10-016 City of Northampton
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Northampton, MA 01060 M' : y -
$EPX of BUILDINp INSPECTIONS
OWNOLE on TWO r MILV sot in 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
1. Name of Applicant - D e i7 / C 1 • h ec. c
Address: 4 5 �f 1/23 / /3 t--pwf � N 7
O S' 7`o Telephone: 7r � - 4 4" 93 f/
.
2- Owner of Property: J <AT//L V /VI A J
/ EVS IC I
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Address: cl / ? /- ZOO � c I - 1 -- i_ rL Telephone: r// g 53 7- 44 '7
3_ Status of Applicant Owner +/ Contractor
4. Type or Brand of Stove: HAfZr ii 17■ 77-3 00 (1o0!j 37 VC
If applicant is not the homeowner: /'
Construction Supervisor's License Number 9? /40c Expiration Date /' - / y`
Home Improvement Contractor Registration Number /6 t� 5--, Expiration Date 7• 07- /
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: 9 - ( APPLICANT'S SIGNATURE i' =---- � --
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DATE: 9 / a — I ` HOMEOWNER'S SIGNATURE° '
APPROVED
DATE: BUILDING OFFICIAL
218 AUDUBON RD BP- 2013 -0332
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 10 - 016 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- 2013 -0332
Project # JS- 2013 - 000531
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: • BERNARDSTON FARMERS SUPPLY 99402
Lot Size(sq. ft.): 326133.72 Owner: MAIEWSKI JOE & KATHY
Zoning: RR(100)/WSP(100)/WP(26)/ Applicant: BERNARDSTON FARMERS SUPPLY
AT: 218 AUDUBON RD
Applicant Address: Phone: Insurance:
43 RIVER ST (413) 648 -9311 0 WC
BERNARDSTONMA01337 ISSUED ON: 9/24/2012 0:00:00
TO PERFORM THE FOLLOWING WORK: INSTALL HARMAN TL300 WOOD 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 9/24/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner