32C-297 (2) City of Northampton
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NORTHAMPTON MA 07060 �
SINGLE OR TWO FAMIL" OLID 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: FE- � r f L n C 0 ET
Address: 4 f V 4 L L E V S I . Telephone: (� - 2 5 1- 5 s
2. Owner of Property: M# o C L I _ � L. 1 +Z. g L A N C K E I/ E
`f l V a ( U � _ Not �vvt r1 e h - 'S q ‘(65.- Address: ( Telephone: _ `� 3'
3. Status of Applicant: V' Owner __ Contractor
4. Type or Brand of Stove:_ V r-- IAA D N k- C a 54 ;NA (V1 i a (C
If applicant is not the homeowner:
Construction Supervisor's License Number Expiration Date
Horne Improvement Contractor Registration Number_ Expiration Date _
All A pplicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification: hereby certify that the information contained herei is true and accurate to the best
of my knowledge.
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DATE: ��1..- � i � APPLICANT'S SIGNATURE ' c" i (-----`
DATE: Q L c ._` \? _ __. HOMEOWNER'S SiGNATURi = _. _ _
APPROVED
DATE: BUILDING OFFICIAL
41 VALLEY ST BP- 2013 -0634
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C - 297 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 -0634
Project # JS- 2013- 001031
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 6098.40 Owner: BLANCHETTE PETER
Zoning: URC(100)/ Applicant: BLANCHETTE PETER
AT: 41 VALLEY ST
Applicant Address: Phone: Insurance:
41 VALLEY ST (413) 259 -5965 0
NORTHAMPTONMAO1060 ISSUED ON:12/6/2012 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VERMONT CASTINGS INTREPID II
WOOD STOVE
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 12/6/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner