22D-113 *
4.
rP
Massachusetts
pEr
*it t 1 D PARTMENT OF BUILDING INSPECTIONS
JAN 2 2 2013 12 Maul Stroet Mum,Lczpal Buziding
Northampton, MA 01060
DEPT OF BLhi uNS
IAA 0 .0E0
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 INPORMATION
1 Name of Applicant r
Address: Telephone.
2. Owner of Property _
Address. — , Telephcle: •
3 Status of Applicant: NOwner Contractor
. -
4 Type or Brand of Stove
---
if applicant is not the homeowner.
Construcl'on Supervisor s License Nur Expiration Date
Horne Improvement Contractor : Number Excratton 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: /. / APPLICANT'S SIGNATURE
DATE: / / I HOMEOWNER'S SIGNATURE 'A ht L
APPROVED
DATE: -2-21 1 BUILDING OFFICIAL /-
60 AVIS CIR BP- 2013 -0709
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 22D - 113 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 -0709
Project # JS- 2013 - 001175
Est. Cost:
Fee: $25.00 P1RMJSSION IS HEREBY GRANTED a TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 24175.80 Owner: DIBRINDISI JOEL R & DOLORES T
Zoning: URA(100)/WSP(100)/ Applicant: OIBRINDISI JOEL R & DOLORES T
AT: 60 AVIS CIR
Applicant Address: Phone: Insurance:
60 AVIS CIR 0 586 - 0233 0
FLORENCEMA01062 ISSUED ON :1/22/2013 0:00:00
TO PERFORM THE FOLLOWING WORK :INSTALL HARMEN PELLET STOVE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of PhilOing Inspector of Wiring D. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Found,tifn:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: O
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS. ` z , * / � ^h QV
Certificate of Occupancvd f ✓� ( Signature: e
FeeType: Date Paid: Amount:
Building 1/22/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner