17C-063 � �blassachnsetts - -
DEPARTMENT OF BUILDVT G INSPECTIONS _
INSPECTOR 212 Main Street ' Municipal Building ,
Northampton, Mass. 01060
SOLID FUEL BURNING APPLIANCE 6 CHIMNEY APPLICATION PERMIT NUMBER
Page Plot Zone
Location
Owner or Lessee
(Name) Mailing Address) Tele. Ne . )
Contractor
(Name (Address) (Tele. No. )
RESIDENTIAL NON-RESIDENTIAL
One family Home Business
Two or More Other
Number of Units Specify
y Stories in Building
Type of Appliance
i New Wood burning
Used Coal
Labeled -��Combination
Date of Purchase Other
Specify
Model or Type
Manufacturer
Purchased From
(Name df Firm)
(Address)
Cost - Construction A Appliance
Chimney New Metal Bestos
'Existing Interior chimney
Separate Flue Exterior chimney
Other appliance attached to flue
,/Masonary Lined
Unlined
Notes 6 Data:
Signature of Applicant:
(Address)
Approved By:
Title: Date:
�}�-l�1� ��
DEPT. OF BUILDING INSPECTIONS BUILDING �° C
+ 212 Main Street 'a �,V
Northampton, MA 01060 PERMIT
17C - 63 VALIDATION
DATE December 1 , 19 88 PERMIT NO. 768
APPLICANT Christine Douglass ADDRESS 169 Chestnut Street Owner
(NO.) (STREET) (CONTR'S LICENSE)
NUMBER OF
PERMIT TO Wood Burning StOVe(_) STORY One Family DWELLING UNITS
(TYPE OF IMPROVEMENT) NO. (PROPOSED USE)
ZONING
AT (LOCATION) 169 Chestnut Street DIISTR CT URA
(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: pprmit fnr tho installation of a wend bur-nine stove (new)
AREA OR 1 ,200.00 PERMIT $ 10.00
VOLUME ESTIMATED COST FEE
(CUBIC/SQUARE FEET)
OWNER Same as Applicant
I� Scant $ BUILDING DEPT.
Same as Applicant's BY
WHITE - FILE COPY . GREEN - FIELD COPY ■ CANARY - APPLICANT COPY ■ PINK - ASSESSORS COPY pA P