11A-007 (4) -�—, of Northampton
Massachusetts .
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a b ( 2014 DEPAJk NT OF BUILDING INSPECTIONS
21 Ma' Street • Municipal Building
�-- orthampton, MA 01060 '
Electric,Plumb'na&Gas Inspections
Northampton•tJIA 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 # ? -
PLEASE TYPE OR PRINT ALL INFORMATION
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1. Name of Applicant: V ��L i`'- ' 1 J
Address: C, ' `�` U o,v e Telephone: S C1\y1 ei
2. Owner of Property: 1 V \ rc- k,( �/ z
Address: Z- �c�i5 Nl b/A C) I o� Telephone: / / J 322 0 -E3 S
3. Status of Applicant:Yowner Contractor
4. Type or Brand of Stove: 4/)+c) 1 o 0
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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: j 1 I I APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
35 CHESTNUT AVE BP-2015-0653
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: I IA-007 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-2015-0653
Project# JS-2015-001255
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.): 11325.60 Owner: ELKINS NIRA HARPER
Zoning: URA(101) Applicant: ELKINS NIRA HARPER
AT. 35 CHESTNUT AVE
Applicant Address: Phone: Insurance:
35 CHESTNUT AVE (413) 320-3158 O WC
LEEDSMA01053 ISSUED ON.12/12/2014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL JOTUL NORDIC QT F 100
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 12/12/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner