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c DEPARTMENT OF BUILDINC INSPECTIONS
k '
INSPECTOR ) 1 212 Mnin Street ' Municipal Building
Northampton, Macs. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE
JOB LOCATION:
/
(map)� (parcel ) bdivision )
cu /HOMEOWNER: � elza
- ------
(Name & Address )
( Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied 0vall xy1s of one ( 1 )or two (2) fami 1 1 e 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 owp a parcel of land on
which he/she resided or intends to reside , on _.ch there is , or is
intended to be , a one or two family dwelling , attached or detached
structures accessory to such use and/or farm strut ures . A person who
constructs more than one home in a two-year period shall not be
considered a homeolner . Such "homeowner" shall snhmit to the Building
Official , op 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 nreserce 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 beo 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 AND SHALL BE ON THE JOB AS SUPERVISOR.
HOMEOWNER SIGNATURE -[4
BUILDING PERMXT #'r
4
Z cn rn
U-) .�
C �
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No y/3 Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage is
1. Location � �� �� � �'ltG=-_ j� Lot No.
2. Owner's name I �CG-�raZf/ix� Address�TL �may �j� a� ,z 721.E _
3. Builder's name Address ✓�
Mass.Construction Supervisor's License No. Expiration Date
4. Addition .re
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage l/ No.of cars Size /G., / f
10. Method of heating
11. Distance to lot lines
12. Type of roof,4
13. Siding house y/N r
14. Estimated cost- 4/ao0
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signature of responsible app,icant
Remarks
Do any signs exist on the property? YES NO
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property?YES NO
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE To
LACK OF INFORMATION.
This co7� to be filled in
by tba Building Dapartment
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
side L: R: G 4, L: y' R: J3 '
- rear
Building height
Bldg Square footage 1 ra
l 3
S`
,
%Open Space: zs
(Lot area minus bldg °
&paved parking)
Parking spaces
#` of Loading Docks
Fill:
'4 vol-time -&' location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
�1.
DA'Z'E: - APPLICANT's SIGNATURE
NOTE: lssuanoe of at zoning permit does not relieve an appiioant's burden to comply with all
zoning requirements and obtain ail required permits from the Board of He-alth. Conservation
6ommission, Department of Publio Worsts and other applionble permit granting authorities.
FILE #
i'
5
Fi 1 e No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: I ,�/( J�GrQl'/�/�' Telephone: !V IJ-5 5'41�'
2. Owner of Property: ��p
Address: V
=, ,,�® Telephone:
3. Status of Applicant: I/ Owner _Contract Purchaser_ Lessee
Other (explain):
4. Job Location:
Parcel Id: Zoning Map# _/_7C_ Parcel# District(s):__�
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property /�2 -e.c. e
6. Description of Proposed UseANork/Project/Occupabon: (Use additional sheets if necessary):
f
7. Attached Plans: Sketch Plan 61"__ Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
Q. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO r/ DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO-__,(,-'_ DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
FILE # G 52 12"
APPPPLICANT/CONTACT PERSON: f �✓� ��
ADDRESS/PHONE:
PROPERTY LOCATION:
MAP /7C- PARCEL: ZONE
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Building Permit Filled nil
F,P Paid
V
THE FOLLOWING ACTION HAS BEEN TARN ON THIS AP ICATION:
Approved as presented/based on information presented
Denied as presented:
der: §
TONING BOARD
Deeds Proof Enclosed
�ONING BOARD OF APPEALS
'Deeds Proof Enclosed
/ZONING BOARD OF APPEALS
(7-
Deeds Deeds Proof Enclosed
01
U v ilability Sewer Availability
_,f Water Potability-Bd Health
-.--- rz�-x_onservation Commission
Signature of Building Inspector Date
NOTE:Issuanoe of a zoning permit does not relieve an appiloant's burden to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Works and other appiioabie permit granting authorities. —