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