42 City of Northampton
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RECEIVED Massachusetts
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piPT- OF BUiLpiNG INSPECTIONS
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 #
PLEASE TYPE OR PRINT ALL INFORMATION
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PROPERTY ADDRESS ( "( - 1 12-a I Ff ° v e
1. Name of Applicant: rrel.44 c,' 4 , U v'61'Z 5 e'er L-- I LL �/ K j°
Address: -P Telephone: � / 7O S
2. Owner of Property: . ac-t4 -.'
Address: Telephone: r' art 7t-
3. Status of Applicant: L Contractor
4. Type or Brand of Stove: 14e4 I C f e l 41 1 a 5 C
Contractor's Name:
Contractor's Address:
Contractor's Phone:
Construction Supervisor's License Number: Expiration Date:
Home Improvement Contractor Registration Number. Expiration Date:
All Applicants must complete a Workers Compensation before we can issue aperrnit - - -- -
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 41 b 1 APPLICANT'S SIGNATURE x.4 6-7-4---7---7,.
6.? DATE: \ ) 7 " HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
669 WESTHAMPTON RD BP- 2013 -0659
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 42 - 043 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 -0659
Project # JS- 2013- 001089
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 25047.00 Owner: JOHNSON FRANCIS & LUCY HARTRY
Zoning: Applicant: JOHNSON FRANCIS & LUCY HARTRY
AT: 669 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
669 WESTHAMPTON RD (413) 584 -9005 0
FLORENCEMA01062 ISSUED ON:12/18/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL HEARTHLAND ITASCA 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 12/18/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner