17A-212 (4) PERMIT APPLICATION CHECX LIST
PAGE /rI PLOT 'A/-� ZONE YES NO DATE
ZONINQ FOEM APPLICATION Ll G
2 . PERMIT P _I£ I ``-
3 . % OW NOT
SET S /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 WATER
8 . REMODELING
9 . ADDITION
0 , ACCESSORY
11 , SIGN
2 , PERMIT FEE — C — MONEY ORDER
'
13 . SPEC ERMIJ REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 7 — C R 780
b . FORM A
16 . FILL
COMMENTS : r
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DEPARTMENT OF BUILDING INSPECTIONS =
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMP`.rION
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(Please Print)
DATE,
JOB LOCATION: ` . �y� ✓ L 1-
(Map) (parcel) (Subdivision)
HOMEOWNER:- / a (� `-711 __" d:' 4 �=
"(11ame & Address)
(Home Phone) (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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE
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BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
a rNORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. Location I = Lot No.
2. Owner's name Address
3. Builder's name ` Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration 1
6. New Porch 'e--
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 cost.-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. ,
61,99 nature ojresponstble app,icane
Remarks
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Date Filed L l File No.
ZONING PPR.MIT APPLICATION
1.' Name of Applicant: ? L
Address: r` Telephone:
2 . Owner of Property: -�
Address Telephone:
3 . Status of Applicant:_L,�wner Contract Purchaser
Lessee Other (explain )
4 . Parcel Identification: Zoning Map Sheets`—i�� Parcels`
Zoning District(s) (include rlay
Street Address ( Y) ,
Required
5. Existing Proposed -by Zonin
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height '
1-.B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L:
- 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 o Proposed Work/Project: (Use additional sheets
if necessary)_ f
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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: ��--' 1j Applicant's Signatur
+ THIS SECTION FOR OFFICIAL U O Y
ZApproved as presented/based on information presented
Denied as presented--Reason:
Special- Permit and/or Site Plan Required:
,.end' g Re red: Variance. Required:
i
s gnat)&e1of Buildi.n etor ` Da to
NOTE: issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required pormits
from tho Board of Hoaith,Conservation Commission, Department of Public Works and otiior applicable permit oranting authorities.
City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 1. Footings and Walls
$ e 2. Structural Components in Place*
3. Complete Building*
No. 1255 Office of the Building Inspector
Zoning Form No. 003707 Date 12/13/94 Fee $20 Check# 4938
Page, 17A Parcel 212 ,Zone URB Section 127 ❑ Yes No
BUI]LDING PERM Ir I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT John Szawlowski before Building Inspections
has permission to Strip & reshingle roof Inspection on Site—Foundations
situated on 126 North Maple Street Inspection of Plumbing—Rough
provided that the person accepting this pen-nit 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.
** Install per Manufacturers information: windows, vinyl siding, Building Inspection—Finish
roofs and woodstoves. Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUO L E PREMISES
C'ertificate of Occupancy --
Buil Spector t�-'