36-002 PERMIT APPLICATION CHECK LIST
PAGE PLOTS ZONE " � f ' t /� S NO DATE
1 . ZONING FORM APPLICATION ,�li.2..--
2 . PERMIT -APPLICATION
3 . OWNER OCCUPANT-STATEMENT IF NO
4 . 3 SETS OF S /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 , WATER AVAILABILITY FORMS
8 . REMODELING INTERIOR
9 , ADDITION
10 , ACCESSORY STRUCTURE
11 , SIGN AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER
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 -
INSPCCTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060 y
HOMEOWNER LICENSE EXEMPTION
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DATE: Q3
(Please Print)
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JOB LOCATION: Sc% 2 U__A9,1"r
�(M p)6wakz_-
(parcel) (Subdivision)
HOMEOWNER: tL -
(Home 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.
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HOMEOWNER SIGNA GJ�- �yuii?i
BUILDING PERMIT #
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
as"""°TO1 NORTHAMPTON, MASS. 19 Additions
y APPLICATION FOR PERMIT TO ALTER Repair
Garage
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1. Location - �) -O --_ Lot No.
2. Owner's name kj(t4--` � '4--4-'� Address
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 cosC �. b�
The undersigned certifies that the above statements are true to the best of his, her
knowled e and belief.
1 LIJ Signature of responsible appicani
Remarks -
Date Filed File No.
ZONING PERMIT APP LI TION (510 . 2)
I . Name of Applicant:
Address : ) Telephone:
2 . Owner of Property: '1 ITL-c.
Address : F 4y— Telephone :
3 . Status of Applicant: C110'wner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 3G1- Parcel#
Zoning District (s) (include over L)J=rll ,tit Street Address
Required
5. Existincr Pr.opos&d by Zonin
Use of Structure/Property , � Et
(if project is only interior work,, ski to #6)
Building height
%B1dg. Coverage (Footprin
Setbacks - front
- side L: L: a R:
- rear
Lot size
Frontage r
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading '
Signs
Fill (volume & location)
6 . Narrative Descripti of Proposed Work/Project : (Use additional sheets
if necessary)
1 l
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 : 2' Applicant' s Signatur
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
ZApproved THIS SECTION FOR OFFICIAL USE ONLY:
as resented based on information s p / presented
Denied as presented--Reason:
pecial' Permit and/or Site Plan Required :
" n5ing Re red: Variance Required :
11Z1.2
gnat e f Building
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, Departmont of Public Works and other applicable permit granting authorities.
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