17C-177 (5) PERMIT APPLICATION CHECK LIST E
PAGE / 7G PLOT
/ 77 ZONE Wj Z-1 " _- S -QATE
1 . ZONING FORM APPLICATION
2 . PERMIT U
3 . OWNER OCCUPANT LIC # IF NOT v i
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 WATER AVAILABILITY S
8 . REMODELING INTERIOR
9 ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNING
2 . PERMIT FEE - CHECK ONLY - MONEY ORDER q
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - C R 780
15 . FORM A
16 . FILL
COMMENTS :
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' DEPARTMENT OF BUILDING INSPECTIONS -
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMP'T'ION
(Please Print)
DATE: -
JOB LOCATION: f�G' 177
(Map) (parcel) (Subdivision)
HOMEOWNER:
Na a=drV i L
(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 G'
BUILDING PERMIT #
a
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
� 6
1 Location Lot No.
/2 Owner's name Address
3. Builder's name '.k�Yl� Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration
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
11. Distance to lot lines
12. Type of roof
614! Siding house
Estimated cost- /(
The undersigned certifies that the above statements are true to the best of his, her
n knowledge and belief.
natu>'e of responsible app,icant
Remarks
Y
Date Filed
File No.
ZONING PERMIT APPLICATION
Name of Applicant:, ,--
Address: Telephone: '
2 . Owner of Property: .
Address : Telephone:
3 • Contract Purchaser
ain: )
4 . F )ning Map Sheet# /7 C / Parcel# 17
Z :lays)
S -� t2
Required
5 . tin Pro Dosed by Zo in
Us ,,
(1 'kr ip o #6)
:
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)
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 knowl dge.
��z� 9L
Date: Applicant' s Signature
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
Denied as presented--Reason:
Sp cial• Permit an Site Plan Required:
d' Require V�a�rianc Required: -,- _
—V&o-'/'v
. %
S gnature � l ing ate
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.
iell-
4io Ci y Of Northampton REQUIRED INSPECTIONS
1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
3. Complete Building*
No. 559 Office of the Building Inspector
Zoning Form No. 002837 Date 6/22/94 Fee S20 Check# 889
Page, 17C Parcel 177 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDING PERmi r
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Harold Jasmin before Building Inspections
has permission to Reshingle porch roof Inspection on Site—Foundations
situated on 29 Plymouth Ave 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 CONSPICU S LA THE PREMISES
Certificate of Occupancy --
g Inspector
19F