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41-010 (4) Cit� of Northampton Massachusetts ? k i DEP OF BTZLDZNG INSPECTIONS ; '2013 21 Street • Minici p al Building DEC �. Northampton, MA 01060 c1lons 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# 3,,)-q J PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: �� l v b 1Yi�G� �-t LL V) S Address: 5 D 0A t!1 e P . , E!6 re K u Telephone: /,1 7 - 3© �J 2. Owner of Property. A YY112- Address: / Telephone: 3. Status of Applicant Owner Contractor 4. Type or Brand of Stove: I�GL 4' a ►'� 1�/� ��' �'t -x A) be- dc-y%k b c i, btu h e�- v rY� ���� j Lie re �la ce_ _ If applicant is not the homeowner: Construction Supervisor's License Number _Expiration Date Home lnprovement Contractor Registration Number Expiration Date All Appticants 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: Ia-a 6 -/ 3 APPLICANTS SIGNATURE (,4'? � DATE: /.� "°4 G HOMEOWNER'S SIGNATURE 0Sd"'tom APPROVED DATE: BUILDING OFFICIAL 50 LOUDVILLE RD BP-2014-0751 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 41 -010 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: woodstove BUILDING PERMIT Permit# BP-2014-0751 Project# JS-2014-001290 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: BERNARDSTON FARMERS SUPPLY 99401 Lot Size(sq.ft.): 102366.00 Owner: LUEKENS JEFFREY&DEBORAH Zoning: Applicant: LUEKENS JEFFREY & DEBORAH AT. 50 LOUDVILLE RD Applicant Address: Phone: Insurance: 50 LOUDVILLE RD (413) 727-3032 (� FLOREN CEMA01062 ISSUED ON.12/27/2013 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL HARMAN XXV PELLET STOVE 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 12/27/2013 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner