38D-032 RECEIVED . •, of Northampton
o T . 1�2p t. \ \S 316
Massachusetts - ' '. •
t-- '' OCT 2 9 2012 sc
r > � i- I t • i , - . ■ e� OF BUILDING INSPECTIONS
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APT. OF BUILDING INSPECTIO Northampton, M8 01060 ss "4-'' - NORTHAMPTON MA 01060 _ j1 i
OINOLE Oa TWO I=AMILV soy in FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check # c t 7 q 4
/6,3 PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant / ) 0 U 9 '466 e'C..
Address: 75 hff)' -/Z/ S J % - 6 (L01�0 -/ PI A Telephone: si/ 46 7 7.a 7)
2_ Owner of Property: 4 h Rp p fir ,, t ' 7 `,,,
Address: /; /J99i L /9V/f )S/ 60 M F rn?7'D �! Telephone: •. 3 - A 6 0'93
3. Status of Applicant Owner 4"' Contractor
4 Type or Brand of Stove: /1' C fl3IYN(S ‚977, &ib arc C V e:
/ 27,5jA / /ED 21/70 ExiSr-isi Y1/00 Ch? M ne)/ t,.�� rot L L 1' A/ r(L....
If applicant is not the homeowner
Construction Supervisor's License Number 995 Expiration Date / 6 - / 5
Home Improvement Contractor Registration Number / & a V 5-9- Expiration Date /- 2 9- -/ V
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: l hereby certify that the information contained herein is true and accurate to the best
of my knowledge. /
DATE: / ®)th/ 1 APPLICANT'S SIGNATURE
-
i ''
DATE: / 0/ Z rl- HOMEOWNER'S SIGNATURE ,g. ,Ig
APPROVED
DATE: BUILDING OFFICIAL
13 HARLOW AVE BP- 2013 -0507
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38D - 032 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 -0507
Project # JS- 2013- 000812
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: BERNARDSTON FARMERS SUPPLY 99402
Lot Size(sq. ft.): 9583.20 Owner: LAPOUR LYNN E
Zoning: URB(100)/ Applicant: BERNARDSTON FARMERS SUPPLY
AT: 13 HARLOW AVE
Applicant Address: Phone: Insurance:
43 RIVER ST (413) 648 -9311 0 WC
BERNARDSTONMA01337 ISSUED ON:10/30/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VT CASTINGS ASPEN WOODSTOVE
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 10/30/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner