32C-275 �A PERMIT APPLICATION CHECK LIST
PAGE PLOT -.._- ZONE .0 r YES NO DATE
1 . ZONING FORM APPLICATION
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC , # IF NOT
4 . 3 SETS OF P ANS PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 , REMODELING INTERIOR
9 . ADDITIO
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNI
12 . PERMIT E - CHECK ONLY - MONEY 0 D5 � 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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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060 4v
HOMEOWNER LICENSE EXEMPTION
(Please Print)
DATE: V CG7 l j
JOB LOCATION:
� (Map) / (py�cel)/? (subdivision)
HOMEOWNER:
(Name & Address)
(Home Phone) (Work Phone)
The current exemption for "homeowners" was extended to include
Owner-occupied Dwellings of one (1)or two (2) fami 1 ies 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, oft 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 Lit t (,. .
BUILDING PERMIT # _
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
' APPLICATION FOR PERMIT TO ALTER Repair
Garage
I. ation l C d-tvt Lot No.
2. Owner's name ,I ' Address
3. Builder's name kYli�'l �s, 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 cos
The undersigned certifies that the above statements are true to the best of his, her
knowledge and be ef.
Signature of responsible app,ican!
Remarks
;Vei)i 002183 Date Filed File No.
ZONING PERMIT APP ICATION (Si0 . 2)
r ,
Name of Appl and: ti�� -cc�{��
Address : \Telephone:
:j owner of Property:
Address : 172 Telephone:
3 . Status of Applicant: I Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# ?,LC Parcel# —,
Zoning District(s) (include v da ) � �'
Street Address & 6fa1 41,y',s ),/. ;' T
Required
5 . Existing Proposed by Zoning
Use of Structure/Property
(if project is only interior yrork, 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/Project : (Use additional sheets
if necessary)
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 knowledge.
Date: q Applicant' s Signature . h
� THIS
SECTION FOR OFFICIAL US O LY:
y A pp roved as presented/based
on information presented
Denied as presented--Reason:
ial' Per it and/or Site Plan Required :
Foli g R fired: Variance Required,*
-/
gBuil nspector at
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.
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