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City of Northampton
` Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building
-w� Northampton, MA 01060 y�1
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
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Permit Fee: $2"0� Check # //74,
PLEA TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: UyMm/y,
Address: 1 `"�`\lI X151 Telephone: 2
2. Owner of Property: 1N,l�lc�
Address: , ( � I v Telephone:
3. Status of Applicant: Owner Contractor Otu, Z
4. Type or Brand of Stove: C" ( '
If applicant is not t hom
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: I APPLICANT'S SIGNATURE
DATE: I( HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
46 FORT HILL TER BP-2016-0105
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 3 1 D- 176 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-2016-0105
Proiect# JS-2016-000190
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 6011.28 Owner: BROWN WILLIAM W
Zoning: URC(100) Applicant: BROWN WILLIAM W
AT. 46 FORT HILL TER
Applicant Address: Phone: Insurance:
113 NORTH MAPLE ST (413) 582-1334 (�
FLORENCEMA01062 ISSUED ON.712812015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL PACIFIC ENERGY 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 7/28/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner