17C-178 (6) PE-RIOT APPLICATION CHECK LIST
PAGE Ile- PLOT I76 ZONE �"�� � � c����' ES NO DAT
ZONINg FORM LTC I 0
21 PERMIT APPLICATION
3 . OWNER OCCUPANT ,STATEMENT L IOs►I IF NOT
4, 3 SETS OF P(_ANS /PLOT PLAN
5 , NEW CONSTRUCTION
6 CURB CUT
7 , WATEE AVAILAGI TTY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 ACCESSORY STRUCTURE
S
12 . PERMIT FEE — CHECK ONLY — MONEY ORDER-�.;-)!S77
13 , SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 — CMR 780
15 . FORM A
16 , FILL
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.SAS Alterations
° NORTHAMPTON, MASS. � _19-Z2 Additions
ti
a Repair
APPLICATION FOR PERMIT TO ALTER
Garage
1. Location ���'f P�'/�� d'/4, Lot No.
2. Owner's name Nvw"O—�, — S V sue;� �� �i d >oi'1 Address ;,7'J Z-&"1D U
3. Builder'sname (0,77e at,-)lee Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration Te K n G o vi 1--k U e l`0 0 n�
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage_ S No.of cars Size
10. Method of heating (:;CL
11. Distance to lot lines
12. Type of roof
13. Siding house D
14. Estimated cost:- C)
The undersigned certifies that the above statements are true to the best of his, her
1 knowledge and belief.
Signature of responsible app,icant
Remarks
i}�q�KNAMATOy
of Nar#lramp f on
+ OR son Cll list Its r
b
DEPARTMENT OF BUILDING INSPECTIONS v
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass, 01000 �a
HOMEOWNER LICENSE EXEMPTION
DATE: 6-
(Please Print)
�
JOB LOCATION:
(Map) (Parcel,) (Subdivision)
HOMEOWNER: v 56irJ �-
( ame & Address )
(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 SIGNA f. iL f
BUILDING PERMIT #
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Date Filed 001. 04' j File No.
20NING PERMIT APPLICATION (910 . 2 )
1. Name of Applicant: ��S6r.7 0--x641ej l
Address : "-13 Telephone : �1
2 . Owner of Property: l�1F �U54✓7 ��d .
Address :_ �'� v _ vt _ Telephone :
3 . Status of Applicant : Owner Contract Purchaser
Lessee 0 he (explain : )
4 . Parcel Identification: Zoning Map Sheet# Marcel# f79 ,
Zoning District (s) (include verlays
Street Address
i Required
5 . Exij3tina P o osed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg . Coverage (Footprii
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 Descr ' ption of Proposed Work/Project : (Use additional sheets
if necessary)
7 . Attached Plans : Sketch Plan Site Plan
a . 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 ONLY: - - - - - - -
�proved as presented/based on information presented
Denied as presented--Reason .
Special' Permit and/or Site Plan Required :
Fining Requir d: Variance Required:
A;.. MAY 19 1993
S gnature of B ilding inspe for
NOTE: Issuance of a zonirv_perMil 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, Deparlrnonl of Public Works and olhor applicable permit granting authorities.
i7•)-
City of Northampton REQUIRED INSPECTIONS
BUILDING DEPARTMENT 2. S�cttural Walls Components in Places*
3. Complete Building*
No. 317 Office of the Building Inspector
Zoning Form No. 001049 Date 5/12/93 Fee $40 Check##
Page 17C Parcel 178 ,Zone URB Section 127 L) Yes �J No
BUI]LDINGPERMI r I
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Susan & hark Glidden before Building Inspections
has permission to Remove 2 interior walls to expand rooms & re-roof porclInspection on Site—Foundations
situated on 23 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.
Building Inspection—Finish
Smoke Detectors(Fire Department)
Other
THIS CARD MUST BE DISPLAYED IN A CONSPICUOUS -PLACE N ];PREMISES
Certificate of Occupancy
Building Ins
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