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37-065 (5) City of Northampton Ns 71"7;:- Massachusetts !e* �c{ `t g DEPARTMENT OF BUILDING INSP •e ° ?�� r k - +� 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