32C-076 (2) City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
Northampton, MA 01060 �5 {1
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LnSI yo E OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
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W% FOW VOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
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a= Permit Fee: $25.00 Check #
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1. Name of Applicant: S:Ott_,V-7 I'S Ljvpi✓
Address: Co U t' zu �T - Telephone: `"1 u —S,11-91L17,
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2. Owner of Pro e • IF1SCLf- 1 C'�Y)• 1 d'^'►�1
P//��rtY�
Address: to U iJ� ST Telephone: 40-5-&548 rK3
3. Status of Applicant:jzowner Contractor
4. Type or Brand of Stove: C4AXV-%VA1,j
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.
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DATE: 2C /1 .1' APPLICANT'S SIGNATURE
DATE: V ILA 57 HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
6 CONZ ST BP-2015-1260
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 32C-076 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-2015-1260
Project# JS-2015-002318
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sg. ft.): 4486.68 Owner: FISCHER SETH H&PATRICIA E SOMMELING
Zoning_URC(100)/ Applicant: FISCHER SETH H & PATRICIA E SOMMELING
AT: 6 CONZ ST
Applicant Address: Phone: Insurance:
6 CONZ ST (413) 531-9742 O
NORTHAMPTON MAO 1060 ISSUED ON.61812015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL HARMAN PGIA 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 Siznature:
FeeType• Date Paid: Amount:
Building 6/8/2015 0:00:00 $25.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner