17A-021 (4) City': o Northampton
alas achusetts
EP2U Tni� OF BUILDING INSPECTIONS '
reet • Municipal Building �a�, �
ri py0? Northampton, MA 01060
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD,COAL, PELLET,CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
Check#—1 161
Please fill in all appropriate information
1. Name of Applicant : 3,9 cLJ
I
Address: � Telephone:
2. Owner of Property : 114 n�
Address: '3-0,Am z Telephone:
3. Status of Applicant : Owner Contractor
4. Type or Brand of Stove : 'Ll C O SL^z
5. Estimated Cost: 0 u
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 a7/6��Z,to to the best of my
knowledge.
DATE: � APPLICANT'S SIGNATURE
DA TE: �� HOMEOWNER'S SIGNATURE 'dI� rl
Y
APPROVED
DATE: BUILDING OFFICIAL
185 SPRING GROVE AVE BP-2016-0584
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 17A-021 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-2016-0584
Project# JS-2016-000971
Est.Cost: $2000.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: OLD HADLEIGH HEARTH & HOME CENTER
Lot Size(sq; ft.): 15594.48 Owner: ENGEBRETSON JESSICA
Zoning: RI(100)/URA(100)/ Applicant: ENGEBRETSON JESSICA
AT: 185 SPRING GROVE AVE
Applicant Address: Phone: Insurance:
185 SPRING GROVE AVE (860) 807-8459 O
FLORENCEMA01062 ISSUED ON:1012712015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL JOTUL CASHINE 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 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:
FeeTyue: Date Paid: Amount:
Building 10/27/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner