17C-311 ,..,, _ City of Northampton
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DEPT. OF BUDDING 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 # j 47
PLEASE TYPE OR PRINT ALL INFORMATION
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1 . Name of Applicant: j\ - c t e l 1 c1 S t-, ct p / r G.. - 1d J I i., r,c. 11 rc, vi es i.'"\ el c, o
Address: 36 HI 1 l C te , " V"� /� f r . a (2 ✓1 t o Telephone: !� 9 y 7? 1 S
2. Owner of Property: 5 iI r I
Address: Telephone:
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3. Status of Applicant: "Owner Contractor
4. Type or Brand of Stove: e /AA G.e l' (s}, n yS ! ' f 0A',' I 1 t /
i Ile itdIQitk. -fl�,G: f�
If applicant is not the homeowner: ) t ' 6 (C....
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 herein is tr e and a • . to to the best
of my knowledge. r
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DATE: �v I3 A PPLICANT'S SIGNATURE t �d �_ ram. DATE: 1 / o � , 3 HOMEOWNER'S SIGNATUR
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APPROVED
DATE: / /6//3 BUILDING OFFICI
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36 HILLCREST DR BP- 2013 -0696
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C - 311 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 -0696
Project # JS- 2013- 001150
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.): 25613.28 Owner: MARTIN RICHARD C TRUSTEE C/O NETANIA SHAPIRO
Zoning: URA(100)/ Applicant: MARTIN RICHARD C TRUSTEE C/O NETANIA SHAPIRO
AT: 36 HILLCREST DR
Applicant Address: Phone: Insurance:
36 HILLCREST DR WC
FLORENCEMA01062 ISSUED ON:1/11/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VERMONT CASTINGS MONTPELIER
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 1/11/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner