44-075 City of Northampton
r' _' - t Massachusetts
Y (
DEPART NT OF BUILDING INSPECTIONS 7-
DEC6 2013 212 Man Street • Municipal Building
l� \Northampton, MA 01060 �i � x� ✓'
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 # (3q
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS 31 FLU(„u a (. 1- t r>ie.A
1. Name of Applicant: ()(n_a)" 1 dAt i\o
Address: 31 Fal{ ,�-\ Q( . Telephone: L113 3O `1LS`�
2. Owner of Property: C'V.2),,t 04,t.r.✓\-c•
Address: Telephone:
3. Status of Applicant: X Owner Contractor
4. Type or Brand of Stove: 14;7)' 3 LP>
Contractor's Name: fvo!.l 66,(e. (t
Contractor's Address:
Contractor's Phone: `{I,5 SC.) / `113 5-A63
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: a 4 i'i ?0 i1) APPLICANT'S SIGNATURE •
DATE: O. i3 I X■3 HOMEOWNER'S SIGNATURE — _I
APPROVED
DATE: BUILDING OFFICIAL
31 FAIRWAY DR BP-2014-0726
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:44-075 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-2014-0726
Project# JS-2014-001231
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 11674.08 Owner: DELANO BRENT J
Zoning: Applicant: DELANO BRENT J
AT: 31 FAIRWAY DR
Applicant Address: Phone: Insurance:
31 FAIRWAY DR
FLORENCEMA01062 ISSUED ON:12/16/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL JOTUL 3CB 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 12/16/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner