43-041 (3) [ r j
At Massachusetts
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2 SPA TIMENT OF BUILDING INSPECTIONS
9 f 12 in Street • Municipal Building
• _ eotict� '- 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 FIREPLACES
Check# `#k
Please fill in ail appropriate information
1. Name of Applicant : 3RUc<�,
Address: 6-S' A0-1L)MV DR riLWe--,�e, 111M Telephone: . �5`! 2 1A?
2. Owner of Property : �yG(�, - !Leh<e, __
Address: J� !1y 4(JM01/ DFQ 1--,>OXAv4 , /V/f Telephone:
3. Status of Applicant :_� 1Owner Contractor
4. Type or Brand of Stove :
5. Estimated Cost :
If applicant is not the homeowner::
Contractor name
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
6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: ? 1:;R3 11Jl APPLICANT'S SIGNATURE
DATE: 23 /6� HOMEOWNER'S SIGNATURE u �
APPROVED
DATE: BUILDING OFFICIAL
58 AUTUMN DR BP-2016-0269
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 43-041 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-2016-0269
Project# JS-2016-000413
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 18382.32 Owner: MARTIN BRUCE S&SOPIE H
Zonin : Applicant: MARTIN BRUCE S & SOPIE H
AT. 58 AUTUMN DR
Applicant Address: Phone: Insurance:
5 8 AUTUMN DR (413) 584-2118 (�
FLORENCEMA01062 ISSUED ON.812612015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL HARMON PELLET STOVE
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 Denartment 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 8/26/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner