24A-173 (7) 301 PROSPECT HGTS BP-2021-0139
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:24A- 173 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-2021-0139
Proiect# JS-2021-000230
Est. Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: OLDE HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq.ft.): 43211.52 Owner: WEIN DOUGLAS
Zoning: URA(100)/ Applicant. OLDE HADLEIGH HEARTH & HOME CENTER
AT. 301 PROSPECT HGTS
Applicant Address: Phone: Insurance:
119 WILLIMANSETT ST (413) 538-9845 WC
SOUTH HADLEYMA01075 ISSUED ON.81512020 0:00:00
TO PERFORM THE FOLLOWING WORK: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 8/5/2020 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax:(413)587-1272
Louis Hasbrouck—Building Commissioner
City of Northampton
"g Massachusetts
DEPART2MNT OF BUILDING zNSFwTTaNs
212 Main Street • Municipal Building * , �b�m
�v. Northampton, MA 01060
f ! C_
APIA ICATION FOR SOLID FUEL APPLIANCE INSTALLATION
Fronerty Information
Owners Name:— , s Lj
Address: '10 l
(No.) (Street Address)
Phone: Cell: 11 3,--1 0 5 Email: Lve , j . p,.,;s �' G �.,l c�
Owners Signature: Date:
Contractor's Information of Applicablel
Name: (0[de ftp,- r t, .j K►m e ce ,l4 Phone: Lila S 3 i 9� 15
Construction Supervisor's License #: css L-c 9 b-7 Expiration: !-I -J 8-AWM
Home Impr. Contractor License #: 1 `I Y I g y Expiration: 9-
Stove Information
Type of Fuel (check all that apply): Wood ✓ Pellet Coal
Location: v �� ,a d„� Freestanding ✓ Insert
Manufacturer: S yv�j k Model: d s L o f S o o
r
------ //�) ------�----FOR BUI LDTNG DEPAR ME T USE ONLY--
Permit -�—�----------
Permit# 46 pate Applied: 42 Total all Fees: $ c4 li 393j
Building Official: u)&-) Date Issued:
Signature of Building Official:
Commonwealth of Massachusetts
Division of Professional Licensure
Bo,jrd of Building Regulations and Standards
ConstructilpAr,'§" ir Specialty
CSSL-098784 Expires : 04128/2021
MATTHEW COX
54 HADLEY STPZE ,xE _ ~. •
SOUTH HADL�
t
Commissioner
JTZ
Office of Consumer Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home Improvement Contractor Registration
n—. Type: Corporation
Registration: 148198
GLDE HDLEIGH HEAR &HOME CENTER, INC Expiration: 09/12/2021
119 W ILALIMANSETT STRETT RT 33
S. HADLEY, MA 01075
Y
ti
SCA 1 A 20M-05i17 Update Address and Return Card.
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TYPE:Corporation before the expiration date. If found return to:
Registration Exoiration Office of Consumer Affairs and Business Regulation
148198 09/12/2021 1000 Washington Street -Suite 710
OLDE HADLEIGH HEARTH&HOME CENTER,INC. Boston,MA 02118
MATTHEW D.COX
119 W ILLIMANSETT StRETT RT 33 r� T�f-G 'gyral
S.HADLEY,MA 01075 UndersecretaryNot valid wi Ko
ut signature
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
IF 600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Man Print Legibly
Name(Business/OrganizatimOndividual)ol6.4� p �.Q,ljq� �f 0,� f0me CQ,'j�itr .i�
Address: 1)g W 1 111maiu& (Men— I
Ci /State/Zi 4% Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time)." have hired the sub-contractors 6 New construction
2.❑ l atm a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g• ❑Demolition
working for me in any capacity, employees and have workers'
insurance.:
9• [3 Building addition
comp.[No workers'comp.insurance P•
required,] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 1 l.❑Plumbing repairs or additions
myself.(No workers'comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.)t c. 152,§1(4),and we have no
employees.[No workers' 13.[1 Other
comp. insurance required.]
*Any applicant that checks box 01 muse 915-0 fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicating such.
iContractors that chock this box must attached an additional sheet showing the name of the sub-coatnctors and state whether or not those entities have
employees. If Ilse subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer that Ls providing workers'compensation Insurance for my employees. Below is the poUcy and Job site
Information,
Insurance CompanyName:'f�aVel.��eS
Policy#or Self-ins.Lic.#: j' '1q�15?j Expiration Date: .L 1
Job Site Address: City/State/zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert(&under therpains/and penaltles of perjury that the Information provided above Is true and correct.
ivs►�tur�' /v -` f^ (/' Date. -7
Phone N:
Of jTcial use only. Do not write In this area,to be completed by city or town officlaL
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing inspector
6.Other
Contact Person: Phone#•
Estimate
�Villimansett
South Nadler. N 1A 0107, 1 I Date Estimate#
=41-',--;,-',8-9845 F
= 17,2020 127511
Name/Address Ship To
Douglas Wein
301 Prospect Heights
Northampton.Ma.01060 i
Description Qty Cost Total
Jotul Oslo V3 Clean Face I 3.559.00 3.559.001
Short Leg Kit I 1 99.00 99.00T'
6"x 25'Einer Kit 1► 1 -25.00 725.00'1'
Damper Scaling.Kit 1 1 4O.GO 40.00 s''
Stove Adapter-Air Cooled 1 50.37 50.37T
6"x 12"- 18"Air cooled 1 89.35 89.351.
Labor { 75().00 750.00
Sales Tax Payable-NIA 6..5% 285.1 7
i
I
I
I {
i
Total S5.59789
Customer Signature