42-178 (3) 1
_ City of Northampton
f at H '-'
5
�
"IS , -, Massachusetts 4,, :... c ' �
; W „
DF»AR 'a, T OF BUILDING INSPECTIONS 2
y, 1 1 �� r { 3 2013 212 in Street •Municipal Building y v I� a c' s
r + ",,.'" i Northampton, MA 01060 SN yy 1,�
DEPT. OF BUILDING IN „ PcCTIONS
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 # ( 7q
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: + c�� y / PG's SO h
Address: /9th ( f (e..�J.,..f � ! KJ Telephone: 9 78 a 1 O E 1 a S
2. Owner of Property: Jeff' � i 'i��e 7/ e � c� ivi a f 1,64 .e P c.,r so,
r
Address: 1 O b [ e vt c1 ti t C r U Telephone: 7 7 2 2 1 6 a( 2 S”`
3. Status of Applicant: PC, Owner Contractor
4. Type or Brand of Stove: Woo 1 S7 c ix
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 herein is true and accurate to the best
of my knowledge.
DATE: /3//13 APPLICANT'S SIGNATURE A ,p7°.c-r.��
DATE: 00i HOMEOWNER'S SIGNATURE i i fee-
0
APPROVED
DATE: BUILDING OFFICIAL
196 GLENDALE RD BP- 2013 -0733
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 42 - 178 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: New Single Family House BUILDING PERMIT
Permit # BP- 2013 -0733
Project # JS- 2013- 000892
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 81021.60 Owner: PEARSON JEFFREY & MARLENE
Zoning: Applicant: PEARSON JEFFREY & MARLENE
AT: 196 GLENDALE RD
Applicant Address: Phone: Insurance:
186 GLENDALE RD (978) 210 -8125 0
FLORENCEMA01062 ISSUED ON:1/31/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOCK 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:
FeeTvpe: Date Paid: Amount:
Building 1/31/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner