31A-024 (13) 42 FRANKLIN ST BP-2017-0361
GIS d: COMMONWEALTH OF MASSACHUSETTS
Mao:Block:31A-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-2017-0361
Project# JS-2017-000601
Est.Cost:$1899.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Grouv: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq. ft.): 17903.16 Owner: DANTON ERIC
Zoning:URB(100)/ Applicant: OLD HADLEIGH HEARTH & HOME CENTER
AT: 42 FRANKLIN ST
Applicant Address: Phone: Insurance:
119 WILLIMANSETT ST (413) 538-9845 WC
SOUTH HADLEYMA01075 ISSUED ON:9/16/2016 0:00:00
TO PERFORM THE FOLLOWING WORK:JOTUL F3 WOOD STOVE
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:
FeeTepe: Date Paid: Amount:
Building 9/16/2016 0:00:00 $40.00
212 Main Street,Phone(413)587/240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
rf i Massachusetts � r��(
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i' in'
i j DEPARTMENT OF BUILDING INSPECTIONS .,
212 Main Street . Municipal Building
Northampton, MA 01060 Ty„,
2.40
v
Co a
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v SINGLE OR TWO FAMILY SOUD FUEL APPUANCE PERMIT APPLICATION
FOR WOOD,COAL,PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
�z / �[
Check# /6 32
Please fill in all appropriate information
t_ Name of Applicant : C•CCN„apv� 9a
Address: 1.12 FrOwtic,(�� 1- Telephone: %/00-1o(�6
2. Owner of Property : S CLWLQ
Address: S -P Telephone:
3. Status of Applicant: X. Owner Contractor GG
4. Type or Brand of Stove : J 01U1U1 � '— to pc(i(�77` SIC' VC-
UL
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5. UL Listing : 114 22_
6. Estimated Cost: t [{4 1
If applicant is not the home ow ::
Iner
Contractor name °lie ICpaIlR t'g1 t w}41,, 5- 1`-0"t^-e 4 +� / '7
Construction Supervisors License Number (SSl_613}%u Expiration Date /2 %L /
i
Home Improvement Contractor Registration Number I ug I b _ Expiration DateCt/t�//7-
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
T Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: q(� / (pAPOEOSIGNATURE
DATE: "1! 1 r � 6 HOMEOWNERS SIGNATUREyc
APPROVED
DATE: BUILDING OFFICIAL
The Commonwealth of Massachusetts
/�at.,ws in Department of Industrial Accidents
? __:;rt_ 1 Congress Street'Suite 100
s _s;�I_ Boston,MA 01114-1017
"t•..;,,,a
www.mass.gov/dia
Workers'Compensatloa Insurance Affidavit Bufders/Contracton/ElecMcians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information / A // Pleat Print/ Lfgibls
Name(Busines/Organivtio ?Indiiviiduuaap: :th?e ,C7%'C / TG 61/'1 (1 /- //1[t . -
Address: //9 /V //),ig/VP2,1 cS
City/State/Zips5)i 1-11n//F/ 04- Oho 95.— Phone#' W. - 6-1;-Ye-98376.—
—
Are you an employer'Cluck the appropriate hoar
coy Type of project(required).
tNi am a employer with employes(full and/or part-trmel' 7 9 New connruerion
251a role pr
opn wnd
or rtnenhip ahave no employees a
wka,s fir me in R ❑ Remodeling
env cap city. INowekers Lowy.wrumee requuN)
J❑I on a hanotmer 4101111 all ort myself No toadies comp mmorwe required) 9. ❑Demolillon
4 I ant a hanawne and will be hiringuacwu to conduct all wok m myIOQBuiiding addition
in property will
none that all coawamrm either have workers'compensation insurance or are,ole II Electrical repairs or add Moro,
pwpawn with no nnpMyccs 12.❑Plumbing repairs or add:: cps
19:am agciwml comment and l have hired tew6cantnems listed on the attached seen- (3.❑Roof repairs
Moe.t Scoraranan have employees and have woken'roup.natant I .ba L
u Ws ars a corpemsiun card asofm chove named their wen ofaanpuon pa MCIc I4.,/CW Other�ll5�,p'/�IY(1.-147 S4rrt .
153.I 04i.an we have on employees.(No woken'comp unmans re w d 1 /-'-'
'Nay applicant that checks hoc el oust also Ell out the Kuban below showing Ilit,workers'compensation piny information
u nonicawpas who suborn the affidavit indicating they arc doing all work and tee lure outside contractors roust snout a new affidavit indicating wen
:<'Omeewn the check to hen must atuehcdan additional shed abowhrgthe time of die sWxomncmn and sure whether or lot thusc cores have
unployees. I(the svbrnnhactora have employees,they mtrst pwvNe edea minces moppolicy number
/am an employer that is providing workers'compensation Insurance for my employees. Maw LT the policy andJob site
rte ormation. - N
Insurance Company Name-__- 7ra Gere/f/ S //7-S(//:417t
P '
_
_
:Icy #or Self-ins. Lic.#: /t / p 176 5974 J / - Expiration Date ./.27/1/7
lob Site Address: Cit /State/Zi
AMI y A i --it' t tr;l'til t , r.s"` R'ft""nit-1'131'1". 'it ' _ :,dale),
Failure to secure coverage as required under MOL a 152,§25A is a criminal violation punishable by a fine up to SI.500.DU
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250 00 is
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insur area
coverage Ye/iteration.
I do hereby certify under the pains and penalties of peaty That the Information provided above is nue and correct.
}na,asdre: .-(Th. .. -' 0,53-4 9892f Date: ----...
Phone#: �/.3 "d7 ,3�' ' �er L/e.c--1
Official use only. Do not write In this area,to be completed by city or town official tl
ll
I.
City or Town: Permit/License If
I Issuing Aathorlty(circle one): iii
I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other 1
! Contact Person: Phone#: _ ',I
Lam{ Ivlaaaaw luactia – latpal tnfciIL of r u UM, Jaicly
(f�E_�/IJ Board of Building Regulations and Standards
Cliiiivit 1.4 A.3.IIIIYEI ICI V ayllf .)lIC4_iiL 9Li tmainialswa'
License: CSSL-098784v. t ,.
Yvv,tf ti I)
MATTHEW COXr
L.
54 Hadley Street ir ik.r.=,
South Hadley Mk 01 :‘1.." ;'
r
47:44.m.. ��t " )I I4a INA �� Expiratiaa'
Commissioner 04/28/2017
f ^i,e ((a4rvmanteteaa, 1C)//ixvuu , road,
kP. Office of Consumer Affairs and Business Regulation
k�,,,. 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration '48198
Type-. Private Corporation
Expiration 9/13120/7 Tr# ?717/n
OLDE HADLEIGH HEARTH & HOME CENT
MATTHEW COX
' 19 'MIL LIMANSETT STRETT RT 33
S H.ADLEY. MA 01075 _- - - - ---
Update Address and return card.Mark reason for.ha nv.
— Address ' Renewal Employment Lost ( ant
/ t /// y%'.Fr/ 4„,,p,Oilict (osar A Aflaws&B Basilian License or registration valid for mdividul use only
i
Ie,.-10ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
r Ift Reo st a[ n 148198 Type: Office of Consumer Affairs and Business Regulation
€xpra.on. .]1312017 Private Colpotatmn 10 Park Plaza Suite 5170
Boston,MA 02116
_._,c c..18"-3 HOME CENTER, INC
i
N?• STRE'T R' 3 e L' Cp .�
undtnecretary - - Not valid without sign re