05-062 (4) ______ p of Northampton
•' AM 1 2014 Massachusetts
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PARY NT OF BUILDING INSPECTIONS = x
ctnc Plumbing&Gas InspeAT'
in Street • Municipal Building 5vti pD�
MA 01060 Northampton, MA 01060
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#
Al EASE TYPE OR PRINT ALL INFORMATION
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1. Name of Applicant: RR--r#h PO4 C I& 10
Address: SZ3 j4UDG180d lei Lt OtD�'3 Telephone: L `7 LL
2. Owner of Property: /t'1 )z/;q q C 14-t o
Address: 533 A(A AU B0 jJ /-D !_EjE !'Mt4 ®l0-r-3 Telephone:(
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3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: -.1 0 7-v-L f w1 oz) L I r,14 �
If applicant is not the homeowner: 44 !
Construction Supervisor's License Number U !1plool Expiration Date
Home Improvement Contractor Registration Number / 19� 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: � 3°,�1`� APPLICANT'S SIGNATURE
DATE: d'�-�° HOMEOWNER'S SIGNATURE t �' �'� d,J
--�--
APPROVED
DATE: BUILDING OFFICIAL
503 AUDUBON RD BP-2014-1136
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 05 -062 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-2014-1136
Project# JS-2014-001930
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 148198
Lot Size(sq.ft.): Owner: PACILIO MARTHA N
Zoning RR(100)/WSP(71)/WP(9)/ Applicant: PACILIO MARTHA N
AT: 503 AUDUBON RD
Applicant Address: Phone: Insurance:
503 AUDUBON RD (413) 585-0775 O WC
LEEDSMA01053 ISSUED ON:5/1/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL JOTUL F600 FIRELIGHT 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 Signature:
FeeType• Date Paid: Amount:
Building 5/1/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner