29-400 (2) -
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building _
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION3`�
Page o29 Plot _^ Zone _49—/L
Location 76 Sandy Hill Road
No. (Street)
Owner or Deborah Connelly 76 Sandy Hill Road 586-5511
Lessee (Name) (Mailing Address) (Tel. No.)
Contractor 4- f-4'„ Z1,2.j
Name (Address) Tel . No,)
RESIDENTIAL NONRESIDENTIAL
X One Family Home Business
Two or More Other
Number of Units Specify
Type of Appliance
New Wood Burning
Used Coal
Labeled Combination
Date of Purchase Other
Specify
Model or Type
Manufacturer
Purchased From
Name of Firm
Address
Cost - Construction & Appliance ��L��•0�
Chimney New Existing
Separate Flue ? _ Other Appliance Attached
To Flue
Masonary/Lined Metal Bestos
Masonary/Unlined
Exterior Interior
Notes & Data:
replacing chimney to furnace.
new chimney will be for furnace and wood stove.
Signature of Applicant:
9
Address
Approved By:
(Title) Oa te
__. .,. r _.d,,,
�. w ..�
.ARTMENT OF BUILDING INSPECTIONS te�rr'� h
212 MAIN STREET BUILDING �O 1�/Q, 00 /17HAMPTON, Ma, 01060 PERMIT Qa /��
24p - 400
VALIDATION
DATE JUlT17� 193 PERMIT NO.
APPLICANT Dehor. b connalI r ADDRESS 76 Sand Hill Road
(N0.1 (STREET) (CONTR'S LICENSE)
PERMIT TO ( I _) STORY Chimney DWELLIING F U NITS 1
TYPE 0 1MPR OYEMEN7) N0. (PROP SED USE)
ZONING ��
AT (LOCATION) 76 Sandy H4 i L Road DISTRICT
(NO.) (ST EET)
BETWEEN AND
(CROSS 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)
REMARKS:
in basement.
AREA OR VOLUME ESTIMATED COST $ 3n0�n� FEE MIT 10.00
(CUBIC/SQUARE FEET) -�
OWNER Deborah Connelly
8U1101
_Qj6kj 0/p
ADDRESS 76 Sandy Hill Rd_ , Northanton, Ma, 01060 BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - A /SESSORS COPY