30A-045 (2) • 1
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his/her construction supervisor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he/she resides or intends to be, a one or two family
dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two -year period shall not be considered a
home owner."
The building, department for the City of Northampton wants person(s) who seek to use
the home owner exemption, to act as their own construction supervisor, to be aware that
by doing so you become responsible for compliance with state building codes and
regulations. The inspection process requires that the building department be called to
inspect work at various stages, which include foundation /footings (before backfill)
sonotube holes (before pour), a rough building inspection (before work is
concealed), insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
jermits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
' understand the above.
(Home owner / 'dent's sign .ire requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
. The Commonwealth of3fassachusetts
=■%-----.2"--- Department of Indus Accidents •
pi, — li
Z ■• . Office of Investigations
600 Washington Street
Boston, MA 02111
... .i.. , T...1.--;"
www.mass.gov/dia
, •
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers -
Applicant Information - Please Print Legibly
Name (Businesi/Organiz' ation/Inclivirin2D: .
• Address: ,. •
. .
City/State/Zip: - Phone.#:
Are you an employer? Check the appropriate box: • Type of project (required): 1
• 1. I am a employer with 4. 0 I am a general contractor and I _
6. 0 New construction
have hired the sub-contractors
employees (full and/or part-time).*
'listed on the attached sheet: 7. 0 Ren:Lodelirt •
2_ 0 I am a sole proprietor or partner-
ship and have no .3.loyees These sub-contractors have .8. 0 Demolidon.
• • working for me in any capacity. envloyees_and have workers' •
9. El Buildiiii addition
[IsTo workers' comp. insuiance
5 0 We are a corpo an d rt 10.0 Electd
requirecL] cal repairs or additions
.. .
3. 0 I am a homeowner doing all work officers havexercised their .
11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.] t ' c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp insurance reqUir.ed.1
*Any applicant 1hat checks box #1 must also fill out the section below showing their svorioers compensation policy infinmation. ': •
t Homeowlicri who submit this affidaVit imficating they are doing all watt and then hire outside contractors must submit anew affidavit indicating such. .
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether-or not those entities have
employees. If the sub-contractors have employees, they must provide their workers' comp policy nmnber.
I am an employer that is providing workers' c ompensation insurance for my einployees. Below is the policy and job site
information. .
.
Insurance Company Name: . • ' - .
. •
Policy # or Self-ins. Lic. #: Expiration Date: -
. . .
Job Site Address: " City/Sta/Zip:'
Attach a copy of the workers' • compensation policy declaration page "(showing the policy number and expiration date).
Failure to secure coverage as required Udder Seetioff25A c 152 can lead to the iiopOsitiOn of Ciiioing penalties of a
fine up to $1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK-ORDER and a fine
of up to $250 00 a day against the violator. Be advised That a copy of this statement may be forwarded to the Office of __,
acie &the DIA for insurance criVeraie - :. -- _ 7 - , 77. -
. ..._....._.. _ .... ... _
_ Ida heriby,ceriffr under the pains•and penalties ofperjztrythat the infomullion provididibove_is.truc_tizid_eorrerf
Signature: ' - - Da • - • . ,
- . ,
Phone ti: , . •
Official use only. Do not write in this area, to be completed by city or ton; rzofficiol
• City or Town:
Permit/License #
Issuing Authority (circle one):
.-
- •
.1. Board of Health 2. Building Department 3. City/Town Clerk 4. EIectricalInspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #: 1". .
• •
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
-, 4 . VMI
$•�8�!_� . �.e3L; 3.rO iii � +�"�:. � � ° .� ,s , ;7 : , °= Not Applicable ❑
Company Name Registration Number
Address Expiration Date
Telephone
SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes ❑ No ❑
! Ras 1" 1
The current exemption for "homeowners" was extended to include Owner - occupied Dwellines of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside, on which there
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm
structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the buildine permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
r.:
ner Signature
. ,
~ ` ,
SECTION 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
New Hous El Addition Alteration(s) Roofing p
Or Doors
D F
Accessory Bldg. � Demolition New Signs [0] Decks [1=1 Siding [D] Other [0]
^- *° ' .
ork: jm~ � p~°x a«�/9�n� pite././MtiraD )944 rr iA1- 7 44-4 "
Alteration of existing bedroom Yes No Adding new bedroom Yes No
Attached Narrative Renovating unfinished basement Yes No
Plans Attached Roll - Sheet
a. Use of buliding : One Family Two Family Other
b. Number of rooms in each family unit: Number of Bathrooms
c. Is there a garage attached?
d. Proposed Square footage of new construction. Dimensions
e. Number of stories?
f. Method of heating? Fireplaces or Woodstoves Number of each
g. Energy Conservation Compliance. Masscheck Energy Compliance form attached?
h. Type of construction
i. Is construction within 100 ft. ofwetlands? Yes No. ls construction within 100 yr. floodplain Yes No
j. Depth of basement or �llar floor below finished grade
k. Wifl building conforrn to the Buliding and Zoning regulatioris? Yes Nu.
I. Septic Tank _____ City Sewer Private well City water Supply
~
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
|. .os Owner ofthe subject
property
hereby authorize
to act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
<-
1, / \/� . aoOvnanAu�ohzed
Agent h��bydodon the fm�goingoppUcodonomtmeand accurate, ho the best ofmyknm�edge
/ /
and belief.
Signed under the pains and penalties of perjury.
��
��N�W 0 / 2 Y//
4 . ��
� �� ' �m
nmmmoxowmovwmo.. `^
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
' Lot Size ! t
Frontage 1 _ 1 I 1 I
Setbacks Front 1 1 1 3 s
Side L: R:I 1 L:! ' R: I i i `
£
Rear i � 1 ` e
Building Height I i ?
Bldg. Square Footage %
Open Space Footage % — — —i ----1
(Lot area minus bldg & paved 1 I i ? E
parking)
# of Parking Spaces I # `° _,
_
Fill: m ,_._ ._..�., 1
Fill: & Location) s _
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES 0
IF YES, date issued:,
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book # Page! 1 and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained ® Obtained ,Date Issued:
C. Do any signs exist on the property? YES (3 NO 0
IF YES, describe size, type and location: i I
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location: r 1
E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
_ r
City of Northampton
Building Department
rp 2,12 Main Street �� .,.
\ROOm 100 .
kt
��C3 Nort pton, MA 01060E �� ���r
,,�
phone 4' 3' 587 -1240 Fax 413 - 587 -1272 f ,� ����.;-
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
SECTION 1 - SITE INFORMATION
,1 Property This section to be completed by office
31 Le,(n.$4o r A4 ie, Map Lot u nit
FIbIr1i14GG u Zane Overtay District
Ekn ° St. Disstdct CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
l)an/y Swe,e, Set.w c a-6 a -hire.
Name (Print) Current Mailing Address:
Sib — f y Og
Telephone
Signature
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) Check Number I y 0/-5
This Section For Official Use Only
Date
Building, Permit Number: Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
Y i
:31 LEXINGTON AVE ' BP- 2011 -0167
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Biock: 30A - 045 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0167
Project # JS -2011- 000272
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 15681.60 Owner: SWEENEY DARCY K
Zoning: URB(100)/ Applicant: SWEENEY DARCY K
AT: 31 LEXINGTON AVE
Applicant Address: Phone: Insurance:
31 LEXINGTON AVE (413) 586 -6408 ()
FLORENCEMA01062 ISSUED ON:8/25/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE IN EXISTING
FIREPLACE
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 8/25/2010 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
01 'flee oi:Coristimer Ail'airs and -1 ifusiness Regtdation
10 Park. P1az:3. - SLIite 5170
Boston, Massacilliscas 02116
Home liTipi Contri4ctor Reoistiatiori
fz,e(iistra1ior).: 131945
Type. Ivclul
• • ••• • Ex21ration: 10[13/ Trti 2:04
• • • -
•
STEVEN A. SILVERMANI .
, •
STEVEN SILVERP:11At\I
:
269 FOMER RD: •
SOUTHAMPTON, MA 01073
re.t rW Nittrit: . ftr
Erriplovriu.11( 1,r.v.,r
Aff'ni.r 1 .Y
HOMEIWIPROVE11,11EP4T1',ONTRACTOR t)ert)re- tb e-tpit €1:tte. If fiitttilf to:
Req a tic II: T?pe: offi At fait's ..111
E.7.xpiratio.rt: 10,-'13.r201.2 -
itfort, 1 1!.1 !t)
3EF `St: • •
t3"IEVEN ,•
, -------
SiDUTHAMPTON M4t.1073 •
1.;fittert,,rt Not IiJ ‘vitlit)o i;itttri;!.
g: J1 1 1 s
77•279•
STE \l'i7.1 A S1LVE.1
2 Ft.)1VER
SOUTHAP 1 t‘4, .tdvk 13112,• 3
.. .
----,
- SECTION 8 - CONSTRUCTIOF SERMES
1 ... ............
7
.1 Licensed Construction Supervisor: Not App:icable ED
Hame of License Holder : Steven Silverman 077279
N
2 G 8 Fern r Roa 7,, ,7 • uthamp_ton. ,, A 01 n71
i
Lo
■ Address Expo ra Dni,
584-7522
c
S'gnature Telepflene
i . vistereci Home irnprovement COntractor: ' Not Appl:cabe. 0
1 Steven Silvel 131945
1 Company Name Regjetration Nun
l 258 :Tomer Road I 10/13//2.
I Address [ EDU Date
i Sou thalYzr) tor . Iva 0 1 0 7 3 T& 584 I
di
5EC110141e- WORKERS COhriPENSATION INSIIRANCE AFFIDAVIT (l'A,G.L c.152, fi 21-7C(6)) 1
i
I Workers Compensation Insurance affida must be completed and submitted with it apprcation. Failure to providelhis affidavit
will result in the denial of the is's.uance of the building permft. , I
. .
Sioied Affidavit Attached Yes II No 0
I
HOille tv nel ._:_,Afzihr ttet
1110 CUrfeElt exemption 101 "homeowners" was extended to include Ownec-occunicA KliwcHiniy:s (loae (1) or two(?) 'Families'
and to allow such homeowner to enage an individual for hire who does not possess a icense, flroviclecl thy.4. the owner 2cts
as sumervisor. Clkin 780, Sixth Edition Section 108.3,5.1.
flefirtitiop of Homeowner: Person (s) who own a parcel of land n which he.islie resides or intends to reside, on which th
is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ Cr rfiVnl
5AFLICi131":::s. A Der411 wi“) c:11trIkL" Yi3:31:0 i71 C,11.=_ E',C1r:13 L i; '• ri.c,.. SkLZ.,t, Ei',.:', :::::: Z3i! aa :.ic.iii.L4'
Such "homcowner" shall ;submit to the Building Official, 00 a form acceptahle 10 tho Buildint4 Oflicial, atnt telsh-a si]
u4. for al: smIeln ',.,\ ork i'l‘erfrirmed under ile: bulafinfl, 1,,n
As acting Construction Stinervio2 your presence. on the job site will be requitvd FrOM time to time, duriin4 and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (WorLers' Compensation) and Chapter 1 (Liability of Ell; pr,inyers to
' Employees for injuries not resulting in Death) of the Massachusetts General Laws Arnotated. yea :Ylav 2 E:2.. 'for person(s)
you r:ire tcp peLLonn \VOik ';01:y0
:sines rc!ry,ensibi!fts/
b'1;;7; Viit199.V.,:a A
Pte 0 S:dif
c't cerge Cry) 710b(9.., h et.) k.tckiJ w1
. J1c:q,tsc . arid or 3ddition to existing housing. corripicto t'fie
r"
•
t. A
`4 ri ;2.; %,2.1,` ;1; 1 ;;) .,"1 ,;
:`,. ` a .] :":
, • 4 ' ft ; ); v •
SECT1011 to OWNCR AUTHORIZATiON - T3 BE COMPLETED WHEN
EP,S ,t.GENT OR CONTRACTCR Pt FOE OZ.:1 -73 PPMT
1
: Steven S3.1verruari, Valley Horne /11proverrterit., Inc.
! . •
/ I
Steven_Silverman.,._ Va11y licitte _Irtprovezitent, Inc
. ..;; •. e , ° ;;V: ;'"• ,`,
Steven Silite,rn.n
/Z/&)
Section 4
ALL INF 11SRMATION MST BE COMPLETED, or PERMIT CAN BE
1ENIED DUE T. LACK OF O) T , TION
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage All
(Lot area minus bldg & paved
.arking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding -ver been issued for /on the site?
NO DON'T KNOW YES
iF YES, date issued:
iF YES: Was the permit recorded at e Registry of Deeds?
NO DON'T KN'W YES
ii YES: enter Book Page and /or Document
B. Does the site contain a rook, body of water or wetlands? NO DON'T KNOW
YES �
iF' YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained P (;tn4le qw^t CEp �firs.;,.i,
C. Do any signs xisi on the property? YES NO
lF YES, u, sci {Dc size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
, •
P Department use only ----
"-- City of Northampton Status of Permit:
E IVED
:u ding Department curb Cut/Drivevvay Permit
12 Main Street Sewer/Septic Availability
SEP - 8 2011 Room 100 wateriweil Availability
ort ampton, MA 01060 Two Sets of Structural Plans
DEPT OF 1 , • • - 4 3- Fax 413-587-1272 Plot/Site Plans':
, --- .
NOFrrHAMPTON MA Other Specify .
APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISI-I A ONE OR TWO FAMILY DWEI LING
SECTION. 1 - SITE INFORMATION
1_1 Property Address:
j/
r
1.-- ix.(4)eizve,- _ A / 2
/,/ a/6771 21 rn/41 /1-7 4- - o oc, 0 ZoMap This section to be completed by office
ne _ . Lot
Ove.-riay District Unit . .
. Elm St. District. CB District__ _
SECTION 2 - PROPERTY 0 AGENT
2.1 Owner of Record:
■ .
K 3/ 1-E x, -
/et 0-/ 6VO6 0
Name (Print) Current Mailing Address:
_ t Cf25■(-- cl-lestc_e_e-- Telephone 3 3' 26. - 7 e
Signature
2_2 Authorized AEent: Steven Silverman
Valley Monte Imp=remz-nt Inc. P.O. Box 60627, Florence, MA 01062
Name (Print) j Current Mailing Aedre.ss:
11 i i At 584
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be ' Officiai Use 01
completed Dy permit applicant
1. Building 5• wo (a) Building Permit Fee
2. Eiectrical j (b) Estimated Total Cost of 4-
— Construction from (6)
3. P!'...!7i7bric; Riine47 r"-Prrtiti: 7,--e
..--- 55
_:::, : Frrj.:-...,-1!,%"1 _
Cc;( Number
Tiijs Section Ver Official Use Orilv ..._____
---
builcingPerrnizNumr.)er: Date [ssuet:
i
, - — ■
-- - 1
1
...... .
...• - frimzsio• _., nsoec or of 31.zileings
31 LEXINGTON AVE BP- 2012 -0229
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A - 045 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: window replaced BUILDING PERMIT
Permit # BP- 2012 -0229
Project # JS- 2012 - 000356
Est. Cost: $5000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: VALLEY HOME IMPROVEMENT INC 077279
Lot Size(sq. ft.): 15681.60 Owner: SWEENEY DARCY K
Zoning: URB(100)/ Applicant: VALLEY HOME IMPROVEMENT INC
AT: 31 LEXINGTON AVE
Applicant Address: Phone: Insurance:
P 0 BOX 60627 (413) 584 -7522
FLORENCEMA01062 ISSUED ON:9/9/2011 0:00:00
TO PERFORM THE FOLLOWING WORK: Kitchen window and garage gable siding
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 9/9/2011 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner
31 LEXINGTON AVE BP-2011-0167
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A - 045 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0167
Project # JS- 2011- 000272
Est. Cost: •
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 15681.60 Owner: SWEENEY DARCY K
Zoning: URB(100)/ Applicant: SWEENEY DARCY K
AT: 31 LEXINGTON AVF
Applicant Address: Phone: Insurance:
31 LEXINGTON AVE (413) 586 -6408 0
FLORENCEMA01062 ISSUED ON:8/25/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE IN EXISTING
FIREPLACE
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: Cp k" 5.3c) - - /G, e1v/
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REG AT S.
1°1° A 4."‘C•4
Certificate of Occupanc nature.
FeeType: Date Amount:
Building 8/25/2010 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner