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36-082 (5) i �q -TC, of Nort4ampton DEPARTMENT OP BUILDING INSPECTIONS �m q INSPECTOR 212 Main Strcet ' Municipal Building Northampton, Mass. 01060 SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION PERMIT NUMBER!j Page'*( Plot Zone Location Owner or Lessee ( jIA aA l P_k Z/ LC)e 7- °/ (Name) ailing Address Tele. No. ) Contractor (Name) (Address) (Tele. No. ) RESIDENTIAL NON-RESIDENTIAL One family Home Business Two or More Other Number of Units Specify Stories in Building Type of Appliance _ New _ Wood burning Used Coal Labeled Combination . Date of Purchase Other Specify Model or Type Ay n "6R Manufacturer U(.. # 'V"--4 Purchased Frq q S L U e s�-h d F' (Name of Firm) h Q I (Ad(rress) Cost - Construction & Appliance o a Chimney _ New (� Metal Bestos Existing Interior chimney Separate Flue Exterior chimney Other appliance attached to flue Masonary Lined Unlined Notes & Data: Ot z Signature of Applicant: .�����.�i.�� ✓�� (Address) Approved By: Vic• Title: Date:�� �-�= y '� � � C '�'• � c � .� n' n O C v, x Q �'f' �E -•, Z p (� rA O � O r+ � n � � rte•. � � r•. � O � n C. fD :9 ro O O O N O ►•� C O G O M 'p W d , .a CA CL C .s O• cn Sv x eD W < ? 'O c F a O h...� rD `C •-r O w ~ C r O � 'U :L7 00 ~_ O O n �;• Q Q g 0 c CL CD CL CD M"C ffl �• O � � O "T � n ry. ^ � a o � LA N o -S O. fD �• v CA o V) o o _. . � aa .0 .0 .0 � CA tti r y �• �• o 0 0 0 0 0 c -ti -ti -ti ° �' M o ° voa aroa cr a w w ►-� � � � � •'a c ° � '' o C O � � O v S 9 ra "*t m- On W a Wt � M02 0=1 5 �4 s= �S ',ti WSPIN MMM r � � sue- r $ TWA Top vivo,On T JAL in on am IS e r . s. z h , i� t� 2 t ' c s s { " 4 "L7 ©" 3 0- M j4 t06 aa. ft jo ew 'taC vo T _ vw ='*it lilt ZA O - rp .y IF:­,.,to !" 4A btl to to w to r•+ ,w ` . * out I 1 c A . 40 . . , � . 4 �' at 04