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' 'DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Strcct ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMP`T'ION
DATE:
4/4/96 ( Please Print)
JOB LOCATION: 12C - 61 - URA/WSP
(Map) (parcel ) ( Subdivision)
HOMEOWNER: Helen Martin 12 Cloverdale St. Florence 584-1519
(Name & Address )
( Horne 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 a `
license , provided that the owner acts as supervisor . CKR780 Section 109 . ! . 1
DEFINITION OF HOMEO', NzER: Person( s ) who own a parcel of land on
which he/she resided or intends to reside , on wh '. ch there ls , or is
intended to be , a one or two family dwelling, attached or detached
structures accessory to such use and/or farm stri_:ctures . is person who
constructs I more than one home in a two-year period shall not be
considered a homeowner . Such "homeowner" shall su'-mit to the Buildinc
Official , on a form acceptable to the Building 0ficial , that he/she
shall be responsible for all such work performed under the buildirs
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 SIGNATUT2B
BUILDING PERMIT ##
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 584-1519 Alterations
a NORTHAMPTON, MASS. 4/4/96 I g Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 12 Cloverdale St. Florence Lot No.
2. Owner's name Helen Martin Address 12 Cloverdale St. Florence
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration Install Raynor garage doors
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
s� p-
14. Estimated cost:- J�4 g;
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. !
/lCs!Yp ��CLGGsc.�
signature of responsible app!cant
Remarks
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 DUB' TO
LACK OF INFORMATION.
This colsmm to be Pilled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontqbe
l
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lotarea minus bldg
' &paved parking}
#, ?f -Parking spaces
rof Loading Docks
Fill:
4vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
DA'Z'E: � ��/rG APPLICANT's SIGNATURE C �
NOTE: Issunnoe of a zoning permit does not relieve nn applioanta burden to oomply with alt
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Worsts and other npplioable permit granting authorities.
=?!.„ FILE ,i
i
P
File No.
ZONING PERMIT APPLI CATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Helen Martin
Address: 12 cloverdale St. Florence Telephone: 584-1519
2. Owner of Property: SAME
Address: Telephone: _
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explac,):
4. Job Location: 12 Cloverdale St.
Parcel Id: Zoning Map# 12C Parcel# 61 District(s): URA/WSP _
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property _ Single Family Residence
6 Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Install Raynor garage doors
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 PermitNahance/Finding ever been issued for/on the site?
NO X 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 X 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 if
PLICANT/CONTACT PERSON: eLEZ � � cLi✓C..
ryr
HONE:
PROPERTY LOCATION:
MAP 2UC PARCEL: f / ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM MIXI) QJIT
Fee PAid
Additinn to Existing
7�
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THE LOWING 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 Commis
y
Signature of Building Inspector Date
NOTE:issuance of a zoning permit does not relieve an applicant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health. Conservation
ComrnLsslon, Department of Public Works and other applioable permit granting authorities. —
g�o� o'g City of Northampton' REQUIRED INSPECTIONS
e T 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 232 Office of the Building Inspector
Zoning Form No. 960827 Date 4/10/96 Fe&20.00 Check# 1975
Page, 12C Parcel 61 , Zone URA/WSP Section 127 ❑ Yes ® No
BUH-JDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Helen Martin before Building Inspections
has permission to install Raynor garage doors. Inspection on Site—Foundations
situated on 12 Cloverdale St. 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 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
** Install per Manufacturer's information: windows, vinyl siding,roofs Smoke Detectors (Fire Department)
and woodstoves
Other
THIS CARD MUST BE DISPLAYED IN A CON$PJCIJOUS PLACE ON THUREMISES
Certificate of Occupancy ,
Building Inspector
IAAY `WP'y' iI �'
tV►M
City of Northam p ton REQUIRED INSPECTIONS
• 1. Footings and Walls
BUDLN
ILG DEPARTMENT 2. SII-UClUra1 holllponCllts ltl P1aCC*
3. Complete Building*
No. 232 01ffice of the Building Inspector
Zoning Form No. 960827 Date_4/10/96 Fe&20.00 Check#1975
Page, 12C Parcel 61 , Zone URA/WSP Section 127 ❑ Yes El No
BUILDING .
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Helen martin before Building Inspections
has permission to install Raynor garage doors. Inspection on Site—Foundations
situated on 12 Cloverdale St. Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinanc°s relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildings in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish
** Install per Manufacturer's information: windows, vinyl siding,roofs Smoke Detectors (Fire Department)
and woodstoves
Other
THIS CARD MUST BE DIS Y A N$P CIJOUS PLACE ON TH REM ES
Certificate of Occupancy _
Building Inspector