17C-247 (4) City of Northampton
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Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS h ,
212 Main Street • Municipal Building y
Northampton, MA 01060
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ui LE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
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WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check #
I PLEASE TYPE OR PRINT ALL INFORMATION�
1. Name of Applicant: f G 1 1�,, -D k)� &HT 4 7k c L ® I' on o6 limo
Address: T�> I V • ' `q i I,) S T—i i 0-(MQ Telephone: 5 Z�– V'ID
2. Owner of Property: L kA e
Address: lC&^-e Telephone:
3. Status of Applicant: Owner Contractor L` (,, �-
4. Type or Brand of Stove: �n Sr i �7 S!o lie- y �f?Ut
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 knowled e.
DATE: APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
73 NORTH MAIN ST BP-2015-0362
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C-247 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-2015-0362
Project# JS-2015-000669
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 19819.80 Owner: O'DONOGHUE PHILIP C&VALLE E DWIGHT
zoning: URB(100)/SI(0)/ Applicant: O'DONOGHUE PHILIP C & VALLE E DWIGHT
AT: 73 NORTH MAIN ST
Applicant Address: Phone: Insurance:
73 NORTH MAIN ST (413) 584-4165 O
FLORENCEMA01062 ISSUED ON.912912014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL 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 9/29/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner