17A-166 City of Northampton
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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 # 3 1 ( 1
PLEASE TYPE OR PRINT ALL INFORMATION
2 : 1. Name of Applicant: I /c � . r " I Yl�-.\
Address: * <1 � j 7,
D Telephone: ■`t" (0 G�S
2. Owner of Property r l � �� VAC ..
Address: Telephone:
3. Status of Applicant: X Owner Contractor
c Type or Brand of Stove: V \e.-
If applicant is not the homeowner:
Construction Supervisor's Lictse 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.
DATE: APPLICANT'S SIGNATURE
DATE:ti.,dil. 0 J- HOMEOWNER'S SIGNATURE J, tit( Gt 'SL 4 t
APPROVED
DATE: BUILDING OFFICIAL
44 KIMBALL ST BP- 2013 -0536
GIs #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A - 166 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 -0536
Project # JS- 2013 - 000867
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 33410.52 Owner: FINCK PRISCILLA P TRUSTEE
Zoning: URB(100)/ Applicant: FINCK PRISCILLA P TRUSTEE
AT: 44 KIMBALL ST
Applicant Address: Phone: Insurance:
44 KIMBALL ST
FLORENCEMA01062 ISSUED ON:11/8/2012 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 11/8/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner