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36-349 (5) City of Northampton gMassachusetts Cp DEPARTMENT OF BUILDING INSPECTIONS , t f L7 — 2 2U14 212 Main Street • Municipal Building — Northampton, MA 01060 Clectric, Fiumbr+ ,� =� , �actions� Nortf'�c.rrrt 11-1 i, ��1060 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