11C-005 05/17/2013 11: 12 14135871272 NTON BLD DEPT PAGE 01/01
City of Northampton •
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Massachusetts "f'
Massachusetts
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;wE Tm¢amz Ofi stIZZDING INSFPCTIONS
212 main street • lt'awricapal auxlaing ”{ 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#
PLEASE�TYPE�O�R PRINT/ALL L INFORMATION
PROPERTY ADORE.SS• / E//.44,, " ,t7 b f, Pf a7'/!
1, Name of Apficar 4440l4Y____�.�..
Address: G Ji <., Telephone:
! .,-/7 f›j4
2. Owner of Property,02,410e441f744¢f
Address: 15 ,0 F'?f Telco hone:?f freir
2. Status of TApp—licennt:.. vner Contractor
4. Type or Brand of Stove: AC, /1111-
Contractor's Name; 7_
Contractor's Address / , f I '... i At.
Contractor's Phone:
Construction Supervisor's License Nurnber, C�&'S4 —0 9 9 c10l Expirafiori.Date: /—6/
Home Improvement Contractor Registration Number: fb ^`) 11'S 7••Expiration Date: 7 - ' -1
All Applicants must complete a Workers Compensation Insurance Affidavit before we can issue a permit
5. Certification:f hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: APPLICANTS SIGNATURE
DATE: • HOMEOWNER'S SIGNATURE
•
APPROVED
DATE: _ BUILDING OFFICIAL
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•
•
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'j of Northampton
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} NT OF BUILDING INSPECTIONS ay
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� �� Street • Municipal Building �,7�. °„�-'
'' orthampton, MA 01060
DEPT.OF 6Ui DING NORTHAMPTON
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 #
PLEASE TYPE OR PRINT ALL INFORMATION
PROPERTY ADDRESS L',/,/46:://47b1/4"4/77, Oft pi ,40,,d4,117
1. Name of Applicant: J /Y4f're,44/ 4J'
Address: ' //fff,f,'4l,- f/I.L.tr 4<L< sA`v.,,,,rl„.,Telephone: y/-lirt7"g/%/
2. Owner of Property:24,/,;,(,)--,xi yz 2,
Address: `/H,C�TAV/i�,;L.�>f 7 Lefa/f<'',,tga, f/O'5, Telephone:,/ 5/ 5}!"
3. Status of AApplicant: yy ,Owner Contractor 'v
L.=
4. Type or Brand of Stove: AC/ / ift”
Contractor's Name: ,, '2 r/A'I 1/14%C
Contractor's Address: ‘, f 7d Yer kfA,y M,'ex 4 4/4A yi g. t 401
Contractor's Phone: w-)72,,-) ‘'.7
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.
rh*-.77) f J 2 .
DATE: C APPLICANT'S SIGNATURE .'77, A i
r /
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
4 HEFFERNAN ST BP-2013-1105
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 11C-005 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-2013-1105
Project# JS-2013-001826
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: BERNARDSTON FARMERS SUPPLY 99401
Lot Size(sq. ft.): 17772.48 Owner: STANLEY THOMAS E&LINDA A
Zoning:URA(100)/ Applicant: STANLEY THOMAS E & LINDA A
AT: 4 HEFFERNAN ST
Applicant Address: Phone: Insurance:
4 HEFFERNAN ST (413) 584-8146 () WC
LEEDSMA01053 ISSUED ON:5/20/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL AGP PELLET 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 5/20/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Louis Hasbrouck—Building Commissioner