36-349 (5) City of Northampton
gMassachusetts
Cp DEPARTMENT OF BUILDING INSPECTIONS ,
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— 2 2U14 212 Main Street • Municipal Building
— Northampton, MA 01060
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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 OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: -" Telephone ' ``'
2. Owner of Property `
Address. Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: '
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.
DATE: + ` ` APPLICANT'S SIGNATURE
DATE: HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
135 DUNPHY DR BP-2014-0845
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 36-349 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-2014-0845
Project# JS-2014-001477
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 63510.48 Owner: BOULAY ANDRE
Zoning: Applicant: BOULAY ANDRE
AT. 135 DUNPHY DR
Applicant Address: Phone: Insurance:
135 DUNPHY DR (413) 374-8619 (�
FLORENCEMA01062 ISSUED ON:21412014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL HARMON ADVANCE 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 2/4/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner