22D-038 (3) �` Massachusetts � ��� _ /r•
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`i q DEP - MEET OF BUILDING INSPECTIONS r ..
�`�"3 0 1 I q 0i2 212 -in Street • Municipal Building � ,, "��
Northampton, MA 01060 s j ' trk y -�<
DEPT. OF 6Ui;.Dl1vU !'`, 'LOTIONS
NORTHAMPTON, 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 # /c 4 "/
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: `I " 1J 4 /h ill ace-, J
Address: /12 Ry n Pc / Pare-1 <p 4 Telephone: SZe 36/ 76 7 (
2. Owner of Property: S.citse.
Address: Telephone:
3. Status of Applicant: KOwner Contractor
4. Type or Brand of Stove: Re4iddor E€ (I O ( 5b f elfz` S
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 is true and accurate to the best
of my knowledge.
DATE: APPLICANT'S SIGNATURE
DATE: / 4 1 17 / 1) " - HOMEOWNER'S SIGNATURE f
APPROVED
DATE: BUILDING OFFICIAL
112 RYAN RD BP- 2013 -0460
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22D - 038 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 -0460
Project # JS -2013- 000732
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 61855.20 Owner: BORDEN BENJAMIN T
Zoning: URA(100)/WSP(100)/ Applicant: BORDEN BENJAMIN T
AT: 112 RYAN RD
Applicant Address: Phone: Insurance:
112 RYAN RD (508) 361 -7671 0
FLORENCEMA01062 ISSUED ON:10/17/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL HEATALATOR ECO CHOICE 50
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 10/17/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner