18C-140 (2) i
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City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building vb
1 * Northampton, MA 01060 rg �
NGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
OR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check #_104
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Z 2C -I e
Address: ! � H01---(� / S( Telephoner-V-f 3
2. Owner of Property: 2
Address: // Telephone:
3. Status of Applicant: /Owner Contractor
4. Type or Brand of Stove:
If applicant is not the homeowner:
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: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
52HATFIELD ST BP-2015-0030
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 140 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-2015-0030
Project# JS-2015-000058
Est.Cost:
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 13634.28 Owner: CAREY WILLIAM A JR&JUDITH H
Zoning URB(IOO)/ Applicant: CAREY WILLIAM A JR & JUDITH H
AT. 52HATFIELD ST
Applicant Address: Phone: Insurance:
52 HATFIELD ST 0586-7382 (}
NORTHAMPTONMA01060 ISSUED ON.71812014 0:00:00
TO PERFORM THE FOLLOWING WORK: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 7/8/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner