36-082 City of Northampton
Massachusetts
01. 2 2013 DEPAR I NT OF BUILDING INSPECTIONS
2 2 M. in Street • Municipal Building
Northampton, MA 01060��. ?�
DEPT.
OF BUILDM G IN 0 1060
1TI0N5
NORTHAMPTON, Mr; 0
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 # < OV
�f PLEASE TYPE O PRINT ALL INFORMATION
✓PROPERTY ADDRESS 479( n �
1. Name of Applicant: 0.,drrlJ
Address: 7 ct..) .,• d� C Telephone:
2. Owner of Property:
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� 3 7 �/,,;1. :E1,a'�f� �� Telephone: : / v
Address: P ��
3. Status of Applicant: I/ Owner Contractor
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Type or Brand of Stove: 0 C/ _e._- 0 -, 5 0 ��
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Contractor's Name:
Contractor's Address:
Contractor's Phone:
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: APPLICANT'S SIGNATURE
V ATE: 03 _ / " / 3 HOMEOWNER'S SIGNATURE Q.O
APPROVED
DATE: BUILDING OFFICIAL
237 WESTHAMPTON RD BP- 2013 -0815
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36 - 082 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 -0815
Project # JS- 2013- 001396
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: A R SANDRI INC ,
Lot Size(sq. ft.): 50965.20 Owner: HERZIG WALLACE B & LORRAINE I
Zoning: Applicant: HERZIG WALLACE B & LORRAINE I
AT: 237 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
(413) 584 -9159 ()
FLORENCEMA01062 ISSUED ON:3/12/2013 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL ECO CHOICE CAB50 PELLET 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 3/12/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner