49-039 r
City of Northampton
Massachusetts
TMENT OF BUILDING INSPECTIONS
(� ain Street • Municipal Building
Northampton, MA 01060 s l 4
19?0
Elecirn'"
SINGLE O o iK411 Y 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: 6A1 y
Address: �j/ K_ t 2cy— Telephone: 3Y/ IPO�0
T
2. Owner of Property: 5e?g e
Address: SliM,( Telephone:
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3. Status of Applicant: Owner Contractor
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4. Type or Brand of Stove: I Slo ✓(f
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.
DATE: APPLICANT'S SIGNATURE
/DATE: &1 .F / OMEOWNER'S SIGNATURE
✓ APPROVED
DATE: BUILDING OFFICIAL
673 PARK HILL RD BP-2014-1039
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 49-039 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-2014-1039
Project# JS-2014-001790
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 347434.56 Owner: CIASCHINI GARY&MARSHA E
Zoning: Applicant: CIASCHINI GARY & MARSHA E
AT: 673 PARK HILL RD
Applicant Address: Phone: Insurance:
(413) 584-3439 O
FLORENCEMA01062 ISSUED ON:41912014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL ACCENTRA 52i PELLET INSERT
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 4/9/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner