23A-053 (3) City of Northampton
Massachusetts
:- OEIV
AR NT OF BUILDING INSPECTIONS
21 Mai Street • Municipal Buildingfb
orthampton, MA 01060
NOV 2 7 2018
DEPT OF BU tDING INSPECTIONS �r�
NORTHAMPTON.MA 01060
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check# i.0 `
Please fill in all appropriate information
1. Name of Applicant :
Address: (�l��"> .;� � � Telephone:
2. Owner of Property: \rjC
Address: X22 l+.}�S�CCC L Telephone: �Ct3 S 6
3. Status of Applicant : /-,-,Owner
/Owner Contractor
4. Type or Brand of Stove : M&cy"
5. UL Listing := -{ 192-
6.
6. Estimated Cost : 0120
7. Email :_,\ )rt0 ,_
CID-
If applicant is not the homeowner::
Contractor name 1GErf�ail
Construction Supervisor's License Number G '6 ( Expiration Date j�- =
Home Improvement Contractor Registration Number J 6 6 b2� Expiration Date _ 20
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: 141-2-6 1 APPLICANT'S SIGNATUREZ) Af, _
DATE: Z i1p, HOMEOWNER'S SIGNATURE
APPROVED
DATE: 11 12--7 1 BUILDING OFFICIAL
12 WEST CENTER ST BP-2019-0634
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23A-053 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-2019-0634
Proiect# JS-2019-001036
Est.Cost: $2000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RICHARD SCOTT 83108
Lot Size(sa. ft.): 5052.96 Owner: GIORDANO LESLIE A
Zoning:URB(100)/ Applicant: RICHARD SCOTT
AT. 12 WEST CENTER ST
Applicant Address: Phone: Insurance:
20 BULLARD AVE (413) 478-6306 O
HOLYOKEMA01040 ISSUED ON.1112812018 0:00:00
,TO PERFORM THE FOLLOWING WORK.ALDERLEA T 4 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 Sienature•
FeeType: Date Paid: Amount-
Building 11/28/2018 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner