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.4)LIE FC1 ELHAN1NIC APPLIANCE & CHIMNEY APPLICATION
— _ _ ---- ---- —
P ,, , ; 1 c t Zont c5< Permit Numbei )7 _
,---) t
.1. _t tl z 1 , r 27 1 ----- 2 e //C__ C 4/
O r 0 1 It sz ,.., , ,---_(,)_ 4, ,<„,„,1. ZA/(/ X - 4 / 75 .. ( 7
(Tele. No.)
ContrPctor
(License Number)
Adurtbs
RESIDENTIAL HO-Ri31DENTIAL
Opc Family h c Lusiness
---
Two or Mo:c ',141 ' Un.lf.: OtLer (Specify)
--__
____ Floors in E14.,
Type of Appliance:
Z,,'--- New // Wood Burning
is
Coal
l
____
Labeled Combination
-
_ -----
Date of puIch, Furnace
----_-- Fireplace Insert
/ ..-
Model or Type of Applinct :2:14_1tI /-_//,,,
Manufacturer
_ --
Porcnosfd From (" _Lf......1f_4 Y 5 LA/ e e'
N of F rm
7r )7 ,-: (--( 1,k 1›: 717 )
Address)
Cost - Construction S. Appliance:
Chimney ----- New Metal Bestos
---, --
/„---- Existing Interior Chimney
Separate Flue Exterior Chimney
_----_.
Other appliance attached to flue
_----_
hi
------
Unlined
------
Notes & Data:
Signature of Applicant; , ' 'N.,
Building Inspector Approval: efed
Date:
' ! DEPT. OF BUILDING INSPECTIONS BUILDING 1,_ 0 . Op
. 212 Main Street o< ` /
;: - Northampton, MA 01060 PERMIT
37 8 VALIDATION
DATE October 6 , 19 86 PERMIT NO. 594
APPLICANT Karen L Humphiss ADDRESS 770 Florence Road Owner
(N0.) (STREET) (CONTR.S LICENSE)
WOOD BURNING STOVE ONE FAMILY NUMBER OF
PERMIT TO () STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
X KXXXXX 770 Florence Road ZONING SR
AT (LOCATION)
D)STR )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 new wood burning stove
AREA VOLUME ESTIMATED COST $ 1 .000.00 FEE 10.00
(CUBIC /SQUARE FEET)
OWNER Same as Applicant
BU 9 54444}2..e.,
ADDRESS Same as Applicant's ILD �ErT
WHITE - FILE COPY • GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY P ,P