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07-003 (2) ity of Northampton Massachusetts _Z, PARTMENT OF BUILDING INSPECTIONS 2 Main Street • Municipal Building j 'y Northampton, MA 01060 oaf pppnbingo& o � Northam 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 s I CJ I n•f CA/I G'fhi Address: 5 3� N D yI y arm 5 11/,(. . Telephone: 519 2(4 /`5 !50- 2. Owner of Property: hlU r(/Y,C:el "A 0/0&2- Mny- as aj6eV-L Address: Telephone: 3. Status of Applicant: / Owner Contractor 4. Type or Brand of Stove: fb f74,L I D o If applicant is not the homeowner: // Construction Supervisor's License Number's & Expiration Date /A O Q 41L !" Home Improvement Contractor Registration Number 7 v Expiration Date g 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: `� lit APPLICANT'S SIGNATURE rn • �GLCc�n DATE: HOMEOWNER'S SIGNATURE APPROVED DATE: BUILDING OFFICIAL 534 NORTH FARMS RD BP-2014-1055 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 07-003 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-2014-1055 Project# JS-2014-001810 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.): 105023.16 Owner: NANGLE N PAIGE Zoning: RR(100)/WSP(100)/WP(65)/ Applicant: NANGLE N PAIGE AT. 534 NORTH FARMS RD Applicant Address: Phone: Insurance: 534 NORTH FARMS RD (319) 268-1550 O WC FLORENCEMA01062 ISSUED ON:411412014 0:00:00 TO PERFORM THE FOLLOWING WORK.-INSTALL JOTUL 450 KENNEBEC WOODSTOVE 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 4/14/2014 0:00:00 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner