07-003 (2) ity of Northampton
Massachusetts
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PARTMENT OF BUILDING INSPECTIONS
2 Main Street • Municipal Building j
'y Northampton, MA 01060
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Northam
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 s I CJ I n•f CA/I G'fhi
Address: 5 3� N D yI y arm 5 11/,(. . Telephone: 519 2(4 /`5 !50-
2. Owner of Property: hlU r(/Y,C:el "A 0/0&2- Mny- as aj6eV-L
Address: Telephone:
3. Status of Applicant: / Owner Contractor
4. Type or Brand of Stove: fb f74,L I D o
If applicant is not the homeowner: //
Construction Supervisor's License Number's & Expiration Date /A O Q 41L !"
Home Improvement Contractor Registration Number 7 v Expiration Date g
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: `� lit APPLICANT'S SIGNATURE rn • �GLCc�n
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
534 NORTH FARMS RD BP-2014-1055
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 07-003 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-2014-1055
Project# JS-2014-001810
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 105023.16 Owner: NANGLE N PAIGE
Zoning: RR(100)/WSP(100)/WP(65)/ Applicant: NANGLE N PAIGE
AT. 534 NORTH FARMS RD
Applicant Address: Phone: Insurance:
534 NORTH FARMS RD (319) 268-1550 O WC
FLORENCEMA01062 ISSUED ON:411412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL JOTUL 450 KENNEBEC WOODSTOVE
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 4/14/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner