30A-070 City of Northampton
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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 #(
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, PLEASE TYPE OR PRINT ALL INFORMATION
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1. Name of Applicant: 1 � tA 54 ' r pio --t" ,Bi LL YY Li ff__,i.
Address: 3 7 1= (l7'ii r . /�r7 U c i__ Telephoner �(� -� / �� l 6 / 0 3
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2. Owner of Property: � ✓� c'" 0 / 0 6 Z
Address: Telephone:
3. Status of Applicant: / Owner Contractor
4. Type or Brand of Stove: /k\" ej j , ?-e . l te±
If applicant is not the homeowner:
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
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my kno ledge / ,� (j/A___________ DATE: 49-1 I Z-- APPLICANT'S SIGNATURE �/l
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DATE: 2 HOMEOWNER'S SIGNATURE " l /k---
APPROVED
DATE: BUILDING OFFICIAL
317 FLORENCE RD BP-2012-0759
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A - 070 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 -0759
Project # JS- 2012- 001338
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 15638.04 Owner: MILLER WILLIAM J & KRISTEL L APPLEBEE
Zoning: URA(100) / /WSP Applicant: MILLER WILLIAM J & KRISTEL L APPLEBEE
AT: 317 FLORENCE RD
Applicant Address: Phone: Insurance:
317 FLORENCE RD (413) 586 -3776 O _
FLORENCEMA01062 ISSUED ON:3/5/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WHITFIELD 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:
FeeType: Date Paid: Amount:
Building 3/5/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner