29-412 (2) s• •a _ CtR of Nart4aniptan
� f �lassarhnsctts -
DEPARTMENT OF BUILDIXG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION PERMIT NUMBER "Z_
Page Z._`j Plot �}tZ, Zone 0V-
7c) rEr.
Location J� �h�� � �C . rinre,nce a l L5, 010loO
Owner or Lessee I -I mrl-1 W, Uer ` VY1Q a5 lihe
(Name) < Mailing Address) Tele. No.)
Contractor o Nadl2agh Chimne�_Su�e�e�s �gb 51. 5 N 1e 5 —9845
(Name) (Address) (Tele. No. )
RESIDENTIAL NON-RESIDENTIAL
One family Home Business
Two or More Other
Number of Units Specify
Stories in Building
Type of Appliance
New Wood burning
Used Coal
Labeled Combination
Date of Purchase Other
V1 Specify
s r)S �
Model or Type 0
C
Manufacturer JW C10&5 7 ,
Purchased From
(Name of Firm)
(Address)
Cost - Construction & Appliance
Chimney V/ New Metal Bestos
Existing Interior chimney
Separate Flue Exterior chimney
Other appliance attached to flue
Masonary Lined
Unlined
Notes & Data:
Signature of Applicant: _
- � (Address)
Approved By: l-
Title: Date:
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