24D-298 City of Northampton
Massachusetts ( ,
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building5bt-
Northampton, MA 01060 E y
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 # IL I
PLEASE TYPE OR PRINT ALL INFORMATION
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PROPERTY ADDRESS Kt �/� ! r i l l rs..L.716! I J `t _�... i 1 I-Z-1i I
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1. Name of Applicant: .,y 9 (� ;iv:f vy14 1 ifh: f a ( I ~t r
Address: i, t ` .Citi 1161 1..4.I 1 1 NA` Telephone: V C) ". (3)3 -
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: X Owner Contractor
('Il�1 I �y- i -{4. Type or Brand of Stove: )(� 11 f pc,`Vi
Contractor's Name: Ni C{.4-41/142.
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Contractor's Address: J y Ho-J (1 0 (O 75
Contractor's Phone: ( 3' S3 g 1 5
Construction Supervisor's License Number: 09 g Cf Expiration Date: 1''f/ .g/ ? (c-
Home Improvement Contractor Registration Number: f 15 ?' ' Expiration Date: cif (3(c-;10 /J 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-3'I APPLICANT'S SIGNATURE /5AA /> : fit
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DATE: /0 HOMEOWNER'S SIGNATURE
APPROVED tef
DATE: BUILDING OFFICIAL
180 ROUND HILL RD BP-2014-0560
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 24D-298 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-2014-0560
Project# JS-2014-000938
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER 98784
Lot Size(sq.ft.): 13198.68 Owner: BARBER EDWARD W&PATRICIA KAUFFMAN BARBER
Zoning:URA(100)/ Applicant: BARBER EDWARD W & PATRICIA KAUFFMAN BARBER
AT: 180 ROUND HILL RD
Applicant Address: Phone: Insurance:
180 ROUND HILL RD (413) 586-6037 () WC
NORTHAMPTONMA01060 ISSUED ON:10/31/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL VC MONTPELIER 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 10/31/2013 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner