17C-055 (4) PERMIT APPLICATION CHECK LIST
PAGE P NO DATE
1 . ZONI FO �APPLICATION
2 , jr
-7-
3 , LICJI IF NOT
3 SET OF -PLANS PLAN
5 . NEW S 0
6 CURB CUT
7 WATER
8 . REMODELING- INTERIOR
9 , ADDITION
0 , ACCESSORY UC
11 . SIGN / AWNING
2 , PERMIT FEE --MONEY ORDE
13 . SPECIAL PERMIT REQ I RED WITH DEED IF APPLICABL
4 . UNDER SECTION 127 - CMR 780
15 , FORM A
16 . FILL
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DEPARTMENT OF 13UILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: Ld 6
JOB LOCATION:
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HOMEOWNER: Map) (Pac-el) (Subdivision)
�U ��' r„i �o�
(Name- & Address)
(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 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 off icial, 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 m- ay 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 SIGNA
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. - Alterations
NORTHAMPTON, MASS. 0/44, !!4 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
1 Location /��jZ ,& f-77 -euc� Lot No.
Owner's name Juh Gam-d hZ A-6a---7e' L: A�,4,rJ Address , L PC
3. Builder's name _ Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? f�D
8. Repair after the fire LAI
9. Garage JO No.of cars Size
10. Method of heating o►J�
11. Distance to lot lines
12. Type of roof /k do qa/,b(
Siding house
14. Estimated cost:- 254
The undersigned certifies that the above statements are we to the best of his, her
^� knowledge and lie .
K �7. �2
Signature responsible appxant
Remarks
c�
0034. 50
Date Filed D��l� �� 19p ` File No.
ZONIN PERMIT APPLICATION (510.2)
l. Name of Applicant:
Address: Telephone:
2 . Owner of Property: iry�_
Address: Telephone:
3 . Status of Applicant: V Owner Contract Purchaser
Lessee Other (explain: )
4. Parcel Identification: Zoning Map Sheet# Parcel# ,
Zoning District(s) (include erlays)
Street Address /& �-�t.Q'
Required
5. Existina Proposed by Zoning
Use of Structure/Property od l s e�.(
(if project is only interior work, skip to #6)
Building height
%B1dg.Coverage (Footprint)
Setbacks - front
- side 2-v 201 0 '
- rear o `
Lot size 201 ,c 1
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)
IX
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 knowledge.
Date
� �?' Applicant's Signature Vi- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL US :
Approved as presented/based on information presented
Dqkpied as presented
aso or Den' lc
ignatu f Building Ins r ate
NOTE: Issuance of a zoning 'd does not relieve 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 autliorities.
City of Northampton REQUIRED INSPECTIONS
• 1. Footings and Walls
e BUILDING DEPARTMENT 2. Structural Components in Place*
0
3. Complete Building*
No. 1050 Office of the Building Inspector
Zoning Form No. 003450 Date 10/18/94 Fee $20 Check# 1170
Page, 17C parcel 55 ,Zone URA Section 127 ❑ Yes No
BUI]LDINGPERMI r-I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John Reagan before Building Inspections
has permission to Construct a 81x8' utility shed Inspection on Site—Foundations
situated on 168 Chestnut street 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 immaate 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 LA O ,T] ' PREMISES
Certificate of Occupancy
Buildin for ?.T�J mw