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17A-021 (4) City': o Northampton alas achusetts EP2U Tni� OF BUILDING INSPECTIONS ' reet • Municipal Building �a�, � ri py0? Northampton, MA 01060 SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION FOR WOOD,COAL, PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES Check#—1 161 Please fill in all appropriate information 1. Name of Applicant : 3,9 cLJ I Address: � Telephone: 2. Owner of Property : 114 n� Address: '3-0,Am z Telephone: 3. Status of Applicant : Owner Contractor 4. Type or Brand of Stove : 'Ll C O SL^z 5. Estimated Cost: 0 u 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 a7/6��Z,to to the best of my knowledge. DATE: � APPLICANT'S SIGNATURE DA TE: �� HOMEOWNER'S SIGNATURE 'dI� rl Y APPROVED DATE: BUILDING OFFICIAL 185 SPRING GROVE AVE BP-2016-0584 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A-021 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-2016-0584 Project# JS-2016-000971 Est.Cost: $2000.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: OLD HADLEIGH HEARTH & HOME CENTER Lot Size(sq; ft.): 15594.48 Owner: ENGEBRETSON JESSICA Zoning: RI(100)/URA(100)/ Applicant: ENGEBRETSON JESSICA AT: 185 SPRING GROVE AVE Applicant Address: Phone: Insurance: 185 SPRING GROVE AVE (860) 807-8459 O FLORENCEMA01062 ISSUED ON:1012712015 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL JOTUL CASHINE 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: FeeTyue: Date Paid: Amount: Building 10/27/2015 0:00:00 $40.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner