07-064 (2) City of Northampton
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t e DEPARNT, OF BUILDING INSPECTIONS S.
212 Main Street • Municipal Building Jti. `b
N °-. Northampton, MA 01060 JsNl 30.,
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# 7/_
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: a 0 h r �l�i �2 /)� /76-IX
Address: "3 J/ /( , ,-4 /z,./( P , ,,f t (Telephone: 5? V ( 2/
2. Owner of Property: ( Q,A., c)
Address: Telephone:
3. Status of Applicant: Owner (/rc ntract or 4. Type or Brand of Stove: ef ` aC, c
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.
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DATE: J Y -7 APPLICANT'S SIGNATURE ,1
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DATE: / / 7 HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
331 NORTH FARMS RD BP-2013-1142
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 07-064 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-2013-1142
Project# JS-2013-001876
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 29795.04 Owner: HORWITZ MARK&JULIA F MOSS
Zoning: RR(100)/WSP(100)/WP(98)/ Applicant: HORWITZ MARK & JULIA F MOSS
AT: 331 NORTH FARMS RD
Applicant Address: Phone: Insurance:
331 NORTH FARMS RD (413) 586-4631 ()
FLORENCEMA01062 ISSUED ON:5/24/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL ALDEREA/PACIFIC ENERGY
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 5/24/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner