35-106 City of Northampton
t" i N , Massachusetts '`
. `: .- d N 1
40 ''' 1 DEPAR NT OF BUILDING INSPECTIONS .:
° 2112 in Street • Municipal Building �,r ;
^1 `i - 2012 I Northampton, MA 01060 : . y
DE'T. C P BUi__
00E
NORTHAMF ": -0':, MA 01060 ..:.:......
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check # 6 3 46 .3P- ( .J -� 1
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS C45 //�� �✓� • l r�/K �--,
1. Name of Applicant: Avtett -ea... 4e d teo b.Q -r }- 2-14G(c)e/
Address: 34 m 0. • ,Ulti bfD l '144 Telephone: 7 /8 ra '25� L i
er
2. Owner of Property: Vtt7 G // I �� 0 vC `/ amt
p
Address: l9toi-c. Telephone: qbv 0-C.
3. Status of Applicant: /Owner Contractor
4. Type or Brand of Stove: le 1 t 4 I-- Sla
Contractor's Name: 1" 4Sh
Contractor's Address:
Contractor's Phone:
Construction Supervisor's License Number: Expiration Date:
Home Improvement Contractor Registration Number: Expiration Date:
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: I / fi ?-- APPLICANT'S SIGNATURE 1
'1 W
DATE: /1511 Z HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
80 DREWSEN DR BP- 2013 -0019
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 - 106 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit # BP- 2013 -0019
Project # JS- 2013- 000023
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: NASH HEARTH & LEISURE_
Lot Size(sq. ft.): 9016.92 Owner: ZUCKER ROBERT G & ANDREA HEAPS ZUCKER
Zoning: Applicant: ZUCKER ROBERT G & ANDREA HEAPS ZUCKER
AT: 80 DREWSEN DR
Applicant Address: Phone: Insurance:
34 SUMMER ST (718) 812 -2544 0
W EYMOUTHMA02188 ISSUED ON: 7/5/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL PELLET STOVE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/5/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner