38B-272 (2) City of Northampton
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DEPARTMENT OF BUILDING INSPECTIONS .
212 Main Street • Municipal Building ''
,,8:4 Northampton, MA 01060 s {a `
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 INFORMATION
PROPERTY ADDRESS " 1 t ......4P-ter: l --4`171-0 - /`7--/'e / °/Q
1. Name of Applicant: -- /iu ` 7/y/t_
Address: .,Sri)P Telephone: //. '-,._f Y— er... 2 U
2. Owner of Property:,__SJ.-„P -
Address: Telephone:
3. Status of Applicant: ✓ Owner Contractor
4. Type or Brand of Stove:
Contractor's Name:
Contractor's Address:
Contractor's Phone:
Construction Supervisor's License Number: Expiration Date:
Home Improvement Contractor Registration Number. Expiration Date:
-----_- - -
Ail Applicants must comprfe a Works-Compensation-Insurance Affidavit before can issue a permit—
5. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
I
DATE: `-' `/ /-� APPLICANT'S SIGNATURE'",)1-w.2-` 4i-ivz,6.-=-4-1'
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DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
250 SOUTH ST BP-2014-0258
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B-272 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-2014-0258
Project# JS-2014-000429
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 6926.04 Owner: FLYNN TIMOTHY J&REBECCA
Zoning:URB(100)/ Applicant: FLYNN TIMOTHY J & REBECCA
AT: 250 SOUTH ST
Applicant Address: Phone: Insurance:
250 SOUTH ST
NORTHAMPTONMAO1060 ISSUED ON:8/30/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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 8/30/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner