38A-018 (7) City of Northampton
Massachusetts :
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I NT OF BUILDING INSPECTIONS
21 i Street • Municipal Building
LA 16 ���[ ! orthampton, MA 01060 s 7
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Electric, Fiu r '
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SINGLE OR T FA1VtiLY-tOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
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Permit Fee: $26-00 Check #
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ���I� At ��j kV j— )
Address: VS� � Telephone: q -5 •,z-c L s� 1
2. Owner of Property: � �
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove:_ a
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 ` z,
DATE: `7 ', HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
13 RUST AVE BP-2016-0068
GIS#: COMMONWEALTH OF MASSACHUSETTS
Ma :Block: 38A-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-2016-0068
Proiect# JS-2016-000121
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 8319.96 Owner: PAINE DAVID A
Zoning. URB(100)/ Applicant: PAINE DAVID A
AT. 13 RUST AVE
Applicant Address: Phone: Insurance:
13 RUST AVE (413) 262-1501 ()
NORTHAMPTON MAO 1060 ISSUED ON:711712015 0:00:00
TO PERFORM THE FOLLOWING WORK:I NSTALLMORSO 3440 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 7/17/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner