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S`31,11) [ UL1., 1'li I'NING A i"LI�£}iCL d,.�' JHIi,E NPLICATION
Owner or Lessee
(Tele. No. ) _
Contractor
Address
RESIDENTIAL K'O?N-•RESIDENTIAL
, Otte Farm I Hot.�(: _ ls�isinc.s:
Two or More Numbcr of Units � � Other (Specify)
Floors in bi dg.
Type of Appliance:
New Wood Burning
Used Coal "
Labeled Combination
Date of purchase Furnace
Fireplace Insert
Model or Type of Appliance 'ea r" ;h_ k_ z7 o- le r
Manufacturer
Purchased From r
n , tNaurae Fin i
Address)
Cost Cost - Construction Appliance: L
Chimney _ New Metal Bestods
Existing Interior Chimney
Separatc Flue Exterior Chimney
Other Pppl_ia.nce attached to flue
N.a.sonary/lined
Unlined
Notes 6 Data:
Signature of Applicant:' 4
Building Inspector ector A roval:
PP .--
hate:
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DEPT. OF BUILDING INSPECTIONS BUILDING �O
! 212 Main Street 0a 6 �°
Northampton, MA 01060 PERMIT
29 - 377 VALIDATION
y DATE December 2, �y 85 PERMIT O. 677
APPLICANT Manuel Santos (Kathleen ADDRESS roo wWood-)rive, Florence Owner
—
(NO.) (STREET) (CONTR•S LICENSE)
Wood Burning tove One Family ome NUMBER of
PERMIT TO g (�) STORY y DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION)
5 Brookwood Drive, Florence ZONING T UM
DISTR
(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 OR s 700.00 PERMIT $ 10.00
VOLUME ESTIMATED COST FEE
E
OWNER XXXXX Samp ns A=ir-ant BUIL
ADDRESS Samr, aC AT) r-.q n t C BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY P1"" IIP