38D-056 -�HgM E E! o Northampton
' sachusetts �,� - . '.
SEP 2 7 W �"
. TMENT F BUILDING INSPECTIONS 3 as
°' ! _ 2 12 Main St t • Municipal Building 2 J d a
�
' it --Nor ton, MA 01060 - � r
DEPT. OF BUILDIN,_. I T r : {Y 1' � ,
NORTHAMPTON MA?'0
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 # 30 g
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: - C�i J i Address: a.b Lo 2. ,J t � � PrtY r'` ! k / elephone: I — , k. — � C
2. Owner of Property: cL � � ; ia�
,
Address:q 0 1 , ri.. 4 - AJDt4",,,A.0-vt-, Telephone: q i s'"v�s 0y'-
3. Status of Applicant: _Owner - ':Contractor )
4. Type or Brand of Stove: tJ LJ O A. f C o,' -,1' .c _ S -1J i in i �LJa fv v ( :'✓* c? '1- `
• If applicant is not the homeowner: / /6//9 '
G Construction Supervisor's License Number 5 SL Expiration Date 7 7
Home Improvement Contractor Registration Number & /:.?? Expiration Date 7 •
All Applicants must complete a Workers Compensation insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained herei is true d accurate to the best
of my knowled e.
DATE: 9 /y /(;,2 APPLICANT'S SIGNATURE 4 f /C> // C rim e
DATE: �( / I q ( HOMEOWNER'S SIGNATURE . .
APPROVED
DATE:_ / BUILDING OFFICI ,
-.'d-A °I'mm°° '/7----"--;-'-' .
40 WINTHROP ST BP- 2013 -0359
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38D - 056 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 -0359
Project # JS- 2013- 000586
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DALE A SMITH 101196
Lot Size(sq. ft.): 6403.32 Owner: DONSON ANDREW C & ERIN HOLMAN
Zoning: URB(100)/ Applicant: DALE A SMITH
AT: 40 WINTHROP ST
Applicant Address: Phone: Insurance:
26 COLLEGE VIEW HGTS (413) 536 -6830
SOUTH HADLEYMA01075 ISSUED ON:10/1/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VERMONT CASTINGS WINTER WARM
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 10/1/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner