24C-121 (7) (City of NorftjNnlpfon
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c;�` R! JtasaarllnssIts a ;
" yne ' ' DCPAtUMeNT OP BUILDING INSPECTIONS f $stty�� '-�
INSPECTOR
212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID
1FUELPLANING APPLIANCE & CHIMNEY
YEY
APPLICATION
PageO , Plot A;2/ Zone tin Permit Number /:
_)(
Location f "4 ,) t' c i. 0h .L 51
O.ner or Lessee 1qql
dna fel '� A I 4- (7,c<F ,4,-€v S—g. I/-6 S? 2 /
l (Tele. No.)
Contractor
(License Number)
Address
RESIDENTIAL NON-RESIDENTIAL
c/Ine 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 C(.r 1,)Wdodp Oct & p F -6e ily
l_
Manufacturer (r).1,,,,�p»�-,J
Purchased From
(Name of Finn)
(Address)
Cost - Construction & Appliances $ .7 $."-C) - X00,""
Chimney New Metal Bestos
1,5---Existing Interior Chimney
Separate Flue Exterior Chimney
Other appliance attached to lue
Masonary/lined
Unlined
Notes & Data: 4' /J
3os" a /.. Cafr sireccy )aA e 6.7
AlA-4i,ue- -s -1-'-)-e-
Signature of Applicant; �j-tet Cd,--e-e-,
a '
Building Inspector Approvals de yl7� Sp%O/
/f 31/'"
Date: