17C-134 (2) ti
Grio of Xart4anipton
DEPARTMENT OF BUILDING INSPECTIONS
INSPECTOR 212 Main Street * Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION PERMIT NUMBER
Page plot Zone
Location
(Ai) (J ' � V
Owner or Lessee
Mailing Add- ess)
(Name) r (Telex No,
Contractor (' 1A 6;v i t
t
ame (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
Manufacturer
Purchased From ulde Had!e;gh Cl!Irjr�ey Sweeps
4f4dQ0dC1vV,pi40) Inn.
580 Newton Street, Rtd, 116
ETNA Rpily, 1-7 A 0 10?0
) 538-9845
Cost Construction & Appliance $ (413-,k vy%A
Chimney New Metal Bestos
Existing Interior chimney
Separate Flue Exterior chimney
Other appliance attached to flue
V_ Masonary Lined
Unlined
Notes & Data:
Signature of Applicant:
(Address)
Approved By: --C-Q
A
Y
Title: Date:
DEPT. OF BUILDING INSPECTIONS BUILDING ZO
1 ! // r
212 Main Street
Northampton, MA 01060 PERMIT <a
17C - 134 VALIDATION
DATE November 18, 19 87 PERMIT NO. 770
APPLICANT David Rurdirk ADDRESS q1 High Strept. Owner
IN 0.1 (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Linnri Rllrni nn_Ctnu°(_I STORY On Fami jv DWELLING UNITS
(TYPE F IMPROVE. T) N0. (PROPOSED U E)
ZONING 11RR
AT (LOCATION) Q� High �t� r�Qt TElnr_PQc ' DISTRICT
(N0.) �� (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: permit for the installation of a wood burning stove (new)
AREA OR 1 .
33100 PERMIT 10.00
VOLUME ESTIMATED COST .� FEE $
(CUBIC/SQUARE FEET)
OWNER Same as Applicant o A
ADDRESS
Same as Applicant's BYILD EPT
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY FOP