37-132 City of Northampton
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SINGLE OR TWO FA I ' OLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS j
Permit Fee: $25.00 Check # ` ,fq
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Timothy Deshaies
Address: 526 Florence Road, Florence, /4/Telephone: (413) 531 -1693
2. Owner of Property: Timothy Deshaies
Address: 526 Florence Road, Floremce MA Telephone: (413) 531 - 1693
3. Status of Applicant: X Owner Contractor
4. Type or Brand of Stove: Vermont Castings Wood Stove Insert
If applicant is not the homeowner:
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 i rue i d ccurate to the best
of my knowledge.
DATE: 09/24/2012 APPLICANT'S SIGNATURE IA t
DATE: 09/24/2012 HOMEOWNER'S SIGNATURE \ V Nifil
APPROVED
DATE: BUILDING OFFICIAL
526 FLORENCE RD BP- 2013 -0340
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37 - 132 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 -0340
Project # JS- 2013 - 000540
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 461910.24 Owner: DESHAIES TIMOTHY
Zoning: Applicant: DESHAIES TIMOTHY
AT: 526 FLORENCE RD
Applicant Address: Phone: Insurance:
526 FLORENCE RD (413) 531 -1693 0 WC
FLORENCEMA01062 ISSUED ON: 9/24/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VERMONT CASTINGS WOOD STOVE
INSERT
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 9/24/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner