36-358 (6) L i
,�, .,:ate:
f Northampton
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ssachusetts
OCT - 2 2014
DEPAR F BUILDING INSPECTIONS
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212 Ma' St eet • Municipal Building
ton, MA 01060
►p,Plumbing&Gas �'
Northam on,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 # q 9t'
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 0 I `
Address: �\ (�1P [S(1(� \ ) 7 Telephone: �Ll
2. Owner of Property: \r��� r� cy--) L)v I
Address: 9,f3 Telephone: `!I 3 r S 1(, C,
-rlprPn
3. Status of Applicant-,�(—Owner Contractor 1
4. Type or Brand of Stove: 36-06 QIdU L CL/
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: O a-�-� APPLICANT'S SIGNATAI.IRE Uk,,
DATE: �C7 l Li HOMEOWNER'S SIGNATUR I
APPROVED
DATE: BUILDING OFFICIAL
91 EMERSON WAY BP-2015-0406
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-358 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cateeory: FIREPLACE BUILDING PERMIT
Permit# BP-2015-0406
Project# JS-2015-000729
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 12414.60 Owner: OAK RIDGE ROAD LLC C/O DOUGLAS KOHL
Zoning: Applicant. DAWSON KIMBERLY
AT. 91 EMERSON WAY
Applicant Address: Phone: Insurance:
91 EMERSON WAY (413) 727-8118 ()
FLORENCEMA01062 ISSUED ON.10/7/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL GAS 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 10/7/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner