05-045 (2) PERMIT APPLICATION CHECK LIST
PAGE PLOT '7'- ZONE � � ! 7 '� (��a ��zrZTr.� �{ YES NO DATE
1 . ZONING FORM APPLICATION o
L_-
2 . PERMIT APPLICATION
3 , OWNER OCCUPANT STATEMENT LIC . # IF NOT
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
S . REMODELING INTERIOR L - -
9 , ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN AWNING
1 2 . PERMIT FEE - CHECK ONLY - MONEY ORDER 4— (,, �
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 - CMR 780
15 , FORM A
16 , FILL
COMMENTS :
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48 .I+�NSBH[IJUOtIJH
DLPARTM<N'I' UN UUILDIT(G lNSP�CTlONS _-
INSPECTOR
212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
]DATE: /O�a L�9
JOB LOCATION. a f1 1Y 5'
�/�'Jr
(.Map) (Parcel) (Subdivision)
HOMEOWNER: l�l II/��i T, LA.VH&1,4 y .r /79 Auh,j eL,nj 5,D-.0
(Name & Address )
to/os 3 X73 u 1Y13 -- A4-9 -
(Home Phone) (Work. Phone )
The current exemption for "hcmeoWnors" .Wa's extended to include
ct
Owner-occupied Dwelling of one (1) or two (2) families and to allow such
homeowner to engage an individual for hire who -doe.q not _nossess a _ -
license, provided that the owner acts as supervisor.' CMR780 Section 109.1 .1 1
DEFINITION Or 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 )
05
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 5-8 6 3 Z Alterations
a NORTHAMPTON, MASS. r0L�. 19 9� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location /7 9 4ub R-,-, it b, Le IYA, 0/0-5 Lot No.
2. Owner's name W i< 7, —Zg:-- Address -s'AH f qs
3. Builder's name S'a►-+E As o w:-t e- Address A/7 ro
Mass.Construction Supervisor's License No. N/A Expiration Date
4. Addition A;41
5. Alteration YES c z Ai E A z90-"^ S AP-1 L
6. New Porch ti ='
7. Is existing building to be demolished?
8. Repair after the fire A;`"
9. Garage A' No.of cars Size
10. Method of heating FoA^,6b Hc;r rur97c,e
11. Distance to lot lines
12. Type of roof S d I N C�c
13. Siding house C'f jW
14. Estimated cost- ` 5-000 /v
The undersigned certifies that the above statements are true to the best of his, her
knowledge belief.
'pq � / n
Signature of responsible app,icant
Remarks
jrw rr
:vim. �r
Date Filed 0003 .
=.; File No.
ZONING PERMIT APPLICATION (§10. 2)
1 . Name of Applicant: A1 //1✓+4,_d
Address : 179 119ou800i /,',6, 4 Z Eps-, -Telephone: -6-616-348A
2 . Owner of Property: _:VlMf
Address : Telephone:
3 . Status of Applicant:XOwner Contract Purchaser
Lessee Other (explain, )
4 . ,Parcel Identification: Zoning Map Sheet#_Qii_ Parcel#a4 ,
Zoning District (s) (include overlays) LJ
Street Address A It I,o-n ecj- ,y L�,-cf �'
Required
5 . Existincr Proposed by Zoning
Use of Structure/Property SroXAG6 136p"Caa^I
(if project is only interior work, skip to #6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side R L R
- 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
if necessary) 9,FH.AQG1,v6 e6 o.-4 ,4o&>yt 6'dxAee Ta Ne OEoMoon AAoW
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: /a�11 �9,Z Applicant ' s Signature:
Z THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented
a n for nial :
ignat of Buildi ector �7 a
NOTE: Issuance of a zoning 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.
7/92 FXAS
S 4�- P4/&j P
City of Northampton RE gUMED IN
PECTIONS
+
BUI]LDINGDEPARTNWNT 2. Structtural Components in Place*
' 3. Complete Building*
No.
705 Office of the Building Inspector
Zoning Form No. 000399 Date 11/9/92 Fee 40 Check# 511
Page, 5 Parcel 45 ,Zone RR Section 127 ❑ Yes ® No
BU11LD1NGPE1ZNW
* 1 umbing and Electrical in r eons required
THIS CERTIFIES THAT William Lashway III before Building Inspections
haspermissionto Convert existing storage space over garage into bedroom Inspo;dononSite—Foundations
situated on 179 Audubon Road Inspz--c don of Plumbing—Rough
provided that the person accepting this permit shall in :;very respect In%p.-�;don of Plumbing—Finish
conform to the terms of the application on file in this orL ;,and to the Gas Inspecri:
provisions of the Statutes and the Ordinances relating to the' ::construction, I;,,,3ection of Wiring—Rou t'
Maintenance and Inspection of Buildings in the City of� .)rthampton. --- "Any violation of any of the terms above noted is an immedi:!- revocation Li xcdon of Wiring—Finish
of this permit Expires six months from date of issuance,i .mot started. Building Inspection—Rough
Note:A certificate of occupancy will be issued by this ofi i;.ipon return Insulation Inspection
of this card signed by the Plumbing,Wiring and Buildin .ispectors.
wilding Inspection—Finish
Smoke Detectors(Fire Departm:;
THIS CARD MUST BE DISPLAYED IN A CONSPICUOU PLA ON THE PREMISES
Certificate of Occupancy
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