29-312 (5) ,r
(rity of Northunipton _-
Z -
,lll«s.AShas�tt. _
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page cpO7 Plot 31.2- Zone Permit Number
Location 3 Y2- -�----
Owner or Lessee R �/`-�- -L.� � Q /
�ele. No.)
Contractor _
License Number)
Address
RESIDENTIAL NON-RESIDENTIAL
_ One Family Home Business
Two or More Number of Units Other (Specify)
Floors in Bldg.
Type of Appliance:
New Wood Burning
_ Used Coal "
Labeled Combination
Date of purchase Furnace
F replace Insert
Model or Type of Appliance qt-v-� 7494�
Manufacturer
Purchased From
Name of Firm
(Address)
Cost - Construction & Appliance: $ _ d d_ fl-rn
Chimney New Metal Bestos
Existing Chimney
Separate Flue Exterior Chimney
Other appliance attached to flue
Masonary/lined
Unlined
Notes & Data:
6
Signature of Applicant:
Building Inspector Approval: /
Date:
IwlWnent of Buildng Inspections �D
212 Main Street BUILDING �a
Northampton, Mass. 01060 PERMIT a leg ,
29 312 VALIDATION
DATE Auvt,_�,_.at?, 34'1-,A� olrvvl've° 365
APPLICANT Robert Gaudreau ADDRESS NSA
(NO.J (STREET) IC ONT R•S LICENSE)
Wood Burning Stove One Family NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
UKA
342 Acrebrook Drive ZONING
DISTRICT
AT (LOCATION)
(N0.) (STREET(
BETWEEN AND
(GROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
Permit for the installation of a wood burning stove
REMARKS:
AREA OR $ 300.00 FEE PERMIT 10.00
ESTIMATED COST
VOLUME
(CUBIC/SQUARE FEET)
OWNER Robert Baudreau IL MT
ADDRESS 4 Crebrook Drive low
WHITE - FILE COPY . GREEN - FIELD COPY CANARY APPLICANT COPY P COPY