35-031 Ci of Northampton
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Northampton, MA 01060 JsF.N /,11,.\'''
T DEPT OF BUILDING i MA010060NS
NORTHAMPTON,
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# A
Q PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 1�10S/��✓ j*C1y9�. 1 c /C''C w i c t ] e/
Address: 7 O 0 f l%M", /t U Roy en.e< Telephone: cif 3 d GP cf�� /
2. Owner of Property: S/9r2.1L
Address: Telephone:
3. Status of Applicant: / caner _Contractor
4. Type or Brand of Stove: V ev i'"so vt Cu/d ti'tiJ j /r A.C U vC
0/d /4
If applicant is not the homeowner:
Jt /74'0,0 d- �U �
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: APPLICANT'S SIGNATURE
DATE: 7/22 HOMEOWNER'S SIGNATURE_ `�
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APPROVED
DATE: _ BUILDING OFFICIAL
782 RYAN RD BP-2014-0225
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35-031 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-2014-0225
Project# JS-2014-000373
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 19994.04 Owner: KAZAKIEWICH ROGER A&VALERIE J SULLIVAN
Zoning: Applicant: KAZAKIEWICH ROGER A & VALERIE J SULLIVAN
AT: 782 RYAN RD
Applicant Address: Phone: Insurance:
782 RYAN RD (413) 586-4584 () WC
FLORENCEMA01062 ISSUED ON:8/27/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VERMONT CASTINGS ENCOVE
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 8/27/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner