29-359 (3) City of Northampton
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AUG 1 9 M i( Massachusetts r
NT OF BUILDING INSPECTIONS
lectric PL 22;71 n street • Municipal Buildings
N F. .m�f�� ,��,i �0 orthampton, MA 01060 ° 1
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, l/���7AW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $ Check# 1110
PLEASE TYPE OR PRINT ALL INFORMATION
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1. Name of Applicant: ���??1\ ±±..���..
Address: �- ( V`T( �Q l S��b� i�c Iephone:
2. Owner of Property:
Address: / Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: c c) ( R C J��
If applicant is not the homeowner:
Construction Supervisor's License Number -�I �� Expiration Date
Home Improvement Contractor Registration Number 1 Q L Expiration Date y f
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. r 1
DATE: " �h APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
243 ACREBROOK DR BP-2016-0207
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 29-359 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-2016-0207
Project# JS-2016-000351
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RICHARD SCOTT 83108
Lot Size(sq.ft.): 15028.20 Owner: DUFFUS MARK R&JANE E ROSA
Zonin . Applicant: DUFFUS MARK R & JANE E ROSA
AT. 243 ACREBROOK DR
Applicant Address: Phone: Insurance:
243 ACREBROOK DR (413) 387-7069 O
FLORENCEMA01062 ISSUED ON.811912015 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL CCO CHOICE CAB 50 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 8/19/2015 0:00:00 $40.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner