29-186 (5) s• '� �z# of Wart4ampton
�ASfIIChIISt�S - __
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building ,Q
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page 11P_ ftot Zone
Location
No.) C (Street)
Owner or f� �- �✓ a ,Y--. 7
Lessee (Name) (Mailing Address) (Tel. No.)
Contractor
Name Address Tel. No.
RESIDENTIAL NONRESIDENTIAL
_ 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
ff
q, n�Specify
Model or Type li -�
Manufacturer
Purchased From
Name of Firm
Address
Cost - Construction & Appliance $ �fG —
Chimney --�New Existing
Separate Flue Other Appliance Attached
/ To Flue
r/ Masonary/Lined Metal Bestos
Masonary/Unlined
Exterior Interior
Notes & Data:
Signature of Applicant.
Address
Approved By.
(Title) (Date)
40
.-., wepef tment of Building Inspections
212 main Street BUILDING O< �i TODD /�//
Northmpton, Ma. 01060 PERMIT <a
29 - 186 VALIDATION
DATE J,1133e 199 19 Al PERMIT NO. 297
APPLICANT y ADDRESS 126 neelpfie]d Drive
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO 11 _1 STORY wr%od..httrrtino stomp DWELLING UNITS 1 _
( I RO E EN ) N0. !PROPOSED SE)
ZONING
AT (LOCATION) 1?6 Deerfield ILriyp DISTRICT 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: New Pxtpri.or masonary/lined chimney and wood-burning,, stove
AREA OR PERMIT nA
VOLUME (CUBIC/SQUARE FEET) ESTIMATED COST . FEE __
� (
OWNER Helen Torrey
BUI FrP
ADDRESS 196 DQprfipld Drivid, Northampton, Ma. 01060 BY ^G
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY