36-010 (3) PERMIT APPLICATION CHECK LIST
PAGE PLOT ZONE t YES NO DATE
441 (41l?14
1 ZONING FORM APPLICATION 7
2 PERMIT APPLICATION
3 OWNER OCCUPANT STATEMENT / LIQ J IF NO
4 3 SETS OF PLANS /PLOT PLAN
5 NEW CONSTRUCTION
6 CURB CUT
7 WATER AVAILABILITY FORMS
8 REMODELING INTERIOR --
I
9 ADDITION
10 ACCESSORY STRUCTURE
11 SIGN / AWNING
12 PERMIT FEE - CHECK ONLY - --MONEY ORDER A416
13 SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 UNDER SECTION 127 - CMR 780
15 FORM A
16 FILL �Q
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions Additions
• Repair W 7e,#4 o"e 'O'em Ve
APPLICATION FOR PERMIT TO ALTER
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` Garage
1. Location_,:� EO,,- e--S T tom- /ezu Lot No.
2. Owner's name L?1`e h A 4N j C-'e IV&&h Address 7 Aa/"e.sTa/ten) /D!'
3. Builder's name JOh IU rs �M11.4 0/il, y Address W e S•7T/e/E'1- 119
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
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his.. her
knowledge a4belief.
Signature of responsible app,icantnt
Remarks
7' `
,' "•a Criik Of XJ=t4a11tVfan
• � •B jitasACitaretY,r
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Maas. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: ^
JOB LOCATION: 3sa /0 1-'6 % 67/ezil t�.^
(Map) parcel) (Subdivision)
HOMEOWNER: if fc b �a h d 1014 , Vic ;e It:
�^ _ (Name. & Address) _
r l c 4/PC' S / AP/)
(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
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 Annotate
HOMEOWNER SIGNATURI: (%C/
BUILDING PERMIT #
r
Date Filed File No.
ZONING PERMIT APPLICATION (§10.2)
I. Name of Applicant: C 5 � -e
Address:_,ER &h e j G./,eA� —Telephone:- ,
2 . Owner of Property: .&C h,114 P1
Address: �a/P_e /fin! IDA` Telephone: ,1` 4 3 3
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain_ / )
4 . ParceIdentification: Zoning Map Sheet# 3 Parcel# /0 . ,
Zoning District s) (include ove lay`)
Street Address
Required
5 Existing Proposed by Zonin
Use of Structure/Property
(if project is only interior work, :skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
— side L: 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 Description of Proposed Work/Project: (Use additional sheets
if necessary) d-e_ q e. / C4° T -�gc.�� Do%14Y99e_0, �Sr�`f=r T
2 0
ut �� ,e D cP d
' oG z ' ,V -KN 5 /-e . 11�? �" S/dslve d % CJr
Th? 14 0"S'e w/ // /U 6 O'e (-'-7 4/A/,g 2 ,d 0,'7
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 knowled
Date: _ Applicant's Signature: 63-W,4�
THIS SECTION FOR OFFICIIAL USE ONLY:
ZApproved as presented/based on information presented
Denied as presented--Reason:
Special" Permit and/or Site Plan Required:
LFdi g Req ' d• Variance Required:
4Sn ature it spector at
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply witli all zoning requirements and obtain all required permits
from tho Board of Hoalth,conservation Commission, Department of Public Works and olhor applicable permit Granting authoritios.
iC9'�-
City of Northampton REQUIRED INSPECTIONS
1. Foogs and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
Nom 497 Office of the Building Inspector
Zoning Form No. 002648 Date 6/8/94 Fee $40 Check#p 146
page, 36 parcel 10 ,Zone uRA Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Richard Walsh before Building Inspections
Repair water damage - soffits, plywood in sunroom
has permission to area, overhead door, broken siding, mi Gc. repairs Inspection on Site—Foundations
situated on 52 Forest Glen Drive Inspection of Plumbing—Rough
provided that the person accepting this pen-nit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office,and to the Gas Inspection
provisions of the Statutes and the Ordinances relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOU LACE N PREMISES
Certificate of Occupancy
Buil '
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