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City of Northampton
" Massachusetts
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DEPAR T OF BUILDING INSPECTIONS
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" ► :. M R 5 2013 212 in Street • Municipal Building
.. ...V Northampton, MA 01060
DEPT. OF Fl i, iti tiS
NORTHAMPTON. MA un obu
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 # 64
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: V l a Ih SOU) �.) Ch
Address: di:Th Che.gliik * ,. 7 y4, t elephone: S — tj
2. Owner of Property: . 11 ) SCB0464.VI
Address: . o.Jn Q. rtes aboV( Telephone:
3. Status of Applicant: V Contractor
4. Type or Brand of Stove: 3 V) O S L V
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: APPLICANT'S SIGNATURE
DATE: . HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
478 CHESTERFIELD RD BP- 2013 -0802
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 15 - 003 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 -0802
Project # JS- 2013- 001371
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): Owner: SCANLAN JOHN B & JUDITH A
Zoning: Applicant: SCANLAN JOHN B & JUDITH A
AT: 478 CHESTERFIELD RD
Applicant Address: Phone: Insurance:
478 CHESTERFIELD RD (413) 584 -5905 ()
LEEDSMA01053 ISSUED ON:3/5/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL JOTUL OSLO F500 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 3/5/2013 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner