17D-043 (4) PERMIT APPLICATION CHECK LIST
PAGE /� PLOT 415 ZONE tZ A16 YES NO DAT
1 ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LI IF NOT 1
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 ADDITION
10 . ACCESSORY STRUCTURE
1 . SIG AWNING
2 E - CHECK ONLY - MONEY ORDER
L -'
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - CMR 780
15 . FORM A
16 , FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
go NORTHAMPTON, MASS. ���� 19� Additions
Repair ,`,
APPLICATION FOR PERMIT TO ALTER --
Garage
1. Location ZY 4czfH :57-- �F,(-aElUC€1, Md , C.)/o tr 0 Lot No.
2. Owner's name ®10/- N fi ,/21AAT 1,-J Address rr f/ -S—7 fLCX C^n M-I s S
3. Builder's name THN /}�grmj Address 3 /f/Gri
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration t
6. New Porch
7. Is existing building to be demolished? A)Q
8. Repair after the fire /0
9. Garage /t10 No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof i9%E
13. Siding house CyGb.
14. Estimated cost:-X _
76 dG
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief.
1 ` Signature of responsible applicant
Remarks
'No rt 11amp tail
�' �NSBNCI�IIIIltI9
6i DEPARTMENT OF BUILDING INSPECTIONS -=
INSPECTOR 212 Main Street • Municipal Building •� �/'
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: 9`-/,5�'%�
JOB LOCATION:
Map) (Parcel) (Subdivision)
HOMEOWNER: .16 d1v �, 1)1 o4 R F 1 AJ = S Diuc7Y - f 71A le
(Name & Address)
y S% tXL0,46rlic�_�1r9 SS. 6/0C C 5r541 160
(Home Phone) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of six ( 6 ) units or less and to allow such
homeowner to engage an individual for hire who does not possess a
license, provided that the owner acts as supervisor. '
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 to six 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 he
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
BUILDING PERMIT #
v-s Pr
000429"
Date Filed y3� v File No.
ZONING PERMIT APPLICATION (§10 .2)
I . Name of Applicant: JZNKJ 'e, MAle- i4J
Address : � (�y ST, El -T_yi'I Telephone:
2 . Owner of Property: iv1F ,-is Adocie
Address: Telephone:
3 . Status of Applicant:_>(- Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet#—M— arcel# LO ,
Zoning District (s) (include ov ri y tJl�
Street Address
Required
5 , Existincr Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%Bldg. Coverage (Footprint)
Setbacks - front
- side 1 R L
_ - rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
6 , sed Work/Project: (Use additional s Bets
7 , Plan Site Plan
g , fy that the information contained herein
ast of my knowledge.
Date it ' s Signature: _ —
THIS SECTION b,OR OFFICIAL USE ONLY:
Approved as presented/based on information presented
D ed as pr rented
or 1:
igna r of Build ' Spector `�� Date
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.
7/92 FXAS
City of Northampton REQUIRED INSPECTIONS
1 . Footings and Walls
BUILDINGDEPARTMENT 2 . Structural Components in
Place g
t�(> 3. Complete Building
No. .;i94 Office of the Building Inspector
Date September 17, 1992 19
BUI DING P RMI
THIS MAY CERTIFY THAT John Martin Insp. on Site — Foundations
has permission to Renovate/remodel bathroom Insp. of Plumbing — Rough
situated on 3 High Street Insp. of Plumbing — Finish
provided that the person accepting this permit shall in every re- Insp. of Wiring — Rough
spect conform to the terms of the application on file in this office,
and to the provisions of the Statutes and the Ordinances relating Insp. of Wiring — Finish
to the Construction,Maintenance and Inspection of Buildings in Insp. of Health (Septic Tanks)
the City of Northampton. Any violation of any of the terms above
noted is an immediate revocation of this permit. Expires six Building Insp. — Rough
months from date of issuance, if not started. Building Insp. — Finish
Note:A certificate of occupancy will be issued by this office upon
return of this card signed by the Plumbing,Wiring and Building Smoke Detectors (Fire Dept.)
Inspectors. Gas Inspection
R THIS CARD MUST BE DISPLAYED IN A CONSP U US E ON THE PREMISES
Certificate of Occupancy
ing Inspector