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DEPARTMENT OF BUILDING INSPECTIONS =
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 y
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: �► I l l g
JOB LOCATION: 2 S L 2-49% V AA. 41
(Map) (parcel) (Subdivision)
HOMEOWNER: v K'r A ns L A 14-4
(Name & Address)
S I tyt m S i ey94.'7i�PrAr! 60
(Home Phone ) (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 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 , 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 SIGNATURE _\I� O � �
BUILDING PERMIT #
10. Do any signs exist on the property? YES NO ✓
IF YES, describe size,type and location:
Are there any proposed changes to or additions of signs intended for the 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 filled i.n
by the Building Department
Required
Existing Proposed By Zoning
Lot size S £� g S ?o
Frontage S 7 5__
Setbacks - front �► 1
- side L: z S R: I& L:_2_ R: t8 �z
- rear
�o tau
Building height Zu 2_0
Bldg Square footage I G / 04-7
%Open Space:
(Lot area minus bldg o
&paved parking) 3 �o cj L S /iv
# of Parking Spaces Z Z
# 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: g l k \q s APPLICANT's SIGNATURE
NOTE: lunuanoe of a zoning permit does not relieve an applioant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applionble permit granting authorities.
FILE #
File No
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: QT Tt L A HA-
Address:- S—I i. tF j S; uo Rr,-A, 1PTrr-' M Telephone: S &4 - I') L o
2. Owner of Property:_ Kv2, t t42oL &c4W4
Address:_ S '16 61P^ Sr Telephone: 584-o" 60
3. Status of Applicant: f Owner Contract Purchaser Lessee
Other(explain):
4. Street Address:_ y t n LI), p424/L-.� fZ0 r}p
Parcel Id: Zoning Map# 2 S c. Parcel# 2Y 11 District(s): U 2q LWP
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 2" t D r'71 bi -
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
�t�cRcE �Qt)Nif" t S ►4 1>0 0o QopcACE CtZ.t-014 3✓LAC"_V4A OdO+L
aCeL4-ti L►ni1r6 l`RONVj -r S 10t auC�.trl cc.,j-e,s04M4 0-10091P.
e-x t S n N Poo N
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 ✓ DONT 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:
ADDRESS/PHONE:
PROPERTY LOCATION:
MAPC' PARCEL: ONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Pnid
Hui ding Permit F*Ilpd ntit
TV
New Cnngtruction
"e
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
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 from Conservation m' si d
S"-
Signature of Building Inspector Date
NOTE:Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
• 1. Footin s and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 750 Office of the Building Inspector
Zoning Form No. 960189 Date 9/5/95 Fee$ _Check# 2908
Page, 25C Parcel 249 ,Zone URA/WP Section 127 ❑ Yes ® No
BUI]LDING PERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Kurt Blaha before Building Inspections
has permission to replace front & side doors,cellary bulkhead,siding & Inspection on Site�—Foundations
situated on 41 Old Ferry Road foundation repair Inspection of Plumbing—Rough
provided that the person accepting this permit 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 pert.Expires six months from date of issuance,if not started. Budding 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 CONSPICUOUS.P ACE N THE MISES
Certificate of Occupancy
Building Inspector �,-
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