05-029 (5) i
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
c.v
Northainpton, Mass. 01060
HOMEOWNER LICENSE EX -=ION
l (Please Print)
DATE: t� )
JOB LOCATION: ") C ! S J Lc
_ (Map) (parcel ) (Subdivision)
HOMEOWNER:- i C(2 +-c)c 5�ec_k4)f
(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 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.
J
HOMEOWNER SIGNATURE
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. -� � - Alterations
NORTHAMPTON, MASS.
Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 1�-0 C:t t k b r-;,3 R61 �C c:-66S Y7�4 0 ' Lot No.
--
2. Owner's name C L c.k'/ Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alterations -1 � �t t ✓�� kC�- -t t' YL
6. New Porch
7. Is existing building to be demolished? `lam
8. Repair after the fire
9. Garage L `: 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.,
Signature of responsible app icani
Remarks
10. Do any signs exist on the property/? YES NO
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colt to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
&paved parking)
# _9f -Parking spaces
# of Loading Docks
Fill:
{vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
r,, is true and ac/curate to the best of my knowledge.
DATE: 3- l%�� 1,;2 / j APPLICANT'S SIGNATURE
NOTE: Issuanoe of a zoning perm does not doe not relieve an applipb s urden to comply wit
zoning requirements and obtain all required permits from 11-ho Board of Health, Conservation
Commission, Department of Publio Works and other applloable permit granting authorities.
FILE #
DEC 2 710 a
File No. ( 'yl°
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION F/, 1 J
1. Name of Applicant: c E: `� - C k u"_'_'k) I I ` � jL L4 C� d)0S)0 "&g1
Address: � yo, ��- 'r�� 1�( 1 i �-� �.<<7S Telephone: Lj h� ��S�r j
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Street Address: `5
Parcel Id: Zoning Map# Parcel# District(s): /lJJ r
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW__X __ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO_(. DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained date issued:
(FORM CONTINUES ON OTHER SIDE)
'g FILE # 9G0` 44
1
APPLICANT/CONTACT PERSON: '�C'n�l✓ , �! '� C� ` 4z-t
ADDRESS/PHONE: 70) �� c�C�rvi ,,� `�
PROPERTY LOCATION:
MAP PARCEL:= ZONE
THIS SECTION FORAFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
70NTNC� FORM FH,T,FI) 0111
Fpf. Paid
f`J
✓/
V
THE�FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION-
✓✓ Approved as presentedibased on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
,'
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
eptic Approval-Bd of Health Well Water Potability-Bd Health
Permit f Con ation Commission
Signatur, £. 1ding pector----- - ate`
NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities. —
°� �"e City of Northampton PX UIRED INSPECTIONS
BUILDINGDEPARTMENT 2. Struct u Ial Components in Place*
3. Complete Building*
No. 1082 Office of the Building Inspector
Zoning Form No.
960544 Date 12/29/95 Fee$20 Check# 1303
Page, 5 Parcel 29 ,Zone--EE/WSP Section 127 ❑ Yes El No
BUI DiNG PER;A11T
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Bruce Stockwell & Syndney Flum-Stockwell before Building Inspections
has permission to install a wood pellet stove. Inspection on Site—Foundations
situated on 240 Audubon Road Inspection of Plumbing—Rough
provided that the person accepting this permit shall in every respect Inspection of Plumbing—Finish
conform to the terms of the application on file in this office, and to the Gas Inspection
provisions of the Statutes and the Ordinatices relating to the Construction, Inspection of Wiring—Rough
Maintenance and Inspection of Buildir.gs in the City of Northampton.
Any violation of any of the terms above noted is an immediate revocation Inspection of Wiring—Finish
of this permit.Expires six months from date of issuance,if not started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this office upon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Building Inspectors.
Building Inspection—Finish ��y��
* Install per Manufacturer's informatics: windows.,vinyl siding,roofs Smoke Detectors (Fire Department q e
and woodstoves
Other
THIS CARD MUST BE I) LAY CON$Pj, S 'LAC ON HE PREMISES
Certificate of Occupancy
But M ing nspec OT