32A-179 (2) City of Northampton
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DEPARTMENT OF BUILDING INSPECTIONS a � x
yp ` . 212 Main Street a Municipal Building
! r Northampton, !Nk 01060 St;h Wr)
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 # L yS
PLEASE TYPE OR PRINT ALL INFORMATION
•
1. Name of Applicant: \\01_0\ �r1�
Address : ri '1)4v. / $1. ‘,NJ(LINAoo..f "COQ Telephone: �-1_ _∎'S -_ ' X04.,
2. Owner of Property; (t►. 'kS --- ----- - - - - -- —
Address: ' �� -c.( S'I. +v 4? te Telephone: ' - (o 1S
3. Status of Applicant: Owner Xontractor
4. Type or Brand of Stove: l i'" 1 - "t aTt..k, �a r+-rt
If applicant is not the homeowner:
Construction Supervisor's License Number Expiration Date
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: it Z .2 APPLICANT'S SIGNATURE 61
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
88 BRIDGE ST BP- 2013 -0473
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32A - 179 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 -0473
Project # JS- 2013- 000757
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13764.96 Owner: FLAHIVE MARY JANE & GREGORY R HAAS
Zoning: URC(100)/ Applicant: FLAHIVE MARY JANE & GREGORY R HAAS
AT: 88 BRIDGE ST
Applicant Address: Phone: Insurance:
88 BRIDGE ST
NORTHAMPTONMAO1060 ISSUED ON:10/23/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL HARMON 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 10/23/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner