29-262 (5) �• : Trip of Northampton
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION PERMIT NUMBER
Page Plot Zone
Location
Owner or Lessee �-� ° :, ..,, t .':��
(Name) Ma.# ing Address) (Tele. No.
Contractor
(Name) (Address) (Tele. No.)
RESIDENTIAL NON-RESIDENTIAL
One family Home Business
Two or More Other
Number of Units Specify
T Stories in Building
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
Chimney New New Metal Bestos
i-,- Existing Interior chimney
Separate Flue _ Exterior chimney
,_j`d Other appliance attached to flue
Y0 Fc:j5 Masonary Lined
Unlined
Notes & Data:
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Signature of Applicant:
(Address)
Approved By:
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I hereby certify that the proposed work is authorized by the owner of record
and I have been authorized by the owner to make this application as his
authorized agent.
SIGNATURE OF AGENT
ADDRESS
(NUMBER) (STREET) (CITY)
APPROVED BY TITLE
DATE 19
DEPT. FILE COPY
ZD
BUILDING
PERMIT VALIDATION
DATE April 23 19_ 6 PERMIT NO. #101
APPLICANT David Helems ADDRESS 92 Long View Drive , Flor.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT To build L-I-) STORY gar2L,%E DWELLING UNITSXA
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) -
ZONING
AT (LOCATION) 92 Long View Drive , Florence DISTRICT URA
(NO.) (STREET)
a BETWEEN AND
°O (CROSS STREET) (CROSS STREET)
rn
IL LOT
M SUBDIVISION LOT BLOCK SIZE
a
p BUILDING IS TO BE 10 FT. WIDE BY 14 FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION
Z TO TYPE T USE GROUP Assec• BASEMENT WALLS OR FOUNDATION concrete
f
D: (TYPE)
° REMARKS; remove old tool shed
AREA OR
VOLUME 21 0 S=. ft. ESTIMATED COST $3.000.00 FEEMIT $ 10.00
(CUBIC/SQUARE FEET)
OWNER David Helems
BUILDING DEP .ag
ADDRESS 29 Long View Drives Florence BY
(Affidavit on reverse side of application to be completed by authorized agent of owner)