29-198 (2) City of Northampton
"* Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building j ?
Northampton, MA 01060 tw 7 �a
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
1. Name of Applicant: Do Lz%o LLA�w
Address: '31 0 f-u k2;y- ffi-�y-c tj to(.Z Telephone: 3 It
2. Owner of Property: b(n ikjn �-A A L.—C-
Address: . l G'.i 1V,41v- VVN v-L r t`{,✓N(,A— Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: AA&U`y�A r\ k "
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 4.UA;n- C:c�
DATE: 1�1 °I (< �� HOMEOWNER'S SIGNATURE 066 1&v—
APPROVED
DATE: BUILDING OFFICIAL
31 OVERLOOK DR BP-2015-1135
GIs#: COMMONWEALTH OF MASSACHUSETTS
MM:Block: 29- 198 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: woodstove BUILDING PERMIT
Permit# BP-2015-1135
Project# JS-2015-002137
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 17728.92 Owner: YAKOVLEV IVAN P&DAWN LUCIA
Zoning: Applicant: YAKOVLEV IVAN P & DAWN LUCIA
AT. 31 OVERLOOK DR
Applicant Address: Phone: Insurance:
31 OVERLOOK DR (413) 584-5536 ()
FLORENCEMA01062 ISSUED ON.511912015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL HARMAN ACCENTRA WOODSTOVE
INSERT
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 5/19/2015 0:00:00 $25.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner