29-251 (5) City of Northampton
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d i • k DEPARTMENT OP BUILDING INSPECTIONS
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\''+•'' 212 Main Street • Municipal Building va s �
Northampton, MA 01060 Nn ,ta\
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 # 6?
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Rj'&r A . S�-i} -}
Address: 2O Qul 1Gr -- d ��-- Ave. 00 -, '''�ttz. Otvl-/O Telephone: `7/,3 L /7'S I - �O6
2. Owner of Property: Uc34S€Qh I I uckc,k- 't;
Address: 61 Q ✓csI0o k - ID riV im' Telephone: y/ 3 -,2(9 - vqo ic
3. Status of Applicant: Owner V Contractor
4. Type or Brand of Stove: a i G &ra. Utz, ) 1€.+ Si'1 S€"I
If applicant is not the homeowner: �,y,
Construction Supervisor's License Number s s roe Expiration Date 4�1�,f�' 4 0't'
Home Improvement Contractor Registration Number 160 6:;19 Expiration Date 0Y7 //y
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 Td accurate to the best
of my knowledge. // 1 ,i
DATE: 0 _> a` / J APPLICANT'S SIGNATURE "1 / k (
DATE: D 3w °� 0 � - �3 HOMEOWNER'S SIGNATURE -�"( r r -..../..../
APPROVED
4 1001 1 y -
DATE: L ` — ! / S BUILDING OFFICIA
61 OVERLOOK DR BP- 2013 -0896
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29 - 251 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 -0896
Project # JS- 2013 - 001531
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD SCOTT 83108
Lot Size(so. ft.): 18120.96 Owner: HUDOCK JOSEPH T JR
Zoning: Applicant: RICHARD SCOTT
AT: 61 OVERLOOK DR
Applicant Address: Phone: Insurance:
20 BULLARD AVE (413) 533 - 6340
HOLYOKEMA01040 ISSUED ON :4/4/2013 0 :00 :00
TO PERFORM THE FOLLOWING WORK :INSTALL QUADRAFIRE PELLET INSERT
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: 01( LI—
THIS PERMIT MAY BE REV e f4 • ; ∎: ;✓ OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND '� O � 09 jr i cto z e # 0.4 000
Certificate of Occuoanc Sig_nature:
FeeType: Date Paid: Amount:
Building 4/4/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner