41-007 c C City of Northampton
/ (J Massachusetts
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NOV 26 TMENT OF BUILDING INSPECTIONS +p� t
1K 212 in Street • M unicipal uilding ' O -,,. r � Northampton, MA 01060
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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 #
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: i r
Address: 1 coil it \A/ E J T N A'N P 9 o fJ �] R. D Telephone: 2 - 5 0- 14 ‘ I
2. Owner of Property: S A / NE po T�(�' ,(� r Y-' - _n p b ?
Address: e r] V /� 1
3. Status of Applicant: '✓ Owner Contractor A
4. Type or Brand of Stove: VE K C r T C A S I I t r c S t C 0 R“
If applicant is not the homeowner:
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: I hereby certify that the information contained her in is true and accurate to the best
of my knowledge.
DATE: 11 1 I 1 2 APPLICANT'S SIGNATURE \ -1-7
DATE: HOMEOWNER'S SIGNATURE S�� F
APPROVED
DATE: BUILDING OFFICIAL
1504 WESTHAMPTON RD BP- 2013 -0595
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 41 - 007 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 -0595
Project # JS- 2013- 000957
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: DANIEL HEWINS 049714
Lot Size(sq. ft.): 43560.00 Owner: HEWINS DANIEL E
Zoning: Applicant: DANIEL HEWINS
AT: 1504 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P 0 BOX 186 (413) 582 -9929
CHESTERFIELDMA01012 ISSUED ON:11/27/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VERMONT CASTINGS ENCORE
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:
FeeTvp Date Paid: Amount:
Building 11/27/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner