38A-081 City of Northampton
Massachusetts
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DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building y,
Northampton, MA 01060 �N
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET,CORN,STRAW OR SIMILAR STOVES, OR FIREPLACES
Check# 8
Please fill in all appropriate information
1. Name of Applicant:
Telephone:
2—� �O
2. Owner of Property : �-
Address: Telephone:
3. Status of Applicant : Owner } Contractor
4. Type or Brand of Stove : 1 C, �> 1
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. i
DATE: APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
32 BURTS PIT RD BP-2016-0353
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma:Block: 38A-081 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-2016-0353
Project# JS-2016-000563
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sa. ft.): 32234.40 Owner: PAYNE ERIC L
Zoning_URB(100)/FFR(0)/ Applicant: PAYNE ERIC L
AT: 32 BURTS PIT RD
Applicant Address: Phone: Insurance:
32 BURTS PIT RD (413) 218-4276 ()
NORTHAMPTONMA01060 ISSUED ON:911512015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL JOTUL 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 9/15/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner