17C-105 (2) PAGE 1110, PLOT 16'-I�—ZONE
PERMIT APPLICATION CHECK LIST
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1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION
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3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT
4 . 3 SETS OF PLANS PLOT PLAN
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5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIG N / AWNI
12 . PERMIT FEE - C �Q ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �� c-C� ,, � /1�z =�'� '�a Lot No.
2. Owner's name Address Scr'fi+uz
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?
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 cos .
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
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Signature of respo Bible appicani
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DEPARTMENT OF BUILDITNG INSPECTIONS -
INSPECTOR 212 Main Street • Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE:
JOB LOCATION:!/ � �, L-�0 ?„r�P/_� �a-C�4��
(41 p) (parcel) (Subdivision)
HOMEOWNER: 2 rx� a4_010
7 °(Name & Addresd)
(Home Phone) (V6rk 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 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 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.
HOMEOWNER SIGNATURE *f l , . �Lcc�
BUILDING PERMIT #
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Date Filed "��" I3 � File No.
ZONING PERMIT APPLICATION (§10 . 2)
I . Name of Applicant ;
Address : � ,x-fL� ,, QV '�� Zcr�� , e1ephone; %i Iff
2 . owner of Property:
Address Telephone ;
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain; Cc�`,2�:-�z �, )
4 . Parcel Identification: Zoning Map Sheet# f76 Parcel# /v`- ,
Zoning District (s) (includ r ove ays) C��j
Street Address ?( f,' .
Required
5 . Ex ' sting Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side 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)
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 : '/cr7
THIS SECTION FOR OFFICIAL USE ONLY: r
Approved as presented/based on information presented
Denied as`presented--Reason :
S ecial' Permit and/or Site Plan Required :
d ' Re re _ Variance Required :
g atu uildin g ctor 141 D to
NOTE: Issuance of ng permit 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, Dopnrlrnonl of Public Works and other npplicnblo pormil granting authorities,
City of Northampton REQUIRED INSPECU011
BUILDING DEPARTMENT 2. Snuccttugral Walls Components in Place*
I Complete Building*
No.
470 Office of the Building Inspector
Zoning Form No. 001246 Date 6/17/93 Fee $20 Check# 209
Page, 17C Parcel 105,Zone uRS Section 127 ❑ Yes ❑ No
BUJILDINGPERAM
THIS CERTIFIES THAT g / * Plumbing and Electrical Inspections require
Norman Gou eon Doris Lococo before Building Inspections
has permission to Enclose existing porch Inspection on Site—Foundations
situated on 71 High 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 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—Finish0
Smoke Detectors(Fire Department)
Other
THIS CARD B S LAVED IN A CONSPI"U P LAC ON THE PREMISES
Certificate of Occup ---
Building Inspector
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