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City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building , t`
Northampton, MA 01060 tit6
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Q- E INGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
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FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check #
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS 7
1. Name of Applicant: , )"
Address:=�/ y�zf Telephone:
2. Owner of Property: 1 7 e
Address: Telephone: c
3. Status of Applicant: I Owner Contractor
4. Type or Brand of Stove:
Contractor's Name:
Contractor's Address:
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: l� APPLICANT'S SIGNATUR
DATE: HOMEOWNER'S SIGNAT
APPROVED
DATE: BUILDING OFFICIAL
31 HENRY ST BP-2015-0347
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-354 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-2015-0347
Project# JS-2015-000634
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa. ft.): 69957.36 Owner: SZAWLOWSKI JEROME S&MICHELLE L GOULET
Zoniny,: Applicant. SZAWLOWSKI JEROME S & MICHELLE L GOULET
AT. 31 HENRY ST
Applicant Address: Phone: Insurance:
25 HENRY ST
NORTHAMPTONMA01060 ISSUED ON:912412014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL HEATILATOR METAL FIREPLACE
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 9/24/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner