30A-001 (2) -4-- City of Northampton
Massachusetts
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street • Municipal Building yeti �a
Northampton, MA 01060
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SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD,COAL,PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check#
Please fill in all appropriate information
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1. Name of Applicant: AO�,,�jp/ :!S7
Address: �)r 17 Telephone:
2. Owner of Property
Address: Telephone:
3. Status of Applicant: Owner Contractor
4. Type or Brand of Stove :- az � -
5. Estimated Cost:
If applicant is not the homeowner::
Contractor name
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
6. Certification: I hearby certify that the information contained herein is true and accurate to the best of my
knowledge.
DATE: APPLICANT'S SIGNATURE
DATE: /,/5— __LH16MEOWNER'S SIGNATURE�-
APPROVED
DATE: BUILDING OFFICIAL
228 FLORENCE RD BP-2016-0370
GIs#: COMMONWEALTH OF MASSACHUSETTS
MU:Block: 30A-001 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate : Wry BUILDING PERMIT
Permit# BP-2016-0370
Project# JS-2016-000603
Est.Cost:
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 20211.84 Owner: WATSON ROBERT E JR
Zoning: URA 100 /WSP(1oo)/ Applicant: WATSON ROBERT E JR
AT. 228 FLORENCE RD
Applicant Address: Phone: Insurance:
228 FLORENCE RD
FLORENCEMA01062 ISSUED ON.912112015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL HELLIWELL 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 9/21/2015 0:00:00 $40.00
212 Main Street, Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner