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()I.I[3 X11 r hORNINI G �APPLIANCE & CHIMNEY APPLIt ATIOI
LOCeLlou
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Coll trac t-car
RF SI€JFttiT':AI. NON—RESIDENTIAL
C�c � F-�Kuii fy Hol"Ic Business
Two or Mop , u _� N112^L t of Units Other (Specify)
Floors ill BIdT.
Type of A pliance:
New Wood Burning;
Used Coal "
Labeled Combination
Dktte of purchase _ Furnace
Fireplace Irsert
Model or Type of Appliance `Z�✓ /� lY l
Manufacturer
Purchaser Frorr ��� S 7v
N a o f Firm
_ [J Gi /J�f
Add ess)
Cost - Construction & Appliance:
Chimney L"-,--New Metal Bestos
Existing Interior Chimney
Separate Flue Exterior Chimney
Other appliance attached to flue
Masona.ry/lined
Unlined
Motes & Data:
Signature of Applicant:
Building Inspector Approval:'
Date: �G/r
_: . .. r..T_ ,_ ,._.., n.,........_,._..,..,rF—� ,._� _._�
M �
s a DEPT. OF BUILDING INSPECTIONS BUILDING
! 212 Main Street $a
Northampton, MA 01060 PERMIT
29 - 336 [� VALIDATION
Francis E. Powers I�CtObA DRESS' 19 e- P rAV NO. 632
APPLICANT X36 crA ef�rook �5rive Owner
IND.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Wood Burning Sto-4e ) STORY One Family DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
AT (LOCATION) 236 Acrebrook: Drive ZONING
DISTRIC
(NO.) (l,TREET)
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 wood burning stove
AREA OR /00.00
VOLUME ESTIMATED COST $ FEE
w$
E 10 PERMIT �
(CUBIC/SQUARE FEET)
OWNER
Francis E. Powers � r '
Cre ro0 lve BU I L
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY - PINK - ASSESSORS COPY p