31A (2) City of Northampton
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nErv�'ly 1 "' Massachuset � �� 5 ''
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`I DEPARTlII�iNT OF BUILDING INSPECT � M'
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DEPT r , T , k i as 212 Main Street • Municipal Building �l- -
N�R'h ` p a °'� Northampton, MA 01060 SN� a ,)‘'‘
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 # ( S I
�` PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: S4 \ e , \A 5 ■ a 1
Address: 0 Y \ 4 0 •4,r-L Telephone: , 110 --. 5> / t — 3 4)-3 2
2. Owner of Property: 4
Address: Telephone:
3. Status of Applicant: /Owner _Contractor
4. Type or Brand of Stove: </0 3 "' `,
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: 04 �'" APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE 6.410-4-
APPROVED
DATE: /0 BUILDING OFFICIA
50 HARRISON AVE BP- 2013 -0647
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A - 224 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate ory: woodstove BUILDING PERMIT
Permit # BP- 2013 -0647
Project # JS- 2013 - 001063
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 9365.40 Owner: WEINSIER LAUREN B & STEVEN T
Zoi,ing: URB(100)/ Applicant: WEINSIER LAUREN B & STEVEN T
AT: 50 HARRISON AVE
Applicant Address: Phone: Insurance:
50.1 IARRISON AVE (413) 341 -3233 O
NG RTHAMPTONMA01060 ISSUED ON:12/12/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL SWEDISH WOODSTOVE
PC ST THIS CARD SO IT IS VISIBLE FROM THE STREET
,c of Plumbing Inspector of Wiring D.P.W. Building Inspector
Un ,aground: Service: Meter:
Footings:
Rev It: Rough: House # Foundation:
Driveway Final:
Fi i Final:
Rough Frame:
Ga : Fire Department Fireplace /Chimney:
Ro:) g h : Oil: Insulation:
Fii . ': Smoke: Final:
TI. IS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
Ar "i OF ITS RULES AND REGULATIONS.
Ce -tificate of Occupancy Signature:
Fe "I'vpe: Date Paid: Amount:
Bu in 12/12/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner