07-065 (3) City of Northampton
RECEIVES Massachusetts s , { .
€ - , Qc 5 C EP - I T OF BUILDING INSPECTIONS
GORIL212 Mai Street • Municipal Building n�
orthampton, MA 01060
OF BUILDING INSPECTIONS
NORTHAMPTON 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 # / /
PLEASE TYPE OR PRINT ALL INFORMATION /144 � Q�D
PROPERTY ADDRESS 3'2- J - 7 t o r--"K rq r µ^ S R c Fbore., cv Z
1. Name of Applicant: .) OS h lei C o a 4 C
Address: 22_ 7 Hop- 4' �a r'.r f o / Telephone: (' 1 3) 7- II S 7
2. Owner of Property: J dsr - Hof r" t e r-c d i 4 4 C c o.
Address: 3 2 , 7 AA.. t F-0,-.0-.5 RI Telephone: C t.( (3 ) 4.3
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: \A/0c o. S 4.0oft
Contrac lia ( �` &i R f Q 1 awe
Contractor's Address: � GYNA h S 4 J /. 1 - 1 6 4 S ( l A
Contractor's Phone:
(M t3 )
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: APPLICANT'S SIGNATURE
/DATE: KV 7r2 \.14:MEOWNER'S SIGNATURE / - 0 -41 % —ct s
APPROVED
DATE: BUILDING OFFICIAL
327 NORTH FARMS RD BP- 2013 -0440
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 07 - 065 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 -0440
Project # JS- 2013- 000704
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 28531.80 Owner: COATES JOSHUA C & MEREDITH BERTRAND
Zoning: RR(100),WSP(100)/WP(59)/ Applicant: COATES JOSHUA C & MEREDITH BERTRAND
AT: 327 NORTH FARMS RD
Applicant Address: Phone: Insurance:
327 NORTH FARMS RD WC
FLORENCEMA01062 ISSUED ON:10/15/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE
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 10/15/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner