29-410 (5) of JKort4ampjon
d �as�acllusetts _=_
DEYARI MENT OF BUILDI)gG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building �.
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page Plot c Zone Permit Number
Location
Owner or Lessee �'1 �y�-
Tele. No.) .�
Contractor ������
License Number
Address g� �,%' � .c
RESIDENTIAL NON-RESIDENTIAL
t-"'One Family Home Business
Two or More Number of Units Other (Specify)
Floors in Bldg.
Type of Appliance:
New Wood Burning
t-1 Used Coal
Labeled Combination
Date of purchase f Furnace
Fireplace Insert
Model or Type of Appliance /��+ - .�^ l�
Manufacturer
Purchased From
Name ofrm
Address)
Cost - Construction 6 Appliance:
Chimney Z,-' New --jam Metal Bestos
Existing Interior Chimney
L-1 Separate Flue ;__ Exterior Chimney
Other appliance attached to flue
Masonory/lined
Unlined
Notes & Data:
'^ 1
n
�i�/ 6 ,11 �'c�e.el�-►�uC' ��c� ,..-Z-Z��,r� C ,- ���?�ZL4/ � -' e
i
Signature of Applicant:
Building Inspector Approval:
Date:
DEPT. OF BUILDING INSPECTIONS BUILDING �O l�J ^�j`�
212 Main Street o� l �/
Northampton, MA 01060 PERMIT <a
r
VALIDATION
X09XX 29 - 410 p
DATE November 4, 19 86 PERMIT NO. 649
APPLICANT Roland L. Lussier ADDRESS 105 Sandy Hill Rd. Owner
Combination Stove (N0.) (STREET) (CONTR'S LICENSE)NUMBER OF
PERMIT TO N(XXNXBIXX I-) STORY One Family DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
AT (LOCATION) 105 Sandy Hill Road ZONING CT URA
(NO.) (STREET)
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; permit for the installation of a combination stove/furnace
AREA OR VOLUME ESTIMATED COST $ 600_QQ FEE .� 1 O.OQ
(CUBIC/SQUARE FEET)
OWNER ramp ac Annl irant ///��
BUILDI D // �
ADDRESS SAMP AS Anpl i rant BY )/
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY - PINK - ASSESSORS COPY I,1 SIIP