29-110 (4) Q► �
City of Northampton
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Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS l
EC 1 2014 t
> �y J 212 Main Street • Municipal Building
Northampton, MA 01060
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 # ��3H
S L! PLEASE TYPE OR PRVT ALL INFORMATION
PROPERTY ADDRESS___I- � l��'7'��"�,._�.n /'P 1 �j.
1. Name of Applicant:_
Address: 2. 6 a 3 ,) Y\ tt D / Q 06i-lt 7 ,Telephone: L� 3 (z
2. Owner of Property: �vCf �rj LwC�
Address: 5' '-I i�yav� 2 cr� - I r,«ti��< t fUtA C I t s > Telephone: 73 L5`1
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove:__
Contractor's Name: Richard Scott
Contractor's Address: 20 Bullard Avenue, Holyoke MA 01040
Contractor's Phone: (413) 533-6340
Construction Supervisor's License Number: 83108 Expiration Date: 06/14/2016
Home Improvement Contractor Registration Number: 160629 Expiration Date: 08/08/2016
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 c
DATE: HOMEOWNER'S SIGNATURE _
i
APPROVED
DATE: BUILDING OFFICIAL
584 RYAN RD BP-2015-0605
GIS#: COMMONWEALTH OF MASSACHUSETTS
MM Block: 29- 110 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit# BP-2015-0605
Project# JS-2015-001169
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD SCOTT 160629
Lot Size(sq_ft.): 22520.52 Owner: Antigoni Lively
Zoning: Applicant: RICHARD SCOTT
AT. 584 RYAN RD
Applicant Address: Phone: Insurance:
20 BULLARD AVE (413) 533-6340
HOLYOKEMA01040 ISSUED ON.12/112014 0:00:00
TO PERFORM THE FOLLOWING WORK:QUADRAFIRE PELLET STOVE - MODEL MV-AE
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 12/1/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner