18C-127 (4) ----r - City of Northampton
Massachusetts
7 ZOR AR"ONT OF BUILDING INSPECTIONS _ .a
12 Main Street • Municipal Building Jar o`a
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} Northampton, MA 01060
Efiec! c.
G >ctions
760
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#
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 1'L- 1'� lC`�1� -� U- j Telephone:
2. Owner of Property: S
Address: Telephone:
3. Status of Applicant: Aowner _Contractor
4. Type or Brand of Stove: � 2,
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. �j
DATE: \ \--I 1 4 APPLICANT'S SIGNATURE / `
DATE: !I HOMEOWNER'S SIGNATURE —
APPROVED
DATE: BUILDING OFFICIAL
86 BLACKBERRY LN BP-2014-0819
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 18C- 127 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-2014-0819
Project# JS-2014-001407
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Groin: Homeowner as Contractor
Lot Size(sq.ft.): 19384.20 Owner: SULLIVAN NEIL
Zoning:URB(100)/ Applicant: SULLIVAN NEIL
AT. 86 BLACKBERRY LN
Applicant Address: Phone: Insurance:
86 BLACKBERRY LN (413) 341-3274 0
NORTHAMPTONMA01060 ISSUI D ON:1/22/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL HARMAN PELLET INSERT
POST THIS CARD SO IT IS VISIBL 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 REVOKI-D 1'.Y THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULA'1'IONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 1/22/2014 0:CU ":) $25.00
212 Main Strcct,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner