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Qrzivr of Northampton *=
JRassachusens' COY'"11.J:6' 411 au' +,�y--'� DEPARTMENT OF BUILDING INSPECTIONS =-
212 Main Street • Municipal Building I '
INSPECTOR Northampton, Mass. 01060 s
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION PERMIT NUMBER g34
Page / ,g Plot )6-) Zone iii/
Location 5.3 4 C-y N t cs- 5'1' Le.S�'-5) MA o i c 3
Owner or Lessee je(c(4 5,...__J 14O,1/4..1-71.;& ,3 eL ( to e c lg.- 5( i._.6 -0-5 S5 t. — e-37 6
(Name) (Mailing Address) (Tele. No.)
Contractor Jr)14 CLAktt L ' S1t&t&. I-kit, St- ..>44.-1- cctS1,
-� FasP, Hit
(Name) (Address) (Tele. No.)
RESIDENTIAL NON-RESIDENTIAL
or One family Home Business
Two or More Other
Number of Units Specify
Stories in Building
Type of Appliance
New
y�' ,J-' 1:-��;c� Wood burning
Labeled --' 0) �L' Combination
Date of Purchase' Other
Specify
Model or Type
Manufacturer
Purchased From
(Name of Firm)
(Address)
Cost - Construction & Appliance $ 1360.3'1
Chimney ✓ New ✓Metal Bestos
Existing Interior chimney
Separate Flue V Exterior chimney
Other appliance attached to flue
Masonary Lined
Unlined
Notes & Data:
Signature of Applicant: %I f6A L -'" c CLN 17 5r
(Address)
'7 Approved By: W'O• �t� Z- 5 t,-it Pt o ic Cj
Title: Date: �`�
■