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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 y
HOMEOWNER LICENSE EY2.NP`.rION
DATE; 7mC.� - l`) �J (Please Print)
JOB LOCATION: / a /I/,
(Map (Parcel) (Subdivision)
HOMEOWNER: �m S C--i r--�Lw �L
(Name & Ad ess)
(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 at
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 persons) 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
BUILDING PERMIT #
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PERMIT APPLICATION` CHECK LIST
PAGE PLOT Af5 ZONE X73 / � _ YES NO DATE
1 . ZONING FORM APPLICATION /
2 . PERMIT I I ON
3 . OWNER OCCUPANT IF NO
3 SET S PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 WATER S
8 . REMODELTNG
9 . ADDITION
10 , ACCESSORY STRUCTURE
11 . SIGN / AWNING
2 , PERMIT FEE - - MONEY ORDE '�±k> G..
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 7 - C R 780
15 , FORM
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. -' - Alterations
NORTHAMPTON, MASS. r:- � !A<' 19`,1 Additions
APPLICATION FOR PERMIT TO ALTER Repair
• Garage
I. Location Lot No.
2. Owner's name Address
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
6. New Porch
7. Is exiWng building to be demolished?
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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.
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Signature`of respons4ble applcant
Remarks
F
0039
Date Filed File No.
ZONING PERMIT APPLICATION (510.2)
1. Name of Applicant: J'03 4;
Address: 1 A) Telephone: 3-
2 . Owner of Property: ,e-��
Address: Telephone:
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain: )
4. Parcel Identification: Zoning Map Sheet# I114; Parcel#
Zoning District(s) (include overlays)
Street Address 3 - �-
Required
5. Existina Pro osed by Zoning
Use of Structure/Property v�-
(if project is only interior work, kip to #6)
Building height e-,
%B1dg.Coverage (Footprint) bc
Setbacks - front
- side
- 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
1 n cessary)
02
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.
odd ����
Date: D Applicant's Signature:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL US ONLY:- -
Approved as presented/based on information presented
Denied as presented
Reason for Denial:
Si ature of Building Inspector Date
NOTE: Issuance of a zoning permit does not relieve an applicants burden to comply with all zoning requirements and obtain all required permits
from the Board of Heafth,Conservation Commission,Department of Public Works and other applicable permit granting authorities.
City of Northampton REQUIRED INSPECTIONS
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BUILDING DEPARTMENT 1. Footings and Walls
$ � 2. Structural Components in Place*
3. Complete Building*
No. 996 Office of the Building Inspector
Zoning Form No. 003423 Date 10/1 1/94Fee 20 Check# 2948
Page, 17A Parcel 185 ,Zone URB Section 127 L) Yes ® No
BUIIL- DING PERMIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Joseph K i re j c zy k before Building Inspections
has permission to Rebuild old chi rkpo rnn.Q tnstorage sh@d Inspection on Site—Foundations
situated on 173 North Maple 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.
** 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 CONSPI US PLAC N THE PREMISES
Certificate of Occupancy - --
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