29-064 (21) s
a (City of Nort4auip tau
Massachusetts 1 -
DEPARTMENT OF BUILDING INSPECTIONS s
INSPECTOR 212 Main Street ' Municipal Building
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE & CHIMNEY APPLICATION
Page Plot Zone . Permit Number
Location
Owner or Lessee - J Ii
Tele. No.)
Contractor ,I//v'/ Ay/i
License Number
Address ��!%;� �l s�f>fk 1''f'f
RESIDENTIAL NON-RESIDENTIAL
One Family Home Business
Two or More Number of Units Other (Specify)
- Floors in Bldg.
Type of Appliance: r
New 1f Wood Burning
Used Coal e'
Labeled Combination
Date of purchase Furnace
Fireplace Insert
Model or Type of Appliance
A
Manufacturer
Purchased From L
Name of Firm
(Address)
Cost - Construction & Appliances
Chimney New Metal Bestos
Existing Interior Chimney
Separate Flue Exterior Chimney
Other appliance attached to flue
Masonary/lined
Unlined
Notes & Data:
Signature of Applicant:
Building Inspector Approval:
Date: 1S
�_ __•EPT. OF BUILDING INSPECTIONS BUILDING ZO
212 Main Street 0< CC)
I IL
Northampton, MA 01060 PERMIT
29 - 64 VALIDATION
DATE February 15, 7g 85 79
APPLICANT
Doanld A. Scagel ADDRESS 1 ferr.T NO. UWLIUL
(NO.) (STREET) (CONTR'S LICENSE)OF
PERMIT TO Wood Burning Stove (-) STORY One Family Home D ELLRING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
AT (LOCATION) 31 KKKM Gilrain Terr. ZONING URA
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: Permit for the installation of a wood burning stove.
AREA OR 50.00 PERMIT d. 10.00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER Same as applicant
ADDRESS Same as Antil icant S BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY • PINK - ASSESSORS COPY POP