21-009 City of Northampton
Massachusetts
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` J DEPARTMENT OF BUILDING INSPECTIONS y;
212 Main Street 0 Municipal Building
Aj Northampton, MA0 060
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.a: SkNPLE 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# 3
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 0 &Lk pc C
Address: q 4 V S J L r R?Telephone:
2. Owner of Property: MyLks 1'1 VE �2--0 8S CA Q�
Address:? y ZI)ri5 r0QW-6 Telephone: .' r? l�7
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
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485 SYLVESTER RD BP-2015-0603
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:21 -009 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Building BUILDING PERMIT
Permit# BP-2015-0603
Project# JS-2015-001153
Est. Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 1067220.00 Owner: MYERS ROBERT&DIANE DROESCHER
zoning: Applicant. MYERS ROBERT & DIANE DROESCHER
AT. 485 SYLVESTER RD
Applicant Address: Phone: Insurance:
485 SYLVESTER RD (413) 584-7795 (�
FLORENCEMA01062 ISSUED ON.1112512014 0:00:00
TO PERFORM THE FOLLOWING WORK:WOOD STOVE - PACIFIC ENERGY ALDERLEA
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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 11/25/2014 0:00:00 $25.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner