31A-196 (2) City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
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212 Main Street • Municipal Building
Northampton, MA 01060
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r NGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
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OR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
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01 N R* Permit Fee: $25.00 Check# 4
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J PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant' %'4 `✓ �� �� 1 t`{-- "���r� v -' �/
Address: n /�n1 _ j� /\J %�T{ �' / vti Telephone:
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove:
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: APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
60 WASHINGTON AVE BP-2015-0602
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 A- 196 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Categoa: woodstove BUILDING PERMIT
Permit# BP-2015-0602
Project# JS-2015-001143
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): 4704.48 Owner: DAVID WHITEHILL
ZoningURB(100)/ Applicant. DAVID WHITEHILL
AT. 60 WASHINGTON AVE
Applicant Address: Phone: Insurance:
60 WASHINGTON AVE
NORTHAMPTON MAO 1060 ISSUED ON:1112412014 0:00:00
TO PERFORM THE FOLLOWING WORK:WOOD STOVE - XLDERLEA T4 (PACIFIC
ENERGY)
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 11/24/2014 0:00:00 $25.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
BP-2015-0602
60 WASHINGTON AVE
COMMONWEALTH OF MASSACHUSETTS
GIs#: CITY OF NORTHAMPTON
MM Block:3 1 A- 196
Low PERSONS CONTRACTING THE GUARANT FUND (MGL� 142A)
Permit Building DO NOT HAVE ACCES
BUILDING PERM IT
Category:woodstove
Permit#
13P-2015-0602
Pro'ect# JS-2015-001143
Est.Cost:
PERMISSION IS HEREBY GRANTED TO:
Fee: $25.0 0 License:
Cons: Contractor:
Homeowner as Contractor
Use rou—
Lot Si_ Ze(S4 ft)• 4704.48 Owner: DAVID WHITEHILL
Zonin � URB 10—O l/ A licant: DAVID WHITEHILL
AT: 60 WASHINGTON AVE Insurance:
Phone:
App_ddress.
60 WASHINGTON AVE
NORTHAMPTONMA01060 ISSUED ON-1112412014 OOD STOVE - XLDERLEA T4 (PACIFIC
TO PERFORM THE FOLLOWING
ENERGY)
POST THIS CARD SO IT IS VISIBLE FROM D.P.W.THE STREET Building Inspector
Inspector of Plumbing Inspector of Wiring
Service: Meter:
Underground: Footings:
Rough: Rough:
House# Foundation:
Driveway Final:
Final: Final: Rough Frame:
Gas:
Fireplace/Chimney-
Rough: Fire Department ('
Insulation:
Oil• �(/�\j, � p
Final:
Final: Smoke:
THIS PERM IT MAY BE REVOKYD E C NO MPTON UPON VIOLATION OF
ANY OF ITS RULES AND REG T N '70
Certificate of Occu anc
Si nature:
Feel e: Date Paid: Amount:
Building
11/24/2014 0:00:00 $25x00
212 Main Street,Phone(413)587-1240,Fax: (413)5871272
Louis Hasbrouck—Building Commissioner