43-121 t A`w.. 2•' 7
�
3 S01S
5
City of Northampton
" " I ; ECEIVED
Massachusetts
c =
•EP' 'TMENT OF BUILDING INSPECTIONS
'4' 4 : : : 1,. SEP 13 2a2' It 4
212 Main Street • Municipal Building •)", 4 � �
No rthampton, MA 01060 �frm ii
OF BW DINti IM$PECi)ON4
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 # (
PLEASE TYPE OR PRINT ALL INFORMATION i- or
PROPERTY ADDRESS 3
P 4 - AL ' r
1. Name of Applicant: --- v � 2 - c'( ,C ,
Address: :'f Telephone: 5 / (/ 7 7
2. Owner of Property: ci
Address: Telephone:
3. Status of Applicant: 1.-'" Owner Contractor 4. Type or Brand of Stove: 6�e 6 -d rt 061- .
Contractor's Name: Cie
e _e_ . /
Contractor's Address: �.
Contractor's Phone:
Construction Supervisor's License Number: ,-----. Expiration Date:
Home Improvement Contractor Registration Number: - Expiration Date: i
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.
/
DATE: o// / 1 APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
193 PARK HILL RD BP- 2013 -0289
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 43 - 121 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- 2013 -0289
Project # JS- 2013- 000471
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 47044.80 Owner: ALTER MURI SIMONE & SAMUEL MURI
Zoning: Applicant: ALTER MURI SIMONE & SAMUEL MURI
AT: 193 PARK HILL RD
Applicant Address: Phone: Insurance:
193 PARK HILL RD
FLORENCEMA01062 ISSUED ON: 9/13/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE - VERMONT CASTINGS
RESOLUTE
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 9/13/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner