17A-064 n PERMIT APPLICATION CHECK LIST
PAGE 7 PLOT rV ZONE
41 ��
YES NO DATE
1 . ZONING FORM APPLICATION L- � �� Q
2 . PERMIT APPLICATION
3 . OWNER OCCUPANT STATEMENT LIC . # IF NOT C/
4 . 3 SETS OF PLANS /PLOT PLAN
5 . NEW CONSTRUCTION
6 . CURB CU
7 . WATER AVAILABILITY FORMS
8 , REMODELING INTERIOR
9 . ADDITION
10 . ACCESSORY STRUCTURE
11 . SIGN / AWNI
12 . PERMIT FEE - CHECK ONLY - MONEY ORDER t/
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 BUILDrNG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building '
Northampton, Mass. 01060
HOMEOWNER LICENSE EXEMPTION
DATE: e3
(Please Print)
�(�
JOB LOCATION:
(MaVIA (parcel) (Subdivision)
HOMEOWNER: ,� ,
(Name & Address)
6 2)37e (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 buildinq
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.
OMEOWNER SIGNATURE r
BU ING PERMIT #
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/ Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No_ ^f f "d Alterations
NORTHAMPTON, MASS. i6 hk 191 Additions
1
APPLICATION FOR PERMIT TO ALTER Repair
Garage
10 Location .S / = _ Lot No.
(2/ Owner's name 6. U6 JV1 1 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:-�iding house
� Co
4. Estimated cost-
s �
The undersigned certifies that the above statements are true to the best of his, her
knowledge end clief. � �
,ra
Signature J responsible Irplicant
Remarks 11,Zi9"' Z--,
Date Filed qaiA�111
(ile No.
ZONING PERMIT APPLICATION (§10 . 2 )
J,/.," Name of Applicant:
A ell,
G ICA166J
Address : L6,-t,�JceT eA e p h o n e: Q
n
2 Owners of Property: y
-r
Address -, 22L2 gf ). r/ _,g_-Eil>CE Telephone .
3 . Status of Applicant: ),. OwnerS Contract Purchaser
Lessee Other (explain: )
4 . Parcel Identification: Zoning Map Sheet# Parcel// 0r
Zoning District (s) (include over s) ,
Street Address 5 ,
Required
5. Existincr Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%BI dg-.-C-aver e (Footprint)
Setbacks - front (5 r
- side L: R: =L: R:
- rear 11 j
Frontage
�1
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
C6 .) 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 : V 3 Applicant' sSignatu e�
�� THIS SECTION FOR OFFICIAL USE L
O Y:
" Approved as presented/based on information p resented
Denied as presented--Reason:
Sp cial' Permit d/or Site Plan Required:
F ' di qui d: Variance Required :
�q6j �S gnature c or ate
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.
i"7,)-
City of Northampton REQUIRED INSPECTIONS
� e
• 1. Footings and Walls
BUILDING DEPARTMENT 2. Structural Components in Place*
I Complete Building*
No. 967 Office of the Building Inspector
Zoning Form No. H Date 10/20/93Fee $20 Check# 2536
Page, 17A pawl 64 ,Zone URB Section 127 ❑ Yes 0 No
BUI]LDINGVERMIT
*Plumbing and Electrical Inspections required
THIS CERTH IES THAT Robert Kearney before Building Inspections
has permission to Install a garden shed 81x101 Inspection on Site—Foundations
situated on 257 Bridge Road 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 of issuance,if not started. 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 CONSPICU U PL ON THE PREMISES
Certificate of Occupancy
g nspector
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