15B-049 (7) City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS ? x
212 Main Street • Municipal Building .D
Northampton, MA 01060 �SNA ����
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN, STRAW OR SIMILAR STOVES, OR FIREPLACE INSERTS
Permit Fee: $25.00 Check# +� /
PLEASE TYPE OR PRINT ALL INFORMATION "
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1. Name of Applicant: ��L �y►i A-NO G b �t
Address: O`'f T,,r,,s Telephone: ef►-6- 36 q-3:2/0, *--3 Ji,7-2.3e($
2. Owner of Property: a/e/," C
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove: Nrrv.O-t pe.Ilc'.t Fv1-h;,e-e pi` lZ 0
-3a 6 36349
If applicant is not the homeowner: opi
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: �1�� APPLICANT'S SIGNATURE U
DATE: ����?�lU HOMEOWNER'S SIGNATURE
APPROVED
DATE:f. ;;Lf f BUILDING OFFICIAL
259 CHESTERFIELD RD BP-2015-0689
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 15B-049 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: WOOD BOILER BUILDING PERMIT
Permit# BP-2015-0689
Project# JS-2015-001338
Est.Cost:
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq.ft.): Owner: MELNIK DANIEL&MARILEE
Zoning: Applicant: MELNIK DANIEL & MARILEE
AT: 259 CHESTERFIELD RD
Applicant Address: Phone: Insurance:
259 CHESTERFIELD RD
FLORENCEMA01062 ISSUED ON.1212912014 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL HARMON PELLET FURNACE PF120
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: 67PC
THIS PERMIT MAY BE O Y CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AN
Certificate of Occu an
Si nature:
FeeType: Date Paid: Amount:
Building 12/29/2014 0:00:00 $25.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner