17D-035 (2) City of Northampton
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DEPARTMENT OF BUILDING INSPECTIONS J '
�cn m, rj 212 Main Street • Municipal Building
SE►' 2 6 1013 Northampton, MA 010604r�
Electric,Plumbing&Gas inspections
Northampton, MA 01060
SINGLE OR TWO FAM OLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check # 2 S(
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS �--\ N �
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1. Name of Applicant: J�‘^n 'v v■g C�
Address: r)—\ Telephone: x{13` 71-7 —$6.3 L
2. Owner of Property: \A/^ 4 Le-r`t E✓`q
Address:
2-' S c�-�n vwe.✓ �v e.�✓,..Q/ Telephone: y t 3 -7 2-7—' 4 3 Z_
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: Au O r 5 0 1 t t D
Contractor's Name: ��'�
Contractor's Address:
Contractor's Phone:
Construction Supervisor's License Number: Expiration Date:
Home Improvement Contractor Registration Number. Expiration Date:
All Applicants must complete a Irkers 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: (1-4 ` i3 APPLICANT'S SIGNATURE � k
DATE: t(Z t3 HOMEOWNER'S SIGNATURE ii)`_����-
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APPROVED
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DATE: ��� �/� BUILDING OFFI
21 SUMNER AVE BP-2014-0393
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17D-035 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-2014-0393
Project# JS-2014-000683
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 7797.24 Owner: JOHN ENGEL
Zoning:URB(100)/ Applicant: JOHN ENGEL
AT: 21 SUMNER AVE
Applicant Address: Phone: Insurance:
21 SUMNER AVE (413) 727-8632 O
FLORENCEMA01062 ISSUED ON:10/2/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL MORSO 7110 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