42-144 �'p
NOV 18 2014 C of Northampton
— Massachusetts
ctw7, Plu i ing&Gas Inspections :G
. (-,,r; an.
PIA C?
i — OF BUILDING INSPECTIONS _
\ 212 Main Street • Municipal Building
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# 3 q2
<l PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: v I��-t To *e_ir—
Address: C(33 Telephone: 413 �a�• 8 03
2. Owner of Property: 5+CLcl0. 7-a*-f- a w) -Iske_ 4t w2S
Address: q W-1_54'VAA,11 '6 rJ PJ Telephone: 13 (03
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: J0 4.0 3�f2)
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: 1 hereby certify that the information contained herein is true and accurate to the best
of my knowledge. _
� ATE: 1 r / APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
933 WESTHAMPTON RD BP-2015-0578
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:42- 144 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Catego!y:woodstove BUILDING PERMIT
Permit# BP-2015-0578
Project# JS-2015-001100
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.): 34412.40 Owner: POTTER STACIA
Zoning: Applicant: POTTER STACIA
AT: 933 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
933 WESTHAMPTON RD (413) 727-8636 O WC
FLORENCEMA01062 ISSUED ON.11/18/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL JOTUL 3CB 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 11/18/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner