28-071 (8) City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building •,.,
Northampton, MA 01060
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 : t/�C� �.I P c C �a ►nd- Ka S
Address: 1613 fef M Telephone:
2. Owner of Property : VrCt a v e( E1—;L- C4 1G{ VVA' Kxy S
Address: 1� 3 S,Y-C UX 5T` 1— Telephone:
3. Status of Applicant: ✓Owner Contractor
4. Type or Brand of Stove : Lo P 1-
5. Estimated Cost : 4 11300
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: Ncv I u, Z01 S- APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
16') SYLVESTER RD BP-2016-0661
GIs#: COMMONWEALTH OF MASSACHUSETTS
MaR:Block: 28-071 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-2016-0661
Project# JS-2016-001105
Est. Cost: $1300.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 40249.44 Owner: KAYS LAURA B&ERIC FRIEDLAND
Zoning: Applicant: KAYS LAURA B & ERIC FRIEDLAND
AT: 163 SYLVESTER RD
Applicant Address: Phone: Insurance:
163 SYLVESTER RD (413) 586-4662 O WC
FLORENCEMA01062 ISSUED ON:11/10/2015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL LOPI 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 11/10/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner