16B-060 (2) City of Northampton
l,` ✓ Massachusetts
' E-;'2` . ' �AR NT OF BUILDING INSPECTIONS
212 Mai Street • Municipal Building i <
orthampton, MA 01060
, NOV 1 7 2015
SINGLE OR TWO FAMILY SOLID FUEL APPLIANCE PERMIT APPLICATION
FOR WOOD, COAL, PELLET, CORN,STRAW OR SIMILAR STOVES,OR FIREPLACES
L/
Check# J 3 3
Please fill in all appropriate information
1. Name of Applicant: � (S(n e h U C ( cz(yam F_I'1 e ►'S C11'l 4
Address: WGUrG� GL- �(oe Telephone: 0 /7-
2. Owner of Property : S6 rye_
Address: Telephone:
3. Status of Applicant : Owner Contractor
4. Type or Brand of Stove
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: N�` �I .� APPLICANT'S SIGNATURE '4 ✓� ���-._
DATE: HOMEOWNERS SIGNATURE
APPROVED
DATE: BUILDING OFFICIAL
9 HAYWARD RD BP-2016-0690
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 16B -060 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-2016-0690
Project# JS-2016-001162
Est. Cost: $4450.00
Fee: $40.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 15333.12 Owner: KRIEBEL GEORGE W JR
Zoning: URB(100)/ Applicant. KRIEBEL GEORGE W JR
AT. 9 HAYWARD RD
Applicant Address: Phone: Insurance:
9 HAYWARD AVE (413) 582-7017 (�
FLORENCEMA01062 ISSUED ON.1111812015 0:00:00
TO PERFORM THE FOLLOWING WORK.INSTALL JOTUL C450 FIREPLACE INSERT
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 11/18/2015 0:00:00 $40.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner