17A-067 (5) / PERMIT APPLICATION CHECK LIST
PAGE 17A- PLOT tO ZONE u YES NO DATE'
ZONING FORM APPLICATION It la/tg
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LICA-IF NOT
4 . 3 SETS OF PLANS ZPLOT PLAN
5 , NEW CONSTRUCTION
6 CURB CUT
7 , WATER VAIL BI T FORMS
8 . REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY- STRUCTURE
11 , SIGN AWNING
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER b 0
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
HOMEOWNER LICENSE EXEMPTION
9 (Please Print)
DATE:
JOB LOCATION: / '7 A o G ,7
(Man) (Parce ) (Subdivision)
HOMEOWNER
(Name Addres )
(Home Phone) (We-rk Ph-one)
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. q "00 4 G Alterations
a NORTHAMPTON, MASS. ti - / 0 19� Z Additions
APPLICATION FOR PERMIT TO ALTER Repair
c�c Garage
1. Location (Y)0V n1 i A i A; 46tr: t'Gre Lot No.
2. Owner's name N o-r c j B O V e-v- \j a-na,S C• Address °.--7� LAO U-Y-.-C n -n
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition ,ADD t Ti c
5. Alteration
6. New Porch
7. Is existing building to be demolished? CV o
8. Repair after the fire
9. Garage 1/ No.of cars Size
10. Method of heating W,,1V E A/Lr-6 Eh -�
11. Distance to lot lines /moo 1- " :3f,, l-" L, r- C; l`( f- J fZ -
12. Type of roof �t�v3r`
13. Siding house
14. Estimated cost:- 1,-
I t;,
f The undersigned certifies that the above statements are true to the best of his, her
now, ge and belief.
Y"
Signatu of responsible appicant
Remarks
000..1 : =x
Date Filed /4 -jp - 91` a File No.
ZONING PERMIT APPLICATION (§10.2)
1. Name of Appli ant: Nf� /�C V D I/ `R
Address: �D �cJ N /1 —Telephone:: �;,Q� j�,
i.•-'"2 . Owner of Property: AJ/4 /UC_( JIR/UV t R
Address: �/ S 7- Telephone: �U(,
1,- 3 . Status of Applicant: lam Owner Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# 1,36 Parcel# Qc.7 ,
Zoning District(s) (include overlays) (I FA /W-SP
Street Address D 0 M n u-v,Tn „:� GF. Fin .'
Required
5.
Existing Pro Dosed by Zoning
Use of Structure/Property " F,v"-
(if project is only interior work, skip to #6)
Building height
%Bldg.Coverage (Footprint) Y`
Setbacks - front o�
- side R L v R S t5
- rear c> vb�
Lot size
Frontage
Floor Area Ratio 7 �
%Open Space (Lot area minus
building and parking) 3,5
Parking Spaces
Loading - rt
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if(J_ necessary)
t4" k t✓F .L ��+�
Y /
7 . Attached Plans: /C 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: /,,—/0 - Applicant' s Signature: 2L14_-e_
/ THIS SECTION FOR OFFICIAL USE ONLY: i
Approved as presented/based on information presented
Denied as presented
as n fo Denial:
ignatAr6 of Buz nspector to
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 grarrting authorities.
7 /n r
City of Northampton REQUIRED INSPECTIONS
A
BUU'-JDING DEPARTMENT I. Footings and palls
2. Structural Components in Place's
3. Complete Building*
Office of the Building Inspector
No. 722
Zoning Fonn No. 000484 Date 11/12/92 Fee $40 Check# 1080 _
Page, 17A Parcel 67 ,Zone URA Sovction 127 J Yes ❑ No
PE BUI,, LDING I MIT
* Plumbing and Electrical Inspections required
THIS CERTIFIES THAT Nancy Boyer Vanasse _ before Building Inspections
has permission to Construct a sun porch addition 61x10' Inspection on Site—Foundations
situated on 22 Mountain Street Inspection of Plumbing—Rough
n this pen-nit shall in eve respect Inspection of Plumbing—Finish
provided that the person accepting pe every pee
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, In.;pcction 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 Is spection of Wiring—Finish 1
of this permit.Expires six months frosn elate of issuance,if not started. F uil6qg Inspection--Pougi. —
Note:A certificate of occupancy will be issued by this office upon return Insulation Inslr„-,ron
of this card signed by the Plumbing,Wiring and Building Inspectors Building Inspection—Finish —
Smoke",:.►etectors(Fire Department)
Other
THIS CARD ST BE DISPLAYED IN A CONSPICVou r,,.LACE ON THE PREMISES
Certificate of Occupanc
l =Building Inspector
1'.1<61 Snlrl7 ,