38B-097 City of Northampton
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t '',.i • T DEPARITME T OF BUILDING INSPECTIONS
J�',k ,•,' T � ,� 2 Main Street •Municipal Building ` ..� . :
i , 1 6 N rthampton, MA 01060 J s�,n. I'`�
DEPT. C Pol -L I \SPEC. IONS
NCRTHAM'PTQN, MA 01030
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 # 2 - 6 )
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PSE OR PRINT ALL INFORMATION
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1. Name of Applica //nt: d,� V f
Address: v /164 VI v U C 5'f ! /1 -�/ a (1 L Telephone: 3 Cf
2. Owner of Property: L k-r. C- LA A 'e
Address: 2 ‘ ilk k [/1 vJ‹ *04 4 (- 7` 1 Telephone: 5 ° f - y ( 7
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3. Status of Applicant: 1 - - Owner Contractor
4. Type or Brand of Stove: 7 i f (4 F3 C ' '
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Cpl c;�'� �c i �e � _4� �"o � ' j ' x '2 / , 3
( .R -57q7/3s/
If applicant is not the homeo ner: c( g 7y� y (
Construction Supervisor's License Number ! Expiration Date (-1/2-iii?
Home Improvement Contractor Registration Number / t--( / G ig Expiration Date C /1/ 3 //
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 - d accurate to the best
of my kn o edg � � ;; ,( )
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DATE: 4 / APPLICANT'S SIGNATUR ' ',
DATE: 1 ' / '� ' HOMEOWNER'S SIGNATURE `�../V/
APPROVED
DATE: BUILDING OFFICIAL
36 MUNROE ST BP- 2013 -0591
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 38B - 097 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 -0591
Project # JS- 2013- 000953
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 6664.68 Owner: RHODES AMY L & ERIK S
Zoning: URB(100)/ Applicant: RHODES AMY L & ERIK S
AT: 36 MUNROE ST
Applicant Address: Phone: Insurance:
36 MUNROE ST
NORTHAMPTONMAO1060 ISSUED ON :11/26/2012 0 :00 :00
TO PERFORM THE FOLLOWING WORK :INSTALL JOTUL F3 CB 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 11/26/2012 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner