35-037 (11) 3
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton, Mass. 01060 PUMIT
SOLID FUEL BURNING APPLIANCE b CHIMNEY APPLICATION
Page_ Plot 27 Zone _
Location mil ( ( -� 5J TC(f V �; 1��� .
-�- No. (Street)_
Owner or
Lessee Nd a --imailing Address Te1. No.)
Contractor F�4 R_(>: C.1*U JN F, ton
(Name) _ (Address) Tel. No.
RESIDENTIAL NONRESIDENTIAL
V/-One Family Home Business
_ Two or More Other
Type of Appliance Number of Units Specify
New 11 Wood Burning
Used Coal �� ��
Labeled Combination
Date of Purchase Other
Specify
Model or Type
Manufacturer _� � �� � ;i . era %��'«f 1 arc'
Purchased From
o !i
Add ess
Cost Construction i Appliance $
Chimney New ✓ Existing
Separate Flue Other Appliance Attached
To Flue
_Z,�asonary/Lined Metal Bestos
Masonary/Unlined
77 Exterior Interior
Notes 6 Data: —"
Signature of Applicants
i res
y
Approved By:
Tile Date
DEPARTMENT OF BUILDING INSPECTIONS
` 212 MAIN STREET BUILDING Zp
NORTHAMPTON, MA. 01060 0< `A ` ,,, ()0
PERMIT
35 - 37
VALIDATION
DATE_ November 13. _19 81 PERMIT NO. 6-39
APPLICANT Tflspi ll l M- LJPrnik ADDRESS 198 UlpA ' Farms Road
S (NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO tdCQd gtnva (_) STORY Fnr wn4L�-bLLrn7n� stovLo DWELLING UNITS 1
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 198 West Farms Road ZONING SR
DISTRICT .,a
(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:
AREA OR $
VOLUME ESTIMATED COST $_1 2nO 00 FEEMIT 10-00
(CUBIC/SQUARE FEET)
i
OWNER Toss h Wernik
ADDRESS 198 West Farms Rd. , Northampton. Ma_ 01060 BU -
IL
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY PINK - ASSESSORS COPY