36-163 (3) r " ,
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RESIDENTIAL EON-RESIDENTIAL
Two or P1oT,€- N,Umbc r E'; "n! t.= Other (Specify)
Floors
Typo of Appliance:
New Wood Burning
Used Coal "
Labeled Combination
Date of Furnace
/t / Fireplace Insert
Model or Type of Appliance 1VA,��? �� L�idq11�T-
ManLlfaeturer
Purchased Fror; cv �N1� !,�)✓ _/� S°Ta v � 5 , (t 1�C y /L��
Ti-�me of Firm)
Cost - Construction A Appliance: 70 vc)
Chimney L`ryLlST.New Metal Bestos
Existing Interior Chimney
Separate Flue Exterior Chimney
_ Other appliance attached to flue
Masonary/lined
Unlined
Notes & Rata:
1
Signature of Applicant:
Building Inspector Approval: J"(
Date:
DEPT. OF BUILDING INSPECTIONS BUILDING Z°
212 Main Street Oa
Northampton, MA 01060 PERMIT
36 - 163 p VALIDATION
DATE November 25, 19 85 PERMIT NO. 672
APPLICANT Louis Furlani ADDRESS X678 Burts Pit Road Owner
(NO.) (STREET) (CONTIVS LICENSE)
Wood Stove AXXX One Family Dwelling NUMBER OF
PERMIT TO (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
1078 Burts Pit Road ZONING SR
AT (LOCATION) 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 isntAllation of a new wood burning stove
AREA OR 700.00 PERMIT 10.00
VOLUME ESTIMATED COST $ FEE
(CUBIC m DARE FEET)
Same as Applicant,
BUI I
ADDRESS BY
WHITE - FILE COPY . GREEN - FIELD COPY w CANARY - APPLICANT COPY • PINK ASSESSORS COPY PINT SIIP