29-319 (4) 'e City of Northa apt"
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page Plot ? Q Zone Qf—L-
Location y /3 fa C.—) are t vim FFCveo uc(z
No, (Street)
Owner or lc� �as�.-r .1` l�l,`�4..ccc�, .,—I ,S'& it — Lt X
Lessee (Name) (Mailing Address) (Tel. No.)
Contractor -S I^ L /_
Name (Address) Tel. No.)
RESIDENTIAL NONRESIDENTIAL
_/X,- 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
Specify
Model or Type
Manufacturer
Purchased From
Name of Firm
Address
Cost - Construction & Appliance $ stn ,C75
Chimney /4\ New Existing
Separate Flue Other Appliance Attached
To Flue
Masonary/Lined Metal Bestos
Masonary/Unlined
Exterior Interior
Notes & Data:
jj
a
Signature of Applicant:
Address
Approved By:
(Title) Date
��ment of Building Inspections
212 Main Street
Northampton, Mass. 01060 BUILDING z° /0
29 - 319 PERMIT Qa
VALIDATION
DATE April 26, 19 84 PERMIT NO. 159
APPLICANT Robert Jekanowski ADDRESS 423 Acrebrook Drive Owner
(NO.) (STREET) (CONTR'S LICENSE)
PERMIT TO Chimney & Wood Burning St�o�ZgDRY Existing One Family NUMBER NG UNITS _
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
423 Acrebrook Drive ZONING URA
AT (LOCATION) DISTRICT
(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 construction of a chimney located on the right side of house and later
a wood burning furnace to be installed will come in with the information at a later
later date for the wood burning furnace.
AREA OR 510.00 PERMIT $ 10.00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER Robert & Mary Jekanowski
ADDRESS 423 Acrebrook Drive BUILDIN
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY - PINK - ASSE SORS COPY