APPLICATION i
2 PERMIT APPLICATION
3 . DER OCCUPAV STATEMENT 1 L IC , i1 IF, NOT
4 . 3 SETS OF PLANS /PLOT PLAN _ --
5 , NEW CONSTRUCTION
6 CURB CUT
7 , WATER AVAILABIOTY FORMS
8 , REMODELING INTERIOR
9 ADDITION
0 , ACCESSORY STBUCTURE
1 , SIG AWNING
12 , PERMIT FEE CHEC ,/ONLY - MONEY ORDER
13 SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 - CMR 780
5 , FORM A
16 FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS
t
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 `
HOMEOWNER LICENSE EXEMPTION
DATE: (4 (Please Print)
�
JOB LOCATION• J " J_
a 0 (Parcel) ( Subdivision)
HOMEOWNER
Na & Address)
(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 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.
HOMEOWNER SIGNA `
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
t o1 NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
a
Garage
1. Location Lot No.
2. Owners name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. _Expiration Date
4. Addition
5. Alteration Z— '
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. 6DQQ
The undersigned certifies that the above statements are true to the best of his, her
knowledge and 'lief.
Signature of re onsible app,icani
Remarks
1{9,.Ct rti !L
Date Filed 41q� q3 0010iU File No .
ZONING PERMIT APPLICATION (510 , 2)
1 . Name of Applicant:
Address : Telephone
2 . Owner of Property: C4 A, 711�z_ -Ail ov- A. 40 Yr__
Address : rj L4 A XZe- O—T Telephone
3 . Status of Applicant`:: Owner Contract Purchaser
Lessee Other (explain ;_ )
4 . Parcel Identification: Zoning Map Sheet# 51?- Parcel#
Zoning District (s) (include o erla s)
Street Addresses ,
Required
5 . Existing Proposed - by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg . Coverage (Footprint)
Setbacks - front
- side R: L:
- rear
Lot size _
Frontage
Floor Area Ratio
%open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & locatio13)
6 , Narrative Descri Lion of Proposed Work/Project : (Use additional sheets
if necessary) -
L
7 . Attached Plans : Sketch Plan Site Plan
8 . Certification : I hereby certify L-hat the information contained herein
is true and accurate to the best of my knowledge .
Date : Applicants Signatur e
THIS SECTION FOR OFFICIA U ONLY:
/Approved as resented based on information presented
P / I
Denied as presented--Reason :__
Special ' Permit and/or Site Plan Required :
in ng qu ' red: _ Variance Required
gna of Bui 6a e ns ector 3
p ./�
NOTE: Issuanco of a zoning permit does not rellove an applicant's burden to comply with all zoning roquirornonls and obtain all roquirod porrnits
from tho Board of Hoallh, Consorvation Commission, Dopattrnonl of Public Works and other applicablo pormit granting authorillos.
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