04-006 (5) PERMIT APPLICATION CHECK LIST
PAGE PLOT CO C ZONE y. i' � � X cf �� Fed. Y S NO DATE
1 . ZONING 0 AP LIC ION
2 . PERMIT P LIC TIO Gam'
3 . OWNER OCCUPANT E E L C # IF NO
4 . 3 SETS OF S PLAN
NEW CONSTRUCTION
6 CURB CUT
7 . WATER L I I FORMS
8 . REMODELING INTERIOR-
9 . AD I IO
0 , ACCESSORY STRUCTURE
11 SIGN I G
2 . PERMIT- FEE - CHECK ONLY - MONEY 09D CZ K-)
13 . SPECIAL PERMIT REQUIRED WITH DEED -IF APPLICABLE
4 . UNDER SECTION 127 - C R 780
15 , FORM A
16 . FILL
COMMENTS :
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE-C�
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JOB LOCATION: s ���+�L-7) a D G/"6
(Map) .(Parcel) '(Subdivision)
(Subdivision)
HOMEOWNER:
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(Name & Addre s) -7�l
(Home Pho e) (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 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 C/, J
BUILDING PERMIT #
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? Zoning
Miscellaneous Additions,Repairs,Alterations,etc. / Tel.No. ✓ Alterations
NORTHAMPTON, MASS. �'n LJ
� I 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location �— Lot No.
2. Ownees name d � � Address
3. Builder's name S rh10 Address Z5-
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? ��Wj 41vv�.
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines c3
12. Type of roof ef `'
13. Siding house CC 5/ 27"27"
14. Estimated cost-
The undersigned certifies that the above statements are true to the best of his,
knowledge and belief.
Signature ojr ponsible appsiean
Remarks
o..rar4r�y
000946
Date Filed File No. 04 - c5cr G
ZONIM PERMIT APPLICATION (§10 . 2) �a
1 . Name of Applicant:
Address : -Telephone: �` f
2 . Owner of Property: ,`y. ?2Y
Address: i/ Telephone: ,
3 . • Status of Applicant: A owner Contract Purchaser
Lessee Other (explain: )
4 . ' Parcel Identification: Zoning Map Sheet# Q'- Parcel#o<-) (,
Zoning District (s) (include overlays)
Street Address
Required
5. Existing 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: 7 R: L: R:
- rear
Lot size 9DD
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/P oject: (Use a dition 1 sheets
I necessary) TL) -7y1 ►5 (��C D
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: 4 9 _ Applicant' s Signature 1�-
ZApproved THIS SECTION FOR OFFICIAL USE ONLY:as presented/based on information presented
Denied as presented--Reason:
pecial Permit and/or Site Plan Required:
F ' ing R ui d: Variance Required:
ignat r fl Buildi Spector DtLte
NOTE: Issuance of ping 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, Department of Public Works and other applicable permit granting authorities.
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C Northampton REQUMED INSPECTIONS
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BUILDING DEPARTMENT 1. Footings and Walls
� 2. Structural Components in Place*
3. Complete Building*
No. 230 Office of the Building Inspector
Zoning Form No. 00 0 9 46 Date 4/2 3/9 3 Fee —$40. Check# 2836
Page, 04 Parcel 006 ,Zone RR/W S P Section 127 ❑ Yes ® No
BUI]LDINGPERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT David Robinson before Building Inspections
has permission to Demolish & Replace old Porch Inspection on Site--Foundations
situated on 588 Kennedy Rd. , Leeds 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
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICU U PL ON TIE PREMISES
Certificate of Occupancy ~
g Inspector
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