17D-060 (8) PERMIT APPLICATION CHECK LIST
PAGE r7 C' PLOT C G o ZONE C) f O ,ar AV YES NO DATE
1 . ZONING FORM APPLICATION k iorey'� ce' MC-
v '+-,qo 3
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT
4 . 3 SETS OF PLANS PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
1 . SIGN / AWNING
C� # '7 i O
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER C-) C)
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . U14DER SECTION 127 - CMR 780
15 . FORM A
16 . FILL
COMMENTS :
n e -n-1 o f r o Y,� I �g i l � 1��� - i r q-t,� { r oy-� L n o o Y- P o r Lo-c
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Crtif r of Nort alllptan
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 s.
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: ,mil// �� .�
JOB LOCATION:
�— (Map) arcel) (Subdivision)
HOMEOWNER: /�//�C1� �, ,, 'W' Z 'r I
(Name & Address) C/ c
(fie 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
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. � � 3 Alterations
NORTHAMPTON, MASS. 19 Additions
% �
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location ��/�f� ' �� �'j'> Lot No.
2. Owner's name 6t/A�o l/�� Address Q G l e7f
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition
5. Alteration � �d �� �.t'�� .�/✓7— �OD�
6. New Porch y�
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 jcost:e
Q�
The undersigned certifies that Lthablove statements are true to the best of his,
knowlede/� d belief. ®�
Signature of responsible app,icant
Remarks
r
00093 .1
Date Filed &/2/z/, File No. ,-7C- oCC
ZONING PERMIT APPLICATION (§10 . 2) U f3
1. Name of App
Address : 1 n Telephone:
2 . Owner of Property: �v�a,�o 10. U"e�✓(I) >
Address : rt Telephone: -
3 . Status of Applicant:ZOwner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# , '7 Parcel# oGC� ,
Zoning District (s) (in lude overlays) ULE 13
Street Address ,02
Required
5 . Existina Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: 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/Pro ct: (Use additional heets
if/Xecess aryl
E �
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 knowl71X�Y��
Date: l�-J�� Applicant's Signature:
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
THIS SECTION FOR OFFICIAL USE ONLY:
!i Approved as presented/based on information presented
Denied as presented--Reason:
S ecial Permit and/or Site Plan Required:
ing quired: Variance Required• q
igna _of Build ' Ins atA
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.
8
ify NorthA REQUIRED INSPECTIONS
BUILDING DEPARTMENT 2: Strucntural Components a in Place*
3. Complete Building*
No.
239 Office of the Building Inspector
Zoning Form No. 000937 Date 4/21/93 Fee $40 Check# 5710
Page, 17C Parcel 60 ,Zone URB Section 127 ❑ Yes ® No
BUI]LDING PERMIT
*Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Edward Driscoll before Building Inspections
has permission to Demolish front hall , re-frame door Inspection on Site—Foundations
situated on 20 Garfield 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 ofissuance,if notstarted. 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 CONSPICAJO S P CE ON TIE PREMISES
Certificate of Occupancy
' � Spector ��