13-032 (2) M . ity of Northampton
• -
' Massachusetts
>t * c;
a' QQ n t'aar -TMENT OF BUILDING INSPECTIONS mi
U 1 Main Street • Municipal Building ON '∎�
- , Northampton, MA 01060
iopttOns
E1e P,urn r,c iO
ctn Norti,e...
SI GLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check # \J�
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS Li \ V_A \q �-
1. Name of Applicant: Drk r��P\lam.
Address: L\\`-\ or- - �� J'r Telephone: S-1?Lo ? -
2. Owner of Property: _
Address: L}\ Telephone: 5-3(
3. Status of Applicant: V/Owner Contractor
4. Type or Brand of Stove: 2ojcnc \--\ VJv '-.> cr‘‘r°� ��P\oaQ-2-. -
Contractor's Name:
Contractor's Address: \\,PS
Contractor's Phone:
Construction Supervisor's License Number: Expiration Date:
Home Improvement Contractor Registration Number: Expiration Date:
Al!Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 1 01 1$ 1 \ 2 APPLICANT'S SIGNATURE
DATE: ‘b ‘.( 1 ' HOMEOWNER'S SIGNATUREjo...�
APPROVED
DATE: BUILDING OFFICIAL
414 NORTH KING ST BP-2014-0483
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 13 -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-2014-0483
Project# JS-2014-000829
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 38507.04 Owner: WILLIAMS DANIELLE K
Zoning: Applicant: WILLIAMS DANIELLE K
AT: 414 NORTH KING ST
Applicant Address: Phone: Insurance:
414 NORTH KING ST
NORTHAMPTONMA01060 ISSUED ON:10/18/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL REGENCY H300 FIREPLACE INSERT
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Numbing 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 10/18/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner