29-433 (4) s UritV of Nort4auipton r
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DEPARTMENT OF BUILDIXG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building ,
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page i � Plot Zone CVAV� Permit Number c9 l
Location _ /lip, tr�r� f3' �ci�✓" �'%tr���c �,�/�
Owner or Lessee _r« Irk , &
(Tele. No.)
Contractor
License Number)
Address
RESIDENTIAL NON-RESIDENTIAL
Z 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
Fireplace Insert
Model or Type of Appliance
Manufacturer , %�r, -ufc�r�
t'v�n Purchased From
Name of Firm
(Address)
Cost - Construction & Appliance: $ G, eo
Chimney New Metal Bestos
Existing Interior Chimney
Separate Flue Exterior Chimney
Other appliance attached to flue
Masonary/lined "
Unlined
Notes & Data:
t
Signature of Applicant: 14"- n
Building Inspector Approval: 'Zct d A
Date: e V7 ��J 7/ f /
Department of Building Inspections
213 Main Street
Norcnpon, Mass. 01060 BUILDING �O V
PERMIT
29 — 433
VALIDATION
DATE November 7, 19 83 PERMIT NO. 649
Gerald C.Koloski
APPLICANT ADDRESS 19 Ellington Road, Florence Owner
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Wood Burning Stove I_) STORY DWELL
One Family RING OF
UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) Ellington Road, Florence, ass ZONING CT
(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 wood burning stove with an interior chimney
AREA OR 20.00 PERMIT 10.00
VOLUME ESTIMATED COST $ FEE
(CUBIC/SQUARE FEET)
OWNER Gerald C. Koloski
ADDRESS 19 Ellington Road, Florence, Mass. 01060 BUILD
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - SSESSORS COPY