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42-043 (3) City of Northampton r` Massachusetts �� ' � DEPARTMENT OF BUILDING INSPECTIONS � } 212 Main Street • Municipal Building b n Northampton, MA 01060 pry ' 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 # �� r / G�PLEASE TYPE OR PRINT ALL INFORMATION PROPERTY ADDRESS C� ( G � /L4��, 7�z�( d / 1. Name of Applicant: �L 2 L(� .� — �T�t l/!SC�1 L t Address: (�((J LV L6sS 144-6e �Ly J}'d�t Telephone: �l l ?7 — s 2. Owner of Property: CP Address: Telephone: 3. Status of Applicant: Owner Contractor 4. Type or Brand of Stove: ( l C+ G [ _ l� ( �� C l l5 Contractor's Name: I C a 1� C r Contractor's Address: t 7 4° i 1�f / !�'7 l ©�-e - �1 �� L�k Z Contractor's Phone: 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: Z 1 APPLICANT'S SIGNATURE DATE: I HOMEOWNER'S SIGNATURE APPROVED DATE: 1 `°jar I .j BUILDING OFFICIAL ~-- ----` �^ °" 669 WESTHAMPTON RD BP-2014-0765 GIs#: COMMONWEALTH OF MASSACHUSETTS Map-.Block:42-043 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:or : woodstove BUILDING PERMIT Permit# BP-2014-0765 Project# JS-2014-001316 Est.Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RICHARD SCOTT 83108 Lot Size(sq. ft.): 25047.00 Owner: JOHNSON FRANCIS&LUCY HARTRY Zoning: Applicant: JOHNSON FRANCIS & LUCY HARTRY AT. 669 WESTHAMPTON RD Applicant Address: Phone: Insurance: 669 WESTHAMPTON RD (413) 584-9005 O FLORENCEMA01062 ISSUED ON:11312014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL QUADRA-FIRE C131200MI-MBK 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 Si nature: FeeType• Date Paid: _Amount: Building 1/3/2014 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner