17C-171 City of Northampton _
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Massachusetts ham.
! OCT TMENT OF BUILDING INSPECTIONS :
2014 s; a
Main Street • Municipal Building
Northampton, MA 01060 ssNly �4
IeCtrIC,Plumbing$Gaa InapsaSM
Northampton,MA 01080
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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: i 1 fib f G
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Address: o� Jam" k d lephone: S
2. Owner of Property: I UL '•a r �� �rv� - �%t
Address: �JvytV\ �/V AV� �IcU ,J�(r !'//�� /reAephone:
3. Status of Applicant: V Owner Contractor
4. Type or Brand of Stove: a o V �6V(2' ✓� Vim"
11 r ct V i IV a, l
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 accuFate to the best .
of my knowledge.
DATE: I APPLICANT'S SIGNATURE --- {
DATE: C f HOMEOWNER'S SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
26 SUMNER AVE BP-2015-0407
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17C- 171 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-2015-0407
Project# JS-2015-000731
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 11020.68 Owner: LOMBARDI BRYAN N&JILL C
Zoning: URB(100)/ Applicant. LOMBARDI BRYAN N & JILL C
AT: 26 SUMNER AVE
Applicant Address: Phone: Insurance:
26 SUMNER AVE
FLORENCEMA01062 ISSUED ON.101712014 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL 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 Deuartment 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 10/7/2014 0:00:00 $25.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner