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17A-166 City of Northampton IHANIp ° o � _ MS`S S�C� , y d i f f Y Massachusetts w _. F 4 �s I DEP TMENT OF BUILDING INSPECTIONS "ma 4) *r 4 °r ' ' 12 ' n Street • • Municipal Buildin J ca �°r+ .- Northampton, MA 01060 , 7,,,, .,c- 3,,, DEFT. O ET_ Nr wr'c cTi5NS NORTHAPvIFTON, MA 01060 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 # 3 1 ( 1 PLEASE TYPE OR PRINT ALL INFORMATION 2 : 1. Name of Applicant: I /c � . r " I Yl�-.\ Address: * <1 � j 7, D Telephone: ■`t" (0 G�S 2. Owner of Property r l � �� VAC .. Address: Telephone: 3. Status of Applicant: X Owner Contractor c Type or Brand of Stove: V \e.- If applicant is not the homeowner: Construction Supervisor's Lictse 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: APPLICANT'S SIGNATURE DATE:ti.,dil. 0 J- HOMEOWNER'S SIGNATURE J, tit( Gt 'SL 4 t APPROVED DATE: BUILDING OFFICIAL 44 KIMBALL ST BP- 2013 -0536 GIs #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 17A - 166 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 -0536 Project # JS- 2013 - 000867 Est. Cost: Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 33410.52 Owner: FINCK PRISCILLA P TRUSTEE Zoning: URB(100)/ Applicant: FINCK PRISCILLA P TRUSTEE AT: 44 KIMBALL ST Applicant Address: Phone: Insurance: 44 KIMBALL ST FLORENCEMA01062 ISSUED ON:11/8/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: INSTALL WOODSTOVE 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 11/8/2012 0:00:00 $25.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner