35-122 (4) ►' Citr of 3K0rt4Rn1Vt"
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DEPARTMENT Of BUILDfNG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
PERMIT NUMBER
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page Plot - 1Q Zone
Location o2 a -2Y F= NSF`) A- y
No. Street l�
Owner or IiS Yy. #,-t ?.5, .0m--:zC &, U1--4
Lessee (Name) Mailing Address) (Tel. No.)
Contractor
Name Address Tel. No.
RESIDENTIAL NONRESIDENTIAL
One Family Hoene Business
Two or More Other
Number of Units Specify
Type of Appliance
New tom' Wood Burning
Used Coal
Labeled Combination
Date of Purchase Other
Specify
Model or Type 4 4
Manufacturer "�l�t�•��ZC. t14" ,1C��- �
Purchased From /z Od �t
(Naing of Firm
Address
Cost - Construction & Appliance $ o�
Chimney New Existing
�^ Separate Flue Other Appliance Attached
To Flue
Masonary/Lined Metal Bestos
Masonary/Unlined
Exterior Interior
Notes & Data:
r `
Signature of Applicant: ' • <. ;- �! � : c CX " i c«/,. f<+lr.
�..� Address
Approved By: 1�kL
'(Titl ate
e
w DEPARTMENT OF BUILDING INSPECTIONS
212 MAIN STREET BUILDING ,e
NORTHAMPTONq MA. 01060 PERMIT <
35 " 122 VALIDATION
DATE Or toper 150 0 19 81 PERMIT NO. 582
APPLICANT RO%11 2njzert g Plumbing&Ht g ADDRESS P-0_ Roo 89. E8s h ton _
(NO.) (STR ET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO {_{ STORY 'felnoll filyare DWELLING UNITS 1
TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 25 DrewsPn Drive ap
DISTRICT sib•
(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: Tnatal l ation of wand burning furnace in existing chimney, separate flue
AREA OR MIT
(CUBIC/SQUARE FEET)
VOLUME ESTIMATED COST $ 1�SQQ.AO FEE in,no
OWNER MrA_ R Hall
BUIL
ADDRESS 1 5 nrtoxspn nrive! Nnrthamnrt_nn, Ma. 01060 BY
l
WHITE - FILE COPY ■ GREEN - FIELD COPY CANARY - APPLICANT COPY ■ PINK - A, ESSORS COPY