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30A-070 City of Northampton -,o Mpj O tl yS '� d'j ti CE 5 �,e 1 T*�' � O V E p Ma ssachusetts �w ? �. 1It:- v "' '1 _ � DEP • - , NT OF BUILDING INSPECTIONS % Q ,, '� , ''' MA "` 5 2 Mai Street • Municipal Building v �b Ks I C orthampton, MA 01060 a. 21 \''� DEPT o O pr oN I N s p c i oNs SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS Permit Fee: $25.00 Check #( �� , PLEASE TYPE OR PRINT ALL INFORMATION JJ 1. Name of Applicant: 1 � tA 54 ' r pio --t" ,Bi LL YY Li ff__,i. Address: 3 7 1= (l7'ii r . /�r7 U c i__ Telephoner �(� -� / �� l 6 / 0 3 F ( 2. Owner of Property: � ✓� c'" 0 / 0 6 Z Address: Telephone: 3. Status of Applicant: / Owner Contractor 4. Type or Brand of Stove: /k\" ej j , ?-e . l te± If applicant is not the homeowner: 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 5. Certification: I hereby certify that the information contained herein is true and accurate to the best of my kno ledge / ,� (j/A___________ DATE: 49-1 I Z-- APPLICANT'S SIGNATURE �/l 1 DATE: 2 HOMEOWNER'S SIGNATURE " l /k--- APPROVED DATE: BUILDING OFFICIAL 317 FLORENCE RD BP-2012-0759 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 30A - 070 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- 2012 -0759 Project # JS- 2012- 001338 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 15638.04 Owner: MILLER WILLIAM J & KRISTEL L APPLEBEE Zoning: URA(100) / /WSP Applicant: MILLER WILLIAM J & KRISTEL L APPLEBEE AT: 317 FLORENCE RD Applicant Address: Phone: Insurance: 317 FLORENCE RD (413) 586 -3776 O _ FLORENCEMA01062 ISSUED ON:3/5/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WHITFIELD PELLET 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: FeeType: Date Paid: Amount: Building 3/5/2012 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner