17A-258 (4) PERMIT APPLICATION CHECK LIST
PAGE I "7 A PLOT ')-f2 ZONE U P P ( 0 0 C-F . 1 c YES N GATE
1 . ZONING FORM APPLICATION
2 . PERMIT P LIC TI
3 . OWNER OCCUPANT E E LIC # IF NO
4 . 3 SETS OF ANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER I FORMS
8 . REMODELING INTERIO
9 . ADDITION
10 , ACCESSORY STRUCTURE
1 . SIGN / AWNING
2 , PERMIT FEE - CHECK ONLY - MONEY ORDER R` L10, 0 L-
3 . SPECIAL U D WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
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of 'Nartl7allip tall
DEPARTMENT OF BUILDING INSPECTIONS =
INSPECTOR 212 MRill Street ' Municipal Building
Northampton, Mass. 01000
HOMEOWNER LICENSE EXEMPTION
//�� (Please Print)
DATE: VC r&6 EI"', �--
JOB LOCATION:
(map) (Parcel) (subdivision)
HOMEOWNER: &,�y,I AT
(Name & Address)
/03 0/9-A, ST Rio/-, EA)C
(Home Phone) (Work Phone )
The current exemption for "homeownpr,s" .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 nossess 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 i2
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 A--r,-C-L
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.� Alterations
aNORTHAMPTON, MASS. �e�t -P�'� ��� 19 � Additions
APPLICATION FOR PERMIT TO ALTER Repair
/�, Garage
1. Location 103 1.- A K S T,eE�-: T- rl U 4 E Aid 6 Lot No.
2. Owner's name 4&% Address /0 -3 Oel K
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition PTO
5. Alteration ✓
6. New Porch s
7. Is existing building to be demolished?
8. Repair after the fires) D
9. Garage /9-)U No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:-
;i "�® .
U The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
7 S' nature of sponsible app�icant
u
Remarks
0.S PT
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Date Filed /G- 0-x7- 9 .--L 1 File No. t-7A—Zf- r
ZONING PEE-R'MIT APPLICATION (§10.2)
1. Name of Applicant:
Address: K ST F-10 R & tUC E Telephone:
2 . Owner of Property: _7—E/9 A X14 t07-
Address: 143 61119C_ `T, Telephone: ---5 •3
3 . Status of Applicant: ZOwner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# ) "7 A Parcel# a�5 g,
Zoning District(s) (include overlays) ,{ �13
Street Address i 0,-3 Q A k S-r.; i=1 n
Required
5 . Existina Proposed by Zonincr
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. 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 Descripti n of Proposed Work/Project• (Us additional sheets
if necessary) 2
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: Applicant' s Signature �---
- - - - -
- - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE Y:
/ pr 71992
✓ Approved as presented/based on information presented
Denied as presented
,aor al
at
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 Health,Conservation Commission, Department of Public Works and other applicable permit granting authorities.
7/92 FXAS
City of Northampton REQUMED INSPECTIONS
A �
1. Footings and Walls
BUILDING DEPARTMENT
2. Structural Components in Place*
3. Complete Building*
No.
684 Office of the Building Inspector
Zoning Form No. 000439 Date 10/28/92Fee $40 Check# 3034
Page, 17A Parcel 258 -,Zone URB
Section 127 ❑ Yes ❑ No
BUI]LDINGPERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Jean Bryant before Building Inspections
has permission to Replace shower, tub and window in bathroom Inspection on Site--Foundations
situated on 103 Oak 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.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICJ US LA ON THE PREMISES
Certificate of Occupancy
nspector C"_C0r_