31C-006 (13) 32 WARD AVE BP-2019-0213
GIS 4: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 31C-006 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL 042A)
Categoy: woodstove BUILDING PERMIT
Permit a BP-2019-0213
Proiect9 JS-2019-000350
Est.Cost:$2000.00
Fee:$40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: LEARY BUILDING COMPANY 104806
Lot Size(sa.ft.): 54450.00 Owner: KABAT-ZINN MAYLA&JON
Zoning:RR(77VWP(66)/URA(29)/FFR(1)/ Applicant.- LEARY BUILDING COMPANY
AT. 32 WARD AVE
Applicant Address: Phone: Insurance:
13 GLENDALE WOODS (413) 336-2611
SOUTHAMPTONMA01073 ISSUED ON:8/17/2018 0:00:00
TO PERFORM THE FOLLOWING WORKJOTEL F-400 CASTINE
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 k 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 8/17/20180:00:00 540.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
"f 4 Massachusetts
n6PAarl18P'r OF mnnmc SBSPEcrx ms
212 Min Sheet • lNn 010 Huildinq
NozGmp[on, [A01060
REQ ED ED
i 7 2018 31�. "�G�
AUG
6p.10 -al 3
ING E OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
ON
CFPT �i;I OING M "00
00
COAL,PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check# 05r tL40
Please fill in all appropriate information
1. Name of Applicant
Address: /� aL6116ALC e—JW S btl , �6uftlA CLPTelephone3 336 zv/
2. Owner of Property:_/Y I ITA # ToN - :ZNN 111
Address: .32 (,)go) tl'R5 ,J Telephone: 0I R`1 - q(p
3. Status of Applicant: Otinierr Contractor
4. Type or Brand of Stove: �U—BI V- Lj(X) LASFWr
5. UL Lisfing: 713q 4
8. Estimated Cost:
//
7. Email: //M /yn..
If applicant is not the homeowner.: �)
Contractor name Email , /1,W(1,) �,-A 01Lt)1.A •C--t
Construction Supervisors License Number ld /O`/90(n Expiration Date 2 /7 20
Home Improvement Contractor Registration Number /&/obQ - Expiration Date S_/ ZO
AO Applicants must complete a Workers Compensation Inwmnce Affidavit beibm we can issue a Permit
8, Certification: I nearby certify that the information contained herein is true a ccurate to the bes of my
knowledge. % o
DATE.—f --I(� ./_ APPLICANTS SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE:_6 ,�%74i P� BUILDING OF ICIAL �
The Caminonweallh of MassachueelGs
({ _ Department of Industrial Accidents
1 Congress Street,Suite 700
Briton, MA 027/4-2017
www me issgm/dia
Aorkers'Compensation lasmsnee A Metal Builders/Contmcfa aIEiectricians/Wumhem.
10 BH FILED WITH I BY ITT MF1"176G ACTH011
Applicant l f r tin Please Print l.eeibl,
Name(Husiurs'Orgmlaalion.'Individuap: /,e4p,/
Address: ,Z G,LEADAf / .kci(5 ,
City/State/Zip: 5«rM Mq ao'43 Phone 4: 3 ' 26(/
r yon s..rmploy.r?Cheek me apta.prille be.: Type of project(required):
IIxm o emplorenwh_ emfil...still)end/nrpan-time) 7. ❑New construction
2.❑1amasolepmlxicra or panrosinand haven.enilovecs w..rku.g fa in R, ❑Remodeling
wryceparat, [No marks col.ins,nal reyuired.l
I lamuhearai .er doir,till work in if No maxot,t surdnc d B. ❑ ldnDemolition
h ysc t amp. In �cr,q..ire I,
a.❑r a ht d n l I i h I t -1 conduct n k n ra p reports l wll 10❑ Building addition
,norrithooll incraem..ehneltion ,ukces .. res vle II.❑Electrical repairs or additions
pmpnctnm wdh no emplopcas 12.❑plumbing repairs or additions
5.❑l am a general...... ..rand l have hired me rob-........fors lrsled no ntc attached sheer 13.❑Roof repairs
bwnv t . h .filo d rk p s
h Warea corporation and its .ITio h ird their ri,gla of'axeilopor per MGl.c. 14.POfher 4,qly. S/WC _ _
pI(dl.and h - nph_ [tto dttslarrrip crop im11
'Anp applicant ttutcheeks box NI mull nls..liltum the secli..npclow sh,ming tile in..vski,, ' anipanolliorl'oll" inpprial ion.
t Homwmtiers.vho submit this affidavit Indicating they are doing411 work and then are outride contractors must submit a nem art idavn and,anng suci.
lContrnc.ors thol cheek his be<mmt awched an additional sheet shmvu(v the name of rob-contmcmrx and sure mhctlneror not throe cronies hove
on.pl..yces. 11 ro,suhcnnwcmrs have ro.pl..vice%they rust provide their moAers car, poll,farror.
!am an employer that is providing workers'conrpensatimr hourioncer for on,employees. Below is the policy and job site
informaflnn.
Insurance.Company Name.
Policy II or Sell-ins. Lie 4: Expiration Date
Job Site Addres _Cir"St-mc2ifs
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGI,c. 152, ys25A is a criminal violation punishable by a fine up to S 1,500.00
and/or one-year imprisonment,as well as civil penalties in the form oft STOP WORK ORDER and a fine of up to 5250.00 a
day against the violator.A copy ofthis statement may be forwarded to the Office of Investigations ofthe DA for insurance
coverage verification.
I do hereby certify d ins nd p er%ury that the infarmotion provided above is true and correct
Si nature: Date' -f0' %F
Phone#: CS 33G -
Official use on(v. Do not write in this area,to be completed by city arttil nf/teirsC
Cit,or Town: Permit/License
Issuing Authority(circle one):
1.Hoard of Health 2.6eikliug Ilepart n i 3.taByflbwn Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#: