29-277 (3) CHV of Wort4a urpton
DEPARTMENT OF BUILDrNG INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building •�
Northampton, Mass. 01060
PERMIT NUMBER
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page r-7 Plot .f 717 Zone '
Location
No Street _
Owner or .a�,,C
Lessee (Name) Mailing Address) Tel. No.)
Contractor 4 c K'
Name Address Tel. No.
RESIDENTIAL NONRESIDENTIAL
One Family Home Business
Two or More Other
Number of Units Specify
Type of Appliance
New // Mood Burning
Used Coal
Labeled Combination
Date of Purchase Other
��--� S ecify /
Model or Type ---
Manufacturer �r ,
Purchased From k-� ✓" fe ;
Name of Firm
(Address)
Cost - Construc Lou & Appliance
Chimney New New Existing
Separate Flue Other Appliance Attached
Flue
Maaonary/Lined ----" Metal Bestoa
Masonary/Unlined
Exterior Interior
Notes & Data: 4�L�
Signature of Applicant:
—(Address
Approved By:
Title Date
ar tk 'TR .�.�`��� .. "E .. .. Go J" vrF r— Y _ _ ..�K' -_
DEPARTMENT OF BUILDING INSPECTIONS
212 MAIN STREET BUILDING o� �s
NORTHAMPTON MA. 01060 fa / �f
PERMIT <
29 - 277 VALIDATION
DATE August 2.5. 19 Al PERMIT NO._ 495
APPLICANT Royal & Karen T.aPlante ADDRESS 345 Rrookeide Puce
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO chimney wood_ stove (_) STORY DWELLING UNITS
P
(TY OF IMPROVEMENT) NO. (PROPOSED U )
ZONING
AT (LOCATION) ltrookg4d_e Circle DISTRICT QRA
(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: NPOT masoinsk=114ned chimney and mood IK11rLL3.ug stove instells.tion
AREA OR ESTIMATED COST $ 900.00 FEEMIT 10.00
VOLUME
(CUBIC/SQUARE FEET)
OWNER Royal & Karen LaPlante
Floren Ma. 01060 BYILg
ADDRESS 335 Brookside Circlece_,
ror
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - AS SSORS COPY