38D-018 (5) City of Northampton
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�, 1' '�� , DEPARTMENT OF BUILDING INSPECTIONS
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� 212 Main Street • Municipal Building J �b
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-�: Northampton, MA 01060 ��N�y- g j.0
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I co Z INGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
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m1 FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
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ca Permit Fee: $25.00 Check # ),( rh
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS Qc IICeA-' l 1 C*4 - )C.),11----of° •� it-(4- C- ( C CC
1. Name of Applicant: C 1 e`j RC u net I 2 c—
Address: cc-----k_ ,7 Telephone: CI� ¶ G6 ? (.
2. Owner of Property: C ICJ RCA-)lN. I
Address: 5 ...--e— Telephone: S""'F_
3. Status of Applicant: K Owner Contractor
4. Type or Brand of Stove: 1r7 u L. (c ., / wc-"Q—" ' 2 5-0
Contractor's Name:
(1, N , 1 IT C (- L. e--ri- t- Psi-, G
Contractor's Address: /0 til;//i 4,a.^SQ# 51-- k f-33 S0,41, r(.d(6�•/ /1 I G 1
Contractor's Phone: y( 5--3 ' &-'15-
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Construction Supervisor's License Number: GSSie'� 8--7&y Expiration Date: 41( "2/-V/ /
Home Improvement Contractor Registration Number: / i f 4/ C O Expiration Date: { " 3/3
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All Applicants must complete a lNorkers rompensatron Insurance Affidavit before we parr 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: l ' c APPLICANT'S SIGNATURE 1----Z___....-------
DATE: HOMEOWNER'S SIGNATURE GY
APPROVED
DATE: BUILDING OFFICIAL
25 HAMPDEN ST BP-2014-0136
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:38D-018 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-2014-0136
Project# JS-2014-000260
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 11020.68 Owner: ROUNDS CALEB M&MARGARET B
Zoning:URB(100)/ Applicant: ROUNDS CALEB M & MARGARET B
AT: 25 HAMPDEN ST
Applicant Address: Phone: Insurance:
25 HAMPDEN ST (413) 585-0674 0 WC
NORTHAMPTONMA01060 ISSUED ON:8/7/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL AVALON 1250 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 8/7/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner