17C-087 (2) 'e tai of Nod4itiliptan -
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE CHIMNEY APPLICATION -
Page ��C Plot `` Zone {
t :a,
Locationl
No. Street)
Owner or "i1 L /'f ( �, z �.
Lessee (Nam (Mailing Address) yr--, , (Tel. No.)
Contractor ( � _
Name (Address) Tel. No.)
RESIDENTIAL NONRESIDENTIAL
One Family Home Business
Two or More Other
Number of Units Specify
Tye of App' ance
`�, -, { � ,C�� " New Wood Burning.
Used Coal
Labeled Combination
�. n 4, Date of Purchase Other
Specify
Model or Type
Manufacturer
Purchased From + �,
Name f Fir%-kyP'
t� ��'" Jl k Address �
Cost - Construction & Appliance $ `
Chimney New \° Existing
Separate Flue Other Appliance Attached
To Flue
Masonary/Lined X Metal Bestos
Masonary/Unlined
Exterior Interior
Notes A Data:
Signature of App
Address ^ J
Approved By:
� w
1 ,
(Title) Date
DEPT. OF BUILDING INSPECTIONS BUILDING za
212 Main Street O< /
Northampton, MA 01060 PERMIT `a
17C _ 87 VALIDATION
O DATE November 19, 19 84 PERMIT NO. EX 652
APPLICANT Sharon A Rupp ADDRESS 100 EMMOM Street Owner
(NO.) Chegti'lW' (CONTR'S LICENSE)
PERMIT TO Wood BurninQ`Stove �L LLILLL NUMBER OF
(_) STORY One Family Home DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
100 � Chestnut Street ZONING
AT (LOCATION) DISTRICT-M
(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 SMALL CONFORM IN CONSTRUCTION
TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION
(TYPE)
REMARKS: permit for the installation of a new wood burning stove; to be installed in the sun room
VOLUME ESTIMATED COST $ 725.00 PEE
, 10 00
(CUBIC/SQUARE FEET) 7
OWNER Same as applicant
ADDRESS e aS applicants address YILDI
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY p'INT IIP