05-040 Cifl! of XVd# =
DEPARTMENT OF BLMDING iNSPEMONS
212 Main Street ' Municipal Building
INSPECTOR Northampton, Mass. 1060
SOLID FUEL BURNING APPLIANCE 6 CHIMNEY APPLICATION PERMIT NUMBER C�'(
Page Plot --- Zone _
Location Sd HZ(LGl ey b"m AlI. Z C e
Owner or Lessee SGZ - v
(Name) Mailing Address) Tele. No.
Contractor
(Name) (Address) (Tole. No.)
RESIDENTIAL NON-RESIDENTIAL
i/_ One family Nome Business
Two or More Other
Number of Units Specify
0& Stories in Building
Type of Appliance
New Wood burning
Used Coal
Labeled Combination
_G, - Date of Purchase Other
�� Specify
Model or Type -
Manufacturer
PUTChWW From _ i9ViQ,U T-fYYl
I� 1� D.YV►itLc
Qk C", Vect (Name of Fi )
(Address)
Cost - Construction S Appliance
Chimney New Metal Bestos
Existing Interior chimney
Separate Flue _� Exterior chimney
Other appliance attached to flue
Masonary Lined
Unlined
Notes A Data:
Signature of Applicant: �
(Address)
Approved Approved by:
Title: Date:
Department of Building Inspections ZO
212 Main Street BUILDING Oa
Northampton, Ma. 01060 PERMIT a
5 - 40 VALIDATION
DATE October 12, 19 R2 PERMIT NO. 568
APPLICANT Christilrip Hilary ADDRESS 765 And uhnn & . Lee.ds
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF 1
PERMIT TO !('i Tl eV .L Mod CtnV�_) STORY - DWELLING UNITS -
(TYPE OF MPROVEMENT) NO. (PROPOS USE)
ZONING
AT (LOCATION) 265 Auduhnn R DISTRICT RR
(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: Nov ma4jnmarn/1 ineA exterior Chimney. and wand-burning s toye installation
AREA OR PERMIT � � n0
VOLUME ESTIMATED COST � 100 0 FEE in-
(CUBIC/SQUARE FEET)
OWNER Chri stine Hilary 8U r
1 DING PT.
ADDRESS 765 Anduhnn Rd- , Leeds, Ma 01053 BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY