43-061 _ 5
P;.,:_ ;'v ED i t y of Northampton
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'# D P 'NT OF BUILDING INSPECTIONS t fir
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.., OF BUILDING Northampton, MA 0 1060 s'b �� �
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 # /G)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /5f'l3 %�lGh'L k r Pt-
Address: 8 .7 vvh ty D,F iv i iy.&9r . Telephone: (' 57-Y
f
2. Owner of Property: , SI '7 C AS 4'2V e
Address: Telephone:
3. Status of Applicant: X Owner Contractor
4. Type or Brand of Stove: a`i4 t,4- A- 4100 Peezer. S'rovz--
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 knowledge.
i
2 _ G-.-
DATE: , 7 -/,� -/.2 APPLICANT'S SIGNATURE' '
DATE: 2 /J` 42 HOMEOWNER'S SIGNATURE /'r°' '**--
APPROVED
DATE: BUILDING OFFICIAL
8 DUNPHY DR BP- 2012 -0805
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 43 - 061 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 -0805
Project # JS- 2012 - 001410
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 15289.56 Owner: PEASE KRISTOPHER T
Zoning: Applicant: PEASE KRISTOPHER T
AT: 8 DUNPHY DR
Applicant Address: Phone: Insurance:
8 DUNPHY DR
FLORENCEMA01062 ISSUED ON:3/19/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL QUADRA FIRE 1200 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 3/19/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner