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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# 30
PLEASE TYPE OR PRINT ALL INFORMATION
1. Nams cf Applicant: Jesse Merrick
Address: 949 an Rd, Florence Ma, 01062 Telephone: (413) 824-1239
2. Owner of Property: Jesse Merrick
Address: 949 Ryan Rd, Florence Ma, 01062 Telephone: ( 13) 924-1239
3. Status of Applicant: X Owner _Contractor
a. Type or Brand of stove: Chappee wood/coal heater- 8033
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 here is tree and accurate he best
of my knowledge. /
DATE: ! APPLICANT'S SIGNATURE
XI
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
949 RYAN RD BP-2015-0621
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 35 -058 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-2015-0621
Project# JS-2015-001201
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa. ft.): 17641.80 Owner: MERRICK JESSE
zoniniz: Applicant. MERRICK JESSE
AT: 949 RYAN RD
Applicant Address: Phone: Insurance:
949 RYAN RD (413) 824-1239 ()
FLORENCEMA01062 ISSUED ON.121512014 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL CHAPPEE WOOD/COAL HEATER 8033
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:
FeeTyne: Date Paid: Amount:
Building 12/5/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner