16B-010 (3) City of Northampton
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Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Buildingf
Northampton, MA 01060'"W
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° LE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
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L�¢ WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25T0 Check #
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PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: /na- o a-Ye± �Cf Y✓�1T
Address: lO i j3rJ,dq,1 f2j. T pye.n(_Q_ Telephone:
2. Owner of Property: yv /TVItGt I�Gty;r�Ce_ �Gi� ��!{QugGtr� ���✓' 7T
Address: Telephone:
3. Status of Applicant: Owner lContractor
4. Type or Brand of Stove: Gydo
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: v�` U APPLICANT'S SIGNATURE Lk�
DATE: O r� O( � HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
101 BRIDGE RD BP-2016-0098
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16B-010 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-2016-0098
Project# JS-2016-000177
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 10018.80 Owner: GARRETT MARGARET
Zoning: URB(100)/ Applicant. GARRETT MARGARET
AT. 101 BRIDGE RD
Applicant Address: Phone: Insurance:
101 BRIDGE RD (617) 538-2515 O
FLORENCEMA01062 ISSUED ON.712712015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL 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 7/27/2015 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner