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DEPARTMENT OF BUILDMC INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: r
JOB LOCATIOON:
(Map) (Parcel) — ( Subdivision)
HOMEOWNER:_ , QI'!'A S F A m,s ;Xr,
(Name & Address )
3��1/�X/4.N /�%�� For CNC e- JVa, alp&D ""S-ay3 S3�j L58R lcs7/�
(Home Phone ) (Work Phone )
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (I )or two (2) fami 1 i es and to allow such .
homeowner to engage an individual for hire who does not possess a `
license, provided that the owner acts as supervisor . GMR780 Section 109. 1 . 1
DEFINITION OF HO EOWNER_ 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 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 corrpieti0i, o- t
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 BE ON THE JOB AS SUPERVISOR-
HOMEOWNER SIGNATURE
BUILDING PERMIT
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No.� � �088y Alterations
NORTHAMPTON,.MASS. �ori� 19,�� Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location -34 L.c AI &�IZ Z2&4i xe— Lot No.
2. Owner's name lVa" C"W M Address34 _Ly4&,ad 6�// i%e4 we A&F. dzzaLa
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
0 Method of heating /�6��� �' .ST�/� 6 A66j, ei-o.i
11. Distance to lot lines
12. Type of roof
13. Siding house X ',
14. Estimated cosu-
The undersigned certifies that the above statements are true to the best of his, her
knowledge and belief. /� n
Signature of respo !e app'leant
Remarks
WA
f MW
10. 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 colimm to be filled
by tl:* Feil3i.ag Departm-nt
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks - frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(l_Ot area minus bidg
&paved parking)
of -Parking Spaces
of Loading Docks
Fill:
4vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of ray knowledge.
.1
DATE: APPLICANT's SIGNATURE
NOTE: /ssuanoe of a zoning permit does not relieve a applicant's burd to oomply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation _
iCommission. Department of Publio Works and other appiioable permit granting authorities.
FILE #
�C
AOp /
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ZONXNG PERMIT APPLICATION (§10 . 2)
"PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: F Ao�ams Tr_
Address: 3,4 _Z�aa jz h:// e=&v C_ h1a. 91&1-a Telephone:
2. Owner of Property:efr�-�ys
oie,(.nTelephone:
1, Status of Applicant: ✓ Owner Contract Purchaser Lessee
Other(explain):
4. Job Location:
Parcel Id: Zoning Map# � � Parcel# ,-" �), District(s): - _l' Z2'2 �—)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: ,/ Sketch Plan J 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/Vadance/Finding ever been issued for/on the site?
NO I i DON'T KNn01n 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 # 9)G S 3 7 Alij�
F
- i 1'(;wCONTICT PERSON:
ADDRESSIPHONE:
t Mi f ,,
": bPERTY LOCATION: C-'4f�
MAP PARCEL: c ZONE 1e2L2 G4
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
7.()NTNG Fngm FRIED (MIT
Fee P51id
lRydiding Permit Filled nvit
b/
/ 2 ' c
c�
Own
OLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: '.
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 Co a ion Commissi
0
Signature of Building Inspec ate
NOTE:tssuanoe of as zoning permit does not relieve an applioant's burden to comply with ail
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publlo Works and other applicable permit granting authorities.
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