35-144 (3) 1
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DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page Plot 1 y Zone C'
Location 41
No. (Street)
Owner or � ' ' �✓—{
Lessee (Name) Mailing /Address) (Tel. No.)
Contractor ) _k � ��,.,r.,��e��s
N e Address Tel. No.
RESIDENTIAL NONRESIDENTIAL
One Family Home Business
Two or More Other
Number of Units Specify
Type of Appliance
mac! New Wood Burning
Used Coal
Labeled Combination
krA K F1 :Zj!4 Date of Purchase Other
Specify
Model or Type
Manufacturer
Purchased From
Name of Firm
Address
Cost - Construction & Awe $
Chimney New Existing
Separate Flue Other Appliance Attached
To Flue
Masonary/Lined Metal Bestos
Masonary/Unlined
Exterior Interior
Notes & Data: 1
i
Signature of Applicant: / —+_
Address
�J
Approved By:
(-Title) (Date)
Department of Building Inspections
2]�I►Main Street BUILDING z° D.DO
Ac rthampton, Ma, 01060 PERMIT Qa 41 A3 g�
35 - 144 VALIDATION
DATE April 73. 19 81 PERMIT NO._ 176
APPLICANT Joan FOX ADDRESS 21 Westwood Terrace, Flo.
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF 1
PERMIT TO New chimney & Stove (1) STORY Wood stove DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. (PROPOSED USE)
ZONING SR
AT (LOCATION) 21 Westwood Terrace Florence DISTRICT
(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: ronetriirt new exterior macnnaxy chimney, brick wall 5' wide by 9' hiah
brick hearth out 5' , install wood-burning stove
AREA OR ESTIMATED COST $ 414-00 FE EMIT $ 0.00
VOLUME
(CUBIC/SQUARE FEET)
1
OWNER Rnnal d & Joan Fox BUILOi PT.
ADDRESS ?1 WPRtwnnd Terrace, Fl nrence Ma 0060 BY ff,"Z�
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY - PINK - ASSESSORS COPY
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