31A-024 (5) City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPE
212 Main Street • Municipal Sui
Northampton, MA 01060 ssPh,
�4 SEP 1 4 3i_!I
Electric
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check#
Please fill in all appropriate information
1. Name of Applicant :
Address: / b / �Ci �6j%�L , /�r'� Telephone:�}/ 3 y
_._Owner of PrepeCtjc_,_. loll Ae�t Y;cl �� R^c� C G�c/
Address: /r �"' N r Telephone q13 `j Sf 6 9
3. Status of Applicant : Owner Contractor `
4. Type or Brand of Stove : VI Y i r✓2.r t;� ',
5. Estimated Cost : I 1`r /Cr C V'k r-
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: APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
42 FRANKLIN ST BP-2016-0325
GIs#: COMMONWEALTH OF MASSACHUSETTS
MN:Block: 3 1 A-024 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-2016-0325
Project# JS-2016-000518
Est.Cost:
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 17903.16 Owner: SIMPSON MARIAN V H
Zoning: URB(100) Applicant: SIMPSON MARIAN V H
AT. 42 FRANKLIN ST
Applicant Address: Phone: Insurance:
42 FRANKLIN ST
NORTHAMPTONMA01060 ISSUED ON:911412015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL WOODSTOVE INSERT
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 Sijjnature:
FeeType: Date Paid: Amount:
Building 9/14/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner