24C-083 (2) Ci y of Northampton
Massachusetts
1 ;
J L 3 2013 DAP NT OF BUILDING INSPECTIONS
+ .Al2 _in Street • Municipal Building J 4 •
- NS Northampton, MA 01060 SxNy` "z 1!")‘
DEPT. NORT OF HAM. BUi TON, 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 # 1
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS 15 Massa So
no tt - 5 +.
1. Name of Applicant: Marl Irtdke.
Address: D Telephone:
2. Owner of Property: MC( Y1.1 � F ,,
Address: (6 Massasoit. Si'. Telephone: L I i3 4 -1 "1o5b
3. Status of Applicant: J Owner Contractor
4. Type or Brand of Stove: V 0 1
Contractor's Name: r � "All..#.1„„Pairfahlietagg-
Contractor's Address: f
Contractor's Phone: 6 7 Cea 7 ^
Q` t /L/ f f
Construction Supervisor's License Number: d ?9 4o 5t Expiration Date: 1--4d /'y
Home Improvement Contractor Registration Number: // 715 L/ Expiration Date: 3 -3/ ` /
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.
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DATE: ' ' � j APPLICANT'S SIGNATURE II 1 l. r • l eftelk"....
DATE: / 8-43 HOMEOWNER'S SIGNATURE e?* eatta./
APPROVED
DATE: BUILDING OFFICIAL
15 MASSASOIT ST BP- 2013 -0712
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24C - 083 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 -0712
Project # JS- 2013- 001190
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: JAMES ROBERTS 99404
Lot Size(sq. ft.): 7492.32 Owner: RADKE MARY BETH
Zoning: URB(100)/ Applicant: JAMES ROBERTS
AT: 15 MASSASOIT ST
Applicant Address: Phone: Insurance:
30 Edwards Rd (413) 527 -6078
WESTHAMPTONMA01027 ISSUED ON:1/23/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL JOTUL 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 1/23/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner