02-027 (6) C V
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116•
Home Improvement Contractor Registration
Registration: 148198
Type: Private Corporation
Expiration: 9/13/2015 Tr# 243956
OLDE HADLEIGH HEARTH & HOME CENT
MATTHEW COX --- ------ --- --- ---- --_ __ -
119 WILLIMANSETT STRETT RT 33 — — -
S. HADLEY, MA 01075 —-----
Update Address and return card.Mark reason for change.
ti zoM-oeiii (� Address ❑ Renewal ❑ Employment L I Lost Card
- -� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
egistration: 148198 Type: Office of Consumer Affairs and Business Regulation
-expiration: 9/13/2015 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
DE HADLEIGH HEARTH&HOME CENTER, INC.
,TTHEW COX
3 WILLIMANSETT STRETT RT 3 g
HADLEY, MA 01075 Undersecretary Not valid without signature
Massachusetts w Department of Public; Sa �C�a��
Board of Building Regulations and Standards.,,;
('trl7strliction Supervisor Spechilty tfis�'�����"J, ��'S ' '"
I.._i C e n s e . CSS l.-098784
St
MATTHEW COX
54 HADLEY STREET,),
SOUTH HADLEY' MA;,{',�I ►';$ /4
r
04/28/2015
C; C3rT)m l 5 s i o n e C
yv ,��p�,�y_, yam. T, •el JJJLV JGL
ITIL--I I�H.J 11YJURHIYIL r HI�C UGI UL
�pATE(Mmlary Y1y)
CERTIFICATE OF LIfi►BILITY INSURANCE 1oL3/14i
THg CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND., EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITVTE A CONTRACT 13ETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: if the certificate holder is an ADD17IONAL INSURED, the policy(les) must be endorsed. If SUSROGATION IS WANED, subject to
the terms and conditions of the policy,certain policies may require an Iondorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsemen s.
PRODUCER CONTACT
NpNONE AME; Denise Bxais
Metras Insurance Agency 413 536-1491 Not: (413) 532,8522
2030 Memorial Drive
Chicopee, MA 01020 AD bas: dblais @metrasinguranae.com
INSURpRS AFFORDINOCOVERAdE NAICft
,__.-... .._ _. ,.._ _... _. _.. INSURPRA: arajVQ1erA InS CO _
IN3URm --._�_.. •— INSURERS:
Older Hadlei,gh Hearth 6 Home Ce INSURER C; _
119 Willimansett St. INSURE
South Hadley, MA 01075 INSURER E•
INSU RER F
COVERAGES CERTIFICATENUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PCR1O0
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TNSR A�Of; BR pc T.�'EFF �6WCY EXp
LT TYPE OF INSURANCE POLICY NUMBER MMlDD/Y MM1DOIVYYY LIMITS
A OENERAt,IJANI.IY 660791OA716 8/30/14 8/30/15 GACHOCCURRENCE S 1 000 U00__.
X COMMERCIAL GENERAL LIABILITY DA GE TOREN ED $ 0,OL +
_P_REMLSLS(Ea oc�u¢onc�_ 0 ,
CLAIMS-MAIM OCCUR ME_ D FJCP arV one penal) s _9,0
PPRSONAL&ADVINJURY 1IOT)OU,0D0 1
9F NEPAL AGGREGATE & 21000,000 1
GEN'L AGGREGATE LIMIT APPLIES PFR PRODUCTS-COMP(QlpAGG a 2 0QgQ 000__
POLICY 7 PR LOC 9
AUTOMOBILELIABIIJTY BA2055C668-14 13/30/2.4 8/30/.5 OI EU INGLELI f' `1,000
ANY AUTO BODILY INJURY(Per person) $
AUTOS
WNrD X SCHEDULED BODILY INJURY(pear eccldent) IF
AUTOS
X HIREDAUTOS X NON-OWNF,D PR PE YD R
_AUTOS (Peraccldont)�., '
S
A UMBRELLALIAO OCCUR CLTP2649Y614-14 8/30/14 8/30/15 EACH OCCURRENCE s 1,0001000
EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1 0OO OOO_
DED RETENTION
WORKERS COMPENSATION UB5Xg7B81-6^Z4 7/12/14 7/12/15 WCSTATU• X OTH-
AND EMPLOYERS'LIABILITY Y t N p&yJJMITS ER_
ANY PROPRIETORIPARTNERIEXECUTIVF — N/A E.L.EACHACCIDENr x_500,000 ,
OrFICERIMEMSER EXCLUDED?
(MI endatory InNH) E.L D1$FASE•EAELaryPLOYE- 500 OOO`
f(yse tleacribw under --
DES4`RIPTIONOFOPERATIONShslaw E.L.DISEA8E-FOLIC LIMIT 500,000
ESCRIPTION Dr DPERATIONS r LOCATIONS/VEHICLES (Attech pCORO 107,Aafcliltonal Remarks scpndyie,{f morn n�a a{s raqu md)
roof of coverage.
ERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Eliza Wilmarding ACCORDANCE WITH THE POLICY PROVISIONS,
680 North Farms Road `
Florence,, MA 01060 A u RIZED E A
D9na.se B ai,8 _
(t)1988-2010 ACORD CORPORATION. All rights reserved.
CORD 25(209 0105) The ACORD name and logo are iregistered marks of ACORD
3ne: Fax: E-Mall:
Hearthstone Quality Home Heating Products, Inc. Homestead Models#8570F and#8570H
Wall Clearances (4-inch legs, with surround)
F[REPLACE
WALL WALL
D
Surround
�--E--�
Trim and side wall clearances
for fireplace installations
D=9" -TO SIDE TRIM
E= 14" -TO SIDE WALLS
Mantle Clearances (4-inch legs, with
surround)
3 6 9 i2
2 `- _ TRIM OR
-- MANTLE DEPTH
22 COMBUSTIBLE
tt MANTLE ABOVE
THIS LINE
a
T 2J •W/I.5"MANTLE
P 26"-W/7.5"MANTLE
° 29"-W/13.5"MANTLE
v
t;.
T
P ALL UNITS
o ARE INCHES
r'
s Surround
T Homestead
0
v
C
13
Hearthstone Quality Home Heating Products, Inc.® Homestead Models#8570F and#8570H
Fireplace Clearances(4-inch legs, without Dimensions and Clearances for
surround) Hearth Mount (#8570H) Stove with
The Homestead stove with 4-inch legs fits uniquely
under a 22-inch lintel. 4-Inch Legs and Surrounds
The following four illustrations depict the stove's
dimensions and fireplace, mantle, and wall
_ clearances for a stove with 4-inch legs with a
c- T surround. (Please refer to "Surround Kit" on page 9
for information about this option.)
22" Stove Dimensions (4-inch legs, with surround)
MIN.
22"
MI-N.
14 .� I 3
minimum��
r I ` III
16" fireplace 4.. 'J Iv.. �I
size
Mantle Clearances(4-inch legs, without surround) Fireplace Clearances (4-inch legs, with surround)
The Homestead stove with 4-inch legs fits uniquely
under a 22-inch lintel.
tt�unt oaTataf
TRIM OR
11 MANTLE DEPTH
E ,
c COMBUSTIBLE
T MANTLE ABOVE 22"%32"
A THIS LINE
B MM./MAX.
0
V 36"-ANY SIZE MANTLE
0 25"/43.5"
P M IN./MAX.
0
F ALL UNITS
r ARE INCHES
a
V
r
Homestead
minimum 4"
16„ fireplace
size
25"
12 -----I }
12
Hearthstone Quality Home Heating Products, Inc.® Homestead Models#8570F and#8570H
4" solid clay brick 0.80 Wall Clearances(4-inch legs, without surround)
Total R-value 2.82
FIREPLACE
'/2" mineral wool insulation 1.56
-18" horizontal still air 0.92
1".cement mortar 0.20 WALL WALL
Total R-value 2.68
Fireplace Install For Hearth Mount D
Stove (#8570H) with 4-inch Legs
Before installing your Hearth Mount stove with 4-inch E-.-)
legs, understand the following dimensions and
clearances. Trim and side wall clearances
for fireplace installations
Dimensions and Clearances for Stove's with D=23" -TO SIDE TRIM
4-inch Legs but without Surrounds E=23"- TO SIDE WALLS
The following four illustrations depict the dimensions
and fireplace, mantle, and wall clearances for a
stove with 4-inch legs and without a surround.
Stove Dimensions(4-inch legs, without surround)
25.5" 23.5"
21.25"
191.5"
f
FRONT VIEW SIDE VIEW SIDE VIE\V
15.I'75"
I
TOP VIEW
11
Olde Hadleigh Hearth& Home Center, Inc. Invoice
119 Willimansett St Rte.33 Date Invoice#
South Hadley, MA 01075
413-538-9845 9/30/2014 115236
Bill To 101 ,01, Ship To
Eliza Wilmerding
680 North Farms Road
Florence,MA 01062
P.O. Number Terms Rep Ship Via F.O.B. Project
10/1/2014
Quantity Item Code Description Price Each Amount
1 10 Hearthstone Homestead 2,699.00 2,699.00T
1 10 6x35 Liner 982.00 982.00T
1 10 Damper Sealing kit 40.00 40.00T
1 10 Hearth Extension 84.95 84.95T
1 Labor Labor 950.00 950.00
1 Deposit Customer Deposit -200.00 -200.00
Sales Tax Payable-MA 6.25% 237.87
Total $4,793.82
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under"Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 7-2013
www.mass.gov/dia
4 The Commonwealth of'Massachusetts I
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
_, �;';' Boston MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Olde Hadleigh Hearth&Home Center,Inc.
Address:119 Willimansett Street
City/State/Zip: South Hadley, MA 01075 Phone #:413/538-9845
Are you an employer? Check the appropriate box: Type of project(required):
1.[✓] I am a employer with 8 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have g, ❑ Demolition
working or me in an capacity. employees and have workers'
g y p �'• 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no Install wood stove
employees. [No workers' 13.❑ Other
_ comp. insurance required.]
.Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
1 f lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:Travelers Insurance Home Improvement Contractor's Liscense#148198 ^�
Policy # or Self-ins. Lie. 0EUB51971381b Expiration Date: 7/12/2015'
Job Site Address:_ 7(� 4!�. fir&_5 fil City/State/Zip: F/adz.-Oj`?,�qe.19 G'/n
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
Fine up to $1,500.00 and/or one-year imprisonment, as4ell as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi .under the aims and genalties o er'u that the in ormation provided above is true ofd co recz
Si nature: Date' 3
Phone#:538-9845 CS SL #9878
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License#
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone#:
SECTION 8-CONSTRUCTION SERVICES
8.1 Licensed Construction Su er isor: Not Applicable :
Name of License Holder: l e/lzz P
License Number
Address Expiration Date
Sig tur Telephone
-7
(V
(qw , - � Ll�
9.,Rea[stere me Imorovement Contractor: Not Applicable
(��Xalf
COMDanv Name Registration Number,
Add s / �q / `/ Expiration Date
Y/e A/ C/Cf/�✓Telephon�%��J �
SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the ilding permit.
Signed Affidavit Attached Yes...v/ No......
11. - Home Owner Exemption
The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families
and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.CMR 780, Sixth Edition Section 10835.1.
Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there
is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm
structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner.
Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of
Northampton Ordinances,State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable)
New House ❑ Addition ❑ Replacement Windows Alteration(s) Roofing
Or Doors ❑
Accessory Bldg. ❑ Demolition ❑ New Signs [O] Decks [M Siding [O] Other
Brief Descriptiop of Proposed
Work: 4:2 Lei 021A
Alteration of existing bedroom Yes -- ' No Adding new bedroom Yes ---No
Attached Narrative Renovating unfinished basement Yes —_,---No
Plans Attached Roll -Sheet
6a. If New house and or addition to existing housing, complete the following:
a. Use of building :One Family ✓ Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. WZA Dimensions
e. Number of stories?
f. Method of heating? 4'0_� Igo tv0d Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. of wetlands? Yes PJO. Is construction within 100 yr. floodplain Yes ✓No
j. Depth of basement or cellar floor below finished grade vZA
k. Will building conform to the Building and Zoning regulations? ✓ Yes No .
I. Septic Tank City Sewer Private well City water Supply
SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, ,5U; /s�wt z/ �r P as Owner of the subject
property
hereby authorize
to ac�on my behalf, in all matters relative to work authorized by this building permit application.
Signatu f Owner Date Zpj
as Owner/Authorized
Agent eby declare that the sta nts and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
l� � WrI►�4�-��
Print N e
Signature of Owner/Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size U eke%re
Frontage
Setbacks Front
Side L: R:� L R:P
Rear
Building Height
Bldg.Square Footage 7� ' %
Open Space Footage /�? %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill: .�.
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
ICU DON i KNUVV
l r tS �J
IF YES, date issued:'
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW YES
IF YES: enter Book : Page- and/or Document#
B. Does they Pte contain a brook, body of water or wetlands? NO Jey DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued: '
C. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: 070 c'-11 f,..e-t- y, �
D. Are there any proposed changes to or additions of signs intended for the property? YES NO ;
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Depar"eint only
�w y p u
t of Northampton Ststis pf Permtt
--I jilding Department Curb,0ut/QgvewayPermlt
OCT _ 201 212 Main Street Sawer/S;ptiAvaflabtr
�� �i 4
Room 100 V1 ateritN !Ay 11 blij
or hampton, MA 01060 Two Sets of Structti1
Electric,Plumbing$G s Ina `a
Northampton, � 87-1240 Fax 413-587-1272 P1oie Plains
APPLICATION TO CONSTRUCT,ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
1.1 Property Address:
This section to be completed by office
�Yn J~� /`A4 12_� Map Lot Unit
Zone Overlay District
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Cf(e, tA1j 1 rK e Cd i✓k &-Tv Ay-r seK u AX a it Z
Name e Current Mailing Address:
T7
Telephone
Signatuig �l
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building �3 (a) Building Permit Fee
r
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
680 NORTH FARMS RD BP-2015-0420
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 02-027 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-2015-0420
Project# JS-2015-000750
Est. Cost: $4794.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 331099.56 Owner: WILMERDING ELIZA
Zoning: RR(100)/WSP(100)/WP(47)/ Applicant: WILMERDING ELIZA
AT. 680 NORTH FARMS RD
Applicant Address: Phone: Insurance:
680 NORTH FARMS RD (413) 694-1477 O WC
FLORENCE ,MA01062 ISSUED ON.1011012014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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 10/10/2014 0:00:00 $25.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner