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25C-034 City of Northampton E IVED Massachusetts -�' j r. �p TNONT OF BUILDING INSPECTIONS ff �I'R 4 Ma =n Street • Municipal Building Northampton, MA 01060 J r, , j v DEPT. OF BUILDING INSPECTIONS NORTHAMPTON, MA 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 # 58 73 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 5 k) Address: c1 N 0 R`4 &w ASP I? -` VAV"1 /f Telephone: L i 1 2 c? 2. Owner of Property: J9Pit N " C fr4N I / {54R/344 �J L Address: S -4 (`U4 / Telephone: 1:4,A-1Q 3. Status of Applicant: k( Owner Contractor 4. Type or Brand of Stove: A V/ -t_.. (in) S f v k cvna_ / Z J'D 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 knowledge. DATE: 3) 9 I1 Z APPLICANT'S SIGNATURE 2 DATE: HOMEOWNER'S SIGNATURE APPROVED DATE: BUILDING OFFICIAL _ -- _ City of Northampton EIVED ssachusetts � n R _ 9 NT OF BUILDING INSPECTIONS r' ,mot a " f�' ` J �Ma n B . reet • Municipal Building Y Nor MA 01060 CI TY - GEPI OF BUILDING INSPECnONS NORTHAMPTON, MAC ; C6;, 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 # 58 9 3 PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: --..)--;>e, p� l �/A I'l 5 �� Address:) ' 0 ft` ,w 4V' we fZ`T'vAmi1 tO nr Telephone: L i 1 3 " ClrIF` t 2T c? 2. Owner of Property: J J{ P-4 Nd C M4NC �,, / `3 8 � � LK Address: S (1i. Telephone: ¶4vi e 3. Status of Applicant: )( Owner Contractor // 4. Type or Brand of Stove: A U/i one S f v K cvr' / ?_5'D 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 knowledge. DATE: 1 APPLICANT'S SIGNATURE p.2(),...d.„. DATE: HOMEOWNER'S SIGNATURE APPROVED DATE: BUILDING OFFICIAL r : 29 NORTHERN AVE BP- 2012 -0785 1 j GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 25C - 034 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 -0785 Project # JS- 2012 - 001376 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 10018.80 Owner: BLACK BARBARA L & JOEL DANSKY & NANCY L FELTON Zoning: Applicant: BLACK BARBARA L & JOEL DANSKY & NANCY L FELTON AT: 29 NORTHERN AVE Applicant Address: Phone: Insurance: 27 NORTHERN AVE (413) 584 -1299 0 NORTHAMPTONMA01060 ISSUED ON:3/12/2012 0:00:00 TO PERFORM THE FOLLOWING WORK:INSTALL WOODSTOVE AVALON SPOKANE 1250 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 3/12/2012 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner