05-016 (6) . PERMIT APPLICATION CHECK LIST
PA ., .� .: YES N D A T.E
1 ZONING FORM APPLICATION
2 . EERMIT APPLICATION
3 . OWNER OCCUPANT T LIC . # -IF NOT
4 . 3 SETS OF PLANS T PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNI
1 2 . PERMIT FEE -l EbW ONLY - MONEY O D .,
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127- CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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DEPARTMENT OR BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE- &" Z
JOB LOCATION: /J ICC(i bo 7-r ReY /fe 415
(Map) (Parcel) (Subdivision)
HOMEOWNER:
(Namel& Address)
cc,z'1 e- 7 - . S 77_�
(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.
HOMEOWNER SIGNATURE
BUILDING PERMIT
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Sj�:Z - f5 J 7/ Alterations
a NORTHAMPTON, MASS. ' 2 - 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /� �'?Zt d l cd h t�� di�� ���'<'i!5' :� �`>� Lot No.
2. Owner's name Jai i e .�//U 17 % be/rW i tit l e' Address__ /,7-
3. Builder's name S�� .7� Address
Mass.Construction Supervisor's License No. _._Expiration Date
4. Addition
5. Alteration (1/0 5? ael La
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 fit'C t c--,
11. Distance to lot lines
12. Type of roof )C I'4't kt
13. Siding house 42117 -e Pig 16 fZ' Glltc fz Gt -It crS c
14. Estimated cost:-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signat- f responsible app,icant
Remarks
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Date Filed ,� C/ File No.
ZONING PERMIT APPLICATION (510 . 2)
1 . Name of Applicant:
Address :_ 1 ,/�Z��C c-tl�,v y� dA' Telephone:
2 . Owner of Property:
Address : zrle Telephone :
3 . Status of Applicant: '_Owner Contract Purchaser
Lessee Other (explain : )
4 . Parcel Identification: Zoning Map Sheet#_-6— Parcel# Alp
Zoning District (s) (include overlays)
Street Address >L ,
Required
5. Existin - Proposed —by Zoning
Use of Structure/Property " �
(if project is only interior work, skip to #6)
Building height
%Bldg. Coverage (Footprint) /L '
Setbacks '�`'c - front
i - side L: 2-1 ' R: 2..,1 L: R: 41
- rear + r
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) C k
cwC-
Y
7 . Attached Plans : ✓ Sketch Plan Site P1
8 . Certification : I hereby certify that the information contained hereii�,_
is true and accurate to the best of my knowledge.
Date : /� `% ? Applicant's Signature:
THIS SECTION FOR OFFICIAL` USE ONLY:
Approved as presented/based on information presented
Deni
S ap --Reason:
l a
Permit
and/or Site Plan Required :
_ .--- nd - g Re ire Variance Required:
c
5 gnatur o ui ld ' /� Y
NOTE: issuance of a zoning perm' A s 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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.�� �ti City TI of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 2. Structural Com onnents in Place*
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3. Complete Building*
No. 1023 Office of the Building Inspector _
Zoning Form No. 001934 Date 11/4/93 Fee 40 Check# 2663
RR
Page, 5 Parcel 16 ,Zone Section 127 ❑ Yes ® No
BUI]LDINGPERiAM
*Plumbing and Electrical Inspections required
THIS CERTU IES THAT Jane Delevingne before Building Inspections
*STORAGE ONLY
has permission to Close garage, construct wall, install 2 windows Inspection on Site-Foundations
situated on 123 Audubon Road 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 rc`,
provisions of the Statutes and the Ordinances relating to the Construction,
Maintenance and Inspection of Buildings in the City of Northampton. Inspection of Wiring—Rough _
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish % ` AM
of this permit.Expires six months from date of issuance,if not started. Building Inspection—RouglO S
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 - Z
Smoke Detectors(Fire Department)
Other
THIS CARD BE APED IN A CONSPICUOUS -LA ON THE PREMISES
Certificate of Occupanc
Building Ins