38A-004 (17) BP-2023-1372
2 BURTS PIT RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
38A-004-001 CITY OF NORTHAMPTON
Permit: Solid Fuel
Appliance
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1372 PERMISSION IS HEREBY GRANTED TO:
Project# 2023 WOOD STOVE Contractor: License:
Est. Cost: NORA WINE CSSL-106199
Const.Class: Exp.Date: 08/24/2024
Use Group: Owner: WOODFIN ELIZABETH &DEIDRE CUFFEE-GRAY
Lot Size (sq.ft.)
MCKENNEY HEARTH&HOME/MCKENNEY
Zoning: URB Applicant: ELECTRICAL CO INC
Applicant Address Phone: Insurance:
100 NORTHAMPTON ST (413)586-5351 XW02257872259
HOLYOKE, MA 01040
ISSUED ON:10/05/2023
TO PERFORM THE FOLLOWING WORK:
INSTALL WOOD STOVE IN LIVING ROOM
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
.; • O
SQ 1 •
Fees Paid: $40.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
A City of Northampton
1 OµSAMYIf+ Ssw BSI
I '?. ..Z :_ , Massachusetts w�'S' E •c,
fr 4tG
(ram': DEPARTMENT OF BUILDING INSPECTIONS y`. Nc
7 °' ,. 212 Main Street • Municipal Building �.`
T � -t'�; Northampton, MA 01060 '�st7•'�, l��r
1•:f '�A� 'nn,
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_i -Ae irICATION FOR SOLID FUEL APPLIANCE INSTALLATION
Property Information
U) okQOwners Name: � 1 n
Address: a I3 A-S PA- get
(No.) (Street Address)
Phone: if 15. 31.. 3I ug Cell: Email:
Owners Signature: Lei <4 Date: W l 3
Contractor's Information (If Applicable)
Name: n OY+. t.)-,v.-� (oye t- c_4_, Phone: li t 3•c313• b33
Construction Supervisor's License #: CSSL..' 10011, Expiration: 5424 21
Home Impr. Contractor License #: gob 13S Expiration: 9 a-S--
Stove Information
Type of Fuel (check all that apply): Wood ✓ Pellet Coal
Location: tA`C\r�t`'�'". Freestanding Insert
Manufacturer: -, ..c Model: 4'tk"k-y_
--- ------- FOR BUILDING DEPARTMENT USE ONLY-- —_______--_—
Permit# R --13 Z Date Applied: Io/4 02-3 Total all Fees: $;-fa . CI+ 4-30 g`1
Building Official: cvi,..)4)55- Date Issued: /i) q•ZOZ 3
(Print)
Signature of Building Official: ✓ �'�
J
Commonwealth of Massachusetts \
Division of Professional Licensure
Board of Building Regulations and Standards
Constructs { Ar Speciafty •
CSSL-106199 - . . „, l l�pires:08/02/2024 .
NORA E WINE' ..+k `.'
8 RUSSELLVi.LE"-4 a,
SOUTHAMPTI* • '',.. .t
'''titifSS 10'
Commissioner daea K. ti.�Uv >.+sZ,
•
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Aff i i Business Regulation
1000 Washing Suite 710
Bosto 118
Home Im rov�me tractactegistration
iUt �y\Type: Corporation
MCKENNEY ELECTRICAL CO,INC egisltation: 200135 UEXPtion:
02/05/2025
DB/A MCKENNEY HEARTH&HOME -
100 NORTHAMPTON STREET r a,r%
HOLYOKE,MA 01040 =V
�____ Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affaifu.S Business Regulation Registration valid for individual use only before the
HOME IMPROVEI NT•CONTRACTOR expiration date.If found return to:
pon Office of Consumer Affairs and Business Regulation
Reg[ — tion 1000 Washington Street-Suite 710
2 ;-w.10'.2025 Boston,MA 02118
MCKENNEY ELECTRI.C.9L-C¢:-A,„i_ _
O/B/A MCKENNEY HEI
AR }I
NORA WINE
100 NORTHAMPTON STf}'EET. _- , ,4,,,...ea i.cG6NA. 0
HOLYOKE,MA 01040 .-,�._-s: "
_ Undersecretary Not valid without signature
The Commonwealth of Massachusetts
ra, Department of Industrial Accidents
�, =1 Office of Investigations
Lafayette City Center
va= 2 Avenue de Lafayette, Boston,MA 02111-1750
www.mass.gov/dia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaiblv
Name(Business/Organization/Individual): McKenrey Electrical- Co. Inc.
Address: 100 Northampton Street
City/State/Zip: Holyoke, MA 01040 Phone#: (413) 536-5551
Are you an employer?Check the appropriate box: Type of project(required):
1.® I am a employer with 4 4• ❑ I am a general contractor and
employees(full and/or part-time).*
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
insurances 9. ❑Building addition
comp.
[No workers' comp.insurance
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑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.®Other Solid Fuel
comp.insurance required.] appliance install
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
emplo}iees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: Liberty Mutual Insurance
Policy#or Self-ins. Lic.#: XWO(222)57 87 2259 Expiration Date: 07/202
Job Site Address: : f 5 1'1"f- Et City/state/Zip:NI`ty r'W`t -)k'O
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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
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 cerg0 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: . 1 l �. \•__ �,_.� Date: Il �'b 123
Phone#: (413) 536-5551
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(check one):
10Board of Health 20 Building Department 31:City/Town Clerk CO Electrical Inspector 5❑'lumbing
Inspector 6.0Other
Contact Person: Phone#: