31A-088 (7) c y of Northampton
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' Massachusetts `
JAN — 7 2016
e DEPA� NT OF BU.TZDING INSPECTIONS
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.9212 Main Street • Municipal Building
DEFT OF t j Northampton, MA 01060
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD,COAL, PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check# ?XC
Please fill in all appropriate information
1. Name of Applicant
Address: 1 7 Telephone: -7357 � 7 / 7
2. Owner of Property
Address: -7 V-Li c,, Telephone:
3. Status of Applicant : Owner Contractor
4. Type or Brand of Stove : �� � 11601G1 �Cc (
5. Estimated Cost: G' G
If applicant is not the homeowner::
Contractor name
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
6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: APPLICANT'S SIGNATURE _
DATE:
-7 HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
17 VERNON ST BP-2016-0874
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31A-088 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory: woodstove BUILDING PERMIT
Permit# BP-2016-0874
Project# JS-2015-001917
Est. Cost: $500.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 16552.80 Owner: ALPER GLEN
Zoning: URB(100)/ Applicant: ALPER GLEN
AT. 17 VERNON ST
Applicant Address: Phone: Insurance:
70 MASONIC ST - APT A (413) 282-8889 O
NORTHAMPTON MAO 1060 ISSUED ON:11712016 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL FISHER MAMA BEAR 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 1/7/2016 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner