24A-239 City of Northampton
t ,,,,,;,,„„;,0,-„ ,� T1'J� Massachusetts .-
,t ` T DEPARTMENT OF BUILDING INSPECTIONS ; t
2 / 2 2 Main Street • Municipal Building r•�
ti
Northampton, MA 01060 j 'PP - \A'''
BUILDING MA 01060 '
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 # - /05 /
PLEASE TYPE OR PRINT ALL INFORMATION /
PROPERTY ADDRESS . `I °i jp p-i 1. , D/^. t r'ha m // / %Sc -
1. Name of Applicant: t / 172 j- ._/ , i y Ce /'
Address: h y / ry /l o _,//i )6 a , Telephone: / `t , 6 /3
2. Owner of Property: � tgr6nr - LTi . 7, u Ci //
Address: \. 5 - 4 /0 t Telephone:
3. Status of Applicant: I/ Owner Contractor
4. Type or Brand of Stove: P/0/2 ("fir` 2 (/) ( S (/e
Contractor's Name: ,Oa_ /0_ ` Simi `7/
Contractor's Address: 2 (a o/l e JL /./� Wr./.174-S &S S J 4 O / G'
Contractor's Phone: (ijic? ` Zi4 ' G, �‘)
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: 1 hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: �1 /2d,,?D /vZ- APPLICANT'S SIGNATURE \, -i / Z/�t_._
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
54 PILGRIM DR BP- 2012 -0812
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24A - 239 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 -0812
Project # JS- 2012- 001417
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DALE SMITH 101196
Lot Size(sq. ft.): 10280.16 Owner: RYAN BARBARA J TRUSTEE
Zoning: URA(100)/ Applicant: RYAN BARBARA J TRUSTEE
AT: 54 PILGRIM DR
Applicant Address: Phone: Insurance:
54 PILGRIM DR (413) 584 -6013 0
NORTHAMPTONMA01060 ISSUED ON:3/20/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL PIONEER BY LOPI 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 3/20/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner