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NORTHAMPTON
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# Id
A PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /1 C Y A . '=
/IUUecJE
Address: ;166 crack`if M O Zz - F oiefri z Ht`s Telephone: 4/3 - 446 -6/6`7
2. Owner of Property: MIS'✓ 1'4 IoUZiE� 4 MtCi-+AEi` 6 lL CL— oGf`
Address: , 6J �OCC.� I--lil' T� Do/4w,1-IKa0) 2-Telephone: /i3 - 7'q� —0/6-5
3. Status of Applicant: ✓Owner Contractor
4. Type or Brand of Stove: i∎ll i- /4m ; ! 1 LG f ic6 6 N
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: APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
266 ROCKY HILL RD BP-2013-1152
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37-073 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-2013-1152
Project# JS-2013-001890
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 17119.08 Owner: TOURJEE MARY ANDERSON&MICHAEL C TOURJEE
Zoning: Applicant: TOURJEE MARY ANDERSON & MICHAEL C TOURJEE
AT: 266 ROCKY HILL RD
Applicant Address: Phone: Insurance:
266 ROCKY HILL RD (413) 446-0159 0
FLORENCEMA01062 ISSUED ON:6/4/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE - KENT MODEL
TILEFIRE CH
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 6/4/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner