02-019 r
/ _City of Northampton
�- �r" p Massachusetts `
, ,APR DJPAR NT OF BUILDING INSPECTIONS M_,
g ���J 212 ain Street • Municipal Building 'a
4-:';'..."'
� � � Northampton, MA 01060 `
ac; DBP7 Or
NORTHAM.O,V i
MA ti�
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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 # 00 1.3
�y PLEASE TYPE OR PRINT ALL INFORMATION<
PROPERTY ADDRESS 5 d it/t9 I- 741 / FA Ren s' 1�U . 4(Q ke,tiGr
1. Name of Applicant: .�-1 �2�G/�' ,)4.4/A/ Co 2+6) -e7'7
Address: ?' ,w: /I fZ i,S RJ Telephone:
2. Owner of Property: LA ui,.e/(,( C� gJ7 �' S U l l\-c__ s ke~ `)
Address: Q 'j f.,ill S a ; Telephone: 5 7 -'�°/5/i
3. Status of Applicant: /Owner Contractor
4. Type or Brand of Stove: /2 L",4 L,ji■ — L UCX, WS 'ti-
Contractor's Name: l---h- j l I'?"ts )-64- 1-44d-/-7-4 AJS7 dt22€,(. �Ja 2/
Contractor's Address: `
Contractor's Phone:
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 a Y//3 APPLICANT'S SIGNATURE allossi;_ ._ '
DAT : 2 HOMEOWNER'S SIGNATURE 4-1-ee
APPROVED
DATE: BUILDING OFFICIAL
589 NORTH FARMS RD BP-2013-0992
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:02-019 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-2013-0992
Project# JS-2013-001650
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sci. ft.): 128937.60 Owner: CORBETT LAUREN&JULIE FISHER
Zoning:RR(100)/WSP(100)/ Applicant: CORBETT LAUREN & JULIE FISHER
AT: 589 NORTH FARMS RD
Applicant Address: Phone: Insurance:
589 NORTH FARMS RD (413) 584-5440 0
FLORENCEMA01062 ISSUED ON:4/24/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL AVALON WOOD INSERT
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 4/24/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner