38C-004 (4) i
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i y of Northampton
Massachusetts ` `St�
PAR NT OF BUILDING INSPECTIONS �?
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DEPT.QFBUlLDINGINSPECnQ112 in Street • Municipal BuildingQ �
No AMPTQN MA01060 Northampton, MA 01060
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: a�6Pu Check # C �
< PLEASEYPE OR P NT ALL INFORMATION
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1. Name of Applicant: wwv
Address: Telephone:
2. Owner of Property:
Address: lcT{ �f �s: Telephone: !
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: .
If applicant is not the homeowner: l /
Construction Supervisor's License Number b( 0% Expiration Date
Home Improvement Contractor Registration Number W4 Expiration Date 0 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.
DATE: APPLICANT'S SIGNATURE
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DATE: HOMEOWNER'S SIGNATURE��'. i�-
APPROVED
DATE: BUILDING OFFICIAL
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-- - _-1 -- -_ --
166 GROVE ST BP-2016-0525
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 38C-004 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-2016-0525
Project# JS-2016-000878
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RICHARD SCOTT 83108
Lot Size(sq. ft.): 36503.28 Owner: GIFFORD JESSICA S&NICOLE R ROCHEFORT
Zoning. URB(100)/ Applicant: GIFFORD JESSICA S & NICOLE R ROCHEFORT
AT. 166 GROVE ST
Applicant Address: Phone: Insurance:
166 GROVE ST
NORTHAMPTON MAO 1060 ISSUED ON.•1012012015 0.00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL QUADRA FIRE FIREPLACE 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 Shmature:
FeeType: Date Paid: Amount:
Building 10/20/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner