25A-157 (7) . PERMIT APPLICATION CHECK LIST
PAGE �� PLOT I'q ZONE YES NO DATE
1 . ZONING FORM APPLICATION j I
2 . PERMIT APPLICATION C-
3 . OWNER OCCUPANT STATEMENT I L C . # IF NOT
4 . 3 SETS OF PLANS ZELOT PLAN
5 . NEW CONSTRUCTION
6 , CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING- INTERIOR ---
9 . ADDITION
10 . ACCESSORY STRUCTURE--- -
11 . SIGN / AWNI
12 , PERMIT FEE- - CHECK ONLY - MONEY ORDER 7/$
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street 4 Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE FXF `T'ION
(Please Print)
DATE: (' CC(
r
JOB LOCATION:
HOMEOWNER- u
(Map) Jparcel) (Subdivision)
(Name & 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 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, 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
i 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 Loca Zoning Laws, and State of Massachusetts
General Laws Annotated. i1
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
y Garage
1. Location ` �� o� Lot No.
2 wner's name ddress -ttti
3. Builder's name 1 �. `��rim Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
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
OEstimated cost:- The undersigned certifies that the above statements are true to the best of his, her
knowledge lief.
S a ure of reiponsible alppicanf
Remarks
ovii'' 002169
Date Filed File No.
ZONING PERMIT APPLICATION (§10 . 2)
I . Name of Applicant: �b � 1st
Address 7 T ephone:
^,
2 . owner of Property: 1 ?
Address : Melephone :
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# �-��� Parcel# ,
Zoning District (s) (include ove ys) (,(
Street Address 'ct .
Required
5. EXistinq Proposed bv Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprin I .
Setbacks - front
- side L: R: L: R:
ar
rea minus
ng)
6;7
F
ation)
n of Proposed Work/Project : (Use additional sheets
Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledg
Date : �4 Applicant Si natur
pp g
THIS SECTION FOR OFFICIAL USE ONLY:
r Approved as resented based on information presented
p /
Denied as presented--Reason:
S ecial' Permit and/or Site Plan Required :
n g Requ ' � Variance Required:
gnatur o Bui ding Ins -tor '�7?-} at
NOTE: Issuance of a zoning oes not,.lieu,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 authorilios.
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