29-221 (4) ,.N.
Fitt of Nart4nmptan
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street w Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page Plot :224 Zone _ft
Location `�Zi 4o/6!
No. Sty et)
Owner or a,�r
Lessee (Nam (Mailin Address) (Tel. No.)
Contractor d� L-,.
(Name) Address Tel. No.)
RESIDENTIAL NONRESIDENTIAL
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 $ 3o4o —
Chimney _� New of Existing
Separate Flue a KIZ" Other Appliance Attached
To Flue
Masonary/Lined Metal Bestos
Masonary/Unlined
s/ Exterior Interior
Notes & Data:
Signature of Applicant: roam Address
Approved By: Aldk -.
- p
O
Title) Date
0WW� 4U®N - �2 BUILDING
U049 Ulan Zta PERMIT ° 40 0
S7 USN6 lDNl0T is:i" jd3-° VALIDATION
•0" DATE 19 PER IT
APPLICAN ADDRESS A
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS -
(TYPE OF IMPR EMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) DISTRICT
(NO.) (STREET)
BETWEEN AND
(CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
BUILDING IS TO BE FT. W3bE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
t '
REMARKS:
VOLUME ESTIMATED COST .� ` J"' `� `A FEE
(CU IC/SQUARE FEET)
OWNER
BUI 1 P
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - ASSESSORS COPY