37-065 (5) City of Northampton
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`t g DEPARTMENT OF BUILDING INSP •e ° ?��
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- +� 212 Main Street • Municipal B1 i (, I
Northampton, MA 0106
OCT — _f 1
2013
SINGLE OR TWO FAMILY SOLID FUEL A' Pt - MIT PLICATION
No;th,;r°Pon&r1n 07GS.p ctions
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR - - - ACE INSERTS
Permit Fee: $25.00 Check# ?-6
PLEASE TYPE OR PRINT ALL INFORMATION •
1. Name of Applicant: 20)/04— (OA/ /,
Address: 9 1 0 - F L� I '�k" /3( (Rai- /,Telephone: "(I ��l -L -3
2. Owner of Property: 1-7aVWfr" em ,t1
Address: ' ,/1\44,15 Telephone:
3. Status of Applicant: wner Contractor
4. Type or Brand of Stove: 701-1/
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: ie)//f j APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
109 BLACK BIRCH TRAIL BP-2014-0390
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 37-065 CITY OF NORTHAMPTON
Lot:-000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit# BP-2014-0390
Project# JS-2014-000677
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): Owner: COHN DONNA
Zoning: Applicant: COHN DONNA
AT: 109 BLACK BIRCH TRAIL
Applicant Address: Phone: Insurance:
109 BLACK BIRCH TRAIL (413) 519-9873 0
FLORENCEMA01062 ISSUED ON:10/2/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL JOTUL 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 10/2/2013 0:00:00 $25.00
212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner