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49-018 (2)
City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building '�.. Northampton, MA 01060 ' C u. u 4 SI ;z LE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION F WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS W 0 Permit Fee: $25.00 Check #��' PLEASE TYPE OR PR p PRINT ALL INFORMATION 1. Name of Applicant: ma,, l t 1 / K 1 V�k", ' `y,� Address: 3"An ��2 Q RL�/ -JCDWA6& Telephone: �� J 2. Owner of Property: I i l!�,(c -� f ,6Lq-tA Address��(© 6 i CVAC, � 4K-6A --VC) C� 1 I Y�, �� -Tel p elephone: 3. Status of Applicant: Owner Contractor 4, Type or Brand of Stove: A-0 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 a accurate to the best of my knowledge. Giti 4� DATE: `I - is— APPLICANT'S SIGNATURE P-7-��--- DATE: '"I rr HOMEOWNER'S SIGNATURE APPROVED DATE: BUILDING OFFICIAL 340 GLENDALE RD BP-2015-0949 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 49-018 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-2015-0949 Project# JS-2015-001836 Est.Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 40597.92 Owner: PION MARK S&KATHLEEN D zonine: Applicant: PION MARK S & KATHLEEN D AT: 340 GLENDALE RD Applicant Address: Phone: Insurance: 340 GLENDALE RD FLORENCEMA01062 ISSUED ON:41912015 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL JOTUL 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 4/9/2015 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner