29-310 (2) 358 ACREBROOK DR BP-2018-1177
GIs f: COMMONWEALTH OF MASSACHUSETTS
MavBlock:29-310 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit. Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Wood Stove BUILDING PERMIT
Permit# BP-2018-1177
Project JS-2018-002109
Est Cost$1700.00
Fee:$40.00 PERMISSIONIS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Size(su.11.): 11717.64 Owner: SIMMONS RANDALL C/O MICHELE L SHARAC
zoning: Applicant SIMMONS RANDALL C/O MICHELE L SHARAC
AT. 358 ACREBROOK DR
ApplicantAddress: Phone: Insurance:
358 ACREBROOK DR
FLORENCEMA01062 ISSUED ON.511012018 0:00:00
TO PERFORM THE FOLLOWING WORK.-PELLET STOVE
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:
FeeTvoe: Date Paid: Amount:
Building 5/10/20180:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton / 2 _ w77
W Massachusetts � � r
IF DEPARTMENT OF BUILDING INSPECTIONS
Ma
,A 212 in Street • Municipal Building
f Nori,ha pion, Mk 01060 'i .a.
RECEIVED
MAY - 8 2018 SI GL OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FO WO D, COAL, PELLET, CORN,STRAW OR SIMILAR STOVES, OR FIREPLACES
DEPTO F BBAMDiNG JN F 0000 N5 Check# t -7`!Y/
Please fill in all appropriate information
1. Name of Applicant : _ _ /nccho,/a ShlfiY/L�J
Address: _ .21-58 410 - e Telephone. -'V,& 99x0
2. Owner of Property : /nGCLio.(r Sh l, '1 r_ 2
Address: 3,58 &. kjov--elle, Telephone: 4j&3- 99a0
3. Status of Applicant / Owner / Contractor
4. Type or Brand of Stove : YJLly�GrLLfid,� _ /fGfHt✓G✓ -- O� -�l.C� I ��'
5. UL Listing
6. Estimated Cost: 4147A4. 00
7. Email : _V7&2-acJmorrl ( /17 cn c/wn
If applicant is not the homeowner::
Contractor name Email
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
8. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: QS-O[J -/8 APPLICANT'S SIGNATURE
DATE: 6.5--05 HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL