30B-118 -- NAM, of Northampton
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E ►,.w- . - TMENT OF BUILDING INSPECTIO y
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,fir ` 212 Main St • Municipal Building ' ,. ` C. ° .
, • � Northampton, MA 01060 sV iy a=�x^
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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 # VI
PLEASE TYPE R PRINT ALL INFORMATION
1. Name of Applicant: Z S `} 1 `
Address: 6 �Q/1 of I/ re . /144 A1. 7Ci" C 14 6 Pelephone: 3 Y 0- 6 3 b
2. Owner of Property: t x`964.1 1 l t
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Address: C3 w �'! ' f , " '4' O/ 0 T O el ephone: l 7 c 9` 3
3. Status of Applicant: _ Owner , _ J Contractor
4. Type or Brand of Stove: Cp„ 0 ,,, ' '
If applicant is not the M own R ‘ (-)1,,,-)6\ Ns S rt
Construction Supervisor's License Number O 3 ) 0 b // Expiration Date (, " ) 9 — 1
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Home Improvement Contractor Registration Number ) b 0 2 5 Expiration Date '
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All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: I hereby certify that the information contained her- in is tru - and accurate to the best
of my knowledge. D
DATE: ' 2 /1- 3 / I/ APPLICANT'S SIGNATURE ' ✓' % 4
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((1 DATE: / L I "� HOMEOWNER'S SIGNATURE lir
APPROVED
DATE: BUILDING OFFICIAL
65 WARD AVE BP- 2012 -0600
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30B -118 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- 2012 -0600
Project # JS- 2012- 001035
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD SCOTT 83108
Lot Size(sq. ft.): 56192.40 Owner: ZIMBALIST ANDREW S & SHELLEY ABEND ZIMBALIST
Zoning: RR(41)/URA(59) / /WP Applicant: RICHARD SCOTT
AT: 65 WARD AVE
Applicant Address: Phone: Insurance:
20 BULLARD AVE (413) 533 -6340
HOLYOKEMA01040 ISSUED ON:12/27/2011 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 12/27/2011 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner