41-007 (3) City of Northampton
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NOV ""T OF BUILDING INSPECTIONS
.0 v r y 212 in Street • Municipal Building
DEFT Northampton, MA 01060
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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#—!aw
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ji A p C ` V✓i r IJ
Address: 1 S o 4 VIE S T P A i-i\P /0�I" __k D Telephone: Z I
2. Owner of Property: A V D b O�P n n .
Address: ( f ry 1/1
3. Status of Applicant:V Owner _Contractor ( '/
4. Type or Brand of Stove: V
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
s. Certification: I hereby certify that the information contained her in is true and accurate to the best
of my knowledge. <
DATE: 11 IZ APPLICANT'S SIGNATURE \�
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
1504 WESTHAMPTON RD BP-2013-0595
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:41-007 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-2013-0595
Project# JS-2013-000957
Est.Cost:
Fee:$25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: DANIEL HEWINS 049714
Lot Size(sq.ft.): 43560.00 Owner: HEWINS DANIEL E
zonina: Applicant. DANIEL HEWINS
AT. 1504 WESTHAMPTON RD
Applicant Address: Phone: Insurance:
P O BOX 186 (413) 582-9929
CHESTERFIELDMA01012 ISSUED ON:11/27/2012 0.00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL VERMONT CASTINGS ENCORE
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 11/27/2012 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner