35-258 (4) City of Northampton
! Massachusetts sr�
DEPAR2%NT OF BUILDING INSPECTIONS
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212 Mai Street • Municipal Building
13 2014
rthampton, MA 01060
Alec'. _L; ction�
060
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
PROPERTY ADDRESS r_TA
1. Name of Applicant: 1 1 G1&I 1 t/je-
Address: I/ 7 y r OIL k�l d Telephone:
2. Owner of Property:-jl f_(_,d d/,YIP //r?U S / t, "7 7
Address: �A fn 1:1 Telephone: r!6 rrt
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: ly aaJ 6 fP ff
Contractor's Name:
Contractor's Address:_ 4ZA,
Contractor's Phone: /,/t-
Construction Supervisor's License Number: j 1 G, Expiration Date: AIA-
Home Improvement Contractor Registration Number: i1 Expiration Date: 4/X-
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: Z' ,2l) ' /` APPLICANT'S SIGNATURE
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DATE: 'z0 HOMEOWNER'S SIGNATURE --------- -- —
APPROVED
DATE: BUILDING OFFICIAL
91 TURKEY HILL RD BP-2014-0822
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 35 -258 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-2014-0822
Project# JS-2014-001410
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 79714.80 Owner: PARSONS TIMOTHY VIETOR&MADELINE NELL MOSER
Zonine: Applicant: PARSONS TIMOTHY VIETOR & MADELINE NELL MOSER
AT. 91 TURKEY HILL RD
Applicant Address: Phone: Insurance:
91 TURKEY HILL RD
FLORENCEMA01062 ISSUED ON:112312014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL JOTUL 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 1/23/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner