17D-040 (7) ADD 106 Fi 1 e NO.
ZONING PERMIT APPLSGATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: Telephone:
2. Owner of Pro
perty Y G
Address: �,� � Telephone:
0
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain):
4 Job Location:
Parcel Id: Zoning Map# /'�� Parcel# Q District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6 Description of Proposed UseANork/ProjecUOccupation: (Use additional sheets if necessary):
7 Attached Plans: C' Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8 Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 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 Z--- 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)
Y
10, Do any signs exist on the property? YES NO L- '
IF YES,describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO 6
IF YES,describe size, type and location:
I1 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col== to be filled in
by the Building DeBartmeat
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks � D
- side L: R: L:`I-'6" R:
- rear �/�ir
Building height I
Bldg Square footage
%Open Space: ! 7
(LOtarea minus bldg
&paved parking) U
# ;of -Parking Spaces
,# fof Loading Docks
Fill:
:(vol-time--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge .
L 1 J
DA'1'E: / APPLICANT's SIGNATURE
NOTE: 1 uanoe of a zoning permit does not relieve an "pplioant's burden to mply with all
zoning requirements and obtain ail required permits from the Board of Healt , Conservation
Commission, Department of Publio Works and other nppllonble permit granting authorities.
FILE If
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DEPARTMENT OF BUILDFNG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building 'gV
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMP`T'ION
G (Please Print)
DATE_ ��/
JOB LOCATION:
Nap) (parcel ) ( subdivision)
HOMEOWNER:_ -
(Name & Address )
( Hon-.e Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied T7,aellings of one ( 1 )or two (2) fami l ; es and to allow such .
homeowner to engage an individual for hire who does not possess a :
license , provided that the owner acts as su ervi sor . Ch1R780 Section 509. 5 . 1
D?FINITION OF HO EOWNER: Person(s ) who owe ) a parcel of land on
which he/she resided or intends to reside , on _.ch there is , or is
intended -o 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 homeo%lgner . Such "homeowner'' shall s�__:-mit to the Buildina
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 AND SHALL B PN THE JOB AS SUPERVISOR.
�— r
HOMEOWNER SIGNATURE
BUILDING PERMIT (#
4 �
a Z
II
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. .� Alterations
NORTHAMPTON, MASS. L-1' r r 191!�- Additions
Repair
APPLICATION FOR PERMIT TO ALTER
Q ,J -i� Garage
" S I•
1. Location 0 f7-C -t Lot No.
Z� /
2. Owner's name Address (f
� J� f"Ue—a
3. Builder's name 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
13. Siding house
14. Estimated cosL-
/ The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
Signaiure of esponsible app ican!
Remarks
FILE # n 43--
PLICANT/CONTAT PERSON:
-
PROPERTY LOCATION: ,
MAP 2,72 PARCEL: lelk) ` ZONE._
THIS SECTION FORAFFICIAL USE ONLY:
' PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULED OUT
Fee PAid
haid 9/115--
Ep
Addition to Existing
Cji!��)Qrriypant Stnternent or License ii
C s
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
!Permit from Conservation Commission
Signature of Building Inspector Date
NOTE:laauanoe of a zoning permit does not relieve an appiioants burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commisalon, Department of Publio Worlca and other applicable permit granting authoritles. —