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07-064 (2) City of Northampton #9 Kl,M.. SS .,� SC : Massachusetts A. - �'c.. c au t 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. • r r/ �� DATE: J Y -7 APPLICANT'S SIGNATURE ,1 s ' Or 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